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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute pyelonephritis is frequent. Its usual signs and symptoms comprise renal pain, fever, inflammation, and presence of germs and leukocytes in the urine. Primary acute E. coli pyelonephritis is frequent in the young female and in most cases is a benign condition. Atypical pyelonephritis may be painless, or without high fever, or lacking bacterial growth in the urine owing to previous inappropriate treatment. Severe pyelonephritis is mainly observed in diabetic, alcoholic or immunocompromised patients. In occasional cases, a common form of pyelonephritis may develop to formation of a renal abscess requiring drainage. When secondary to urinary tract abnormalities, pyelonephritis may be complicated with septicaemia and can induce early and severe renal tissue damage. This form warrants early urological treatment. The common pyelonephritis of the young female without previous history of febrile urinary tract infection requires little imaging. Conversely, extensive uroradiological workup is mandatory in the very young and the elderly, in the male, when treatment is not rapidly effective or in case or early relapse. In some cases, pyelonephritis leads to the development of cortical scars, the long-term prognosis of which remains to be determined.
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PMID:[Clinical description of acute pyelonephritis]. 837 14

Urinary tract infections rank first among the infections of patients with diabetes mellitus. They are encouraged by chronic hyperglycaemia and occur more frequently in diabetic women aged over 50 who suffer from disorders of the autonomic nervous system responsible for disturbances of bladder voiding. Another facilitating factor in younger women is pregnancy. Acute pyelonephritis is more dangerous than in non-diabetic populations, being often painless and therefore neglected. An unexplained blood glucose imbalance may be the only manifestation of acute pyelonephritis. In these patients, pyelonephritis is more frequently complicated by pyonephritis or papillary necrosis, both capable of threatening the patient's life or renal function. Moreover, since the diabetic kidney is exposed to a specific glomerulopathy with nephroangiosclerosis and interstitial lesions, all infections may aggravate these lesions, and they must be treated vigorously. Antibiotics may be less effective due to reduction of their tissue levels, and relapses, more frequent and resistant to treatment, may call for prophylactic treatment in certain patients. This is why urinary tract infections must be detected systematically and with a frequency which depends on the presence or absence of facilitating factors: female sex, age, neuropathy, mechanical causes and pregnancy. Using dipsticks that detect urinary leucocytes and nitrates makes detection easier and less costly.
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PMID:[Acute pyelonephritis in diabetic patients]. 837 19

Scintigraphic evaluation of urinary tract infection, pyelonephritis, and renal scarring represents a significant portion of a clinical pediatric nuclear medicine practice. Renal scarring from recurring infection remains an important cause of end-stage renal disease and hypertension in the pediatric population. However, the clinical presentation in infants and young children is often elusive, and clinical diagnosis of upper tract involvement is frequently unreliable. As a result, diagnostic imaging has a critical role to play in the localization of infection to the lower or upper urinary tract. Radionuclide cystography and renal cortical imaging have become mainstays of this evaluation. Direct radionuclide cystography is the preferred cystographic screening technique, because it has lower radiation exposure and greater sensitivity for the detection of vesicoureteral reflux than either indirect radionuclide cystography or fluoroscopic contrast cystography. Renal cortical scintigraphy has become the standard for the detection of pyelonephritis and renal scarring. Correlation with histopathology has demonstrated a high degree of diagnostic accuracy. Acute pyelonephritis has been shown to be the necessary etiologic factor for the development of subsequent renal scarring, and the mechanism of renal injury in pyelonephritis has been extensively studied in experimental models. The ability of prompt and appropriate antibiotic therapy to dramatically reduce the incidence of subsequent scarring also has been conclusively demonstrated both clinically and in the experimental model. Vesicoureteral reflux was once thought to be a necessary prerequisite for the development of renal scarring. Although it is clear that the intrarenal reflux of infected urine will create pyelonephritis in the experimental model, the high incidence of pyelonephritis and subsequent scarring in the absence of demonstrable vesicoureteral reflux leaves the role of reflux in question. Although the role of vesicoureteral reflux is incompletely understood, its detection nevertheless remains a standard part of the patient's evaluation.
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PMID:Scintigraphic evaluation of pediatric urinary tract infection. 837 94

