All EMS presentations
GU/RenalClinical presentation

Urinary complaint / UTI / retention

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Urinary symptoms may reflect infection, obstruction, retention, stone disease, bleeding, medication effect, or neurologic dysfunction and can progress to renal injury or sepsis.
  • Anuria, severe retention, fever with shock, flank pain with infection, gross bleeding with clots, or new neurologic deficits requires escalation.
  • Keep medication or neurologic cause in the differential; overlapping or concurrent illness remains possible.
  • For urinary complaint / uti / retention, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious3 conditions
PyelonephritisTime-sensitive high-risk possibility

HPI

Clarify dysuria/frequency; unable to void; last urination.

Signs & symptoms

Fever, flank pain, vomiting, hypotension, or reduced urine output.

Focused exam

Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.

Brief pathophysiology

Pyelonephritis may cause urinary complaint / uti / retention through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.

Temperature (°C)

Trend temperature

Fever or hypothermia raises concern for systemic infection.

Blood pressure (mmHg)

High or low

Renal disease, volume overload, or dehydration can alter pressure in either direction.

Heart rate (bpm)

May rise

Pain, fever, dehydration, and shock can increase rate.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.

Front-load in the triage report

  • Pyelonephritis: Fever, flank pain, vomiting, hypotension, or reduced urine output.
  • Dysuria/frequency.
  • Unable to void?
UrosepsisTime-sensitive high-risk possibility

HPI

Clarify unable to void; last urination; hematuria.

Signs & symptoms

Fever, flank pain, vomiting, hypotension, or reduced urine output.

Focused exam

Obtain a 12-lead ECG when electrolyte disturbance is plausible; Assess bladder distension, suprapubic or flank tenderness, hydration, urine character, catheter function, edema, and infection signs.

Brief pathophysiology

Urosepsis may cause urinary complaint / uti / retention through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.

Respiratory rate (breaths/min)

May rise early

Tachypnea is included in NEWS2 and can precede overt hypotension.

Temperature (°C)

High or low

Absence of fever does not exclude sepsis; hypothermia is concerning.

Heart rate (bpm)

Often rises

Tachycardia is common but may be blunted by age or medication.

Blood pressure (mmHg)

May fall

Relative hypotension and trend matter; profound hypotension can be late.

Front-load in the triage report

  • Urosepsis: Fever, flank pain, vomiting, hypotension, or reduced urine output.
  • Unable to void?
  • Last urination.
Obstructive renal injuryTime-sensitive high-risk possibility

HPI

Clarify last urination; hematuria; fever/rigors.

Signs & symptoms

Fever, flank pain, vomiting, hypotension, or reduced urine output.

Focused exam

Obtain a 12-lead ECG when electrolyte disturbance is plausible; Assess bladder distension, suprapubic or flank tenderness, hydration, urine character, catheter function, edema, and infection signs.

Brief pathophysiology

Obstructive renal injury may cause urinary complaint / uti / retention through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Shock can be present before profound hypotension. Trend perfusion, mental status, pressure, and pulse characteristics; the direction varies with cause and treatment.

Blood pressure (mmHg)

May fall

Relative change from baseline may be important before absolute hypotension appears.

MAP (mmHg)

May fall

A falling MAP supports impaired perfusion but is not the only endpoint.

Heart rate (bpm)

Often rises

Tachycardia is common; neurogenic, toxic, paced, or medication effects can alter the response.

Pulse pressure (mmHg)

May narrow

Narrow pulse pressure can reflect reduced stroke volume, although distributive states may differ.

Front-load in the triage report

  • Obstructive renal injury: Fever, flank pain, vomiting, hypotension, or reduced urine output.
  • Last urination.
  • Hematuria.
Common2 conditions
Lower UTICommon presentation pattern

HPI

Clarify dysuria/frequency; unable to void; last urination.

Signs & symptoms

Dysuria, frequency, suprapubic discomfort, poor stream, or palpable bladder may fit.

Focused exam

Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.

Brief pathophysiology

Lower UTI may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.

Temperature (°C)

Trend temperature

Fever or hypothermia raises concern for systemic infection.

