pyelonephritis

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pyelonephritis:

see nephritisnephritis
, inflammation of the kidney. The earliest finding is within the renal capillaries (glomeruli); interstitial edema is typically followed by interstitial infiltration of lymphocytes, plasma cells, eosinophils, and a small number of polymorphonuclear leukocytes.
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Pyelonephritis

 

an inflammation of the calyxes, pelvises, and parenchyma of the kidneys caused by the colon bacillus, staphylococcus, Pseudomonas aeruginosa, Proteus, and by other microorganisms. Primary, acute or chronic, and unilateral or bilateral forms of pyelonephritis are distinguished from secondary pyelonephritis, which is preceded by other diseases of the kidney and urinary tract. The morphologic changes associated with the disease take the form of clusters of cellular infiltrates. In chronic pyelonephritis, the kidney surface exhibits multiple cicatricial retractions. The cortical layer is thin and uneven.

Acute pyelonephritis often begins with fever, chills, and pain in the lumbar region. Urination is painful and frequent, and there may be headaches, nausea, and vomiting. Nitrogenous residues may increase in the blood in the early stages. The urine contains pus, red blood cells, albumin, and numerous bacteria, more than 100,000 per ml of urine. Treatment consists of antibacterial therapy with sulfanilamides, nitrofurans, and antibiotics. During the stage of fever, the intake of protein should be limited. Later the diet may be normal, with a copious intake of fluids, application of heat to the lumbar region, and antispasmodics.

The presence of chronic pyelonephritis is often revealed during urinalysis or the taking of blood pressure. The patient may complain of general weakness, headache, lack of appetite, pain in the lumbar region, and increased frequency of urination. The skin is pale and dry. The disease’s progress is bilateral. The urine’s specific gravity decreases and hypertension frequently develops, as does renal insufficiency. Diagnostic methods include urinalysis and examination of the renal functions, roentgenography, the use of radioisotopes, and occasionally biopsy of the kidneys. Treatment consists of prolonged antibacterial therapy with such drugs as nitrofurans, sulfanilamides, antibiotics, and NegGram. In the case of hypertension, hypotensive drugs are prescribed and the impaired urine flow is normalized. If such contraindications as renal insufficiency, obstruction of the urinary tract, and marked hypertension are absent, treatment in the Truskavets, Essentuki, Zheleznovodsk, or Sairme sanatoriums may be prescribed.

REFERENCES

Pytel’, A. Ia., and S. D. Goligorskii. Pielonefrit. Moscow, 1961.
Ratner, N. A. Bolezni pochek i gipertoniia, 2nd ed. Moscow, 1971.

F. M. PALEEVA

pyelonephritis

[¦pī·ə·lō·ne′frīd·əs]
(medicine)
The disease process resulting from the effects of infections of the parenchyma and the pelvis of the kidney. Also known as interstitial nephritis.
References in periodicals archive ?
Symptomatically, XGP usually presents with stigmata of chronic pyelonephritis including flank pain, fever, malaise, reduced appetite, and weight loss [13].
However, large focal XGP can be symptomless and silent.
Currently, no guidelines exist for optimal treatment of XGP but, generally, treatment consists of a combination of broad spectrum antibiotics and nephrectomy [16, 17].
XGP can be divided into diffuse and focal types based on its radiographic features.
In conclusion, we encountered a rare case of XGP in the upper pole of the kidney with an incomplete double ureter.
There is highly variable clinical presentation of XGP with acute symptoms of urinary tract infection (dysuria, hematuria, fever, chills and flank pain) or chronic, nonspecific symptoms (weight loss, malaise and anorexia).
Although ultrasound can be used for initial assessment of patient with complicated UTI and suspected pyelonephritis, and can raise suspicion or diagnose XGP, a preferred radiologic modality is CT abdomen and pelvis with contrast as it provides highly specific imaging findings and accurate assessment of the renal involvement along with extrarenal extent of disease.
Ultrasound of diffuse XGP typically demonstrates an enlarged kidney with a large amorphous central echogenicity that corresponds to a renal pelvis staghorn calculus, multiple fluid-filled masses, and pelvic contracture.
Though rare in the general population, XGP is a relatively common variant found in surgically managed pyelonephritis.
Proteus mirabilis and E coli have been reported as the most common organisms associated with XGP, but a sterile urine culture is not uncommon.