Pyelonephritis

What is it?

Is the infectious inflammation of the parenchyma and renal pelvis, of abrupt onset, which appears in all ages and in both sexes, although with a predominance of the female sex. In uncomplicated cases it is found in 80% of cases, but when there is an associated obstructive process, Proteus, Klebsiella or Pseudomonas are the most frequent.

There is also the chronic pyelonephritis, much less frequent, associated with chronic obstructive processes such as large stones.

How is it produced?

The urinary tract infection affecting the kidney It is admitted that it can come through three different routes, the most frequent and common being the ascending route, as in the case of cystitis. The hematogenous route can occur in immunocompromised patients due to the presence of septic microembolisms that affect the kidney via the bloodstream. The lymphatic invasion it is also described but has little clinical relevance.

It is admitted that if the ascending route is the most common, most pyelonephritis patients should have vesicoureteral reflux, that is to say, a congenital anomaly that allows the passage of urine from the bladder to the kidney. The latter cannot be demonstrated in all patients with pyelonephritis, so it is accepted that they may have transient reflux associated with inflammation of the bladder that facilitates the passage of germs from the bladder to the kidney.

A part are the pyelonephritis of obstructive cause, for example by a stone in the urinary tract or by extrinsic compression. Because urine cannot flow into the bladder, it becomes infected and affects the kidney upstream, requiring urinary diversion apart from antibiotics to solve the infectious problem.

Symptoms

Should be suspected in patients with fever, chills, profuse sweating, and pain in the renal fossa, generally unilateral, preceded in most cases by dysuria and urinary burning. The pain can sometimes radiate towards the ureteral tract and can be mistaken for a. Palpation of the lumbar fossa is usually painful. The bimanual palpation of the lumbar fossa can reveal an increase in kidney size. Urine is usually smelly and can be associated with hematuria. There may be nausea or vomiting and affect the general state, even being able to enter septic shock.

Chronic pyelonephritis gives a much more larval symptomatology with asthenia and nonspecific low back pain, but being able to have a much more important analytical affectation.

Diagnosis

The diagnosis is made through the clinic with a correct history and physical examination together with the performance of a urine culture and blood analysis.

In the blood test highlights leukocytosis with deviation to the left and in some cases involvement of coagulation tests. It is advisable to perform imaging tests to rule out an associated obstructive urinary tract process, especially if there is persistent fever after 72 hours evolution with adequate antibiotic treatment, in the presence of a pregnancy, or if there are structural abnormalities and / or a history of kidney stones.

The renovesical ultrasound It is usually the first test to be carried out, due to its safety and the great information it gives about the kidney and the urinary tract. If there are doubts about possible abscesses or obstructive problems, abdominal CT it will be necessary.

Treatment

Its handling can be outpatient or hospital depending on the factors associated with the patient that advise it.

Treatment of acute pyelonephritis involves a correct hydration of the patient either orally or intravenously and depending on whether the general condition is affected or not, hospital admission will be carried out. Treatment is based on antibiotic therapy according to various guidelines and protocols. They can be used third generation cephalosporins, amoxicillin-clavulanate, fluoroquinolones or even antibiotic associations depending on the severity of the patient.

Treatment will always be at least two weeks of antibiotic. If in the first 48 hours there is no clinical response to treatment, the presence of an obstructive process that would imply the unblocking of the urinary tract should be suspected, always requiring hospital admission. Both pregnant and pediatric patients are contraindicated fluoroquinolones. Once the clinical improvement of the patient has been achieved, a control urine culture is advisable, to ensure the disappearance of germs from the urinary tract.

Prevention measures

The prevention measures are, that is, adequate hydration to dilute the urine and carry germs, together with hygienic measures. Taking cranberry concentrate also appears to reduce the chance of kidney infections.