Chronic Pyelonephritis

(Chronic infectious tubulointerstitial nephritis)

The chronic pyelonephritis (PN) is an ongoing pyogenic infection of the kidney, which occurs almost exclusively in patients with essential anatomical abnormalities. Symptoms may be absent or occur as fever, malaise and flank pain. The diagnosis is made by urinalysis, culture and imaging procedures. Treatment involves administration of antibiotics and correction of the structural perturbations.

The chronic pyelonephritis (PN) is an ongoing pyogenic infection of the kidney, which occurs almost exclusively in patients with essential anatomical abnormalities. Symptoms may be absent or occur as fever, malaise and flank pain. The diagnosis is made by urinalysis, culture and imaging procedures. Treatment involves administration of antibiotics and correction of the structural perturbations.

(See Introduction to urinary tract infections.) The chronic pyelonephritis (PN) is an ongoing pyogenic infection of the kidney that occurs almost exclusively in patients with essential anatomical abnormalities. Symptoms may be absent or occur as fever, malaise and flank pain. The diagnosis is made by urinalysis, culture and imaging procedures. Treatment involves administration of antibiotics and correction of the structural perturbations. In most cases there is a reflux of infected urine into the renal pelvis. Causes include obstructive uropathy, struvite stones and – most frequently – vesicoureteral reflux (VUR). Pathologically atrophy and Kelchdeformierung with additional Parenchymvernarbung are observed. Chronic pyelonephritis may develop into chronic kidney disease. Patients with chronic pyelonephritis may have residual foci of infection, predisposing to bacteremia or – in kidney transplant patients who are transferred to the urinary tract and kidney transplant. Xanthogranulomatous pyelonephritis (XPN) almost always occurs on one side and provides an abnormal inflammatory response to the infection is. Giant cells, fatty macrophages and cholesterol-containing folds causing the yellow color of the infected tissue. The kidneys are enlarged, and perirenal fibrosis and adhesions with the surrounding retroperitoneal structures are common. The disorder is almost always unilateral and very often occurs typically in middle-aged women with a history of recurrent UTI on. Long-term urinary tract infections and increase (by a stone as a rule) the risk. The most common pathogens are Proteus mirabilis and Escherichia coli. Symptoms and discomfort symptoms and complaints are often vague and contradictory. Some patients may have fever, flank or abdominal pain, discomfort, or anorexia. Usually, in XPN a unilateral mass can be palpated. Diagnostic urinalysis and urine culture Imaging Techniques Chronic pyelonephritis is suspected in patients with a history of recurrent urinary tract infections and acute pyelonephritis. However, most patients with the exception of children with VUR have no such history. Sometimes the diagnosis is suspected because typical findings are randomly found during an imaging examination. Because the symptoms are vague and non-specific, can be derived no diagnosis through it. Typically urine and culture findings and imaging methods are used. The urine sediment is usually poor in cells, but kidney epithelial cells, granular cylinders and occasionally Leukozytenzylinder may be present. Proteinuria is almost always available and can be in the nephrotic range when VUR caused extensive kidney damage. If both kidneys affected, a lack of concentration and a hyperchloraemic acidosis may occur prior to significant azotemia. The urine culture can be both sterile and positive with Gram-negative organisms in general. The initial imaging is usually done with ultrasound, spiral CT or IVU a characteristic feature of chronic pyelonephritis (usually with reflux or obstruction) is traditionally when imaging a large, deep, segmental, coarse, cortical scar that usually spreads to one or more of the calyces. The upper pole is the most common site. The adrenal cortex is lost and the renal parenchyma becomes thinner. The uninvolved kidney tissue may increase locally with segmental extension. As an expression of severe chronic reflux may be a ureteral. Similar results are found in a urinary tract tuberculosis. In XPN, urine cultures almost always P. mirabilis, or E. coli grow. CT imaging is performed to detect stones or other obstacles. The imaging shows an avascular mass with a variable degree of enlargement to the kidney. Sometimes, in order to distinguish cancer (z. B. renal cell carcinoma), a biopsy may be needed or the remote during nephrectomy tissue can be examined. Prognosis The course of a chronic pyelonephritis is extremely variable, but the disease is typically very slowly progressive. In most patients an adequate renal function is maintained ? 20 years after onset. By frequent episodes of acute pyelonephritis occur even with treatment to further destruction of renal structures and functions. predisposes a permanent obstruction or maintains the pyelonephritis and increases the intrapelvic pressure that damages the kidney directly. Therapy if an obstruction can not be eliminated, and recurrent Harninfekte are common, long-term therapy with antibiotics (eg. B. trimethoprim / sulfamethoxazole, trimethoprim, a fluoroquinolone, nitrofurantoin) can be displayed and be needed over time. Complications of uremia or high pressure must be treated specifically. When XPN initial treatment should be given with antibiotics to bring the local infection control, followed by en bloc nephrectomy and removal of the affected tissue. Patients who unterziehne is a kidney transplant and have a chronic pyelonephritis, may need a nephrectomy before transplantation. Key Points Chronic pyelonephritis usually affects patients who are predisposed to urinary reflux into the renal pelvis (eg., By VUR, obstructive uropathy or struvite stones). Walk out of chronic pyelonephritis, if patients have recurrent acute pyelonephritis, but the diagnosis is often first suspected based on incidental findings in imaging. Gain an imaging technique (ultrasound, spiral CT or IVU). If the obstruction can not be resolved, a long-term antibiotic prophylaxis should be considered.

Health Life Media Team

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