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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Pyelonephritis is very common, with 120-130 [[incidence|cases annually]] per 100,000 women and 30-40 cases per 100,000 men. <ref>{{cite journal |author=Czaja CA, Scholes D, Hooton TM, Stamm WE |title=Population-based epidemiologic analysis of acute pyelonephritis |journal=Clin. Infect. Dis. |volume=45 |issue=3 |pages=273-80 |year=2007 |pmid=17599303 |doi=10.1086/519268}}</ref> | Pyelonephritis is very common, with 120-130 [[incidence|cases annually]] per 100,000 women and 30-40 cases per 100,000 men. <ref>{{cite journal |author=Czaja CA, Scholes D, Hooton TM, Stamm WE |title=Population-based epidemiologic analysis of acute pyelonephritis |journal=Clin. Infect. Dis. |volume=45 |issue=3 |pages=273-80 |year=2007 |pmid=17599303 |doi=10.1086/519268}}</ref> | ||
==Historical Perspective== | |||
[[Urinary tract infections]] have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC. In 1836, Philadelphia surgeon Joseph Parrish published the earliest record of [[interstitial cystitis]] by describing three cases of severe lower urinary tract symptoms without the presence of a [[bladder stone]].The term "[[interstitial cystitis]]" was coined by Dr. [[Alexander Skene]] in 1887 to describe the disease.<ref name=abc> Interstitial Cystitis. Wikipedia.https://en.wikipedia.org/wiki/Interstitial_cystitis#History Accessed on February 8, 2016</ref> | |||
Classification | |||
Cystitis may be classified according to the [[etiology]] and [[therapeutic]] approach into 5 subtypes: traumatic, [[interstitial]], [[eosinophilic]], [[hemorrhagic cystitis]], and cystitis cystica. For the purpose of treatment, cystitis may also be classified into acute uncomplicated, complicated, and recurrent cystitis.<ref name="pmid22233286">{{cite journal| author=Friedlander JI, Shorter B, Moldwin RM| title=Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. | journal=BJU Int | year= 2012 | volume= 109 | issue= 11 | pages= 1584-91 | pmid=22233286 | doi=10.1111/j.1464-410X.2011.10860.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22233286 }} </ref><ref name="pmid4775738">{{cite journal| author=Watson NA, Notley RG| title=Urological complications of cyclophosphamide. | journal=Br J Urol | year= 1973 | volume= 45 | issue= 6 | pages= 606-9 | pmid=4775738 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4775738 }} </ref><ref name="pmid27621918">{{cite journal| author=Kilic O, Akand M, Gul M, Karabagli P, Goktas S| title=Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 6 | pages= e24562 | pmid=27621918 | doi=10.5812/ircmj.24562 | pmc=5002967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27621918 }} </ref><ref name="pmid9378923">{{cite journal| author=Hooton TM, Stamm WE| title=Diagnosis and treatment of uncomplicated urinary tract infection. | journal=Infect Dis Clin North Am | year= 1997 | volume= 11 | issue= 3 | pages= 551-81 | pmid=9378923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9378923 }} </ref><ref name="pmid27843222">{{cite journal| author=Halder P, Mandal KC, Mukherjee S| title=Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication. | journal=Indian J Urol | year= 2016 | volume= 32 | issue= 4 | pages= 329-330 | pmid=27843222 | doi=10.4103/0970-1591.189718 | pmc=5054670 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27843222 }} </ref> | |||
Pathophysiology | |||
Cystitis occurs when the normally sterile [[lower urinary tract]] ([[urethra]] and [[bladder]]) is infected by bacteria, which leads to irritation and [[inflammation]]. Females are more prone to the development of cystitis because of their relatively shorter [[urethra]]. Bacteria does not have to travel as far to enter the [[bladder]], which is in part due to the relatively short distance between the opening of the [[urethra]] and the [[anus]]. The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.<ref name="pmid10969044">{{cite journal| author=Hooton TM| title=Pathogenesis of urinary tract infections: an update. | journal=J Antimicrob Chemother | year= 2000 | volume= 46 Suppl A | issue= | pages= 1-7 | pmid=10969044 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10969044 }} </ref> | |||
==Causes== | |||
Most of cases of Pyelonephritis are caused by ''[[escherichia coli]] ("E. coli")'', a bacterium found in the lower [[gastrointestinal tract]]. Other causes of cystitis include certain [[medications]], [[diabetes]], [[Crohn's disease]], iatrogenic causes, [[endometriosis]], [[pelvic inflammatory disease]], [[urinary obstruction]], and [[bladder incontinence]]. | |||
==Differential Diagnosis== | |||
Cystitis must be differentiated from other causes of [[dysuria]] such as [[Cystitis]], [[urethritis]], [[prostatitis]], [[vulvovaginitis]], [[urethral stricture]]s or diverticula, [[benign prostatic hyperplasia]] and [[neoplasm]]s such as [[renal cell carcinoma]] and cancers of the bladder, prostate, and penis.<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635 }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306 }} </ref> | |||
==Epidemiology and Demographics== | |||
Urinary tract infections are the most frequent [[bacterial infection]] in women.Females are more commonly affected with pyelonephritis than males.<ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306 }} </ref>.<ref name="pmid15206056">{{cite journal| author=Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE| title=Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 1 | pages= 75-80 | pmid=15206056 | doi=10.1086/422145 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15206056 }} </ref> | |||
==Risk Factors== | |||
Common risk factors in the development of pyelonephritis include urinary catheters, bladder stones, [[diabetes]], [[pregnancy]], [[catheterization]], bowel [[incontinence]], old age, and immobility. | |||
==Natural History, Complications, and Prognosis== | |||
==Diagnosis== | |||
===History and Symptoms=== | |||
===Physical Examination=== | |||
===Laboratory Findings=== | |||
==Treatment== | ==Treatment== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis.[1].
