Monday, June 16, 2014

Urinary Tract Infections of the Kidney

Urinary tract infections can affect the lower urinary tract (bladder, and prostate in men) or the upper urinary tract (kidneys and ureters).  Infections of the lower urinary tract can be problematically symptomatic - symptoms include dysuria (pain with urination), foul-smelling urine, hematuria (blood in the urine), frequency and urgency.  However, lower tract infections are not often dangerous.  Infections of the upper tract can be extremely dangerous as bacteria in the extremely vascular kidneys can quickly spread around the body, leading to massive infection.

Infections of the upper tract manifest as a number of distinct entities, which we will review in this blog:

Acute Pyelonephritis

Acute Pyelonephritis (AP) refers to an infection and inflammation of the kidney and renal pelvis (where the urine collects).  AP can range from a mild, self-limited infection to life-threatening urosepsis (septic shock caused by urinary bacteria in the blood).  Most cases of AP are caused by E.coli (80%), most of which are equipped with P. pili - a special bacterial growth that helps the infection "ascend" the urinary tract in the kidney.  Occasionally, AP can be associated with obstructing kidney stones.  This circumstance is known as obstructive pyelonephritis and is a surgical emergency.

Symptoms can vary, but usually include fever, chills and flank pain, although can include nausea, vomiting and nonspecific abdominal pain.  AP is a clinical diagnosis defined by the triad of:

  • fever
  • flank pain
  • leukocytosis (elevated white blood cell count in the blood)
  • bacteriuria if often, but not reliably present

Therefore, the work-up involves routine blood work (complete blood count, basic metabolic panel) and urine tests (urinalysis and urine culture).  Imaging can either be CT scan or ultrasound and is indicated if suspicion of a kidney stone, anatomic abnormalities, recent urologic surgery or recurrent pyelonephritis.  The role of imaging is mainly to rule out obstructive pyelonephritis by looking for hydronephrosis.  Other non-specific findings on imaging can be renal enlargement, hyper- or hypoenhancing parenchyma and perinephric stranding (a sign of inflammation around the kidney).

AP can be stratified into uncomplicated and complicated forms of the disease.  In addition to distinguishing the different presentations in these groups, these classifications describe different forms of treatment.

Uncomplicated Acute Pyelonephritis

A patient with uncomplicated AP has a normal urinary tract by history and is clinically stable (no sepsis).  Therefore imaging is not warranted and treatment is outpatient therapy with an oral antibiotic (fluoroquinolone, amoxicillin or augmentin; NOT bactrim) for seven days.  Urine cultures can be repeated five days after treatment and/or two weeks after completing therapy to ensure eradication of the bacteriuria.

Complicated Acute Pyelonephritis

A patient with complicated AP is either acutely ill or has:

  • an anatomic abnormality (either congenital or after reconstructive surgery) 
  • recent urologic surgery
  • an obstructing ureteral stone
  • recurrent pyelonephritis 
  • uncomplicated AP with no response to therapy after 72 hours

These patients should be admitted to the hospital, undergo axial imaging (CT) and treated with 14 days of antibiotics.  Broad-spectrum, intravenous antibiotics should be initiated and may be transitioned to oral antibiotics when clinically stable to complete the 14-day course.  If any consideration of obstruction (i.e. hydronephrosis), the blockage should be relieved either with ureteral stent(s) or nephrostomy tube(s).  Patients with complicated AP should have repeat urine cultures at 5 days and 2 weeks after completing therapy as up to 30% will relapse after the initial 14-day course. 

Infected Hydronephrosis / Pyonephrosis

This entity is defined by bacterial infection in a hydronephrotic (or blocked, swollen collecting system) kidney.  There may be air in the collecting system and the treatment is conservative, including antibiotics (3-14 days depending on presentation) and relief of obstruction when applicable.  This should be distinguished from emphysematous pyelonephritis (see below) - which is a life-threatening bacterial infection of the kidney where air may appear in the renal parenchyma.

