Pyelonephritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Pyelonephritis is distressful condition requiring emergent medical management. Most individuals who are treated adequately with antibiotics do not have complications. A surgical management with removal of stone or obstructing tumor may sometimes be required to prevent complications and prevent obstructive pyelonephritis and stop the course of chronic pyelonephritis. The most common complication of pyelonephritis is recurrent infections. Most episodes of pyelonephritis are uncomplicated and are easily treatable. The prognosis of pyelonephritis varies depending on the type of pyelonephritis and on the timing and duration of treatment. The mortality in case of UTI is between 5% to 33%.
Natural History
If left untreated, Pyelonephritis can lead to papillary necrosis and ultimately leading to scarring of the kidneys. This scarring can cause renal failure in some cases. Abscess formation in or around the renal tissue is also possible. Pyelonephritis can prove fatal in some cases without treatment. The following factors influence the prevalence of pathogens in the kidneys:[1][2][3][4]
- History of pyelonephritis
- Recent history of hospitalization
- Nephrolithiasis
- Immunosuppression
Complications
Pyelonephritis can lead to the following complications:[1][5][6]
Life threatening complications
- Kidney failure
- Sepsis and septic metastasis to bones and endocardium[7]
- Peritonitis[8]
Other complications
- Renal scarring[9]
- Dilation of renal pelvis
- Renal atrophy[9]
- Sub actute-chronic interstitial nephritis[9]
- Chronic kidney disease
- High blood pressure (results from a structural problem in the urinary tract or repeated episodes of pyelonephritis)
- Perinephric abscess made by cortical staphylococcal renal abscess or by rupture of a renal abscess[3][11][14]
Prognosis
- Most episodes of pyelonephritis are uncomplicated and are easily treatable. The prognosis of pyelonephritis varies depending on the type of pyelonephritis and on the timing and duration of treatment.[4]
- The mortality in case of UTI is between 5% to 33%.[4]
- Acute pyelonephritis has a mortality of 10-20%.[16][17]
- Type 1 emphysematous pyelonephritis has a mortality of 69% while type 2 emphysematous pyelonephritis has a mortality of 18%.[18]
References
- ↑ 1.0 1.1 Efstathiou SP, Pefanis AV, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG; et al. (2003). "Acute pyelonephritis in adults: prediction of mortality and failure of treatment". Arch Intern Med. 163 (10): 1206–12. doi:10.1001/archinte.163.10.1206. PMID 12767958.
- ↑ HUTCH JA (1962). "The role of the ureterovesical junction in the natural history of pyelonephritis". J Urol. 88: 354–62. PMID 14450231.
- ↑ 3.0 3.1 Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
- ↑ 4.0 4.1 4.2 4.3 4.4 Kofteridis DP, Papadimitraki E, Mantadakis E, Maraki S, Papadakis JA, Tzifa G; et al. (2009). "Effect of diabetes mellitus on the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis". J Am Geriatr Soc. 57 (11): 2125–8. doi:10.1111/j.1532-5415.2009.02550.x. PMID 20121956.
- ↑ Anderson KA, McAninch JW (1980). "Renal abscesses: classification and review of 40 cases". Urology. 16 (4): 333–8. PMID 7414775.
- ↑ Fowler JE, Perkins T (1994). "Presentation, diagnosis and treatment of renal abscesses: 1972-1988". J Urol. 151 (4): 847–51. PMID 8126807.
- ↑ Siroky MB, Moylan R, Austen G, Olsson CA (1976). "Metastatic infection secondary to genitourinary tract sepsis". Am J Med. 61 (3): 351–60. PMID 986763.
- ↑ 8.0 8.1 Yeow Y, Chong YL (2016). "Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess". J Surg Case Rep. 2016 (12). doi:10.1093/jscr/rjw211. PMC 5159021. PMID 27915241.
- ↑ 9.0 9.1 9.2 Meyrier A, Condamin MC, Fernet M, Labigne-Roussel A, Simon P, Callard P; et al. (1989). "Frequency of development of early cortical scarring in acute primary pyelonephritis". Kidney Int. 35 (2): 696–703. PMID 2651759.
- ↑ Lee BK, Crossley K, Gerding DN (1978). "The association between Staphylococcus aureus bacteremia and bacteriuria". Am J Med. 65 (2): 303–6. PMID 686015.
- ↑ 11.0 11.1 Dembry LM, Andriole VT (1997). "Renal and perirenal abscesses". Infect Dis Clin North Am. 11 (3): 663–80. PMID 9378929.
- ↑ Fair WR, Higgins MH (1970). "Renal abscess". J Urol. 104 (1): 179–83. PMID 4913271.
- ↑ Yen DH, Hu SC, Tsai J, Kao WF, Chern CH, Wang LM; et al. (1999). "Renal abscess: early diagnosis and treatment". Am J Emerg Med. 17 (2): 192–7. PMID 10102326.
- ↑ Saiki J, Vaziri ND, Barton C (1982). "Perinephric and intranephric abscesses: a review of the literature". West J Med. 136 (2): 95–102. PMC 1273539. PMID 7039139.
- ↑ Kawamoto A, Sato R, Takahashi K, Luthe SK (2016). "Iliopsoas abscess caused by chronic urolithiasis and pyelonephritis". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-218541. PMID 27974344.
- ↑ Roberts FJ, Geere IW, Coldman A (1991). "A three-year study of positive blood cultures, with emphasis on prognosis". Rev Infect Dis. 13 (1): 34–46. PMID 2017629.
- ↑ Ispahani P, Pearson NJ, Greenwood D (1987). "An analysis of community and hospital-acquired bacteraemia in a large teaching hospital in the United Kingdom". Q J Med. 63 (241): 427–40. PMID 3310074.
- ↑ Wan YL, Lee TY, Bullard MJ, Tsai CC (1996). "Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome". Radiology. 198 (2): 433–8. doi:10.1148/radiology.198.2.8596845. PMID 8596845.