小结
定义
病史和体格检查
关键诊断因素
- 排尿困难
- 新发夜尿
- 尿液浑浊
- 危险因素
- 发热
其他诊断因素
- 尿急
- 肉眼血尿
- 尿频
- 耻骨上疼痛或压痛
- 腰部疼痛
- 肋脊角压痛
- 新发失禁
- 新发谵妄/虚弱,或者谵妄/虚弱恶化
- 糖尿病失控
- 不适感
- 寒颤
危险因素
- 性活动
- 使用杀精剂
- 绝经后
- UTI 阳性家族史
- 复发性 UTI 的病史
- 有异物存在
- 胰岛素治疗的糖尿病患者
- 终生 UTI 发生率很高
- 近期使用抗生素
- 膀胱排空欠佳
- 年龄增长
诊断性检查
首要检查
- 尿试纸(试验)
- 尿培养和药敏
需考虑的检查
- 尿显微镜检查
- 排泌后残余尿量
- 肾脏超声
- 腹部/盆腔 CT
治疗流程
未留置尿管:年龄 <65 岁且非孕妇
未留置尿管:年龄 ≥65 岁
未留置尿管:孕妇
留置尿管
撰稿人
专家顾问
Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP
Consultant Renal Physician
Honorary Associate Professor
Nephrology Department
Leeds Teaching Hospitals NHS Trust
Head of MBChB
School of Medicine
University of Leeds
Leeds
UK
利益声明
AL has been the principal applicant/co-applicant for a number of grants including: Engineering and Physical Sciences Research Council Research - Multiplexed AKI biomarker detection with a single molecule biosensor; Leeds Cares - A novel, non-invasive diagnostic approach to assess kidney transplant health through the targeted measurement of biomarkers of kidney injury and immune response in kidney transplant recipients at the Leeds Teaching Hospitals NHS Trust; Kidney Research Yorkshire - Use of enhanced technology to characterise haemodialysis treatment for acute kidney injury (AKI); Bringing It Home - Validation of a micro-sampling technique for measuring tacrolimus and creatinine remotely; and to fund a research nurse; British Renal Society - Renal function assessment with point of care creatinine in diverse populations (RAPID), and several NIHR grants including on a) Improving the quality of post-discharge care following AKI b) An investigation into the use of remote blood sample collection to reduce health inequalities in patients with mental health disorders c) A comparison of remote blood collection devices: a human factor use study d) Defining the characteristics for a novel automatic device to monitor urine output in catheterized patients e) Leeds Medtech and In-vitro Diagnostic Cooperative Grant Extension f) Surgical MedTech Co-operative for the 2019/20 proof-of-principle funding stream g) A pilot investigation into the use of beta-trace protein for residual renal function estimation in haemodialysis h) Application of functional MRI to improve assessment of chronic kidney disease (AFiRM study) i) SuperResPath-Renal: Quantitative super-resolution technology for a fast, decentralised clinical diagnosis of renal pathologies. AL is the co-author of a number of manuscripts including on extracorporeal treatments, AKI, kidney function testing prior to contrast-enhanced CT, plasma exchange and glucocorticoids in severe ANCA-associated vasculitis, COVID-19 rapid diagnostics, multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome, and on a summary of NICE guidance on CKD. AL is the author of several book chapters on nephrology and AKI. AL has received expenses for accommodation and travel for conferences at which he has given lectures, other than those delivered virtually. AL was a member of the AKI Scientific Program Committee for the ISN World Congress of Nephrology 2020-2021 and Chair of this same committee in 2021-2022.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Una J. Lee, MD
Female Pelvic Medicine and Reconstructive Surgery Section of Urology and Renal Transplantation
Virginia Mason Medical Center
Seattle
WA
利益声明
UJL declares that she has no competing interests.
同行评议者
Sheilagh Reid
Consultant Urological Surgeon
Princess Royal Spinal Injuries Unit
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
利益声明
SR is lead for the spinal injuries urology course; in the past this course has received funding from Coloplast, AMS, and Hollister. SR is chair of the Female, Neurological, and Urodynamic Urology section of the British Association of Urological Surgeons.
编辑
Tessa Davis
Section Editor, BMJ Best Practice
Consultant in Paediatric Emergency Medicine
Royal London Hospital
London
UK
利益声明
TD declares that she has no competing interests.
Emma Quigley
Section Editor, BMJ Best Practice
利益声明
EQ declares that she has no competing interests.
Susan Mayor
Lead Section Editor, BMJ Best Practice
利益声明
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 膀胱过度活动症
- 膀胱或上尿道尿路上皮癌
- 非感染性尿道炎
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