Pyelonephritis

Nov 14, 2021 | 0 comments

Nov 14, 2021 | Writing Guide | 0 comments

Acute Pyelonephritis can be defined as infection that occurs in the renal pelvis and in most cases it is always followed by an individual having infections in the renal parenchyma. The main source of infection is majorly from the bladder but in some cases haematogenous spread can also happen. The organisms that cause this are almost similar to those that cause Urinary Tract Infection for example; *Escherichia coli and proteus species. *When there is a repetitive occurrences of acute pyelonephritis, the affected individual have a higher chance of acquiring chronic pyelonephritis. This may in return lead to the scarring and destruction of tissues of the renal organs because of repeated inflammation (Leroy et al., 2013).
Acute Pyelonephritis can be acquired at any given age. In a previous research, it was found that 3% of girls and 1% of the boys have the probability of acquiring this infection by the time they are 7 years of age. However, it was found that women between the age of 15-29 have the highest incidents of these cases and are closely followed by babies and the aged (Colgan et al., 2011). It has the following symptoms; fever which is variable but in some cases might be extremely high to the extent of producing rigors, vomiting and nausea, loin pain which can be bilateral or unilateral, in some cases it may be associated with UTI symptoms. However in children and more so infants, symptoms are less in most cases and urine culture should be done frequently in sick children in order to be sure.
This disease can be diagnosed through the following ways; first and foremost urinalysis. In most cases, the urine of the infected individual is usually cloudy and has offensive smell. Sample of urine should be cultured and sent to microscopy. The microscopy of urine identifies pyuria. Studies that were currently undertaken showed that procalcitonin is a biological marker when it comes to acute pyelonephritis diagnosis in children. The third way of diagnosis is by imaging. This is useful when the clinical picture is ambivalent because structural problems are not very uncommon. It is majorly recommended in children and men and is a compulsory test for patients who have recurrent pyelonephritis and it might also assist in the identification of stones.
In management of acute pyelonephritis, it is recommended that patients should have enough rest and take adequate fluids. The second way of management is the admission of these patients in the hospital. As much as many of these patients can be taken care of in the community, guidelines recommend admission of expectant women because of their complication risks. Other cases that may involve admission are; the inability of the patient to take fluids, severe pain, the obstruction of the urinary tract, extreme vomiting and the failure to respond positively to treatment. Another way of managing this infection is by taking antibiotics. The patient is advised to begin empirical antibiotic treatment when waiting for sensitivity and culture. It is recommended that adults should either take coamoxiclav 500/125mg tablets or ciprofloxacin 500mg for 7 days (Strohmeier et al., 2014).
Co-amoxiclav is recommended for children as a first line treatment and the second line treatment as cefixime. It was found out that children who do not receive early treatments with intravenous antibiotics have a greater chance of developing renal scarring. Other studies have showed that for children over the age of one month, this infection can be managed and controlled by oral therapy. This infection can be prevented by; considering prophylactic treatment for women who have a minimal of three symptomatic infections per annum and reserve antibiotic prophylaxis for children who have a high risk of complications for example renal scarring (Nickavar and Sotoudeh, 2011).
References
Colgan R., Williams M., Johnson J., (2011). *Diagnosis and treatment of acute pyelonephritis in women.* Am Fam Physicisian.
Leroy S., Fernandez A.,Nikfar R. et al., (2013). *Association of procalcitonin with pyelonephritis and renal scars in pediatric UTI.* Pediatrics. Epub
Strohmeier Y., Hudson E., Willis N. et al., (2014). *Antibiotics for acute pyelonephritis in children.* Cochrane Database Syst Rev.