1, symptoms of lower urinary tract infection Typical acute lower urinary tract infection often manifests as acute cystitis, mainly with symptoms of urinary tract irritation (urinary frequency, urinary urgency, urinary pain) and discomfort in urination, usually due to irritation in the bladder triangle and posterior urethritis. There is usually no fever or pain in the kidney area. Acute cystitis is most often caused by an upstream infection with an acute urethritis. Urgency is mostly accompanied by painful urination, i.e., burning pain in the bladder and urethral area during urination. Some patients have mid to lower abdominal pain at the end of urination. Urinalysis may reveal cloudy urine, increased white blood cells in the urine, and occasionally hematuria (microscopic hematuria and visual hematuria). Recurrent episodes of UTI for more than 1 year are called chronic UTI. chronic UTI can also be acute at some point in its course. Chronic cystitis is characterized by recurrent symptoms of urinary frequency and urgency over a long period of time, but the symptoms are milder and more moderate, and can sometimes occur acutely. A small to moderate amount of pus cells can be found in the urine. Most have a history of acute cystitis. Many of these patients have stones, deformities or other obstructive factors, so further investigations should be performed to detect the cause, trigger or complications in a timely manner. If it is not convenient to visit the clinic, you can also consult with me directly by phone to give you some timely advice. 2, acute upper urinary tract infection (acute pyelonephritis) symptoms typical symptoms of acute upper urinary tract infection (i.e. acute pyelonephritis) are chills, high fever, lumbago, can be accompanied by urinary frequency, urinary urgency, painful urination and discomfort in urination and other symptoms of lower urinary tract infection, percussion pain in the kidney area is obvious, blood leukocyte count is increased, there may be hematuria and pus urine, leukocyte tubular type can be found in the urine. There is often nausea and vomiting, and some patients may have nocturia, and bacteraemia is more common. Typical patients often have three groups of clinical manifestations: ① urinary tract irritation symptoms: that is, urinary frequency and urinary urgency pain. Systemic symptoms include fever, chills, malaise, poor appetite, nausea, vomiting, abdominal pain, and neutrophilia, which are sometimes misdiagnosed as acute cholecystitis or acute appendicitis. Complex acute pyelonephritis can often be septic, and diabetic patients can develop acute renal papillary necrosis, with detached renal papillae obstructing the ureter, often leading to severe sepsis or acute renal insufficiency. (iii) Local symptoms: pain in one or both kidney areas, percussion pain and pressure pain in the spinal rib area, in addition to pressure pain points at the quarter rib point (intersection of the rib margin and the midline of the clavicle) and the upper ureter point (flat umbilicus at the outer edge of the rectus abdominis muscle). In clinical practice, there are many patients with very atypical symptoms, and it is difficult to distinguish between upper and lower urinary tract infections. Lower urinary tract infection can be without symptoms of urinary tract irritation such as frequency, urgency, painful urination and discomfort in urination; acute pyelonephritis can also be without fever and pain in the kidney area. In patients with lower urinary tract irritation and true bacteriuria, only 50% to 70% of the infections are confined to the bladder, and the remaining 30% to 50% of patients have insidious upper urinary tract infections. Therefore, in our clinical work, we need to be alert to the presence of occult upper urinary tract infections in patients who simply present with lower urinary tract infections. If you suspect that the local hospital diagnosis can also be directly and I telephone consultation, in time to give you some advice, as soon as possible to go to the regular hospital for medical treatment. 3, symptoms of chronic pyelonephritis Chronic pyelonephritis refers to chronic interstitial nephritis with renal scar formation and recurrent urinary tract infections. For patients who have had recurrent urinary tract infections with structural abnormalities of the urinary tract since childhood, almost all have chronic pyelonephritis. In patients who do not have genitourinary tract abnormalities but have recurrent episodes of urinary tract infection, it is less likely to cause chronic renal insufficiency. The clinical manifestations of chronic pyelonephritis can be divided into five types: ① Recurrent type: This type has more typical symptoms. Patients have recurrent episodes of urinary tract irritation with bacteriuria. There is often low-grade fever and mild or moderate renal pain. (2) Long-term low-grade fever: Long-term low-grade fever, along with dizziness, fatigue, weight loss and loss of appetite, without urinary tract irritation, sometimes misdiagnosed as tuberculosis or other chronic diseases. (iii) Hypertensive type: With a history of urinary tract infection, the main manifestation is hypertensive symptoms characterized by dizziness, headache and weakness. It may be accompanied by proteinuria and anemia, and the kidney function may be reduced, often without urinary tract irritation, and there may be intermittent bacteriuria or aseptic urine. Hematuria: A few cases are characterized by recurrent episodes of hematuria, dark red and cloudy urine, mostly accompanied by back pain and back pain, hematuria can subside on its own, and the morphology of red blood cells in urine is usually normal. ⑤ Asymptomatic bacteriuria type: Patients have no systemic symptoms and urinary tract irritation, and a large number of bacteria and a small amount of white blood cells can be detected in urine.