Can a Silent Kidney Infection or Genetic Predisposition Underlie Recurrent UTIs?

, University of Calgary and Alberta Children's Hospital


Medscape General Medicine. 1996;1(1) 

In This Article

Abstract and Introduction


Complications resulting from persistent and repeated urinary tract infections (UTIs) account for nearly 1 million hospital admissions annually. Cystitis, a localized bladder infection occurring in the lower tract, is recognized by a symptom complex of dysuria, frequency, urgency, and suprapubic tenderness; pyelonephritis, which refers to upper tract infection of the kidneys, classically manifests with flank pain and systemic as well as cystitis signs. An empiric 3-day antibiotic regimen has been shown to be more than 95% effective in curing cystitis. But for a subgroup of patients, a relapse of "cystitis" within 4 weeks can signal a subclinical, "silent," pyelonephritis. A 14-day course of antibiotics is indicated to treat the recurrent UTI. Follow-up urinalysis and urine cultures arethen repeated 2 and 4 weeks after therapy. If symptoms and/or bacteriuria are again documented with the same organism, subclinical pyelonephritis is presumed; a prolonged 6-week course of antibiotics is then warranted to prevent prolonged problems and complications associated with UTIs. When the problem is reinfection with a microorganism different from that responsible for the last infection, short-course therapy for 3 days may be prescribed for each episode. When reinfection occurs more frequently than 2 to 3 times a year, however, antibiotic prophylaxis to prevent reinfections is warranted.


Approximately 15%-20% of women with otherwise normal urinary tracts will have at least 1 infection during their lifetime, and 10%-15% of women will have recurrent infections. Urinary tract infections (UTIs), which account for about 7 million visits to physicians each year, are one of the most common medical conditions requiring outpatient treatment. Complications resulting from persistent and repeated infections necessitate well over 1 million hospital admissions annually.[1] Physicians and other health care personnel need to understand the factors that predispose women to recurrent UTIs in order to more effectively manage the problem and better educate their patients about preventive measures that might lessen the potential for UTI recurrence.