Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (249 page)

Urine culture may be normal in patients with renal or perinephric abscess if the infected tissue does not communicate with the collecting system. Drainage of such localized infections is performed for therapeutic reasons, as well as to collect material for culture, Gram stain and any other laboratory evaluation.

   Other Laboratory Testing:

   Pregnancy testing may be appropriate for women presenting with otherwise uncomplicated UTI.

   In patients with complicated UTI, blood cultures are recommended for patients with fever, hypotension, or other signs of sepsis. Other laboratory testing appropriate for the clinical presentation is recommended.

Suggested Readings

Cai T, Mazzoli S, Mondaini N, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat.
Clin Infect Dis.
2012;55:771–777.

Gorgon LB, Waxman MJ, Ragsdale L, et al. Overtreatment of presumed urinary tract infection in older women presenting to the emergency department.
J Am Geriatr Soc.
2013;61:788–792.

Hooton TM. Uncomplicated urinary tract infection.
N Engl J Med.
2012;366:1028–1037.

McIsaac WJ, Moineddin R, Ross S. Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystis.
Arch Intern Med.
2007;167:2201–2206.

Nicolle LE, Bradley S, Colgan R, et al. Infectious diseases society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
Clin Infect Dis.
2005;40:643–654.

Semeniuk H, Church D. Evaluation of the leukocyte esterase and nitrite urine dipstick screening tests for detection of bacteriuria in women with suspected uncomplicated urinary tract infections.
J Clin Microbiol.
1999;37:3051–3052.

U.S. Preventive Services Task Force. Recommendation statement: screening for asymptomatic bacteriuria in adults.
Ann Intern Med.
2008;149:43–47. See:
www.uspreventiveservicestaskforce.org/uspstf08/asymptbact/asbactsum.htm

Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients.
Clin Infect Dis.
2004;38:1150–1158.

TUBERCULOSIS, RENAL
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   Definitions and Key Concepts

   Renal tuberculosis is a common form of extrapulmonary tuberculosis. The disease is caused by hematogenous seeding of the kidney during mycobacteremia that may occur during primary infection or late reactivation with miliary dissemination.

   Who Should Be Suspected/Who Should Be Tested?

   The clinical manifestations of renal TB are variable; many patients show minimal symptoms and may be identified after workup for pyuria or microscopic hema turia, which are almost universally seen. Systemic symptoms are uncommon. Patients may complain of dysuria; gross hematuria may occur.

   Diagnosis should be suspected in a patient with a history or increased risk of mycobacterial disease, especially TB, and signs (e.g., microhematuria or pyuria) or symptoms (e.g., dysuria) of UTI. Routine urine culture is negative, although contaminated urine or coincidental UTI may confound the diagnosis.

   Diagnostic and Laboratory Findings

   Patients with possible renal tuberculosis should be evaluated for pulmonary tuberculosis and infection at other extrapulmonary sites, as appropriate. Testing should include screening (e.g., TST), culture and imaging studies, as well as detailed physical examination and history.