Pyelonephritis
From Wikipedia, the free encyclopedia
| ICD-10 | N10.-N12., N20.9 | |
|---|---|---|
| ICD-9 | 590, 592.9 | |
| DiseasesDB | 29255 11052 | |
| MedlinePlus | 000522 | |
| eMedicine | ped/1959 | |
| MeSH | C12.777.419.570.643.790 | |
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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[edit] 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 infectins can result in fibrosis and scarring.
Chronic pyelonephritis is often caused by Xanthogranulomatous pyelonephritis.
[edit] Causes
Ascending bacteria from lower urinary tract infections, mainly cystitis and prostatitis.
[edit] 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.
[edit] 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).
[edit] 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.
[edit] See also
[edit] References
- Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician 71 (5): 933-42. PMID 15768623. Full text
- Williams DH, Schaeffer AJ (2004). "Current concepts in urinary tract infections". Minerva Urol Nefrol 56 (1): 15-31. PMID 15195028. Full text (PDF)
