Pyelonephritis classification: Difference between revisions
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==Overview== | ==Overview== | ||
Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, [[emphysematous]], and [[xanthogranulomatous]] pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis. | Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, [[emphysematous]], and [[xanthogranulomatous]] pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis.<ref name="pmid22417256">{{cite journal| author=Hooton TM| title=Clinical practice. Uncomplicated urinary tract infection. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 11 | pages= 1028-37 | pmid=22417256 | doi=10.1056/NEJMcp1104429 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22417256 }} </ref> | ||
==Classification== | ==Classification== | ||
Revision as of 15:32, 24 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pyelonephritis may be classified according to the duration of disease and etiology into 5 subtypes: acute uncomplicated, acute complicated, chronic, emphysematous, and xanthogranulomatous pyelonephritis. Most cases of Pyelonephritis are acute uncomplicated and occur in normal healthy individuals with no history of a structural urinary tract anomaly or any long disease. Classification of pyelonephritis helps understand dynamics and specify treatments according to the duration, severity and the type of pyelonephritis.[1]
Classification
There are five different types of pyelonephritis:[1][2]
- Acute Uncomplicated Pyelonephritis
- Acute pyelonephritis is a common clinical diagnosis in patients who present with fever, chills, and flank tenderness.
- Infections typically result from ascending retrograde spread through the collecting ducts into the renal parenchyma.
- Patients are referred for CT evaluation of acute pyelonephritis when symptoms are poorly localized or complications are suspected.
- Acute Complicated Pyelonephritis
- Acute complicated Pyelonephritis is the type that occurs in patients with known structural abnormalities of the urinary tract, pregnant or post menopausal women or in the presence of a disease like diabetes etc.
- Acute complicated Pyelonephritis requires a prolong duration of broad spectrum antibiotics.
- CT scan is used for confirmation and for detection of complications.
- Chronic Pyelonephritis
- Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. It is unclear that, whether it is an active chronic infection, arises from multiple recurrent infections, or represents stable changes from a remote single infection.
- Hypertension is frequently a long-term sequela.
- Emphysematous Pyelonephritis
- Emphysematous pyelonephritis represents a severe life-threatening infection (overall mortality rate of approximately 50%) of the renal parenchyma with gas-forming bacteria.
- Underlying poorly controlled diabetes mellitus is present in up to 90% of patients who develop emphysematous pyelonephritis.
- Patients present clinically with varying degrees of renal failure, lethargy, acid-base irregularities, and hyperglycemia.
- E coli is the causative bacterial source in approximately 70% of cases
- Xanthogranulomatous Pyelonephritis
- Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma.
- XGP is associated with a staghorn calculus in approximately 70% of cases.
- Patients with diabetes are particularly predisposed to the formation of XGP.
- Treatment is nephrectomy.
- At histologic analysis, the inflammatory mass is composed of lipid-laden macrophages and chronic inflammatory cells.
References
- ↑ 1.0 1.1 Hooton TM (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256.
- ↑ Lucaj R, Achong DM (2017). "Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging". Clin Nucl Med. 42 (1): 73–75. doi:10.1097/RLU.0000000000001415. PMID 27824318.