Urinary Tract Infections
Urinary tract infections (UTIs) are common among people with ADPKD, and are a particular problem for women. These infections should always be taken seriously and fully investigated, because frequent UTIs may worsen kidney function in some people with ADPKD.
Causes of UTIs
A UTI occurs when bacteria infect the urinary tract. The urinary tract consists of:
- The kidneys
- The ureters (tubes from the kidneys to the bladder)
- The bladder
- The urethra (tube from the bladder to the outside)
Anyone can get a UTI, but these infections are a particular problem for people with PKD. This is thought to be because the cysts in the kidneys interfere with the normal flow of urine, and even minor delays in the flow increase your chance of an infection. It is also possible that kidney cysts make infections more likely by altering the tissues of the kidneys.
The bacteria that cause UTI enter the urinary tract through the urethra. This explains why UTI's are more common in women. The urethra is shorter in women than in men, so it is easier for bacteria to enter the urinary tract from the outside—for example, after a bowel movement.
Some people with ADPKD can have frequent UTIs, often from the same germ. This may be due to:
- Persistent infection in a cyst
- A kidney stone
- Not drinking enough fluid
- For women, re-infection during sexual intercourse.
Symptoms of UTIs
The most common symptoms of UTI include:
- Pain or a burning sensation when you urinate
- An urgent need to pass often small amounts of urine
- Fever, chills, and back pain (when the infection is in the kidneys).
You should tell your doctor as soon as you have symptoms of a possible UTI so that you can start treatment as soon as possible.
It is very important for your doctor to collect a urine sample from you for culture. This is to enable the laboratory to grow or ‘culture’ any bacteria in your urine sample to make sure that you can be given the right antibiotic.
If the germ is different with each infection, this suggests that the bacteria are coming from outside the body. If the same germ is found each time, the antibiotics may not be destroying the infection, and you need another treatment
Any UTI should be treated promptly with appropriate antibiotics. People with ADPKD may need to take a higher dose of antibiotics, and an infection in a cyst is likely to need a longer course of treatment.
Review by a nephrologist or urologist is also advisable, as some people with PKD may need a longer course of low-dose, regularly switched (rotating) antibiotics.
People with PKD can reduce the likelihood of frequent UTIs by:
- Drinking at least two litres of fluid every day (but first check with your doctor in case you are on restricted fluids because of your kidney function).
- Avoiding fluids that can irritate the bladder (e.g. pure fruit juices, alcohol and caffeine-containing drinks such as tea, coffee, cola).
- Urinating every two hours during the day.
Women with PKD who have frequent UTIs should:
- Wash the genital area before sexual intercourse.
- Drink a glass of water before intercourse and urinate within 30 minutes afterwards to flush out any bacteria that may have entered the urethra.
- Wipe from front to back after urinating or a bowel movement to reduce the chance that bacteria will be transferred to the urethra.
- Choose underwear made of natural materials such as cotton, and do not wear thongs, which can irritate the urethra.
- 'Double-void' when urinating, by standing up after urinating and then re-sitting or squatting to release any remaining urine that could stay in the urinary tract and become stale.