Epidemiology and Demographics
Pyelonephritis is very common, with 120-130 cases annually per 100,000 women and 30-40 cases per 100,000 men. [2]
Historical Perspective
Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC. In 1836, Philadelphia surgeon Joseph Parrish published the earliest record of interstitial cystitis by describing three cases of severe lower urinary tract symptoms without the presence of a bladder stone.The term "interstitial cystitis" was coined by Dr. Alexander Skene in 1887 to describe the disease.[3]
Classification Cystitis may be classified according to the etiology and therapeutic approach into 5 subtypes: traumatic, interstitial, eosinophilic, hemorrhagic cystitis, and cystitis cystica. For the purpose of treatment, cystitis may also be classified into acute uncomplicated, complicated, and recurrent cystitis.[4][5][6][7][8]
Pathophysiology Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria, which leads to irritation and inflammation. Females are more prone to the development of cystitis because of their relatively shorter urethra. Bacteria does not have to travel as far to enter the bladder, which is in part due to the relatively short distance between the opening of the urethra and the anus. The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.[9]
Causes
Most of cases of Pyelonephritis are caused by escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Other causes of cystitis include certain medications, diabetes, Crohn's disease, iatrogenic causes, endometriosis, pelvic inflammatory disease, urinary obstruction, and bladder incontinence.
Differential Diagnosis
Cystitis must be differentiated from other causes of dysuria such as Cystitis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis.[10][11]
Epidemiology and Demographics
Urinary tract infections are the most frequent bacterial infection in women.Females are more commonly affected with pyelonephritis than males.[11].[12]
Risk Factors
Common risk factors in the development of pyelonephritis include urinary catheters, bladder stones, diabetes, pregnancy, catheterization, bowel incontinence, old age, and immobility.
Natural History, Complications, and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Treatment
Medical Treatment
Treatment of Pyelonephritis is usually medical. In case of any risk factors like catheters or obstructing stones or masses, the management includes removing the risk factors to prevent further progress of the disease and the pathogen accumulation.
Surgery
In recurrent infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to improve chances of recurrence.
References
- ↑ Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician. 71 (5): 933–42. PMID 15768623.
- ↑ Czaja CA, Scholes D, Hooton TM, Stamm WE (2007). "Population-based epidemiologic analysis of acute pyelonephritis". Clin. Infect. Dis. 45 (3): 273–80. doi:10.1086/519268. PMID 17599303.
- ↑ Interstitial Cystitis. Wikipedia.https://en.wikipedia.org/wiki/Interstitial_cystitis#History Accessed on February 8, 2016
- ↑ Friedlander JI, Shorter B, Moldwin RM (2012). "Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions". BJU Int. 109 (11): 1584–91. doi:10.1111/j.1464-410X.2011.10860.x. PMID 22233286.
- ↑ Watson NA, Notley RG (1973). "Urological complications of cyclophosphamide". Br J Urol. 45 (6): 606–9. PMID 4775738.
- ↑ Kilic O, Akand M, Gul M, Karabagli P, Goktas S (2016). "Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children". Iran Red Crescent Med J. 18 (6): e24562. doi:10.5812/ircmj.24562. PMC 5002967. PMID 27621918.
- ↑ Hooton TM, Stamm WE (1997). "Diagnosis and treatment of uncomplicated urinary tract infection". Infect Dis Clin North Am. 11 (3): 551–81. PMID 9378923.
- ↑ Halder P, Mandal KC, Mukherjee S (2016). "Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication". Indian J Urol. 32 (4): 329–330. doi:10.4103/0970-1591.189718. PMC 5054670. PMID 27843222.
- ↑ Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
- ↑ Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
- ↑ 11.0 11.1 Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
- ↑ Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE (2004). "Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy". Clin Infect Dis. 39 (1): 75–80. doi:10.1086/422145. PMID 15206056.