Urinary tract infections (UTIs) are amongst the most frequent bacterial infections in the community, as well as in healthcare systems. In renal insufficiency—especially stages 2–5 chronic kidney disease (CKD) and in dialysis—UTIs are frequent due to impaired immunity, and metabolic imbalances, and often require nuanced management. Escherichia coli remains the most common pathogen, though others like Proteus, Pseudomonas, and Enterococcus are also implicated in the infection. Clinical diagnosis relies on pyuria, bacteriuria, and the presence of symptoms; however, urine tests can be misleading, especially in oliguria or anuria. Treatment follows standard UTI guidelines, but antibiotics must be adjusted for the estimated glomerular filtration rate (eGFR) and dialysis clearance to avoid toxicity. Nephrotoxic agents (aminoglycosides, polymyxins) are used cautiously; Nitrofurantoin and Trimethoprim-Sulfamethoxazole are often avoided due to low urinary excretion and accumulation risk.^[1]