| Pyelonephritis Classification and external resources |
|
| ICD-10 | N10.-N12., N20.9 |
|---|---|
| ICD-9 | 590, 592.9 |
| DiseasesDB | 29255 11052 |
| MedlinePlus | 000522 |
| eMedicine | ped/1959 |
| MeSH | D011704 |
Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A urinary tract infection ( UTI) is a bacterial Infection that affects any part of the Urinary tract. The renal pelvis is the funnel-like dilated proximal part of the Ureter in the Kidney. The kidneys are complicated organs that have numerous biological roles Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused In Medicine, systemic inflammatory response syndrome ( SIRS) is an inflammatory state of the whole body (the "system" without a proven source It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa It is a form of nephritis. Nephritis is Inflammation of the Kidney. The word comes from the Greek nephro- meaning "of the kidney" and -itis meaning "inflammation" It can also be called pyelitis. [1]
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Signs and symptoms
It presents with dysuria (painful voiding of urine), abdominal pain (radiating to the back on the affected side) and tenderness of the bladder area and the side of the involved kidney ("renal angle tenderness"). In Medicine, specifically Urology, dysuria refers to painful Urination. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease In many cases there are systemic symptoms in the form of fever, rigors (violent shivering while the temperature rises), headache and vomiting. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Rigor is a shaking occurring during a high Fever. It occurs because cytokines and Prostaglandins are released as part of an Immune A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In severe cases, delirium may be present. Delirium is an acute and relatively sudden (developing over hours to days decline in attention-focus perception and Cognition. [1]
Diagnosis
The presence of nitrite and leukocytes (white blood cells) on a urine dipstick test in patients with typical symptoms are sufficient for the diagnosis of pyelonephritis, and are an indication for empirical treatment. The nitrite Ion is NO2− The anion is bent being Isoelectronic with O3. A dipstick is one of several devices dipped into a liquid to perform a chemical test or to provide a measure of quantity of the liquid Formal diagnosis is with culture of the urine; blood cultures may be needed if the source of the infection is initially doubtful. A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory Blood culture is Microbiological culture of Blood. It is employed to detect Infections that are spreading through the bloodstream ( Bacteremia, [1]
If a kidney stone is suspected (e. Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form g. on the basis of characteristic colicky pain, disproportionate amount of blood in the urine), X-rays of the kidneys, ureters and bladder (KUB) may assist in identifying radioopaque stones. Renal colic is a type of Pain commonly caused by Kidney stones. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. In human Anatomy, the ureters are muscular ducts that propel Urine from the Kidneys to the Urinary bladder. In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the [1]
In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux (urine from the bladder flowing back into the ureter) or polycystic kidney disease. Vesicoureteral reflux (VUR is an abnormal movement of Urine from the bladder into Ureters or Kidneys Urine normally travels from the kidneys In human Anatomy, the ureters are muscular ducts that propel Urine from the Kidneys to the Urinary bladder. Polycystic kidney disease ( PKD, also known as polycystic kidney syndrome is a progressive ciliopathic, Genetic disorder of the Kidneys Investigations that are commonly used in this setting are ultrasound of the kidneys or voiding cystourethrography. In Urology, a voiding cystourethrogram ( VCUG) also micturating cystourethrogram ( MCUG) is a technique for watching a person's Urethra [1]
Causes
Most cases of "community-acquired" pyelonephritis are due to bowel organisms that enter the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. Enterococcus faecalis – formerly classified as part of the Group D Streptococcus system – is a Gram-positive Commensal Bacterium Hospital-acquired infections may be due to coliforms and enterococci, as well as other organisms uncommon in the community (e. g. Klebsiella spp. Klebsiella is a Genus of non-motile, Gram-negative, Oxidase-negative Bacteria with a prominent Polysaccharide , Pseudomonas aeruginosa). Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped Bacterium with unipolar motility. Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis. Cystitis is Inflammation of the Urinary bladder. The condition more often affects women but can affect either sex and all age groups Prostatitis is an Inflammation of the Prostate gland in men A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits [1]
Risk is increased in the following situations:[1][2]
- Mechanical: any structural abnormalities to the kidneys and the urinary tract, vesicoureteral reflux (VUR) especially in young children, calculi (kidney stones), urinary tract catheterisation, urinary tract stents or drainage procedures (e. Vesicoureteral reflux (VUR is an abnormal movement of Urine from the bladder into Ureters or Kidneys Urine normally travels from the kidneys Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form In urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their g. nephrostomy), pregnancy, neuropathic bladder (e. A nephrostomy is an artificial opening created between the Kidney and the Skin which allows for the drainage of Urine directly from the upper part of the Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female g. due to spinal cord damage, spina bifida or multiple sclerosis) and prostate disease (e. Spina bifida ( Latin: "split spine" is a developmental Birth defect involving the Neural tube: incomplete closure of the Embryonic neural Multiple sclerosis (abbreviated MS also known as disseminated sclerosis or encephalomyelitis disseminata) is an autoimmune condition in which the The prostate (from Greek προστάτης - prostates, literally "one who stands before" "protector" "guardian" is a g. benign prostatic hyperplasia) in men
- Constitutional: diabetes mellitus, immunocompromised states