The 99mTc-DMSA scan is accepted as the most sensitive imaging modality for detecting areas of renal parenchymal scarring. More recently the DMSA scan has also been shown to be of value in imaging areas of renal parenchymal involvement in both children and adults with acute pyelonephritis. We assessed the acute DMSA scan findings in a consecutive series of 81 patients hospitalized with acute pyelonephritis. Acute pyelonephritis was diagnosed if the patient had a fever of > 37.8 degrees C, loin pain or tenderness and infected urine (99% Escherichia coli). Patients had a blood culture taken (8 positive), as well as a hematological (leukocytosis 75%) and biochemical screen, C-reactive protein (CRP) (increased in 57 of 66 [86%]) and urinary tract ultrasonography. If the initial DMSA scan was abnormal it was repeated after three months and in some instances again at six months. If persisting defects were noted an intravenous urogram was then undertaken. Of the 81 patients, 37 (46%) had an abnormality on the DMSA scan. Nineteen had a single defect, 12 multifocal defects, five features suggestive of pre-existing renal parenchymal scarring (all later shown to have reflux nephropathy) and one a shrunken kidney. Those patients with an abnormal scan had a higher CRP concentration than those with a normal scan. Of the 31 patients who had either a focal or multifocal defect on their initial DMSA scan there was adequate follow-up on 24 patients. In 18 of these the defects had resolved by six months (usually within three months), while of the remainder, three were shown to have reflux nephropathy, one had a large single renal cyst and another an area of parenchymal calcification. Fifty-three of 76 patients (70%) had normal ultrasonography. In adults with acute pyelonephritis, the DMSA scan may prove to be the most useful renal imaging procedure.
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PMID:DMSA renal scans in adults with acute pyelonephritis. 886 86

Acute pyelonephritis is a clinical syndrome that can be confused with other conditions. To investigate this problem, a retrospective cohort study was conducted using two mutually exclusive sets of clinical criteria for acute pyelonephritis in women 15 years of age or older who presented to the emergency department of a university hospital. All patients had pyuria, and one group had documented fever (temperature of > or = 37.8 degrees C) while the other group had a temperature of < 37.8 degrees C but had other evidence of possible upper tract infection. The study cohort was comprised of 103 febrile and 201 afebrile patients. Afebrile hospitalized patients were ultimately found to have another diagnosis more often than were the febrile hospitalized patients (35% v 7%; P = .02), and the afebrile nonhospitalized patients were more likely to have another diagnosis than were the febrile nonhospitalized patients (13% v 0%; P = .004). Other diagnoses included cholecystitis, pelvic inflammatory disease, and diverticulitis. The positive predictive value of the definition of pyelonephritis in the febrile group was 0.98, and it was 0.84 for the afebrile group. Physicians examining patients with clinical evidence of acute pyelonephritis but without objective fever should be alert for alternative diagnoses.
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PMID:Fever in the clinical diagnosis of acute pyelonephritis. 911 15

Acute uncomplicated urinary tract infection is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract. Most of these infections are caused by E. coli, which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents. Review of the published data suggests that a 3-day regimen is more effective than a single-dose regimen for all antimicrobials tested. Regimens with trimethoprim-sulfamethoxazole seem to be more effective than those with beta lactams, regardless of the duration. Because of increasing resistance to trimethoprim-sulfamethoxazole, an alternative regimen such as nitrofurantoin (in a 7-day regimen), a fluoroquinolone, or an oral third-generation cephalosporin may be a better empiric choice in some areas. Acute pyelonephritis caused by highly virulent uropathogens in an otherwise healthy woman may be considered an uncomplicated infection. The optimal treatment duration for acute uncomplicated pyelonephritis has not been established, but 10- to 14-day regimens are recommended. We prefer to use antimicrobials that attain high renal tissue levels, such as a fluoroquinolone, trimethoprim-sulfamethoxazole, or an aminoglycoside, for pyelonephritis. Acute uncomplicated cystitis or pyelonephritis in healthy adult men is uncommon but is generally caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women.
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PMID:Diagnosis and treatment of uncomplicated urinary tract infection. 937 23

