A pregnant patient at 24 weeks' gestation complains of fever, chills, flank pain, frequency, dysuria, and abdominal pain. A urinalysis demonstrates 100,000 proteus bacteria per mL. The clinician should recognize these findings as:

Question

A. Glomerulonephritis
B. Cystitis
C. Pyelonephritis
D. Nephrolithiasis

Answer 1

ANS: C
UTIs consist of either cystitis, an infection in the bladder, or pyelonephritis, an infection in the kidneys. Cystitis occurs in about 1% to 2% of the pregnant population, and cultures usually grow out a single pathogen, typically Escherichia coli or a species from the genera Staphylococcus, Proteus, Klebsiella, or Pseudomonas (Moran, 2004). Untreated UTIs and pyelonephritis may result in preterm labor and delivery, maternal sepsis, or even septic shock and death.
Asymptomatic bacteriuria may be present in 2% to 10% of pregnancies and is diagnosed by the growth of 100,000 colonies per milliliter of a single pathogen that is cultured from a clean-voided urinary specimen (Cohen, 2008). This may be indicative of an underlying disorder, such as an anatomic urinary tract abnormality or chronic pyelonephritis. Asymptomatic bacteriuria may lead to pyelonephritis and is associated with an increased risk of preterm labor and low-birth-weight babies.
Subjective
Inquiries should be made about the presence of risk factors (frequent/recurrent UTIs, diabetes, urinary tract abnormalities, STDs). Inquire also about any urgency, frequency, dysuria, suprapubic pain, abnormal urinary flow pattern, discolored or malodorous urine, fever, chills, flank pain, or GI complaints.
Objective
Evaluation includes documented fever, clean catch urine, pelvic examination/wet mount (for vaginal infections), costovertebral angle or suprapubic tenderness, urine culture, CBC, and signs of shock (tachycardia, hypotension, and pallor).