- Behavioural: change in sexual partner within the last year, spermicide use
- Positive family history (close family members with frequent urinary tract infections)
Pathology
Acute pyelonephritis is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney. Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Spermicide is a substance that kills sperm, inserted vaginally prior to intercourse to prevent pregnancy Family history is the systematic narrative and research of past events relating to a specific Family, or specific families Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Parenchyma is a term used to describe a bulk of a substance It is used in different ways in Animals and in Plants. Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. A glomerulus is a Capillary tuft surrounded by Bowman's capsule in Nephrons of the vertebrate Kidney. [1] Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial The renal pelvis is the funnel-like dilated proximal part of the Ureter in the Kidney. The renal cortex is the outer portion of the Kidney between the Renal capsule and the Renal medulla. Chronic infections can result in fibrosis and scarring. Fibrosis is the formation or development of excess fibrous Connective tissue in an organ or tissue as a reparative or reactive process as opposed to a formation of Fibrous
Treatment
As practically all cases of pyelonephritis are due to bacterial infections, antibiotics are the mainstay of treatment. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Mild cases may be treated with oral therapy, but generally intravenous antibiotics are required for the initial stages of treatment. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. The type of antibiotic depends on local practice, and may include fluoroquinolones (e. The quinolones are a family of synthetic Broad-spectrum antibiotics. g. ciprofloxacin), beta-lactam antibiotics (e. β-lactam antibiotics are a broad class of Antibiotics that include Penicillin derivatives Cephalosporins Monobactams Carbapenems g. amoxicillin or a cephalosporin), trimethoprim (or co-trimoxazole) or nitrofurantoin. Amoxicillin ( INN) or amoxycillin ( BAN) is a moderate-spectrum bacteriolytic β-lactam antibiotic used to treat Bacterial Infections The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Trimethoprim ( INN) (traɪˈmɛθəprɪm is a bacteriostatic Antibiotic mainly used in the Prophylaxis and treatment of Urinary tract infections Co-trimoxazole (abbreviated SXT TMP-SMX TMP-SMZ or TMP-sulfa is an Sulphonamide, Antibacterial combination of Trimethoprim and Sulfamethoxazole Nitrofurantoin is an Antibiotic. It is usually used in treating Urinary tract infection. Aminoglycosides are avoided due to their toxicity, but may be added for a short duration. An aminoglycoside is a molecule composed of a sugar group and an Amino group [1]
If the patient is unwell and septic, intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and vasodilation and to maximise urine output. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein.
In recurrent infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to improve chances of recurrence. If no abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose Sexual intercourse, in its biological sense is the act in which the male reproductive organ (in humans and other higher animals enters the female reproductive tract [3] In children at risk of recurrent UTIs, meta-analysis of the present literature indicates that not enough studies have been performed to conclude prescription of long-term antibiotics have a net positive benefit. [4] Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit. Cranberries are a group of Evergreen dwarf Shrubs or trailing vines in the genus Vaccinium subgenus Oxycoccos [5]
Some recommend other nutritional approaches to prevent recurrence of UTIs. Increasing fluid intake, consuming cranberry juice, blueberry juice, and fermented milk products containing probiotic bacteria, have been shown to inhibit adherence of bacteria to the epithelial cells of the urinary tract. Cranberries are a group of Evergreen dwarf Shrubs or trailing vines in the genus Vaccinium subgenus Oxycoccos Blueberries are Flowering plants in the genus Vaccinium, sect Probiotics are Dietary supplements containing potentially beneficial Bacteria or Yeasts According to the currently adopted definition by FAO / [6]
Epidemiology
Pyelonephritis is very common, with 12-13 cases annually per 10,000 population in women and 3-4 cases per 10,000 in men. Incidence is a measure of the risk of developing some new condition within a specified period of time Young women are most likely to be affected, traditionally reflecting sexual activity in that age group. Human sexual behavior or different human sexual practices encompass a wide range of activities such as strategies to find or attract partners ( Mating and display Infants and the elderly are also at increased risk, reflecting anatomical abnormalities and hormonal status. [7]
See also
References
- ^ a b c d e f g h Ramakrishnan K, Scheid DC (2005). Pyonephrosis ( Greek pyon "pus" + nephros "kidney" is an infection of the renal collecting system "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician 71 (5): 933-42. PMID 15768623.
- ^ Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE (2005). "Risk factors associated with acute pyelonephritis in healthy women". Ann. Intern. Med. 142 (1): 20-7. PMID 15630106.
- ^ Schooff M, Hill K (2005). "Antibiotics for recurrent urinary tract infections". American family physician 71 (7): 1301-2. PMID 15832532.
- ^ Williams GJ, Wei L, Lee A, Craig JC (2006). "Long-term antibiotics for preventing recurrent urinary tract infection in children". Cochrane database of systematic reviews (Online) 3: CD001534. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16855971.
- ^ Raz R, Chazan B, Dan M (2004). "Cranberry juice and urinary tract infection". Clin. Infect. Dis. 38 (10): 1413-9. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15156480.
- ^ Krause, Marie V. ; Mahan, L. Kathleen; Escott-Stump, Sylvia (2004). Krause's food, nutrition, and diet therapy. Philadelphia: W. B. Saunders, 969. ISBN 0-7216-9784-4.
- ^ Czaja CA, Scholes D, Hooton TM, Stamm WE (2007). "Population-based epidemiologic analysis of acute pyelonephritis". Clin. Infect. Dis. 45 (3): 273-80. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17599303.
External links
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