Pyelonephritis interventions

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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

There are no recommended therapeutic interventions for the management of [disease name].

OR

[Name of intervention] is not the first-line treatment option for patients with [disease name]. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of [name of intervention] depends on the stage of [disease or malignancy] at the time of diagnosis.

OR

[Name of intervention] is the mainstay of treatment for [disease or malignancy].

Indications

[Name of intervention] is not recommended for the management of [disease name].

OR

[Name of intervention] is not the first-line treatment option for patients with [disease name]. [Name of intervention] is usually reserved for patients with either:

• [Indication 1]
• [Indication 2]
• [Indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either:

• [Indication 1]
• [Indication 2]
• [Indication 3]

Name of Intervention

Different interventions might be used to diagnose or treat pyelonephritis.

Renal biopsy

• A biopsy can be done to confirm the diagnosis of a complex renal pathology or to check the extent and type of damage to the kidney.
• It is used specifically in case of xanthogranulomatous pyelonephritis that is confused with renal tumors usually Wilm's tumor.
• The histopathological exam of the biopsy specimen confirm xanthogranulomatous type of pyelonephritis.

Ureteroscopy

Flexible ureteroscopy is done for the treatment of obstructive pyelonephritis. It is very effective in removing large proximal placed ureteral stones that are greater than 1.5cm. It can be performed after drainage of an infected kidney to effectively remove renal stones. Flexible ureteroscopy has a stone free rate of almost 80%. It has advantages over Transperitoneal laparoscopic ureterolithotomy in that:

• It causes less post operative pain
• Has a lesser hospital stay
• Early return to daily routine

Double J Stenting

Double J stenting, also known as DJ Stenting, is a conservative management method for emphysematous pyelonephritis. A nephrostomy tube or DJ stunt can be used to decompress the urinary tract which may be enlarged secondary to various reasons like a tumor or an obstructing stone.

Percutaneous nephrostomy

Percutaneous nephrostomy is an effective treatment option for emphysematous pyelonephritis which is characterized by necrotizing damage to the parenchyma of the kidney and its adjoining tissue leading to gas formation. Percutaneous nephrostomy should be accompanied by adequate hydration and glycemic control.

Nephrolithotomy/Ureterolithomy

Percutaneous nephrolithotomy or transperitonial laproscopic ureterolithotomy (TLU) are effective surgical treatment options for pyelonephritis. TLU is effective in removing large ureteral stones with a very high stone free rate approaching upto 100%.