Pyelonephritis

 ICD9           = 590, 592.9|
 ICDO           = |
 Image          = |
 Caption        = |
 OMIM           = |
 OMIM_mult      = |
 MedlinePlus    = 000522 |
 eMedicineSubj  = ped |
 eMedicineTopic = 1959 |
 DiseasesDB     = |

}} Pyelonephritis is an ascending urinary tract infectionthat has reached the pyelum (pelvis) of the kidney(nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably. It requires antibioticsas therapy. It is a form of nephritis.

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. Photo at: Atlas of Pathology

Chronic pyelonephritis is often caused by Xanthogranulomatous pyelonephritis.

Signs and symptoms

It presents with high spiking fever, backache, vomiting dysuria(painful voiding), rigorsand often also with confusion. There may be renal angle tenderness on physical examination.

Diagnosis

Nitriteand leukocyteson a urine dipstickare often detected, which may be an indication for empirical treatment. Formal diagnosis is with cultureof 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 intravenouslyto improve the effect. Trimethoprim(or co-trimoxazole) or nitrofurantoinare 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 cefalosporinsare often favoured.

References

• {{qif

  |test={{{Authorlink|}}}
  |then={{wikilink
        |1={{{Authorlink}}}
        |2={{{Author|{{{Last|}}}{{{else{{{test|}}}|{{{test{{{test|}}}|{{{then|}}}}}}}}}}|then=, {{{First}}}}}}}}
        }}
  |else={{{Author|{{{Last|}}}{{{else{{{test|}}}|{{{test{{{test|}}}|{{{then|}}}}}}}}}}|then=, {{{First}}}}}}}}

}}{{qif

 |test={{{Coauthors|}}}
 |then=, {{{Coauthors}}}

}}{{qif

 |test={{{Date|}}}
 |then= ({{{Date}}})
 |else={{qif
   |test={{{Year|}}}
   |then={{qif
     |test={{{Month|}}}
     |then= ({{{Month}}} 2005)
     |else= (2005)
    }}
  }}

}}{{qif

 |test={{{Author|{{{Last|{{{Year|}}}}}}}}}
 |then=. 

}}{{qif

 |test={{{URL|}}}
 |then=[{{{URL}}}
 |else=

}} Diagnosis and management of acute pyelonephritis in adults{{qif

 |test={{{URL|}}}
 |then=]
 |else=

}}{{qif

 |test={{{Journal|}}}
 |then=. Am Fam Physician

}}{{qif

 |test={{{Volume|}}}
 |then= 71

}}{{qif

 |test={{{Issue|}}}
 |then= (5)

}}{{qif

 |test={{{Pages|}}}
 |then=: 933-42

}}{{qif

 |test={{{ID|}}}
 |then=. {{{ID}}}

}}. PMID 15768623Full text

• {{qif

  |test={{{Authorlink|}}}
  |then={{wikilink
        |1={{{Authorlink}}}
        |2={{{Author|{{{Last|}}}{{{else{{{test|}}}|{{{test{{{test|}}}|{{{then|}}}}}}}}}}|then=, {{{First}}}}}}}}
        }}
  |else={{{Author|{{{Last|}}}{{{else{{{test|}}}|{{{test{{{test|}}}|{{{then|}}}}}}}}}}|then=, {{{First}}}}}}}}

}}{{qif

 |test={{{Coauthors|}}}
 |then=, {{{Coauthors}}}

}}{{qif

 |test={{{Date|}}}
 |then= ({{{Date}}})
 |else={{qif
   |test={{{Year|}}}
   |then={{qif
     |test={{{Month|}}}
     |then= ({{{Month}}} 2004)
     |else= (2004)
    }}
  }}

}}{{qif

 |test={{{Author|{{{Last|{{{Year|}}}}}}}}}
 |then=. 

}}{{qif

 |test={{{URL|}}}
 |then=[{{{URL}}}
 |else=

}} Current concepts in urinary tract infections{{qif

 |test={{{URL|}}}
 |then=]
 |else=

}}{{qif

 |test={{{Journal|}}}
 |then=. Minerva Urol Nefrol

}}{{qif

 |test={{{Volume|}}}
 |then= 56

}}{{qif

 |test={{{Issue|}}}
 |then= (1)

}}{{qif

 |test={{{Pages|}}}
 |then=: 15-31

}}{{qif

 |test={{{ID|}}}
 |then=. {{{ID}}}

}}. PMID 15195028Full text (PDF)

External links

• GPnotebook523567119
• DDB29255 (acute)
• DDB11052 (chronic)de:Pyelonephritis

fr:Pyélonéphrite pt:Pielonefrite ru:??????????? sv:Pyelonefrit

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Pyelonephritis Wikipedia article Pyelonephritis.