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

Clinical Symptoms

Infection of the urinary tract may involve only the lower urinary system (ie, bladder), or it may involve both the lower and upper tracts (Fig. 1). Cystitis is the term used for localized bladder infection, whereas pyelonephritis refers to upper tract infection of the kidneys.

Patients with cystitis may have a symptom complex of dysuria, frequency, urgency, and tenderness over the bladder in the suprapubic area, but systemic symptoms (ie, fever, chills, and/or rigor) are rarely present due to the localized nature of the infection. In contrast, acute pyelonephritis usually manifests with flank pain and systemic symptoms, such as elevated WBC and fever, in addition to one or more typical "cystitis" symptoms (eg, dysuria, frequency, urgency, and suprapubic tenderness). Urinary tract localization studies indicate that up to 30% of women who present with cystitis symptoms may also have subclinical pyelonephritis.[10,11,12] However, because the symptoms are initially not distinct, kidney infection may only become evident because of frequently relapsing infections occurring after appropriate antibiotic treatment has been given for "cystitis."