Practice Paper 2: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Acute pyelonephritis describes renal infection and inflammation. This condition is usually secondary to an ascending UTI, but may also be seen following instrumentation of the urogenital tract or haematological transfer of infection from the bloodstream to the kidney. Certain conditions, such as urinary reflux, anatomical abnormalities and urinary stasis secondary to urinary tract obstruction, predispose to the development of pyelonephritis. Patients present with a history of malaise, fever, rigors, vomiting, dysuria, haematuria and loin pain. Escherichia coli and Enterobacter faecalis are the most common pathogens causing acute pyelonephritis. Investigation of acute pyelonephritis requires urine dipstick analysis, urine cultures, blood cultures, serum inflammatory markers, and serum urea and electrolytes. An abdominal X-ray and renal tract ultrasound should be performed to identify any calculi and rule out an obstruction, respectively. The treatment of pyelonephritis requires intravenous antibiotics (e.g. cefuroxime ± gentamicin for up to 14 days). Alterations to antibiotics should be made on the basis of culture and sensitivity results.
The Urinary System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Since stasis allows bacterial invasion through the urinary tract, urinary stasis is frequently implicated in acute pyelonephritis, and it may arise from such underlying disorders as ureteral or urethral strictures, renal calculi ("kidney stones" formed through the process of nephrolithiasis), tumors, prostatic hypertrophy, or neurogenic bladder. Symptoms of acute pyelonephritis include fever and chills, vomiting, and bladder irritation from infected urine, causing urgency and frequency of urination (also called miction or micturition). A more descriptive term for acute pyelonephritis, although one that is less frequently used, is acute infective tubulointerstitial nephritis because it describes the infective nature of the disease and the involvement of the tubules and their interstitial spaces. The term pyelonephritis should only be applied to diseases with documented urinary tract infection (UTI).
Complications Related to Neurogenic Bladder Dysfunction II
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
Renal and ureteral injury in NGB dysfunction can result from both acute and chronic conditions. Acute causes include infection and sudden obstruction. Pyelonephritis occurs due to ascending bacteriuria from the lower urinary tract, as a result of catheterization or poor bladder emptying. Acute obstruction of a renal unit is typically caused by nephrolithiasis, which is a risk factor for developing both temporary and permanent renal insufficiency. In patients with NGB dysfunction, stones are frequently composed of struvite (“infection stone”), due to the high urinary pH typical in persons with chronic bacteriuria, although metabolic stones can be present as well.1 In acute nephrolithiasis, the degree of obstruction, duration of obstruction, and presence of bacteriuria all affect the severity of the renal injury and the likelihood of functional recovery. It is likely that the high incidence of nephrolithiasis in some groups of patients with NGB dysfunction (e.g., reported as 7%–30% in patients with spinal cord injury [SCI]2,3) contributes to the higher risk of renal insufficiency compared to the general population.
Rotula aquatica Lour. mitigates oxidative stress and inflammation in acute pyelonephritic rats
Published in Archives of Physiology and Biochemistry, 2022
A. Vysakh, Kuriakose Jayesh, Ninan Jisha, V. Vijeesh, Sebastian Jose Midhun, Mathew Jyothis, M. S. Latha
Pyelonephritis is an infectious disease caused by bacterial invasion to the upper urinary tract. The bacterial invasion to urinary tract elicits an inflammatory response that results in clinical complications like kidney failure. The conventional approach to cure pyelonephritis has been focused on killing the bacteria causing this pathology. The bacterial infection in lower and upper urinary tract is accompanied by inflammation and oxidative stress. So, the antibacterial treatment is not sufficient to reduce the pathophysiology of the disease. The antibiotic therapy was only being able to reduce the bacterial count and most of them have capable to cause adverse effect such as nephrotoxicity and ototoxicity (Subramanian et al.2015). Therefore, an urgent need for developing new drugs having both antimicrobial and anti-inflammatory activities for treating the pyelonephritis and its associated pathological conditions. The previous studies in our lab prove that methanolic extract of Rotula aquatica was able to reduce the inflammation in RAW 264.7 cells (Vysakh et al.2018b) and also have antibacterial effect. Based on these data, current study was carried out to evaluate the effect of methanolic extract of Rotula aquatica in ameliorating pyelonephritis in in vivo model.
Urinary tract infection during pregnancy: current concepts on a common multifaceted problem
Published in Journal of Obstetrics and Gynaecology, 2018
Kallirhoe Kalinderi, Dimitrios Delkos, Michail Kalinderis, Apostolos Athanasiadis, Ioannis Kalogiannidis
Urinary tract infections in pregnancy are classified as either asymptomatic or symptomatic. Asymptomatic bacteriuria is defined as the isolation of bacteria in at least 1 × 105 colony-forming units per mL of cultured urine, in the absence of signs or symptoms of a UTI. Symptomatic UTIs are divided into lower tract (acute cystitis) or upper tract (acute pyelonephritis) infections (Bahadi et al. 2010). Asymptomatic bacteriuria occurs in 2–15% of pregnant women and is a major risk factor for developing symptomatic UTIs during pregnancy (Ipe et al. 2013). The prevalence of symptomatic urine infection during pregnancy is less common, complicating about 1–2% of all pregnancies (Schnarr and Smaill 2008). Among symptomatic UTI, cystitis is defined as significant bacteriuria with associated bladder mucosal invasion, whereas pyelonephritis is defined as significant bacteriuria with associated inflammation of the renal parenchyma, calices and pelvis. The major symptoms of cystitis are dysuria, urgency and frequent urination and the affected patient may present with suprapubic tenderness. Pyelonephritis is usually accompanied by fever, lumbar pain, nausea and vomiting. If asymptomatic bacteriuria is untreated, 20–40% of cases progress to acute UTI, such as pyelonephritis and can likely cause multiple pregnancy complications, including premature delivery in 20–50% of cases (Whalley 1967; Patterson and Andriole 1997; MacLean 2001).
Adverse events and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids – a systematic review and future perspectives
Published in International Journal of Hyperthermia, 2023
Jakub Kociuba, Tomasz Łoziński, Magdalena Zgliczyńska, Maciej Byrczak, Salvatore Giovanni Vitale, Maciej Skrzypczak, Kornelia Zaręba, Michał Ciebiera
Other reported AEs included urinary tract infections or hematuria. Their potential pathophysiology is unknown. The authors of one analyzed study reported pyelonephritis that needed antibiotic therapy [32]. Some authors suggested cystitis related to Foley catheterization during the procedure, but the opinion was not supported by evidence [24,36]. Further investigation is needed to establish which patients are in the risk group for this AE and should receive prophylactic antibiotic therapy before the procedure. Vaginal discharge and bleeding or fibroid expulsion after the procedure were also mentioned in several cases (Table 1). Moreover, abdominal subcutaneous tissue and muscle edema were reported. However, they were only an MRI finding after the procedure without any or with minimal symptoms in almost all cases [33].
Related Knowledge Centers
- Acute Kidney Injury
- Costovertebral Angle Tenderness
- Dysuria
- Fever
- Pyonephrosis
- Nausea
- Polyuria
- Kidney
- Pathogenic Bacteria
- Sepsis