Simple acute cystitis is cured by single-dose or 3-day treatment. Complicated acute cystitis requires clinical, bacteriological and imaging examinations. Treatment must be continued for 10 days and controlled. Acute pyelonephritis in women requires bacteriology, ultrasonography and plain x-rays and must be rapidly treated by fluoroquinolone or cephalosporin. High-risk acute pyelonephritis justifies admission to hospital, more elaborate examinations and active treatment.
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PMID:[Therapeutic strategies in urinary tract infections in women]. 992 41

Acute pyelonephritis should be classified clinically at the time of presentation into either uncomplicated or complicated categories. The diagnostic workup includes history, physical examination, urinalysis (including a Gram stain), and urine culture. Patients with suspected complicated pyelonephritis require the standard assessment plus blood cultures and urinary tract imaging, preferably a computed tomography (CT) scan. Patients with moderate, uncomplicated pyelonephritis can be managed as outpatients with either a fluoroquinolone (7-14 days) or trimethoprim/sulfamethoxazole (at least 14 days). Patients with severe, uncomplicated pyelonephritis can be considered for short-term hospitalization and initial administration of intravenous antibiotics. Therapy for patients with complicated pyelonephritis should include initial hospitalization, supportive therapies, administration of wide spectrum intravenous antibiotic therapy, and relief of aggravating conditions. Such maneuvers could consist of simple bladder catheterization, percutaneous nephrostomy drainage, or definitive surgery. Patients with complicated pyelonephritis require longer duration of culture-specific antibiotic dosing, careful monitoring, long-term follow-up, and possible definitive management of their underlying condition.
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PMID:The management of acute pyelonephritis in adults. 1144 95

Acute pyelonephritis is one of the most common indications for antepartum hospitalisation. When acute pyelonephritis is diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration. There are limited data by which to assess the superiority of one antibacterial regimen over the other in terms of efficacy, patient acceptance and safety for the developing fetus. There is a small body of evidence to support the ambulatory treatment of pregnant women with pyelonephritis in the first and early second trimesters.
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PMID:Pyelonephritis in pregnancy: treatment options for optimal outcomes. 1173 35

Acute uncomplicated UTI is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract. Most of these infections are caused by E. coli, which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents, especially TMP-SMX. In women with risk factors for infection with resistant bacteria, or in the setting of a high prevalence of TMP-SMX-resistant uropathogens, a case can be made for using a fluoroquinolone or nitrofurantoin. Use of nitrofurantoin for the empiric treatment of mild cystitis is supportable from a public health perspective in an attempt to decrease uropathogen resistance because it does not share cross-resistance with more commonly prescribed antimicrobials. Beta-lactams and fosfomycin should be considered second-line agents for empiric treatment of cystitis. Acute pyelonephritis in an otherwise healthy woman may be considered an uncomplicated infection. Fluoroquinolone regimens are superior to TMP-SMX for empiric therapy because of the relatively high prevalence of TMP-SMX resistance among uropathogens causing pyelonephritis. TMP-SMX, effective for patients with mild to moderate disease, is an appropriate drug if the uropathogen is known to be susceptible. It is reasonable to use a 7- to 10-day oral fluoroquinolone regimen for outpatient management of mild to moderate pyelonephritis in the setting of a susceptible causative pathogen and rapid clinical response to therapy. Most women with acute uncomplicated pyelonephritis are now managed safely and effectively as outpatients. Acute uncomplicated cystitis or pyelonephritis in healthy adult men is very uncommon but is generally caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women. The choice of antimicrobials is similar to that recommended for cystitis in women except that nitrofurantoin is not considered a good choice. Treatment duration should generally be longer than that recommended for women.
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PMID:The current management strategies for community-acquired urinary tract infection. 1284 72


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