Disorders of the renal system
Judy Bothamley, Maureen Boyle in Medical Conditions Affecting Pregnancy and Childbirth, 2020
Pyelonephritis is an acute bacterial infection of the renal pelvis which can spread into the tissue of the kidney. It occurs in approximately 1–2% of all pregnancies and is most commonly the result of an ascending urinary tract infection6. Symptoms of pyelonephritis include backache, tenderness, high fever, rigors, lower UTI symptoms and nausea and vomiting16. Acute pyelonephritis can cause preterm rupture of the membranes and trigger uterine contractions and hence is a cause of preterm labour and low birth weight16. Diagnosis is made by a combination of symptoms and urine culture. Blood cultures may be indicated if the woman has a raised temperature and/or other signs of sepsis. Treatment will require admission to hospital, IV antibiotics and rehydration. Implementation of the septic bundle may be indicated. Monitoring for fetal well-being and assessment for contractions will be undertaken. Regular observations recorded on a MEOWS chart are advocated as both sepsis and respiratory deterioration may occur, and prompt recognition and referral are needed. An ultrasound of the urinary tract should be performed to identify any renal stones, structural abnormalities, obstruction, or excessive dilation of the renal pelvis or ureters16. The recurrence rate for pyelonephritis is up to 18% so urine samples must be regularly sent for laboratory assessment for the remainder of the pregnancy and in the postnatal period.
Schistosoma haematobium
Eric S. Loker, Bruce V. Hofkin in Parasitology, 2015
Pathology As with S. mansoni, the pathology caused by S. haematobium results from eggs trapped in the tissues, in this case primarily in the bladder wall. Infections are often accompanied by hematuria (blood in the urine) (Figure 2). Long-term infection can incite squamous cell carcinoma in the bladder, a rare example of cancer induced by a eukaryotic infectious agent. Damage to the ureters can obstruct the flow of urine and cause hydronephrosis (dilation of the pelvis and calyces of the kidneys). Pyelonephritis, or bacterial infection in the kidney, is another frequent consequence of infection. Damage to the glomeruli of the kidneys resulting from deposition of immune complexes can also occur. Infection can result in lesions in the lower female genital tract, likely facilitating the spread of sexually transmitted diseases, including HIV.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The diagnosis of acute pyelonephritis is usually made via history and physical examination in conjunction with positive urinalysis, and imaging is not generally needed, except in patients with an atypical presentation or a suspected complication. IV contrast-enhanced CT is the imaging method of choice in adult patients. The classic findings of acute pyelonephritis on CT are wedge-shaped and striated areas of decreased enhancement. There is also usually stranding of the perinephric fat and thickening of Gerota’s fascia. The kidney involved may also be enlarged or demonstrate areas of focal swelling in the acute setting, and then may become scarred and contracted if the infection progresses to a chronic state. The imaging abnormalities, however, usually resolve over 1–5 months. Persistent pyuria after appropriate antibiotic treatment correlates with residual inflammation that may still be detected with imaging. However, in most patients, clinical signs such as fever abate within 24–48 hours after appropriate antibiotic therapy, and patients are considered clinically cured within 4–5 days [2].
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.
Surgical aspects of venous pelvic pain treatment
Published in Current Medical Research and Opinion, 2019
S. G. Gavrilov, O. I. Efremova
Aorto-mesenteric compression of the left renal vein (the nutcracker syndrome) is the top second anatomical cause of vein dilation and blood reflux in the left gonadal vein. This syndrome develops when the superior mesenteric artery extends inferiorly at an acute angle with the aorta, causing compression of the left renal vein, which results in the occurrence of left-sided renal phlebohypertension and, eventually, valvular incompetence and dilation of the gonadal and parametrial veins, i.e. PCS development. According to various authors, aorto-mesenteric compression of the left renal vein with pre-stenotic dilation of the vessel by more than 50% was found in 30–40% of studied patients, and the nutcracker syndrome is observed in 15–17% of patients with VPP10. According to White and Holdstock, in some cases duplex ultrasound angioscanning reveals pseudo-nutcracker syndrome caused by a siphon effect of left ovarian vein reflux, rather than true anatomical pathology11. Another syndrome to note is uretero-ovarian conflict, known as right gonadal vein syndrome (RGVS), which occurs due to compression of the right ureter by the dilated unilateral ovarian vein. RGVS was first described by Clark in 1964, who published an analysis of 129 such patients12. He suggested that, during pregnancy, the aberrant right gonadal vein can squeeze the ureter, causing symptoms of ureteral obstruction that persist after delivery. This leads to disruption of the normal passage of urine, the occurrence of signs of urinary infection and the development of chronic pyelonephritis.
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).
Related Knowledge Centers
- Acute Kidney Injury
- Costovertebral Angle Tenderness
- Dysuria
- Fever
- Pyonephrosis
- Nausea
- Polyuria
- Kidney
- Sepsis
- Pathogenic Bacteria