Pyelonephritis classification: Difference between revisions
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==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== | ||
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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 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.