4.

4.Difference between acute pyelonephritis and Uncomplicated UTI are all except

a. Loss of Concentrating ability

b. Presence of White blood casts

c. Presence of Antibody against Tamm-Horsfall proteins of tubules

d. Bacterial colony Count more than 10⁸
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Answer

d. Bacterial colony Count more than 10⁸

Reference:

Harrison 16^th Edition Page 1717

Journal reference :

a. P. LARSSON, A. FASTH, U. JODAL, A. SOHL ÅKERLUND, C. SVANBORG EDÉN (1978) : URINARY TRACT INFECTIONS CAUSED BY PROTEUS MIRABILIS IN CHILDREN The Antibody Response to O and H Antigens and Tamm-Horsfall Protein and Bacterial Adherence to Uro-epithelium . Acta Paediatrica 67 (5), 591–596. doi:10.1111/j.1651-2227.1978.tb17807.x

b. Kidney International (1976) 9, 23–29; doi:10.1038/ki.1976.3. Experimental pyelonephritis: The effect of chronic active pyelonephritis on renal function. Thomas E Miller1, David Layzell1 and Elaine Stewart1

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Discussion

Normal urine is sterile. UTI can therefore be diagnosed if a single viable gram negative bacterium inhabits the urinary tract (kidney, ureters, bladder). In reality, the bacteria causing UTI multiply in log phase growth in normal urine, and most people with urinary tract infection have 10⁴-10⁶ bacteria/ml. The acute number will depend on the urine flow rate, characteristics of the urine, the duration of infection, etc. The problem in diagnosis is that of contamination arising from voided specimens passing through the non-sterile distal urethra. For this reason, clinicians use the criteria of 10⁵ bacteria/ml of “clean catch” urine to diagnose UTI. At this level, < style=""> At counts of 1000-10,000/ml, there is a 50/50 chance the result represents contamination. Such a count may represent true infection, but to be sure a second culture showing the same organism might be more convincing. The second criteria for diagnosing UTI is the presence of pyuria (> 5 WBC/HPF) on the urinalysis.

Explanation

a. A severe loss of urine concentrating capacity was demonstrable when the maximum urinary osmolality of a group of cases with pyelonephritis was compared with controls. Concentrating capacity decreased sharply over the first month but further loss over an eight-month period was minimal.

b. Presence of White blood casts is Pathognomic for Pyelonephritis

c. Presence of Antibody against Tamm-Horsfall proteins of tubules . "An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli"

d. Bacterial colony Count more than 10⁸

Comments : This is what the Journal Says : Sera from seven girls with acute symptomatic pyelonephritis and nine children with acute symptomatic cystitis caused by Proteus mirabilis were analysed for antibodies against the bacterial O and H1 antigens and the Tamm-Horsfall protein. An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli. In contrast no difference in adhesive ability was noted comparing Proteus strains causing acute pyelonephritis or cystitis

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