In: Categories » Health » Medicine and alternative » ACUTE PYELONEPHRITIS
| Clinical Definition This is a clinical diagnosis, made on the basis of fever, flank pain, and tenderness, often with an elevated white count. It may affect one or both kidneys. There are usually accompanying symptoms suggestive of a lower urinary tract infection (frequency, urgency, suprapubic pain, urethral burning or pain on voiding) that led to the ascending infection, which resulted in the subsequent acute pyelonephritis. The infecting organisms are commonly -Escherichia coli, enterococci (Streptococcus faecalis), Klebsiella, -Proteus, and Pseudomonas. Urine culture is positive for bacterial growth, but the bacterial count may not always be above the 100,000 colony-forming units (cfu)/mL of urine, which is the strict de.nition for urinary infection. Thus, if you suspect a diagnosis of acute pyelonephritis from the symptoms of fever and flank pain, but there are only 1000cfu/mL, manage the case as acute pyelonephritis. Investigation and Treatment For those patients who have a fever but are not systemically unwell, outpatient management is reasonable. Culture the urine and start oral antibiotics according to your local antibiotic policy (which will be based on the likely infecting organisms and their likely antibiotic sensitivity). We use oral ciprofloxacin, 500mg b.i.d. for 10 days. If the patient is systemically unwell, admit them to hospital culture urine and blood, and start intravenous fluids and intravenous antibiotics, again selecting the antibiotic according to your local antibiotic policy. We use i.v. ampicillin 1 g t.i.d. and gentamicin, 3 mg/kg as a once daily dose. Arrange for a kidney and urinary bladder (KUB) x-ray and renal ultrasound, to see if there is an underlying upper tract abnormality (such a ureteric stone), unexplained hydronephrosis, or (rarely) gas surrounding the kidney (suggesting emphysematous pyelonephritis). If the patient does not respond within 3 days to this regimen of appropriate intravenous antibiotics (confirmed on sensitivities), arrange for a CTU. The lack of response to treatment indicates that you are dealing with a pyonephrosis (i.e., pus in the kidney, which like any abscess will respond only to drainage), a perinephric abscess (which again will respond only to drainage), or emphysematous pyelonephritis. The CTU may demonstrate an obstructing ureteric calculus that may have been missed on the KUB x-ray, and ultrasound and will show a perinephric abscess if present. A pyonephrosis should be drained by insertion of a percutaneous nephrostomy tube. A perinephric abscess should also be drained by insertion of a drain percutaneously. If the patient responds to i.v. antibiotics, change to an oral antibiotic of appropriate sensitivity when they become apyrexial, and continue this for approximately 10 to 14 days.
|
legal disclaimer
1) Our website is not responsible for the information contained by this article as well for any and all copyright infringements by authors and writers. E-articles is a free information resource. If you suspect this article for any copyright infringements, please read the Terms of service and contact us to investigate the problem.
2) The E-articles directory team is not responsible for inaccuracies, falsehoods, or any other types of misinformation this tutorial may contain and will not be liable for any loss or damage suffered by a user through the user's reliance on the information gained here. Please read the Terms of service
Useful tools and features
If you like this article (tutorial), please link to it from your web page using the information above. Linking to this page, this is the only way to help us improve our service, the same time providing your visitors with a way to improve their online experience.
related articles
Naturopathy is a broad system of medicine built upon simple and reliable principles. One of these principles is that proper circulation to internal organs and tissues is a necessity for pain relief, optimal metabolic function, and repair of damaged or infected tissue and for general well being. There are many ways to improve circulation and hydrotherapy, the use of alternating hot and cold water, is one of the oldest. Constitutional hydrotherapy is a special technique that greatly improves recovery...
2. Breakthrough research into the causes of eczema and its treatment
Eczema known in medical terms as Dermatitis is an inflammation of the skin. Generally, eczema denotes swollen, reddened and itchy skin. Eczema is a common condition. Though not life threatening or contagious it can make one feel uncomfortable and self-conscious. Eczema affects one in every five people at some point in their lives. This article uncovers new breakthrough research into the causes of eczema. Causes of Eczema as per the modern science A number of health conditions, allergies, genetic factors, ph...
3. Sleepatil is the best way to make stress go away
Feeling too many pressures on you? Do you suffer from sleep deprivation because you are constantly thinking about tests or pending reports? If so, it means you are stressed. There are sometimes when stress can be of some help, from a certain point of view, because it can encourage you to meet a deadline or get things done. But, if you are stressed too often or for a long period of time there is a higher risk of suffering from diseases like depression, heart disease and problems like that. Stress is a feeling that manifests whe...
4. Chiropractic Helps Migraines; Clinical Trial Says
New studies show that chiropractic treatment is effective for migraine sufferers. 72% of migraine sufferers experienced either 'substantial' or 'noticeable' improvement after chiropractic treatment, according to clinical trials performed at a university in Australia. This study defies the historical bias against chiropractic that some medical practitioners have maintained. The 123 participants in the study had suffered migraines for an average of 18 years. Approximately 22 per cent of patients had a 60% reduction or be...
5. Accutane Drug and Its Generic Substitutions
Accutane is used to treat skin alternations such as acne pimples and to avoid spots on the face; it also provides a glowing skin. It is a normal desire of every teenager to have a glowing skin without any spots. But a lot of some factors spoil the skin: wrong nutrition, bad environment and oily skin; they cause acne, pimples, and spots on the face, until treated in time. All these facts spoil not only the appearance of the young people but also their self-confidence. Accutane drug is used to minimize the acne on the face....
6. A Worldful of Germs
There are many microscopic organisms and particles around us that can cause serious illness. But some of these organisms can also be beneficial to the human body. Germs are everywhere. You practically live in a world full of germs. No matter how often you wash your hands and how many times you take a bath, you cannot totally get rid of them. But not all germs are harmful. In fact, some germs can keep you healthy. That is why it is very important that you should know which ones are beneficial and which ones can pose danger t...
7. Preventing West Nile Virus
The past few summers, strains of the West Nile Virus have been found in mosquitoes throughout the country. Known to effect humans through infected mosquitoes, the virus can cause severe symptoms including diarrhea, fever, chills, vomiting, and fatigue which can last more than 10 days. Recovery usually consists of a long recuperation marked with fatigue. Prevention is key when it comes to protecting yourself from West Nile virus. Heed the following tips to keep you and your family protected. Insect Repellent...
8. Arthritis : When Things Are Swell
About arthritis, its types, symptoms, how debilitating it can get, and how to relieve simple arthritic pain. Arthritis is one of the most debilitating conditions affecting mostly people over the age of 55. It doesn't only affect that specific age group, but also a percentage of young adults. It's not just a simple disease but a group of conditions that may cause damage not only to your bones but also to other organs in the body. Different forms of arthritis manifest different symptoms. Common symptoms of arthritis in...