Acute Focal Bacterial Nephritis / Renal Abscess

Acute Focal Bacterial Nephritis is a localized infection of kidney characterized by heavy leukocyte infilatration and may represent early abscess formation.  It is diagnosed only by imaging in a patient with symptoms similar to AP.  Treatment is 7-14 days of antibiotics with consideration of repeat cultures and repeat imaging to make sure the process is resolving and not progressing to a renal abscess.  A renal abscess is a localized, purulent collection in the kidney.  A perirenal abscess is a purulent collection adjacent to the kidney while a pararenal abscess refers to a collection near the kidney but outside of Gerota's fascia (often unrelated to a kidney infection).  Most often, abscesses resolve with antibiotics and conservative treatment, however large abscess may be aspirated or percutaneously drained to facilitate resolution of illness.  

Xanthogranulomatous Pyelonephritis 

Xanthogranulomatous Pyelonephritis (XGP) can be considered chronic, end-stage pyelonephritis.  XGP is a process caused by severe, chronic obstruction and infection with resultant destruction of the kidney.  As most (83%) cases of XGP are associated with an obstructing kidney stone, the offending bacteria is E.coli or proteus species in most cases.  Patients with XGP often present with a smoldering case of flank pain, persistent UTI and can be associated with intermittent fevers, weight loss, malaise or a palpable mass if the kidney is large.  Radiographically, an XGP kidney typically appears with the triad of renal enlargement, poor function, and large pelvic calculus; although occasionally XGP can resemble renal cell carcinoma.  However, the diagnosis is pathological: the kidney parenchyma will have lipid-laden macrophages in a background of active infection.  Treatment is nephrectomy.

Emphysematous Pyelonephritis

Emphysematous Pyelonephritis (EP) is an acute, gas-forming infection of the kidney parenchyma.  It is most often caused by an ascending E.coli infection.  EP presents like AP in an acutely ill patient with air in the parenchyma of the kidney.  Patients often have comorbidities, chronic illnesses or are immunosuppressed; the most common comorbidity is diabetes.  Historically, the mortality of this entity approached 50%.  However, with better diagnostic capabilities and intensive care, the mortality from this disease has decreased dramatically.  Treatment involves broad-spectrum, intravenous antibiotics; supportive therapies and percutaneous drainage of the kidney with urgent nephrectomy if failure to respond.


Schaeffer, A. Chapter 10. Campbell-Walsh Urology 10th ed. Eds. Wein et al. Philadelphia: Elsevier, 2012. pp294-313
Rucker C M et al. Radiographics 2004;24:S11-S28
Craig W D et al. Radiographics 2008;28:255-276
Syed A. Akbar et al. Applied Urology 2009;38:3
D. Kudalkar et al. Heart & Lung 2004; 33:5: 339-342
Craig W D et al. Radiographics 2008;28:255-276

26 comments:

  1. In India, there are various medical tour operators providing complete leadership to you on the best choices obtainable for your treatment based on your inputs. Top Orthopaedic Hospitals in India have infrastructure and technology along with the reasonable & economic costs that Hospitals of India manoeuvre on.

    ReplyDelete
    Replies
    1. I don't known if here is the right forum to say this I am very glad for what Prophet Ogbeifun did for me i meant dr ogbeifun through a friend he helped win a court case of divorce few months ago and when i contacted him he help me to cast a death spell on my mother inlaw who was really troubling my life and future, she never wanted my progress, each time I get a job from a company, I get drove back because of the witch craft mother inlaw I have, I never knew my mother inlaw was the one troubling me, until one day I contacted Dr Ogbeifun for help and he told me Justine my mother inlaw is the one troubling me and he help me to cast unto her a death spell. I am happy because the evil doer is dead and ever since then my life have turn around for good things now work fine for me and am now a happy living beautiful with my family, thanks to Dr Ogbeifun. i recommend you to dr Ogbeifun if you have any kind of problem he will help you restore your marriage life back again. contact him via email ogbefunhearlingtemple@gmail.com or call/whatsapp him via +2348102574680  

      Delete
  2. Thank you for sharing useful articles about diseases. I have been reading them all. In order to treat UTI there has been lots of research going on for years. Some scientists have come up with a conclusion that Cranberry Concentrate Liquid can cure and prevent urinary tract infections significantly. I have seen some cases in which lots of UTI patients have treated their UTI with this berry juice.

