acute pyelonephritis

áíéï�óá ëïéìùîçóõí èùò äåí å�é�ë�êåôáéåíßïôå á�éôåßôáé åéóáãùã

êáôÜ êáíüíá óå õãé è ëåá

ÄÄ á�üïîåßá å�é�ëåãì�íç ~÷ñüíéï ~________________________

ôõ�éê� åéêüíá :o â�èéï Üëãïò,o êïéëéáêü /�õåëéêü Üëãïò,

o +- : óõóôçìáôéê�òåêäçë'óåéò [ë.÷ íáõôßá,�ìåôïò],

o +- : óçìåßá [ë.÷ �õñåôüò(>37.8ºC), and/orcostovertebral angletenderness ]

o +- : åêäçë'óåéò UTI /êõóôßôéäáò

ó�áíßùò :

o sepsis,o multiple organ systemdysfunction,

o shock, and/or acute renalfailure

ïîåßá å�éåëåãì#íç :

o emphysematous pyelonephritis,o renal corticomedullary abscess,o perinephric abscess, oro papillary necrosis

÷ñüíéïò :

��ïõëç óõì�ôùìáôïëïãßá åâäïìÜäùí ùò ìçí'í óå�äáöïò äéÜìåóçò íåöñßôéäáò ë.÷ äéáëëåß�ïõóåòëïéì'îåéò óå ÷ñïíßùò á�ïöñáãì�íï íåöñü

xanthogranulomatous pyelonephritis) orvesicoureteral reflux

äéÜãíùóç :

ç á�ïõóßá �õñåôï� ó÷åäüí á�ïêëåßåé ôç íüóï

óå - åõáéóèçóßá �ëåõñïó�ïíäõëéê'í ãùíé'í+ êïë�éê óçìåéïëïãßá :

�ë ñç êïéëéáêü /�õåëéêü �ëåã÷ï ÄÄ á�ü �õåëéê öëãìí.

ô�óô åãêõìïó�íçò

ç á�ïõóßá �õïõñßáò ó÷åäüí á�ïêëåßåé ôç íüóï ÄÄá�ü á�ïöñáêôéê âëÜâç

óå å�é�ëåãì�íç = �õïõñßá + âáêôçñéïõñßá, althoughthese findings may be absent if the infection doesnot communicate with the collecting system or if thecollecting system is obstructed

ãåíéê ï�ñùí= ÷ñçóéìüôçôá ìüíï ôùí WBC êõëßíäñùí = á�üäåéîçíåöñéê ò �ñï�ëåõóç´ò ôçò �õïõñßáò

âáêôçñéïõñßá>10(5) CFU per mL of organisms óôï 95% +íüóïõ>10(4) CFU, >10(3) CFUåáí ôï äåßãìá åë öèç á�ü êáèåô ñá : >10(2) CFU

÷ñ'óç êáôÜ ãêñáì

óõí èùò äåí á�áéôï�íôáé á�åéêïíßóåéò

á�üëõôç �íäåéîç =ECHO or CT åáí óå 48 - 72 á�ï �íáñîçò áãùã ò,�áñáì�íïõí óçìåßá /êáé �õñåôüò

�áèïëïãéêÜ åõñ ìáôá �áñáì�íïõí ì�÷ñé 3 ì íåòìåôÜ á�ï ôçí êëéíéê âåëôßùóç

Escherichia coli > Klebsiellapneumoniae > Staphylococcussaprophyticus

äéá÷åßñçóç :

åíõäÜôùóç, áíôéìéêñïâéáêÜ

12 IV óôï ÔÅbêáôü�éí per os êáô ' ïßêïí

åíäåßîåéò åéóáãùã�ò :

o Severe illness with high fevers, pain,o marked debility Inability to maintain

oral hydration oro take oral medicationso Pregnancyo Concerns about patient compliance

å�é�ëåãì#íç :

o E. coli is the most common

o Citrobacter sp,o Enterobacter sp,o Pseudomonas aeruginosa,o enterococci,

o Staphylococcus aureus,

o fungi account for a higher proportion incomplicated than uncomplicatedpyelonephritis

S. saprophyticus is an uncommon cause ofcomplicated UTI