Урология - Pyelonephritis

Primary acute pyelonephritis

No diseases of upper urinary tract in anamnesis

General symptoms: fever more than 38 C, chillswith shaking, reddened skin, moist skin, vomiting,nausea, general ill feeling, rapid pulsus

Local symptoms: pain at lumbal area, pain on shaking the lumbal area (be careful), frequent painful urination (if cystitis is also present)

Secondary acute pyelonephritis

Appears on the basis of another urological disease which leads to the impaired urine outflow or bloodflow impairments (stones of urinary tract, urinary tract abnormalities, pregnancy, constrictions of uretra and ureter, benigh prostatic hyperplasia).

General and local symptoms are the same as in acute pyelonephritis

Chronic pyelonefhritis

Can be an outcome of acute pyelonephritis

Causes:

Non diagnosed and non removed inpairments of urine outflow

Incorrect treatment of acute pyelonephritis

Formation of L-forms of bacteria

Concomittant diseases (diabetes mellitus, obesity, tonsilltis etc)

Immunodeficient conditions

Active inflammation

Leucocytes 25000 and more in 1 ml of urine

Bacteriuria 100000 and more in 1 ml of urine

Active leucocytes 30 % and more at all patients

Steihaimer-Malbine cells 25-50% of patients

Erytocyte sedimentation rate 12 mm/hour and more at 50-70 % of patients.

Active leucocytes

Large, light-blue leucocytes with big nucleus, poor coloured protoplasm and active grains with brownian mowement. They have high ingestion activity regarding bacteria

Latent inflammation

Leucocytes up to 2500 in 1 ml of urine

Up to 10000 in 1 ml of urine

Active leucocytes – 15-30% at 50-70% of patients

 Stenhaimer-Malbine cells are absent

 ESR not more than 12 mm/hour

Remission

Leucocytes are absent

Bacteria are absent

Active leucocytes are absent

Stenhaimer-Malbine cells are absent

ESR less than 12 mm/hour

Diagnostics

Anamnesis

Blood test ( leucocytosis with left shift)

Urinalysis ( leucocytes, bacteriuria, false proteinuria, active leucocytes)

Positive shaking symptom

Ultrasound

Plain X-Ray

IVU

CT

Chromocystoscopy

Arteriography

 PHSYCAL SIGNS

1.Among general signs increased temperature, pulse rate.

2.In local examination, tenderness at the renal angle in the back and over the affected kidney.

3.Percussion over the renal angle may be painful.