| Pyelonephritis:
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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.
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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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