Bacteriuria and the Diagnosis of Infections of the Urinary Tract

Pyelonephritis and related infections of the urinary tract are among the most frequently encountered, most frequently undiagnosed, and most difficult to manage of all infections. The lack of clear views of the pathogenesis, diagnosis, and treatment of infections of the urinary tract is well recognized.^1-3 A few selected data indicate the magnitude of the problem. 1. Pyelonephritis is the commonest disease of the kidneys at autopsy. Active pyelonephritis has been found in 10% to 20% of autopsies in several general hospitals,^4-6and healed pyelonephritis occurs about as frequently as does active pyelonephritis.⁶ 2. Pyelonephritis has been implicated, with varying degrees of evidence, in such disorders as hypertension, chronic renal insufficiency, toxemias of pregnancy, various disturbances in electrolyte metabolism, diabetes mellitus, pregnancy, and stone formation. 3. Despite the importance of this group of diseases the diagnosis of infection of the urinary tract is made in only about 20%