    ReplyDelete
  3. Very Nice blog!
    Thanks for giving such a blog where we can share our opinions.
    For more information on Best Urologist in Pune Find Best Urologist in Pune

    ReplyDelete
  4. For many years, it was assumed that manual male enhancement exercises to increase the size of the penis were a mere myth. Even men’s magazines would state that manual exercises do not work.

    Now, we know this is not the case and has never been the case. Manual exercises have been used successfully over thousands of years and were common practices in many cultures.

    The penis is made of tissue and when stress is placed on the tissue, it can expand in size. The size increases can be in length or thickness. Cellular division is what occurs to cause the increase in the size of the penis. defining malextra website

    ReplyDelete
  5. Here priestEka we are here to make your dream of pregnancy and other related human diseases over in your life have a happy home. Wespecialise in helping people with their problems such as.
    1 bringing back your lost .
    2 spell to improve your businesses.
    3 spell to bring back your ex-lover( bring back your husband/wife/boyfriend/girlfriend)
    4 spell for business protection from colleague.
    5 spell to prevent witchcraft from your life and that of your family.
    6 spell to prevent you from accident during your business journey.
    7. spell to get employment easily
    We also specialise in providing solutions in any of this spiritual gynaecology diseases affect human existence such as:
    1 fibroid, asthma, ALL STD,
    2 weakness of man organ
    3 infections of all kind (yeast infection)
    4 blockage from the fallopian tube
    5 cyst. From the ovaries
    6 unpleasant smell from the virgina
    7 irregular menstration, menopause
    8 infertility for easy Conception.
    9.skin diseases, Toilet infection and bad body odor…….Etc..
    10.Watering sperm (low sperm count) not able to get woman pregnant.
    Simply contact the spiritualist PriestEka on (dreka14demons@gmail.com) to get his Herbal Medication to cure your disease and put yourself on a motherhood side of life..
    (No more adoption, with PriestEka your problem will solve and you will have your child with ease.
    Contact us at (dreka14demons@gmail.com) your solution home!

    ReplyDelete
  6. It’s a well-known fact that too many men are dissatisfied with the size of their penis. In some instances, it’s simply a matter of wishful thinking for something a bit more impressive. In other situations, however, this bodily dissatisfaction could lead to social isolation and even depression.
    helpful vigrx plus review

    ReplyDelete
  7. Depression is a serious condition and its detrimental impact should never be underestimated.

    If your depression worsens and you can’t escape from the negative thoughts, seek therapy. An experienced therapist will give you the tools to cope with the problem and to conquer your anxiety.helpful extenze website

    ReplyDelete
  8. I’m Mark Russ , I contracted HIV in 2009, I was told by my doctor that
    there’s no possible cure for HIV. I started taking my ARV’s, My CD4 was 77
    and viral load was 112,450. I saw a website of Dr. Imoloa also I saw a lot
    of testimonials about him on how he uses herbal medicine to cure HIV. I
    contacted him and told him my problems, He sent me the herbal medicine and
    I took it for 7 days after then I went for check-up and I was cured. The
    medicine has NO SIDE EFFECT, there’s no special diet when taking the
    medicine. He also cure DIABETES, EX BACK, ALS, HEPATITIS B, CANCER, HERPES
    1) If you want your ex back.
    (2) If you always have bad dreams.
    (3) You want to be promoted in your
    office.
    (4) You want women/men to run after
    you.
    (5) If you want your own children
    (6) You want to be rich.
    (7) You want to tie your husband/wife to
    be
    yours forever.
    (8) If you need financial assistance.
    (9) How you been scammed and you
    (10) and if you ant your herpes cure back
    want to recover you lost money
    (11) CANCER,
    (12) DIABETES,
    (13) HIV&AIdS,
    (14) URINARY TRACT INFECTION,
    (15) CANCER,
    (16) IMPOTENCE,
    (17) BARENESS/INFERTILIY
    (18) DIARRHEA
    (19) ASTHMA..
    Also contact him with the above.
    and lots more. You can reach him on drimoloaherbalmademedicine@gmail.com or
    Whatsapp +2347081986098 all thanks to dr imoloa he is really a great man .

