Pathophysiology of Upper and Lower Urinary Tract Infections

Respond on two different days who selected at least one different factor than you, in one or more of the following ways:Offer alternative diagnoses and prescription of treatment options for urinary tract infections.Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives

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Pathophysiology of Upper and Lower Urinary Tract Infections

Lower urinary tract infections (UTIs) involve the urethra and the bladder; upper urinary tract infections include the ureters and the kidneys. Upper UTIs are rarer than lower UTIs but typically are more severe (Healthline, 2019). Microorganisms are the most common agent resulting in UTI infection. Microorganisms can include Escherichia coli (E. Coli) and staphylococcus saprophyticus. Less common mircroorganisms are proteus, klebsiella, pseudomonas, viruses, fungi, tubercular bacilli, and parasites. Gram-negative bacilli move into the urethra, next to bladder, then on to the ureter, and kidney. Infection begins as an inflammatory response producing edema within the bladder wall. The bladder feels full with only small amounts of urine present, but the urgency of needing to urinate is present and appears more often than usual (Huether & McCance, 2017). Signs and symptoms of lower UTIs might include frequency, nocturia, dysuria, urgency, and hematuria (in some cases). Signs and symptoms of upper UTIs might include nausea, vomiting, fever, chills, low back, flank pain, abdominal pain and mental status changes in the elderly population (Barkley, 2018).

Pathophysiology Impact and Patient Factors

Women are more prone than men to experience UTIs, possibly because of urethral irritation during sexual intercourse or because they have a shorter urethra, making it easy for microorganism transmission (Berkowitz, 2007). Microorganisms mostly associated with a female diagnosis would be E.Coli and microorganisms primarily related to a male diagnosis would be proteus species. Disorders with lower UTIs might be, urethritis/dysuria, and cystitis. Diseases with upper UTIs might be, renal, pyelonephritis, and renal abscess (Barkley, 2018). Contributing patient factors might be age, prior UTI history, pregnancy, immunocompromised patients, urinary catheter usage, and poorly controlled diabetes (Healthline, 2019).

Diagnosis and Treatment

Diagnostic test for lower UTIs are urinalysis, esterase detection on dipstick, and presence of nitrate by dipstick. Treatment for lower UTIs are ciprofloxacin, augmentin, bactrim (commonly), additionally amoxicillin, macrobid, levaquin, monurol, and primsol maybe prescribed. The preferred treatment course is 3-days instead of 7-day to maximize benefits and minimize treatment drawbacks (Barkley, 2018).

Diagnostic test for upper UTIs are ESR elevation, and white blood cell casts appearing on urinalysis. Treatment for upper UTIs is Bactrim, Augmentin, Cipro, tobramycin, or gentamicin. For patients with upper UTIs experiencing nausea and vomiting, hospitalization may be necessary (Barkley, 2018).


Barkley, T. (2018). Adult-gerontology primary care nurse practitioner. West Hollywood, CA: Barkley & Associates.

Berkowitz, A. (2007). Clinical pathophysiology made ridiculously simple. Miami, FL: MedMaster, Inc.

Healthline. (2019). Everything you need to know about urinary tract infection. Retrieved from

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.


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