PYELONEPHRITIS Flashcards
Who is most at risk of developing a urinary tract infection?
Male children before puberty - congenital abnormalities
Female adults after puberty - short urethra
Male adults after the age of 40 - prostatic hyperplasia
What are the risk factors for developing a UTI?
Sex Long-term catheterization Diabetes Lower urinary tract obstruction - congenital abnormalities or calculi Pregnancy Tumours Immunosuppression Vesicoureteral reflux
What are the two routes of spread that cause acute pyelonephritis?
Ascending infection: bacteria (most often from gut) enter kidney via lower urinary tract if there is an incompetent vesicoureteric valve
Haematogenous spread: septicaemia or infective endocarditis
What are the three organisms most commonly responsible for community acquired urinary tract infections?
E. coli - 80-90%
Proteus mirabilis - 5-10%
Klebsiella - 1-2%
What are the five organisms most commonly responsible for hospital acquired urinary tract infections?
E. coli - 45-55% Klebsiella - 15-20% Proteus mirabilis - 10-15% Pseudomonas - 10-15% Enterococcus - 10-12%
How do patients with pyelonephritis present?
General malaise Fever Loin pain Tenderness Rigors Dysuria (pain passing urine) - not present in all patients unlike lower UTI
Is wedged-shaped suppuration (pus) of the kidney a feature more commonly associated with acute pyelonephritis by retrograde ureteric spread or haematogenous spread?
Retrograde ureteric spread
What are the important complications of acute pyelonephritis?
Renal papillary necrosis Perinephric abscesses Pyelonephrosis Chronic pyelonephritis Fibrosis and scarring
What is pyelonephrosis?
Obstruction of the pelvicalyceal system (pelvis of the kidney not the hip). It is a complication of pyelonephritis.
How would you treat suspected acute pyelonephritis?
Take urine sample for urine culture and antibiotic sensitivity test
Start on antibiotics:
Fluoroquinolones such as ciprofloxacilin
Cephalosporins
Gentamicin
Trimethoprim/sulfamethoxazole
What is chronic pyelonephritis?
A condition characterised by long standing scarring of the kidney parenchyma, which develops from tubulointerstitial inflammation.
What are the two causes/types of chronic pyelonephritis?
Obstructive
Reflux nephropathy
What is obstructive related chronic pyelonephritis?
Chronic obstruction prevents pelvicalyceal drainage and increases the risk of renal infection. Chronic pyelonephritis develops because of recurrent infection.
What is reflux nephropathy related chronic pyelonephritis?
Most common cause. Associated with congenital vesicoureterical reflux. Reflux results from the abnormal angle at which the ureter enters the bladder. Reflex occurs during micturition.
Are clubbed calyces seen in acute or chronic pyelonephritis?
Chronic
