Pyelonephritis classification: Difference between revisions
Jump to navigation
Jump to search
Usama Talib (talk | contribs) No edit summary |
m (Bot: Removing from Primary care) |
||
| (7 intermediate revisions by 3 users not shown) | |||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Pyelonephritis is an upper urinary tract infection. Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, [[Emphysematous pyelonephritis|emphysematous]], and [[Xanthogranulomatous inflammation|xanthogranulomatous]] pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long term disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis. | Pyelonephritis is an upper [[urinary tract infection]]. Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, [[Emphysematous pyelonephritis|emphysematous]], and [[Xanthogranulomatous inflammation|xanthogranulomatous]] pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long-term disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis. | ||
==Classification== | ==Classification== | ||
There are five different types of pyelonephritis:<ref name="pmid22417256">{{cite journal| author=Hooton TM| title=Clinical practice. Uncomplicated urinary tract infection. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 11 | pages= 1028-37 | pmid=22417256 | doi=10.1056/NEJMcp1104429 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22417256 }} </ref><ref name="pmid27824318">{{cite journal| author=Lucaj R, Achong DM| title=Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging. | journal=Clin Nucl Med | year= 2017 | volume= 42 | issue= 1 | pages= 73-75 | pmid=27824318 | doi=10.1097/RLU.0000000000001415 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27824318 }} </ref><ref name="pmid27974344">{{cite journal| author=Kawamoto A, Sato R, Takahashi K, Luthe SK| title=Iliopsoas abscess caused by chronic urolithiasis and pyelonephritis. | journal=BMJ Case Rep | year= 2016 | volume= 2016 | issue= | pages= | pmid=27974344 | doi=10.1136/bcr-2016-218541 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27974344 }} </ref><ref name="pmid28104111">{{cite journal| author=Peng CZ, How CK| title=Diagnostic Challenge of Emphysematous Pyelonephritis. | journal=Am J Med Sci | year= 2017 | volume= 353 | issue= 1 | pages= 93 | pmid=28104111 | doi=10.1016/j.amjms.2016.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28104111 }} </ref><ref name="pmid28091422">{{cite journal| author=Wang HD, Zhu XF, Xu X, Li GZ, Liu N, He F et al.| title=Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage. | journal=Chin Med J (Engl) | year= 2017 | volume= 130 | issue= 2 | pages= 247-248 | pmid=28091422 | doi=10.4103/0366-6999.198021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28091422 }} </ref><ref name="pmid28028578">{{cite journal| author=Upasani A, Barnacle A, Roebuck D, Cherian A| title=Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis. | journal=Cardiovasc Intervent Radiol | year= 2016 | volume= | issue= | pages= | pmid=28028578 | doi=10.1007/s00270-016-1522-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28028578 }} </ref><ref name="pmid27915241">{{cite journal| author=Yeow Y, Chong YL| title=Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess. | journal=J Surg Case Rep | year= 2016 | volume= 2016 | issue= 12 | pages= | pmid=27915241 | doi=10.1093/jscr/rjw211 | pmc=5159021 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27915241 }} </ref> | There are five different types of pyelonephritis:<ref name="pmid22417256">{{cite journal| author=Hooton TM| title=Clinical practice. Uncomplicated urinary tract infection. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 11 | pages= 1028-37 | pmid=22417256 | doi=10.1056/NEJMcp1104429 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22417256 }} </ref><ref name="pmid27824318">{{cite journal| author=Lucaj R, Achong DM| title=Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging. | journal=Clin Nucl Med | year= 2017 | volume= 42 | issue= 1 | pages= 73-75 | pmid=27824318 | doi=10.1097/RLU.0000000000001415 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27824318 }} </ref><ref name="pmid27974344">{{cite journal| author=Kawamoto A, Sato R, Takahashi K, Luthe SK| title=Iliopsoas abscess caused by chronic urolithiasis and pyelonephritis. | journal=BMJ Case Rep | year= 2016 | volume= 2016 | issue= | pages= | pmid=27974344 | doi=10.1136/bcr-2016-218541 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27974344 }} </ref><ref name="pmid28104111">{{cite journal| author=Peng CZ, How CK| title=Diagnostic Challenge of Emphysematous Pyelonephritis. | journal=Am J Med Sci | year= 2017 | volume= 353 | issue= 1 | pages= 93 | pmid=28104111 | doi=10.1016/j.amjms.2016.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28104111 }} </ref><ref name="pmid28091422">{{cite journal| author=Wang HD, Zhu XF, Xu X, Li GZ, Liu N, He F et al.| title=Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage. | journal=Chin Med J (Engl) | year= 2017 | volume= 130 | issue= 2 | pages= 247-248 | pmid=28091422 | doi=10.4103/0366-6999.198021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28091422 }} </ref><ref name="pmid28028578">{{cite journal| author=Upasani A, Barnacle A, Roebuck D, Cherian A| title=Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis. | journal=Cardiovasc Intervent Radiol | year= 2016 | volume= | issue= | pages= | pmid=28028578 | doi=10.1007/s00270-016-1522-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28028578 }} </ref><ref name="pmid27915241">{{cite journal| author=Yeow Y, Chong YL| title=Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess. | journal=J Surg Case Rep | year= 2016 | volume= 2016 | issue= 12 | pages= | pmid=27915241 | doi=10.1093/jscr/rjw211 | pmc=5159021 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27915241 }} </ref> | ||
