Recurrent UTIs: Controlling Those Nasty Little Bladder Infections

[Dr. Anne Cameron]
Someone getting a bladder infection, a cystitis, and that being left untreated for a day or two turning into urosepsis pyelonephritis is less than 1%. The reason that is because the bacteria that because cystitis are different than the bacteria that because pyelonephritis. They're completely different bacteria and they may all be E.coli, but they have different pili and different fimbriae on the bacteria. People who have pyelonephritis, they don't present with bladder pain, urgency, frequency, and then get a fever and then get flank pain. These people present with fever, flank pain, and they're feeling terrible, nausea, vomiting, they feel absolutely awful. Most of them have no lower urinary tract symptoms. The bacteria basically bypassed the bladder and went straight to the kidneys. Those people are very different. They present clinically very differently.

The people who do get a cystitis that turns into pyelonephritis often have some anatomic abnormality. Those are people who've had kidney transplants and kidney transplant patients all have reflux into their transplant kidney. That's how a transplanted kidney is placed into the bladder. That's normal to have reflux, but it puts them at high risk of pyelo. Also, some people have reflux congenitally or have had some bladder surgery. They might have outlet obstruction, they may be catheterizing, and their bladder functions differently. Those people, a cystitis can turn into a pyelonephritis. In the general population with a normal bladder, cystitis really does not cause pyelonephritis.