Teach you how to identify the difference between urinary tract infection and lupus nephritis

Dieyou Xiaoliu is a product manager of an Internet company.

After the examination, Xiao Liu found that the report was "weakly positive for urine protein.

Xiao Liu nervously said: Is it because the lupus disease has worsened? !

1.

Urinary tract infection, also known as urinary system infection, is one of the most common infection types in patients with lupus erythematosus, second only to respiratory system infections [1]

Among them, women with lupus erythematosus are a high-risk group of urinary tract infections [2]

1.

A study showed that among 33 patients with lupus erythematosus who had urinary tract infections, all received long-term glucocorticoid and immunosuppressive therapy, 31 cases (93.

It can be seen from this that it is precisely because patients with lupus erythematosus receive long-term hormone and immunosuppressive therapy that the body's immune function is low, which leads to a significant increase in the incidence of infection [3]

2.

In a study on whether indwelling catheters can cause urinary tract infections, it was found that in 38 cases of lupus erythematosus patients with indwelling catheters, 18 cases (47.

3.

One of the important reasons why women with lupus are more likely to be targeted by urinary tract infections is mainly related to the structural characteristics of the female urethra

Because women’s urethra and vagina are short and straight and close to the anus , this physiological structure creates a “unique” environment for urinary tract infections, which makes women more likely to be contaminated by feces or vaginal secretions.

It can be seen that Ms.

Two, silly and confused: Urinary tract infection or lupus nephritis?

In the case of Ms.

So the question is: What is the difference between the symptoms of urinary tract infection and nephritis? In order to distinguish the two types of diseases, what kind of clinical examinations will be done?

1.

After a urinary tract infection, patients generally experience painful urination, frequent urination, urgency, low back pain, lower abdominal pain and other symptoms
.
In terms of examination, general doctors will first perform physical examination, laboratory and imaging examinations based on the patient’s symptoms
.

After some operations, if the doctor finds that the patient meets one of the following indicators on the checklist, he is diagnosed as a urinary tract infection:

1.
The fresh mid-section urine sediment was Gram stained and observed with an oil microscope, and the bacteria were more than 1 per field of view ;

2.
Fresh mid-section urine bacterial culture count ≥ 105  CFU/ml;

3.
The urine culture of bladder puncture is positive [5]
.

2.
Lupus nephritis

The symptoms of lupus nephritis are somewhat similar to those of urinary tract infections, but compared to general urinary tract infections, the symptoms of lupus nephritis are more serious and complicated
.
For example, light micro patient may have only a small amount of proteinuria or hematuria symptoms, but severe cases may occur nephrotic syndrome or rapidly progressive glomerulonephritis [6]
.

In addition, patients often show unexplained increased blood pressure, anemia, edema, skin itching, bleeding gums, loss of appetite, nausea, vomiting, backache, back pain and other symptoms
.

In terms of diagnosis and examination, lupus nephritis is also more complicated and rigorous than urinary tract infections
.
For example, patients with lupus erythematosus suspected of having lupus nephritis must undergo a "kidney biopsy" pathological examination [7]
.

In addition, the timing of biopsy is when the urine protein is quantified> 0.
5g/L or the glomerular filtration rate (eGFR) is reduced that cannot be explained by other reasons , before it can be diagnosed as lupus nephritis [7]
.

3.
Will urinary tract infection cause nephritis?

Urinary tract infection and lupus nephritis, two seemingly unrelated diseases, are actually very related
.

The kidney is the organ most easily affected by lupus erythematosus.
A number of studies have found that patients with lupus erythematosus combined with lupus nephritis have a significantly higher incidence of urinary tract infection [8]
.

In addition, some studies have found that when lupus patients are combined with urinary tract infection, the risk of eventually inducing nephritis is also higher
.
Moreover, when urinary tract infection is combined with lupus nephritis, it can aggravate the original renal damage, accelerate the progression of the disease, and affect the efficacy of hormones [9]
.