* '''Acute Uncomplicated Pyelonephritis''' | * '''Acute Uncomplicated Pyelonephritis''' | ||
:*Acute pyelonephritis is a common clinical diagnosis in normally healthy patients who present with [[fever]], [[chills]], and [[Flank Pain|flank]] tenderness. | :*Acute pyelonephritis is a common clinical diagnosis in normally healthy patients who present with [[fever]], [[chills]], and [[Flank Pain|flank]] tenderness.<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref name="pmid10433573">{{cite journal| author=Echols RM, Tosiello RL, Haverstock DC, Tice AD| title=Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 1 | pages= 113-9 | pmid=10433573 | doi=10.1086/520138 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10433573 }} </ref> | ||
:*[[Infections]] typically result from ascending retrograde spread through the collecting ducts into the renal [[parenchyma]]. | :*[[Infections]] typically result from ascending retrograde spread through the collecting ducts into the renal [[parenchyma]]. | ||
:*Patients are referred for [[CT]] evaluation of acute pyelonephritis when symptoms are poorly localized or complications are suspected. | :*Patients are referred for [[CT]] evaluation of acute pyelonephritis when symptoms are poorly localized or complications are suspected. | ||
* '''Acute Complicated Pyelonephritis''' | * '''Acute Complicated Pyelonephritis''' | ||
:*Acute complicated Pyelonephritis is the type that occurs in patients with known structural abnormalities of the [[urinary tract]], [[pregnant]] or [[post menopausal women]] or in the presence of a disease like [[diabetes]]. | :*Acute complicated Pyelonephritis is the type that occurs in patients with known structural abnormalities of the [[urinary tract]], [[pregnant]] or [[Menopause|post menopausal women]] or in the presence of a disease like [[diabetes]]. | ||
:*Acute complicated pyelonephritis requires a prolong duration of broad spectrum [[antibiotics]]. | :*Acute complicated pyelonephritis requires a prolong duration of broad spectrum [[antibiotics]]. | ||
:*[[CT scan]] is used for confirmation and for detection of complications. | :*[[CT scan]] is used for confirmation and for detection of complications. | ||
* '''Chronic Pyelonephritis''' | * '''Chronic Pyelonephritis''' | ||
:*Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. It is unclear that, whether it is an active chronic infection, arises from multiple recurrent infections, or represents stable changes from a remote single infection. | :*Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. It is unclear that, whether it is an active chronic [[infection]], arises from multiple recurrent [[Infection|infections]], or represents stable changes from a remote single [[infection]]. | ||
:*[[Hypertension]] is frequently a long-term sequela and so is an [[iliopsoas]] [[abscess]]. | :*[[Hypertension]] is frequently a long-term sequela and so is an [[iliopsoas]] [[abscess]]. | ||
* '''[[Emphysematous]] Pyelonephritis''' | * '''[[Emphysematous]] Pyelonephritis''' | ||
:* [[Emphysematous pyelonephritis]] represents a severe life-threatening infection (overall mortality rate of approximately 50%) of the renal parenchyma with gas-forming bacteria. | :* [[Emphysematous pyelonephritis]] represents a severe life-threatening infection (overall mortality rate of approximately 50%) of the renal [[parenchyma]] with gas-forming [[bacteria]]. | ||
:* Underlying poorly controlled [[diabetes mellitus]] is present in up to 90% of patients who develop [[emphysematous pyelonephritis]]. | :* Underlying poorly controlled [[diabetes mellitus]] is present in up to 90% of patients who develop [[emphysematous pyelonephritis]]. | ||
:* Patients present clinically with varying degrees of [[renal failure]], [[lethargy]], [[acid-base | :* Patients present clinically with varying degrees of [[renal failure]], [[lethargy]], [[Acid-base imbalance|acid-base imbalances]], and [[hyperglycemia]]. | ||
:* [[E coli]] is the causative bacterial source in approximately 70% of cases. | :* [[E coli]] is the causative bacterial source in approximately 70% of cases. | ||
:* It can be further divided into type 1 and 2 depending on presence of fluid and pattern of gas accumulation. | :* It can be further divided into type 1 and 2 depending on presence of fluid and pattern of gas accumulation. | ||
