Урология - Pyelonephritis

Special investigation

1.BLOOD EXAMINATION – reveals high neutrophil count. The ERS is increased.

2.URINE is usually scanty and highly concentrated. It is usually cloudy. Urine contains large amounts of pus and bacteria.

3. X-RAY

Straight X-ray of the abdomen may not be decisive except some obliteration of the renal shadow due to oedema of the kidney.

Excretory urography shows slight diminution of function in acute stage.

Non dilated renal pelvis is observed at 10 minutes film

IVU Acute secondary pyelonephritis

•First roengenogram: contract fluid is visualised in the left renal pelvis and vesical bladder, right kidney does not excrete contrast fluid

•Secobnd roentgenogram: dilation of right renal pelvis and upper part of the right ureter due to the roentgennegative calculus of the upper part of the ureter.

Arteriography

Chronic pyelonephritis.

A symptom of a burnt tree.

Renal carbuncle

Grey scale regimen. A round shaped zone of slightly elevated echogenity at the lover pole of kidney

Renal carbuncle

Doppler regimen: almost total absence of blood vessels at the area of carbuncle. At other parts of renal parenchyma vascularisation is normal.

Chronic pyelonephritis

Uneven kidney contour is observed slight dilatation of renal pelvis

Complications

Perinephric absess

Sepsis

Acute renal failure

Pyonephrosis

Nephrosclerosis

Differential diagnosis

1.Acute appendicitis

2.Acute cholecystitis

3.Acute diverticulitis mimicking left sided acute pyelonephritis.

4. Pancreatitis

5.Basal pneumonia

6.Herpes Zoster