It can be seen that when a urinary tract infection that has not been treated in time evolves into a complex urinary tract infection, the kidneys can be involved and renal complications are prone to occur
.
Therefore, butterfly friends need to pay attention to the seemingly small but common complication of urinary tract infection and treat it in time
.

4.
What to do with urinary tract infection? Cure and prevent with both hands!

rule:

Once lupus erythematosus is diagnosed as a combined urinary tract infection, the doctor will first check to determine which bacteria caused the infection, or which bacteria are sensitive to and which antibiotics are resistant to
.
After clarifying the above problems, the doctor will prescribe a sufficient amount of antibiotics for a full course of treatment based on the patient's symptoms
.

As the pathogenic bacteria of urinary tract infection is Escherichia coli the most intestinal bacteria, the general experience medication will choose levofloxacin, nitrofurantoin, compound trimethoprim, ceftazidime and other drugs for treatment
.
The specific doctor will adjust the medication according to the urine culture and drug sensitivity results, and the test results
.

Note : Once you have a urinary tract infection, you must strictly follow the doctor's advice and adhere to the medication during the treatment period.
Do not stop the medication at will to avoid the resurgence of bacteria
.

Defend:

Urinary tract infections are prone to recurring attacks, and they can easily cause lupus nephritis
.
In order to avoid urinary tract infections, it is recommended that appropriate protection should be done daily:

Drink as much water as possible and urinate more often.
You need to urinate once every 2 to 3 hours to dilute your urine and remove bacteria in your urine, reducing the risk of urinary tract infections
.
At the same time, you should pay more attention to your diet, avoid spicy and greasy foods, tobacco, alcohol, and strong tea, and eat more fruits and vegetables
.

2.
Keep your private parts clean

Patients should pay attention to the vulva cleansing, and develop the habit of washing regularly and changing underwear frequently
.
At the same time, toilet paper should be used to wipe the vulva after urination, it is recommended to follow the order from front to back
.
In addition, attention should be paid to the cleaning of the perineum to reduce the growth of bacteria in the urethra[10]
.

3, the rational use of antibiotic drugs

Different antibiotics have different therapeutic doses and usage.
It is recommended to follow the instructions or follow the doctor's advice
.
If symptoms worsen rapidly or significantly aggravate during treatment with antibiotics, you need to inform your doctor and get treatment in time
.

4.
Regular physical examination

Urinary tract infections sometimes not as respiratory infections and digestive tract infections like symptoms, the symptoms can be presented occult manifestations, such as can be no urinary frequency, urinary tract infection symptoms of urinary urgency, dysuria, and some only as fatigue, fever, Performance [2]
.
Therefore, it is sometimes difficult to judge whether it is co-infection or lupus activity
.

Therefore, it is recommended that patients with lupus erythematosus should have regular urine routines, especially after the use of hormones, or patients with renal impairment and nephrotic syndrome, should be more alert to the occurrence of urinary tract infections
.

Concluding remarks

If lupus erythematosus patients with urinary tract infection cannot be detected in time, it is easy to induce or aggravate the progression of lupus nephropathy and affect the prognosis
.
Therefore, early detection, early diagnosis, and active treatment of urinary tract infections are an important aspect of preventing the deterioration of renal function
.

Dieyou Xiaoliu is a product manager of an Internet company.
He has a habit of holding back urine for a long time because of his busy work
.
Last summer, when Xiao Liu was working overtime, he suddenly experienced paroxysmal lower abdominal distension and pain, accompanied by frequent urination, so Xiao Liu hurriedly asked for leave to go to the hospital for a check-up
.

After the examination, Xiao Liu found that the report was "weakly positive for urine protein.
" Xiao Liu was puzzled, so he consulted a doctor.
After reading the report, the doctor informed Xiao Liu that she had a " urinary tract infection
.
"

Xiao Liu nervously said: Is it because the lupus disease has worsened? !

1.
Why do urinary tract infections have a soft spot for women with lupus?

Urinary tract infection, also known as urinary system infection, is one of the most common infection types in patients with lupus erythematosus, second only to respiratory system infections [1]
.
Mainly refers to acute or chronic inflammation caused by the abnormal reproduction of pathogenic microorganisms in the kidneys, ureters, bladder and urethra
.

