1.14 Non-specific infections of the kidney parenchyma and of the capsules Flashcards
(39 cards)
Non-specific infections of the kidney parenchyma and of the capsules- list
Acute uncomplicated pyelonephritis
Acute complicated pyelonephritis
*Chronic pyelonephritis
*Xanthogranulomatous pyelonephritis
*Papillary necrosis
*Emphysematous pyelonephritis
*Pyonephrosis
urosepsis
Pyelonephritis def
An infection of the parenchyma and the collecting system of the kidney, most
often occurring as a result of an ascending infection
Acute uncomplicated pyelonephritis More common in
women
Acute uncomplicated pyelonephritis
Symptoms
o chills
o Flank or back pain
o Fever
o Vomiting and nausea
o Fatigue
o Painful urination
o Increased frequency
o Nocturia
o Cloudy or abnormal urine color
o Mental changes, confusion
Acute uncomplicated pyelonephritis- diagnosis
o Based on history, PE, laboratory and imaging tests
o Laboratory tests
* Urinalysis: WBC, RBC, bacteria in urine
* 100 000 bacteria count
* Identify causative organism: E. coli, klebsiella, Enterobacter, proteus,
pseudomonas
o Blood analysis: CRP, WBC, ESR, PCT
o Radiographic
* US to rule out concurrent obstruction
* Contrast enhanced CT: confirms the diagnosis.
Perfusion defect, parenchyma enlargement.
Acute uncomplicated pyelonephritis- treatment
o Resolve in 2-3 weeks with antibiotics, first few days IV
* Augmentin
* 3rd generation cephalosporins
* fluoroquinolone
supportive
Acute complicated pyelonephritis- definition
- Structural or functional abnormalities in UT (obstruction)
- Anatomical anomaly (VUR, calycomegalia, ureteral stricture), cancer, stone
- Metabolic abnormalities predisposing to UTI: DM, immune deficiency, pregnancy
- unusual pathogens
- recent UT instrumentation
- Recent AB use
Pathogenesis- Acute complicated pyelonephritis
Obstruction in the upper UT
Acute complicated pyelonephritis- Symptoms
Severe general symptoms:
* High fever,
* fatigue, shaking,
* chills
* nausea
* vomiting,
* abdominal pain
* flank pain
* dry tongue
Acute complicated pyelonephritis- diagnosis
o Laboratory tests
* Urinary sediment: WBC, casts, RBC
* urine culture
* Blood tests: CRP, ESR, WBC etc.
o Imaging
* US can show potential abscess and size of kidney and collecting system
* CT, contrast enhanced CT
* excretory urography
* DMSA
Acute complicated pyelonephritis- Treatment
o Remove complicating factors
o Hospitalization
* first few days IV antibiotics
* supportive
o Drainage!!!!!
Chronic pyelonephritis Definition
Chronic pyelonephritis is characterized by renal inflammation and scarring induced by :
* recurrent or persistent renal infection,
* vesicoureteral reflux,
* or other causes of urinary tract obstruction.
It occurs almost exclusively in patients with major anatomic anomalies , most commonly young children with vesicoureteral reflux (VUR).
o Reflux nephropathy: Association with a small, clubbed scarred, kidney with VUR
Chronic pyelonephritis pathogenesis
o Hematogenous or ascending
o Incomplete treated acute pyelonephritis > scarring and atrophy > slow
progression into chronic state
Chronic pyelonephritis predisposing factors
o Urinary obstruction
o Pregnancy
o Metabolic disease
o Iatrogenic cause
o Generalized and local lack of resistance
Chronic pyelonephritis symptoms
o Asymptomatic in many
o Pregnant present with UTI often
o Complication of chronic azotemia: Hypertension, visual impairment, headache,
fatigue, polyuria, polydipsia
Chronic pyelonephritis Diagnosis
o Radiological and pathological examination
o Urinalysis: Leukocytosis, RBC, proteinuria
o Increased creatinine
o Radiographic imaging
* US: Small atrophic kidneys on affected side, calyceal dilatation, cortical
scarring
* IV urogram: Small atrophic kidney, renal scarring with clubbing of underlying calyx, poles are commonly affected
* Radioisotope studies
Chronic pyelonephritis Treatment
o Limited since damage is irreversible
o Eliminating recurrent UTI and VUR, obstruction or stones
o Long-term antibiotics
o Surgical removal of affected kidney to prevent complications
o Kidney transplant or dialysis if chronic failure develops
Complication of chronic azotemia in chronic pyeloneph
Hypertension,
visual impairment,
headache,
fatigue,
polyuria, polydipsia
Xanthogranulomatous pyelonephritis- definition
Rare, severe, chronic, diffuse destructive parenchymal inflammatory disorder
o Unilateral mostly, resulting in non-functioning enlarged kidney with obstructive
uropathy secondary to stone
retroperitoneal involvement in Xanthogranulomatous pyelonephritis (3)
- Kidney alone
- Kidney and perinephric fat
- Kidney, perinephric fat and extensive retroperitoneum
Xanthogranulomatous pyelonephritis- pathogenesis
o Unknown
o Primary factors needed
* Obstruction
* UTI
* Nephrolithiasis
o Proposed: Obstruction > infection > tissue destruction and collection of lipid
material by histiocytes.
Lipid-laden macrophages are distributed around the
parenchymal abscesses and calyces.
Fibrous tissue reaction form granulomatous process initially, that infiltrates and replaces renal parenchyma
Xanthogranulomatous pyelonephritis- symptom
o Flank pain, fever, chills, bacteriuria
o Flank mass
Xanthogranulomatous pyelonephritis- diagnosis
o Laboratory: Urine culture showing E. coli or proteus
o Blood test
o Imaging: CT
Xanthogranulomatous pyelonephritis- treatment
Nephrectomy
