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.[1][2]
Classification
There are five different types of pyelonephritis:[1][3][4][5][2]
- Acute Uncomplicated Pyelonephritis
- Acute pyelonephritis is a common clinical diagnosis in normally healthy 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 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 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
- ↑ 1.0 1.1 Hooton TM (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256.
- ↑ 2.0 2.1 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.
- ↑ 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.