Pyelonephritis

A pyelonephritis is a bacterial infection of the urinary tracts high, concerning thus the small basin (Pyélite) and the renal parenchyma (Néphrite), complicating or joining an infection and/or ignition low urinary tracts.

Pyelonephritis is year ascending Urinary leaflet infection that has reached the pyelum (pelvis) off the Kidney ( nephros in Greek). Severe yew the infection is, the term " urosepsis " is used interchangeably. It requires Antibiotic S ace therapy. -->

Pathology

Acute pyelonephritis is purulent year exudative localized ignition off kidney and renal pelvis. Renal The parenchyma present in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, concealment central remains and germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early training courses, glomeruli and vessels normal are. Photo At: Atlas off Pathology-->

Signs and symptoms

Fever, backache, vomiting Dysuria (painful voiding), rigors and often also with confusion. There may renal Be angle tenderness one Physical examination. -->
  • unilateral Lumbago irradiating towards the external genitals and the thigh homolatérale
  • abdominal Pains
  • Fever > 38,5°C and shivers, vomiting
  • paralytic Iléus
  • possible Septicaemia being able to become complicated in septic Shock
  • urinary Turbid Pyurie
  • /bleedings

Diagnosis

It is initially made with the examination Symptôme S, then with the complementary examinations:

The formal diagnosis is made by a culture urine and a Hémoculture.

  • inflammatory Bactériurie
  • Syndrome
  • Imagery, to seek a calculation.

Nitrite and Leukocyte S one has Urine dipstick are often detected, which may Be year indication for empirical treatment. -->

Among patients presenting of chronic pyelonephritides, it is important to exclude an anatomical anomaly, like a backward flow vésico-urétéral, where the urine goes up bladder in the Uretère.

Treatment

Antibiotic S, which are often administered Intravenous ly to improve the effect. Trimethoprim (gold Co-trimoxazole) gold Nitrofurantoin are often used first-line, although in full-blown pyelonephritis Amoxicillin (with gold without Clavulanic acid), gentamycin (with gold without ampicillin) gold has third generation Cefalosporin S are often favoured. -->

Pyelonephritis is treated with antibiotics. The treatment varies according to the type of pyelonephritis:

  • moderate acute Pyelonephritis: a fluoroquinolone if sensitivity of the germ,

  • serious acute Pyelonephritis: fluoroquinolone and scanner with 1 month, to check the effectiveness of the treatment
  • severe acute Pyelonephritis: fluoroquinolones and a Aminoglycoside

Treatment in the expectant mothers

Caution! In the expectant mother, one does not give a fluoroquinolone but a Béta-lactamine, associated with a monitoring of the fetus.

In several cases, a hospitalization would be necessary for an intravenous antibiotic administration.

Most typical present or in group: mictionnelles burns and not urethral burns, pollakiurie, pains abdominal or lumbar often unilateral…

the simplest test: the urinary strip which is read by the doctor after two minutes of waiting or according to the note. It positive for at least one of the following signs: Nitrites or Leucocytes or Erythrocytes. It is then necessary to take a sample for the bacteriological examination before treatment.

the immediate processing can be: Rocéphine (ceftriaxone) 500 Mg IM for each 40 kg . A regulation of an antibiotic such as augmentin PO with a traditional posology according to the weight for at least 7 days.

A clinical control at 48 hours.

The badly tolerated forms (by the patient, its entourage or its doctor) will be addressed to a heavier structure-->

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