THE DIAGNOSTICS OF THE URINARY TRACT INFECTIONS: CHRONIC CYSTITIS - REALITY OR MYTH?

Abstract

THE AIM of the work was an attempt to reveal criteria of differential diagnostics of chronic pyelonephritis and chronic cystitis on the basis of a retrospective study of the main anamnestic data and clinic-laboratory symptoms of the urinary tract infections (UTI). PATIENTS AND METHODS. A retrospective analysis of medical documentation of 450 UTI women was made. The presence of chronic UTI (> 1 year) without impaired functions of the kidneys and symptoms of obstruction was taken as a criterion of inclusion of the patients in the investigation. The women were divided into two groups. The first group consisted of women with chronic pyelonephritis (CPN) (n=370), the second group – with chronic cystitis (CC) (n=80). Scitigraphic investigation was performed in all CC patients with RFP of different mechanism of elimination: 1) renoscitigraphy with ⁹⁹ᵐTc -DMSA – was considered as a “golden standard”. 2) renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate - for the assessment of accuracy of the diagnosis method. RESULTS. A comparative analysis of differences of absolute frequencies associated with signs of PN has shown that only 2 of them differed considerably in the groups under study. However, the distinctions, found between patients with CPN and CC were of quantitative rather than qualitative character. Renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate has shown that in 59 patients (74%) with the diagnosis CC there were classical signs of pyelonephritis – “scars”. CONCLUSION. On the basis of using the data of anamnesis and clinic-laboratory characteristics of UTI which are used by physicians in their every-day clinical practice it is not possible to establish the topic of the process (cystitis or pyelonephritis). Renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate is an objective method of diagnosing UTI: the sensitivity of the method is 98%, the specificity – 62%. The scitigraphic investigation data demonstrate the presence of signs of PN in 100% of patients with frequent relapses of CC; in 95% of the patients who had only 2 episodes of cystitis during a year there was no involvement of the kidneys in the inflammatory process.