    ReplyDelete
  9. I’m Mark Russ , I contracted HIV in 2009, I was told by my doctor that
    there’s no possible cure for HIV. I started taking my ARV’s, My CD4 was 77
    and viral load was 112,450. I saw a website of Dr. Imoloa also I saw a lot
    of testimonials about him on how he uses herbal medicine to cure HIV. I
    contacted him and told him my problems, He sent me the herbal medicine and
    I took it for 7 days after then I went for check-up and I was cured. The
    medicine has NO SIDE EFFECT, there’s no special diet when taking the
    medicine. He also cure DIABETES, EX BACK, ALS, HEPATITIS B, CANCER, HERPES
    1) If you want your ex back.
    (2) If you always have bad dreams.
    (3) You want to be promoted in your
    office.
    (4) You want women/men to run after
    you.
    (5) If you want your own children
    (6) You want to be rich.
    (7) You want to tie your husband/wife to
    be
    yours forever.
    (8) If you need financial assistance.
    (9) How you been scammed and you
    (10) and if you ant your herpes cure back
    want to recover you lost money
    (11) CANCER,
    (12) DIABETES,
    (13) HIV&AIdS,
    (14) URINARY TRACT INFECTION,
    (15) CANCER,
    (16) IMPOTENCE,
    (17) BARENESS/INFERTILIY
    (18) DIARRHEA
    (19) ASTHMA..
    Also contact him with the above.
    and lots more. You can reach him on drimoloaherbalmademedicine@gmail.com or
    Whatsapp +2347081986098 all thanks to dr imoloa he is really a great man .

    ReplyDelete
  10. i am from USA, i am here to give my testimony how i was cured from HIV, i
    contacted my HIV via blade. a friend of my use blade to peel of her
    finger nails and drop it where she use it, so after she has left i did know
    what came unto me i looked at my nails, my nails were very long and i took
    the blade which she just used on her own nails to cut of my finger nails,
    as i was maintaining my names, i mistakenly injured myself. i did even
    bothered about it, so when i got to the hospital the next week when i was
    ill the doctor told me that i am HIV positive, i wondered where did i got
    it from so i remembered how i use my friend blade to cut off my hand so i
    feel so sad in my heart to the extent that i don’t even know what to do, so
    one day i was passing through the internet i met a testimony of a lady that all
    talk about how she was cured by a doctor called DR Imoloa so i quickly
    emailed the doctor email, and he also replied to me an told me the
    requirements which i will provide and I do according to his command,
    he prepare a herbal medicine for me which i took. he
    called me the next week that i should go for a test which i did to my own
    surprise i found that i was HIV negative. Thanks to him once more the great
    doctor that cured me DR Imoloa so you can also emailed him at
    {drimoloaherbalmademedicine@gmail.com} or whatssapp him on +2347081986098} God Bless you Sir.

    ReplyDelete
  11. Greetings to you all, i am here today on this forum giving a life testimony on how Dr Idahosa has cured me from Hiv Virus, i have been stocked in bondage with this virus for almost 2years now, i have tried different means to get this sickness out of my body i also heard there was no cure to the virus, all the possible ways i tried did not work out for me, i do have the faith that i was going to be cured one day, as i was a strong believer in God and also in miracles, One day as i was on the internet i came across some amazing testimonies concerning how Dr Idahosa has cured different people from various sickness with his Herbal Herbs Medicine, they all advised we contact Dr Idahosa for any problem, with that i had the courage and i contacted Dr Idahosa i told him about my Sickness, He told me not to worry that he was going to prepare some Herbal Medicine for me, after some time in communication with Dr Idahosa, he finally prepared for me some herbs which he sent to me and he also gave me prescriptions on how to take them, My good friends after taking Dr Idahosa Herbs for some weeks i started to experience changes in me and from there, I noticed my Hiv Virus was no longer in my body, as i have also gone for test, Today i am fit and healthy to live life again, I am so happy for the good work of Dr Idahosa in my life, Friends if you are having any types of disease problem kindly email Dr Idahosa on { dridahosasolutioncenter@gmail.com} or call his WhatsApp number on +2348134261542 God Bless you Sir.

