Pyelonephritis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 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]
- Acute Uncomplicated Pyelonephritis
- Acute pyelonephritis is a common clinical diagnosis in patients who present with fever, chills, and flank tenderness.
- 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 etc.
- 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.
- 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 irregularities, and hyperglycemia.
- E coli is the causative bacterial source in approximately 70% of cases
- 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.