Among them, women with lupus erythematosus are a high-risk group of urinary tract infections [2]
.
By consulting the data, we found that there are three main reasons for the higher incidence of urinary tract infections in women with lupus :

1.
Drug therapy factors

A study showed that among 33 patients with lupus erythematosus who had urinary tract infections, all received long-term glucocorticoid and immunosuppressive therapy, 31 cases (93.
9%) had a treatment course of more than 2 years, and 30 cases had a treatment course of more than 3 years ( 91.
9%)
.

It can be seen from this that it is precisely because patients with lupus erythematosus receive long-term hormone and immunosuppressive therapy that the body's immune function is low, which leads to a significant increase in the incidence of infection [3]
.

2.
Factors of indwelling catheter

In a study on whether indwelling catheters can cause urinary tract infections, it was found that in 38 cases of lupus erythematosus patients with indwelling catheters, 18 cases (47.
4%) had urinary tract infections
.
This indicates that indwelling catheter is a major factor leading to a significant increase in the incidence of urinary tract infections in patients with lupus erythematosus [4]
.

3.
Body structure factors

One of the important reasons why women with lupus are more likely to be targeted by urinary tract infections is mainly related to the structural characteristics of the female urethra
.

Because women’s urethra and vagina are short and straight and close to the anus , this physiological structure creates a “unique” environment for urinary tract infections, which makes women more likely to be contaminated by feces or vaginal secretions.
In addition, women with lupus have long-term Acceptance of immunosuppressant drugs and hormone therapy weakens the body's resistance to bacterial infections, which is also an important reason why lupus women are prone to urinary tract infections [4]
.

It can be seen that Ms.
Liu's diagnosis of urinary tract infection was not accidental, but a long-planned event
.

Two, silly and confused: Urinary tract infection or lupus nephritis?

In the case of Ms.
Liu mentioned above, a careful friend may notice a detail, which is the "weakly positive urine protein" on Ms.
Liu's report
.
You know, in the diagnosis of lupus nephritis , urine protein is also an important diagnostic basis.
Patients with lupus nephritis generally show increased urine protein
.
Lupus kidney is the clinical manifestation of lupus disease activity involving the kidneys, which indicates that the lupus condition is aggravated and even has the risk of recurrence.
This is also an important reason why Ms.
Liu suspects that the lupus condition is aggravated
.

So the question is: What is the difference between the symptoms of urinary tract infection and nephritis? In order to distinguish the two types of diseases, what kind of clinical examinations will be done?

1.
Urinary tract infection

After a urinary tract infection, patients generally experience painful urination, frequent urination, urgency, low back pain, lower abdominal pain and other symptoms
.
In terms of examination, general doctors will first perform physical examination, laboratory and imaging examinations based on the patient’s symptoms
.

After some operations, if the doctor finds that the patient meets one of the following indicators on the checklist, he is diagnosed as a urinary tract infection:

1.
The fresh mid-section urine sediment was Gram stained and observed with an oil microscope, and the bacteria were more than 1 per field of view ;

2.
Fresh mid-section urine bacterial culture count ≥ 105  CFU/ml;

3.
The urine culture of bladder puncture is positive [5]
.

2.
Lupus nephritis

The symptoms of lupus nephritis are somewhat similar to those of urinary tract infections, but compared to general urinary tract infections, the symptoms of lupus nephritis are more serious and complicated
.
For example, light micro patient may have only a small amount of proteinuria or hematuria symptoms, but severe cases may occur nephrotic syndrome or rapidly progressive glomerulonephritis [6]
.

In addition, patients often show unexplained increased blood pressure, anemia, edema, skin itching, bleeding gums, loss of appetite, nausea, vomiting, backache, back pain and other symptoms
.

In terms of diagnosis and examination, lupus nephritis is also more complicated and rigorous than urinary tract infections
.
For example, patients with lupus erythematosus suspected of having lupus nephritis must undergo a "kidney biopsy" pathological examination [7]
.