Blood pressure (mmHg)

High or low

Renal disease, volume overload, or dehydration can alter pressure in either direction.

Heart rate (bpm)

May rise

Pain, fever, dehydration, and shock can increase rate.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.

Front-load in the triage report

  • Dysuria, frequency, suprapubic discomfort, poor stream, or palpable bladder may fit.
  • Dysuria/frequency.
  • Unable to void?
RetentionCommon presentation pattern

HPI

Clarify unable to void; last urination; hematuria.

Signs & symptoms

Dysuria, frequency, suprapubic discomfort, poor stream, or palpable bladder may fit.

Focused exam

Obtain a 12-lead ECG when electrolyte disturbance is plausible; Assess bladder distension, suprapubic or flank tenderness, hydration, urine character, catheter function, edema, and infection signs.

Brief pathophysiology

Retention may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.

Temperature (°C)

Trend temperature

Fever or hypothermia raises concern for systemic infection.

Blood pressure (mmHg)

High or low

Renal disease, volume overload, or dehydration can alter pressure in either direction.

Heart rate (bpm)

May rise

Pain, fever, dehydration, and shock can increase rate.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.

Front-load in the triage report

  • Dysuria, frequency, suprapubic discomfort, poor stream, or palpable bladder may fit.
  • Unable to void?
  • Last urination.
Mimics2 conditions
MedicationImportant alternative presentation

HPI

Clarify dysuria/frequency; unable to void; last urination.

Signs & symptoms

Anticholinergic drugs, prostate disease, or spinal pathology can produce retention.

Focused exam

Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.

Brief pathophysiology

Medication can resemble urinary complaint / uti / retention through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.

Temperature (°C)

Trend temperature

Fever or hypothermia raises concern for systemic infection.

Blood pressure (mmHg)

High or low

Renal disease, volume overload, or dehydration can alter pressure in either direction.

Heart rate (bpm)

May rise

Pain, fever, dehydration, and shock can increase rate.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.

Front-load in the triage report

  • Anticholinergic drugs, prostate disease, or spinal pathology can produce retention.
  • Dysuria/frequency.
  • Unable to void?
Neurologic causeImportant alternative presentation

HPI

Clarify unable to void; last urination; hematuria.

Signs & symptoms

Anticholinergic drugs, prostate disease, or spinal pathology can produce retention.

Focused exam

Obtain a 12-lead ECG when electrolyte disturbance is plausible; Assess bladder distension, suprapubic or flank tenderness, hydration, urine character, catheter function, edema, and infection signs.

Brief pathophysiology

Neurologic cause can resemble urinary complaint / uti / retention through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.

Temperature (°C)

Trend temperature

Fever or hypothermia raises concern for systemic infection.

Blood pressure (mmHg)

High or low

Renal disease, volume overload, or dehydration can alter pressure in either direction.

Heart rate (bpm)

May rise

Pain, fever, dehydration, and shock can increase rate.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.

Front-load in the triage report

  • Anticholinergic drugs, prostate disease, or spinal pathology can produce retention.
  • Unable to void?
  • Last urination.
Red flags

Findings that should escalate concern

  • Anuria, severe retention, fever with shock, flank pain with infection, gross bleeding with clots, or new neurologic deficits requires escalation.
  • Pyelonephritis, urosepsis, or obstructive renal injury: Fever, flank pain, vomiting, hypotension, or reduced urine output.
Related medications

Medication recognition

AmoxicillinApixabanRivaroxabanClopidogrelCephalexinWarfarin
Related EMS presentations

Continue the clinical pathway

InfectiousFever / suspected infection / sepsisGU/RenalFlank pain / renal colicInfectiousSuspected sepsisGU/RenalDialysis complicationGU/RenalHematuria
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. A02: Patient AssessmentBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for patient assessment.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. Acute kidney injury: prevention, detection and managementNational Institute for Health and Care Excellence

    Clinical guidance for recognizing renal risk, oliguria, obstruction, electrolyte complications, and deterioration.

  3. Urologic EmergenciesMedical Clinics of North America · 2018

    Recognition of urinary obstruction, infection, retention, hematuria, and other time-sensitive urologic conditions.