Урология - Pyelonephritis

Lesson 2

Pyelonephritis

Pyelonephritis

A non-specific inflammation of kidney interstitial tissue and renal tubules affecting both renal parenchyma and renal pelvis.

Epidemiology

Most common kidney disease in all age groups

3-5% of pregnant women suffer from acute pyelonephritis

Those children whose mothers suffered from pyelonephritis during pregnancy are more prone to suffer from this disease.

Acute pyelonephritis in children takes second place after infections of respiratory tract

Among adults it can be observed at 100 persons from 100000

60-75% of patients are 30-40 years old

Pathogenesis

Most cases are due to ascending infections from urine flow abnormalities

Urinary outflow obstruction results in urine stasis providing an environment for bacterial proliferation ( in secondary pyelonephrtis)

Seeding of the kidney by circulating bacteria or septic emboli from valvular vegetations in edocarditis (hematogenous).

ASCENDING INFECTION -In majority of cases acute pyelonephritis develops from infection in the bladder through mechanism of vesicoureteral reflux.

HAEMATOGENOUS INFECTION –

Pyogenic cocci are more often seen in haematogenous infection, though E coli. Is the commonest infecting organism in all cases of pyelonephritis.

Aetiology

Escherichia coli 75%

Proteus mirabilis 10%

Staphylococcus saprophiticus 10%

Enterococcus, Enterobacter

Klebsiella

Candida albicans

Predisposing factors

General: low immunological reactivity, diabetes mellitus, complocated pre-natal period in children

Local factors: outflow abnormalities (BPH, pregnancy, calculi, vesicouretral reflux, vesicouretral reflux, neurogenic bladder etc); invasieve diagnostical methods (cystoscopy, uretrography, retrograde ureteropyelography)

Clinical features

 SYMOTOMS

1.Constant ache over one o both kidneys is the most frequent complain (this is mainly caused by distention of the renal capsule due to oedema). The pain may radiate to the lower abdomen or to the groin mimicking ureteric colic.

2.Increased frequency of micturition, urgency, nocturia and burning sensation of urination are the complaints due to cystitis which is often accompanied with.

3.Prodromal symptoms – headache, lassitude, nausea, vomiting and prostraition.

4.Rigor alongwith high temperature is quite common.