    ReplyDelete
  12. Great post. There are many medications and remedies for UTI. But the
    herbal UTI supplements are more effective.

    ReplyDelete
  13. I was despondent because i had a very small penis, about 2.5 inches soft and 4 inches hard not nice enough to satisfy a woman, i have been in so many relationship, but cut off because of my situation, i have used so many product which doctors prescribe for me, but none could offer me the help i searched for. i saw some few comments on the INTERNET about this specialist called Dr movo and decided to contact him on his email: {drmovo.supernaturalherbalmedic@gmail.com} so I decided to give his herbal product a try. i emailed him and he got back to me, he gave me some comforting words with his herbal pills for Penis Enlargement, Within 3 week of it, i began to feel the enlargement of my penis, " and now it just 4 weeks of using his products my penis is about 9 inches longer, and i had to settle out with my Ex girlfriend JOY, i was surprised when she said that she is satisfied with my sex and i have got a large penis. Am so happy, thanks to Dr movo I also learn that Dr movo also help with Breast Enlargement Hips and Bums Enlargement etc.. If you are in any situation with a little Penis, weak ejaculation, small breast_hips_bums do get to Dr movo now for help on his email:{drmovo.supernaturalherbalmedic@gmail.com} or whatsapp +2347061865209.

    ReplyDelete
  14. This is such a great resource that you are providing and you give it away for free. I love seeing blog that understand the value of providing a quality resource for free
    Urinary Incontinence Treatment in Bangalore | Irregular Cycles treatment in bangalore | Hysteroscopy in Bangalore

    ReplyDelete
  15. I want to share my testimony on how i get cure of my HERPES GENITAL with
    the help of Doctor idahosa, i have being suffering for this disease for a
    very long time now.i have try several means to get rid of of the (HERPES)
    disease for the last five years and had constant pain, especially in my
    knees. During the first year,I had faith in God that i would be healed
    someday.This disease started circulate all over my body and i have been
    taking treatment from my doctor, few weeks ago i came on search on the
    internet if i could get any information concerning the prevention of this
    disease, on my search i saw a testimony of someone who has been healed from
    (Hepatitis B and Cancer) by this Man Dr idahosa and she also gave the email
    address of this man and advise we should contact him for any sickness that
    he would be of help, so i wrote to Dr idahosa telling him about my (HERPES
    Virus) he told me not to worry that i was going to be cured!! hmm i never
    believed it,, well after all the procedures and remedy given to me by this
    man few weeks later i started experiencing changes all over me as the
    Doctor assured me that i am cured,after some time i went to my doctor to
    confirmed if i have be finally healed behold it was TRUE, So friends my
    advise is if you have such sickness or any other at all you can email Dr
    idahosa on { dridahosasolutioncenter@gmail.com } sir i am indeed grateful
    for the help i will forever recommend you to my friends and to share this
    to every one that have any of this sickness you can call his whatssAp via
    +2348134261542

    ReplyDelete
  16. I don't known if here is the right forum to say this I am very glad for what Prophet Ogbeifun did for me i meant dr ogbeifun through a friend he helped win a court case of divorce few months ago and when i contacted him he help me to cast a death spell on my mother inlaw who was really troubling my life and future, she never wanted my progress, each time I get a job from a company, I get drove back because of the witch craft mother inlaw I have, I never knew my mother inlaw was the one troubling me, until one day I contacted Dr Ogbeifun for help and he told me Justine my mother inlaw is the one troubling me and he help me to cast unto her a death spell. I am happy because the evil doer is dead and ever since then my life have turn around for good things now work fine for me and am now a happy living beautiful with my family, thanks to Dr Ogbeifun. i recommend you to dr Ogbeifun if you have any kind of problem he will help you restore your marriage life back again. contact him via email ogbefunhearlingtemple@gmail.com or call/whatsapp him via +2348102574680  

