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    Nephrology (kidney) :
 
 

Pyelonephritis:

Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably. It requires antibiotics as therapy. It is a form of nephritis. It can also be called pyelitis.

Pyelonephritis is a kidney infection, usually from bacteria that have spread from the bladder.

Possible causes of infection include the following:

  • infections in the bladder
  • use of a catheter to drain urine from the bladder
  • use of a cystoscope to examine the bladder and urethra
  • surgery on the urinary tract
  • conditions such as prostate enlargement and kidney stones that prevent the efficient
  • flow of urine from the bladder
  • Symptoms and signs include back, side, and groin pain; urgent, frequent urination; pain or burning during urination; fever; nausea and vomiting; and pus and blood in the urine.

Diagnosis is made with a urine test to identify bacteria and formations of white blood cells, called casts, shaped like tubes in the kidneys. If an infection cannot be easily cured, x rays might be done to look for abnormalities in the kidneys, ureters, and bladder. A kidney infection is treated with an appropriate antibiotic, and abnormalities may need to be surgically treated.

Risk Causes
Pyelonephritis can cause/be caused by the following:

  • Structural & renal abnormalities
  • calculi and urinary tract catheterisation
  • stents or drainage procedures
  • pregnancy
  • diabetes
  • primary biliary cirrhosis
  • immunocompromised patient
  • neuropathic bladder.

Pathology

Acute pyelonephritis is an, exudative purulent localized inflammation of kidney and renal pelvis. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal.[1] Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renale pelvis to the renale cortex. Chronic infections can result in fibrosis and scarring. Chronic pyelonephritis is often caused by Xanthogranulomatous pyelonephritis.

Causes

Ascending bacteria from lower urinary tract infections, mainly cystitis and prostatitis.

Signs and symptoms

It presents with high spiking fever, backache, vomiting, dysuria (painful voiding), rigors and often also with confusion. There may be renal angle tenderness on physical examination.

Diagnosis

Nitrite and leukocytes on a urine dipstick are often detected, which may be an indication for empirical treatment. Formal diagnosis is with culture of the urine and bloods.In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteric reflux (urine from the bladder flowing back into the ureter).

Treatment

Treatment is with antibiotics, which are often administered intravenously to improve the effect. Trimethoprim (or co-trimoxazole) or nitrofurantoin are often used first-line, although in full-blown pyelonephritis amoxicillin (with or without clavulanic acid), gentamycin (with or without ampicillin), fluoroquinolones (eg. ciprofloxacin) or a third generation cephalosporins are often favoured.

 

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