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Urnary tract infectin, Acute pyelonephritis

Renal and perirenal abscessSep, 22, 2005

Dr. Chien-Lung Chen

壢新醫院畢業後一般醫學內科訓練課程教案

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學習目標

1. Complete history, physical examination and laboratory analysis

2. Differential diagnosis.

3. Adequate management and treatment

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Contents

• 1. Definition

• 2. Risk factors

• 3. Clinical presentation..

• 4. Diagnosis

• 5. Treatment

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Definition

• Upper UTI: pyelonephritis

• Lower UTI: cystitis, urethritis, prostatitis

• UTI Relapse: same organism, <2wks

• UTI reinfection: different organism, >2wks

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Definition

• Symptomatic: frequecy, urgency, dysuria

• flank pain, fever,chills

• 1) cystitis

• 2) APN

• 3) prostatitis

• Asymptomatic UTI: s/s(-), pyeuria(+)

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Definition

• Uncomplicated: • 1) normal urinary tract• 2) normal renal function• Complicated:• 1) Abnormal urinary tract: stone, VUR, ileal • conduit, indwelling catheter, prostatitis, ….. • 2) Immune compromised: DM, C/T, neutropenia• 3) Virulent organism: metastatic Staphylococcus• aureus, Proteus mirabilis• 4) Male

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Risk factors

• 1. Age

• 2. Pregnancy

• 3. Diaphragm use

• 4. Sexual activity

• 5. Chronic disease, DM, H/T, CVA

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Clinical features

• 1. Acute urethral syndrome: frequency, • dysuria, burning, suprapubic pain, cloudy• urine, incontinence• 1) vaginitis: leukorrhoea, candida albicans• trichomonas vaginalis, gardnerella • vaginalis, G(-) bacilli• 2) Urethritis: chlamydia, herpes virus• 3) Prostatitis

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Clinical features

• 2. UTI• 1) Cystitis: dysuria,frequency, pelvic pain• bacteriuria, hematuria• 2) APN: flank pain, fever, malaise, ……• 3) Cx: • a. abscess formation• b. Xanthogranulomatous pyelonephritis• c. Emphysematous pyelonephritis• d. CRF

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Diagnosis

• 1. Complete history

• 2. Symptoms and signs

• 3. Pyuria: WBC > 5/hpf, nitrite(+), leucyte

• esterase, bacteria

• 4. Leucocytosis

• 5. U/C

• 6. B/C

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Management

• 1. Asymptomatic UTI: no tx except

• pregnancy and URO invasive procedure

• 2. Uncomplicated lower UTI:

• Oral A/B( baktar, keflex, amoxil) x 3D

• 3. APN:

• IV A/B ( Cef +GM ) x 3-5 d fever (-)

• oral A/B x 7-10d

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Renal abscess

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Renal abscess

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Renal abscess

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Xanthogranulomatous pyelonephritis

• 1. Chronic bacterial PN• 2. Uncommon, <1%• 3. Old age, female 70%• 4. Path: unknown• 5. Mψ with PAS(+) granules• 6. P. mirabilis, E. coli, S. aureus• 7. Dx: CT• 8. Tx: local resection + antibiotics

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Perirenal abscess

• 1. Etiology: S. aureus, E.coli, P.mirabilis

• 2. Pathogenesis: pus-material in the

Gerota’s fascia.

• 3. S/S: fever, flank pain, chills, dysuria

• 4. Dx: echo, CT, angiography, Ga scan

• 5. Emphysematous pyelonephritis- gas-forming organism.

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Treatment

• 1. Early surgical drainage

• 2. Antibiotics as adjunctive treatment

• 3. Antibiotics irrigation prior to

nephrectomy.

• 4. Prognosis is poor, mortality is 20-50%

• 5. Prompt diagnosis and immediate definitive surgery.