    ReplyDelete

  17. was so confused consigning my HIV positive result I have been scam med couple of times............ DR.AHAM Herbalhome was my last trier, 11 mounts ago I contacted him then he told me not to worry, we talked for some days and I made a purchase for the herbs within a week. I was surprised when the herbal medication was delivered to my door step. they delivered the herbs here in Swansea Wales. First I was surprised that I finally got a trusted doctor, after two weeks of taking the herbs, I felt strong and I was amazed by it but could not believe it. after taking the whole medication, DR.AHAM requested I go for a medical check up and i did so the next day and the result came out "NEGATIVE". I was amazed and couldn't believe my eyes. so I went for test in 3 different hospital and the test results also came out "NEGATIVE"..... the virus was totally gone, I cried passionately because the herbs was the greatest gift given to me and i was also given a second chance to life. I had wondered all my life if people of such as DR.AHAM Herbalhome still exists in this world until the day I reached out to them.
    Get in touch wet him through his email address at ahamherbalhome100@gmail.com or reach him on his direct line +2348107862473(whatsapp enabled)
    WeChat ID
    dr_ahamherbalhome100

    ReplyDelete
  18. Am sharing this testimony to partners suffering in their relationships because there is an enduring solution. My husband left me and our 4 kids for another woman for 1 year. I tried to be strong just for my kids but I could not control the pains that torment my heart. I was hurt and confused. I needed a help, so i did a research on the internet and came across a site where I saw that Dr. Godday a spell caster,who can help get lot lovers back within few hours I contacted him and he did a special prayer and spells for me. To my surprises, after few days, my husband came back home. That was how we reunited again and there was a lot of love, joy and peace in the family. You can as well contact Dr. Godday, a powerful spell-caster for solutions on his contact Email: goddayspiritualhome@gmail.com Whats app only +1{919}4956404

    ReplyDelete
  19. There is a great herbal man called Dr voodoo who can cure Hepatitis B virus and other deadly diseases with the use of natural herbs to cure Hepatitis B virus problems. He is from Africa and he is a great doctor and he can also cure you as well if you are have the problem And other deadly disease and here is email address voodoospelltemple66@gmail.com or Whatsapp +2348140120719 HERPES CURE,CANCER CURE,HIV/AIDS CURE,HPV CURE

    ReplyDelete
  20. I want to share this to the entire public on how Dr Ede cured me from herpes 1&2 with his herbs, I never believe it will work because the doctors keep saying there is no cure but I was desperate and needed to get this thing out of my body. I saw a comment online testifying how Dr. Ede cured her from herpes and hpv and I contacted Dr. Ede and explain my problem to him and he prepares the cure and sends it to me through UPS, Which I use just the way He instructed me and thank God today I am a beneficiary of this cure. I went to my doctor for checkup after two weeks of taking the herbs and I was tested Herpes 1&2 Negative and my doctor told me that the virus is completely gone from my system and he was very shock also and ask for his contact then I gave it to him and he also contacted him in need of other patients. So I will tell you all who are looking for a cure to his/her Herpes Virus, I will advise you to do a very good research about herbalist Ede and see more about his good work and a lot of people are benefiting from him right now. He also cured my Uncle and his wife from HPV. Dr Ede heals with natural herbs. Please I urge you to contact him now through his WhatsApp on + 2 3 4 7 0 6 4 2 9 0 5 4 6 You can thank me later

    ReplyDelete
  21. For many years, it was assumed that manual male enhancement exercises to increase the size of the penis were a mere myth. Even men’s magazines would state that manual exercises do not work.
    red kameez black salwar
    black and red salwar

    ReplyDelete
  22. Sometimes we feel fever because of UTI. UTI is very painful, so to treat this problem UTI supplements helps a lot

    ReplyDelete