Pylonephritis

Question 1

What is Acute Pylonephritis?

Answer 1

this is infection of renal pelvis and kidney that usually results from ascent of a bacterial pathogen up to the ureters from the bladder to the kidneys

Question 2

Etiology of A.Pylonephritis

Answer 2

• E.Coli
• Klebsiella
• Proteus
• Enterobacter
• Pseudomonas
• Serratia
• Citrobacter
• occasionally Streptococcus fecalis and rarely S.Aureus

Hematogenous way of infection occurs infrequently

Question 3

Diagnosis of A.Pylonephritis

Answer 3

-Urinalysis-Phidias,bacteriuria,hematuria
Urine culture and sensitivity (before and during therapy)
-CBC- neutrophil is leukocytosis
-intravenous urography may show stones or obstruction
-Renal US( stones,hydronephrosis, or absess)
-voiding cystourethrography(VCUG)- it is delayed for several weeks coz of transient reflux can often occur during an acute infection)

Differential diagnosis 
Pancreatitis 
Basal pneumonia 
Appendicitis 
Cholecystitis 
Appendicitis 
Diverticulitis 
Pelvic inflammatory disease

Question 4

Treatment of A.Pylonephritis

Answer 4

Intravenous antibiotic therapy done after cultures are sent
A quinolone or ampicillin (1g i.v q6h) and gentamicin or tobramycin (1,5mg/kg iv q8h
Obstruction must be relieved
If the urine continues to show infection reevaluation is done to rule out obstruction, abscess, or inappropriate antibiotic section
If symptoms have resolved after 2-5days of i.v antibiotics the patient may be switched to per oral medication for an additional 10-14days

Question 5

Pyonephrosis

Answer 5

Refers to a patient with acute pylonephritis complicated by obstructed hydronephrosis
The ivu will show no function or poor visualization of the involved kidney
Renal US makes the diagnosis
50% of the obstructed Pylonephrotic kidneys are nonfunctional

In treatment- iv antibiotics and immediate relief of obstruction by either a percutaneous nephrostomy or placement of a retrograde ureteral stent are mandatory.

Question 6

Emphysamatous pyelonephritis

Answer 6

It is an acute necrotizing parenchymal and perirenal infection
It is a rare complication of acute pyelonephritis in which organisms generally E.Coli ferment glucose to CO2 and H20 producing gas in the renal parenchyma.