In addition, the timing of biopsy is when the urine protein is quantified> 0.
5g/L or the glomerular filtration rate (eGFR) is reduced that cannot be explained by other reasons , before it can be diagnosed as lupus nephritis [7]
.

3.
Will urinary tract infection cause nephritis?

Urinary tract infection and lupus nephritis, two seemingly unrelated diseases, are actually very related
.

The kidney is the organ most easily affected by lupus erythematosus.
A number of studies have found that patients with lupus erythematosus combined with lupus nephritis have a significantly higher incidence of urinary tract infection [8]
.

In addition, some studies have found that when lupus patients are combined with urinary tract infection, the risk of eventually inducing nephritis is also higher
.
Moreover, when urinary tract infection is combined with lupus nephritis, it can aggravate the original renal damage, accelerate the progression of the disease, and affect the efficacy of hormones [9]
.

It can be seen that when a urinary tract infection that has not been treated in time evolves into a complex urinary tract infection, the kidneys can be involved and renal complications are prone to occur
.
Therefore, butterfly friends need to pay attention to the seemingly small but common complication of urinary tract infection and treat it in time
.

4.
What to do with urinary tract infection? Cure and prevent with both hands!

rule:

Once lupus erythematosus is diagnosed as a combined urinary tract infection, the doctor will first check to determine which bacteria caused the infection, or which bacteria are sensitive to and which antibiotics are resistant to
.
After clarifying the above problems, the doctor will prescribe a sufficient amount of antibiotics for a full course of treatment based on the patient's symptoms
.

As the pathogenic bacteria of urinary tract infection is Escherichia coli the most intestinal bacteria, the general experience medication will choose levofloxacin, nitrofurantoin, compound trimethoprim, ceftazidime and other drugs for treatment
.
The specific doctor will adjust the medication according to the urine culture and drug sensitivity results, and the test results
.

Note : Once you have a urinary tract infection, you must strictly follow the doctor's advice and adhere to the medication during the treatment period.
Do not stop the medication at will to avoid the resurgence of bacteria
.

Defend:

Urinary tract infections are prone to recurring attacks, and they can easily cause lupus nephritis
.
In order to avoid urinary tract infections, it is recommended that appropriate protection should be done daily:

Drink as much water as possible and urinate more often.
You need to urinate once every 2 to 3 hours to dilute your urine and remove bacteria in your urine, reducing the risk of urinary tract infections
.
At the same time, you should pay more attention to your diet, avoid spicy and greasy foods, tobacco, alcohol, and strong tea, and eat more fruits and vegetables
.

2.
Keep your private parts clean

Patients should pay attention to the vulva cleansing, and develop the habit of washing regularly and changing underwear frequently
.
At the same time, toilet paper should be used to wipe the vulva after urination, it is recommended to follow the order from front to back
.
In addition, attention should be paid to the cleaning of the perineum to reduce the growth of bacteria in the urethra[10]
.

3, the rational use of antibiotic drugs

Different antibiotics have different therapeutic doses and usage.
It is recommended to follow the instructions or follow the doctor's advice
.
If symptoms worsen rapidly or significantly aggravate during treatment with antibiotics, you need to inform your doctor and get treatment in time
.

4.
Regular physical examination

Urinary tract infections sometimes not as respiratory infections and digestive tract infections like symptoms, the symptoms can be presented occult manifestations, such as can be no urinary frequency, urinary tract infection symptoms of urinary urgency, dysuria, and some only as fatigue, fever, Performance [2]
.
Therefore, it is sometimes difficult to judge whether it is co-infection or lupus activity
.

Therefore, it is recommended that patients with lupus erythematosus should have regular urine routines, especially after the use of hormones, or patients with renal impairment and nephrotic syndrome, should be more alert to the occurrence of urinary tract infections
.

Concluding remarks

If lupus erythematosus patients with urinary tract infection cannot be detected in time, it is easy to induce or aggravate the progression of lupus nephropathy and affect the prognosis
.
Therefore, early detection, early diagnosis, and active treatment of urinary tract infections are an important aspect of preventing the deterioration of renal function
.