🔁 A Case Study: Diabetic Woman with Recurrent UTI

A 50-year-old woman with poorly controlled diabetes for over 10 years presented with fever, chills, burning urination, and increased urinary frequency—classic signs of a lower urinary tract infection (UTI), most likely acute cystitis.

This was her third episode in six months, qualifying as a recurrent UTI, defined as:
✅ Two or more infections in 6 months
✅ Three or more infections in 12 months

🚩 Common Risk Factors for Recurrent UTI

1. Poorly controlled diabetes mellitus – Most common underlying cause
2. Immunosuppressed states – e.g., transplant recipients, HIV, or long-term steroids
3. Structural abnormalities – Congenital anomalies, vesicoureteric reflux (VUR), urinary stones

🔬 Diagnostic Workup: A Structured Evaluation

A comprehensive workup helps prevent recurrence and avoid complications:

• Strict glycemic control – Foundation in diabetic patients
• Urine culture – For pathogen identification and antibiotic sensitivity
• Ultrasound abdomen – Detects stones, hydronephrosis, anatomical issues
• Post-void residual urine (PVR) – Elevated levels may need uroflowmetry and urology input
• Gynecological exam – Especially in postmenopausal women to assess atrophic vaginitis
• Digital rectal exam (in men) – To evaluate for prostatomegaly
• CT/MRI abdomen – When ultrasound is inconclusive or deeper assessment is required
• Micturating cystourethrogram (MCU) – Essential in children to evaluate for reflux

💊 Management Strategies

• 💧 Hydration – Encourage fluid intake of 2.5–3.5 liters/day
• ⏱️ Timed voiding – Every 2–3 hours to reduce stasis
• 🧼 Personal hygiene – Especially post-void and post-coital hygiene
• 💊 Antibiotic prophylaxis – Low-dose, long-term, under specialist guidance in select cases
• 🍒 Cranberry extract – May help reduce E. coli adherence in the bladder
• 💆‍♀️ Topical estrogen – For postmenopausal women with vaginal atrophy
• 🏥 Surgical intervention – For correctable anatomical causes

🧠 Clinical Takeaway

Recurrent UTIs demand a holistic and individualized approach.
Effective management includes treating underlying conditions like diabetes, ruling out anatomical issues, and reinforcing prevention strategies. Collaboration between nephrologists, urologists, and gynecologists is key to reducing recurrences and protecting long-term kidney health.