What is pyelonephritis?

pyelonephritis is inflammation of the kidneys. The most common cause is a bacterial infection so it is also known as a kidney infection or upper urinary tract infection. Infection is usually caused by pathogens ascending through the urinary tract, although in some cases they can also enter the bloodstream.

The most common symptoms are high fever, flank pain, nausea, burning and burning when urinating and frequent urination. If left untreated, it can be complicated by sepsis and kidney failure. Treatment consists of administering antibiotics; In severe cases, hospitalization of the patient may be necessary.

Pyelonephritis is quite common, especially in adult women among whom there is a prevalence between 1 and 2 per thousand against 0.5 per thousand among men. Although treatment is generally effective and has a good prognosis, in elderly patients the risk of death from renal failure can be as high as 40%.

most prominent symptoms

The symptoms of pyelonephritis usually appear quickly, within a few hours to a day. It usually includes a high fever, pain when urinating, and abdominal pain radiating to the sides of the back. Nausea and vomiting are also common symptoms.

Chronic pyelonephritis causes persistent abdominal pain and blood often appears in the urine. Proteins related to inflammatory processes can accumulate in tissues and trigger AA amyloidosis.

In advanced pyelonephritis, the signs of septic shock such as rapid breathing, drop in blood pressure and even delusions.

Causes

The most common cause of pyelonephritis is due to invasion of the urinary tract by bacteria common in the digestive tract. Escherichia coli is the most common (70-80%), followed by others such as Enterococcus faecalis. In hospital-acquired pyelonephritis, other bacteria such as Pseudomonas aeruginosa, Kiebsiella, and coliform bacteria.

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Most cases of pyelonephritis start as a lower urinary tract infection that progresses to the bladder and then to the kidneys. The risk increases with the following factors:

mechanical factors: structural changes in the urinary tract, vesicoureteral reflux, kidney stones, placement of urethral stents, and other mechanical causes such as tumor growth (eg, prostate in men) or pregnancy that may facilitate the flow of urine from the bladder to the kidneys . systemic diseases: diabetes, immunocompromised states. personal and family history: Frequent urinary tract infections among family members and previous urinary tract infections. Personal habits: changes in sexual habits, use of spermicides, etc.

Diagnosis

The diagnosis of pyelonephritis is usually based on physical examination and description of symptoms. Physical examination usually reveals fever, pain, and tenderness in the sides of the back. Physical examination is usually accompanied by urinalysis. Test strips that detect nitrites and lymphocytes in the urine are usually sufficient for diagnosis, although a culture and antibiotic sensitivity test.

If kidney stones are suspected, if the condition does not improve with treatment, or if there is large amounts of blood in the urine, various imaging techniques are often used, especially x-rays and ultrasound of the kidneys, ureters, and urinary bladder to confirm the diagnosis. and rule out other possible causes of the clinical picture.

types

Pyelonephritis is generally classified into two major groups: acute pyelonephritis and chronic pyelonephritis.

Acute pyelonephritis is defined as a purulent and exudative inflammation located in the renal pelvis and kidneys. The parenchyma of the kidneys (the functional tissue) has suppurative necrosis and the tubules can be damaged. In the early stages, the glomeruli and vessels appear normal.

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chronic pyelonephritis involves recurrent infections that leave visible scarring in the parenchyma. Infection can appear in the form of pyonephrosis (infection in the collecting systems of the kidney) and perinephrotic abscesses (around the kidney).

A rare type of chronic pyelonephritis is xanthogranulomatous pyelonephritis. It shows granulomatous abscesses, severe destruction of renal tissue and a clinical picture similar to that produced by renal cell carcinoma.

Treatment

When pyelonephritis is suspected, bacterial culture with antibiotic sensitivity testing is common, as most cases of pyelonephritis are due to bacterial infections and antibiotics are the main treatment.

The antibiotic chosen depends on the results of the culture and the sensitivity profile it presents. Among the most used antibiotics are fluoroquinolones, cephalosporins, aminoglycosides, trimethoprim and others, alone or in combination.

In cases that require hospitalization, antibiotic treatment is usually intravenous, and body temperature and white blood cell counts are closely monitored. If there is obstruction of the urinary tract for any reason, urethral stents are usually implanted to relieve urinary emptying.

Treatment of xanthogranulomatous pyelonephritis usually requires surgical intervention with removal of the affected kidney or partial nephrectomy if feasible.

In patients with recurrent urinary tract infections, a detailed study is needed to find out the underlying cause that produces repeated infections.

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