* '''Xanthogranulomatous Pyelonephritis''' | * '''Xanthogranulomatous Pyelonephritis''' | ||
:*Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by [[nephrolithiasis]] and resulting in infection and irreversible destruction of the renal parenchyma. | :*Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by [[nephrolithiasis]] and resulting in [[infection]] and irreversible destruction of the renal [[parenchyma]]. | ||
:*XGP is associated with a staghorn [[calculus]] in approximately 70% of cases. | :*XGP is associated with a staghorn [[calculus]] in approximately 70% of cases. | ||
:*Patients with [[diabetes]] are particularly predisposed to the formation of XGP. | :*Patients with [[diabetes]] are particularly predisposed to the formation of XGP. | ||
| Line 38: | Line 38: | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Medicine]] | |||
[[Category:Infectious disease]] | |||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
[[Category: | [[Category:Urology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
Latest revision as of 23:54, 29 July 2020
|
Pyelonephritis Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Pyelonephritis classification On the Web |
|
American Roentgen Ray Society Images of Pyelonephritis classification |
|
Risk calculators and risk factors for Pyelonephritis classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Pyelonephritis is an upper urinary tract infection. Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, emphysematous, and xanthogranulomatous pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long-term disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis.
Classification
There are five different types of pyelonephritis:[1][2][3][4][5][6][7]
- Acute Uncomplicated Pyelonephritis
- Acute pyelonephritis is a common clinical diagnosis in normally healthy patients who present with fever, chills, and flank tenderness.[8][9]
- Infections typically result from ascending retrograde spread through the collecting ducts into the renal parenchyma.
- Patients are referred for CT evaluation of acute pyelonephritis when symptoms are poorly localized or complications are suspected.
- Acute Complicated Pyelonephritis
- Acute complicated Pyelonephritis is the type that occurs in patients with known structural abnormalities of the urinary tract, pregnant or post menopausal women or in the presence of a disease like diabetes.
- Acute complicated pyelonephritis requires a prolong duration of broad spectrum antibiotics.
- CT scan is used for confirmation and for detection of complications.
- Chronic Pyelonephritis
- Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. It is unclear that, whether it is an active chronic infection, arises from multiple recurrent infections, or represents stable changes from a remote single infection.
- Hypertension is frequently a long-term sequela and so is an iliopsoas abscess.
- Emphysematous Pyelonephritis
- Emphysematous pyelonephritis represents a severe life-threatening infection (overall mortality rate of approximately 50%) of the renal parenchyma with gas-forming bacteria.
- Underlying poorly controlled diabetes mellitus is present in up to 90% of patients who develop emphysematous pyelonephritis.
- Patients present clinically with varying degrees of renal failure, lethargy, acid-base imbalances, and hyperglycemia.
- E coli is the causative bacterial source in approximately 70% of cases.
- It can be further divided into type 1 and 2 depending on presence of fluid and pattern of gas accumulation.
- Xanthogranulomatous Pyelonephritis
- Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma.
- XGP is associated with a staghorn calculus in approximately 70% of cases.
- Patients with diabetes are particularly predisposed to the formation of XGP.
- Treatment is nephrectomy.
- At histologic analysis, the inflammatory mass is composed of lipid-laden macrophages and chronic inflammatory cells.
References
- ↑ Hooton TM (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256.
- ↑ Lucaj R, Achong DM (2017). "Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging". Clin Nucl Med. 42 (1): 73–75. doi:10.1097/RLU.0000000000001415. PMID 27824318.
- ↑ 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.
- ↑ Peng CZ, How CK (2017). "Diagnostic Challenge of Emphysematous Pyelonephritis". Am J Med Sci. 353 (1): 93. doi:10.1016/j.amjms.2016.03.002. PMID 28104111.
- ↑ Wang HD, Zhu XF, Xu X, Li GZ, Liu N, He F; et al. (2017). "Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage". Chin Med J (Engl). 130 (2): 247–248. doi:10.4103/0366-6999.198021. PMID 28091422.
- ↑ Upasani A, Barnacle A, Roebuck D, Cherian A (2016). "Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis". Cardiovasc Intervent Radiol. doi:10.1007/s00270-016-1522-z. PMID 28028578.
- ↑ 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.
- ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
- ↑ Echols RM, Tosiello RL, Haverstock DC, Tice AD (1999). "Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis". Clin Infect Dis. 29 (1): 113–9. doi:10.1086/520138. PMID 10433573.