Management Of Acute Pyelonephritis Research Articles

Causes and Management of Acute Pyelonephritis

Acute pyelonephritis is a bacterial infection that causes kidney inflammation. Pyelonephritis is a kidney infection that develops as a result of an ascending urinary tract infection that travels from the bladder to the kidneys. Acute pyelonephritis affects over 250,000 people each year, resulting in more than 100,000 hospitalizations. Infection with Escherichia coli is the most prevalent cause. Fever, vomiting, abdomen or loin discomfort, and fatigue are all symptoms of acute pyelonephritis, however Fever is the most clinically useful symptom. Escherichia coli is the causative agent in more than 80% of instances of acute pyelonephritis. Staphylococcus saprophyticus, and enterococci are among the other etiologic factors. While Infections caused by Klebsiella, Enterobacter, Clostridium, or Candida are more common in diabetic patients. Acute pyelonephritis can be treated as an outpatient or as an inpatient procedure. Outpatient treatment is available for healthy, young, non-pregnant women with uncomplicated pyelonephritis. The choice of first-line oral antibiotics depends on local antibiotic resistance characteristics, although trimethoprim alone or in combination with sulphamethoxazole, cephalexin, or amoxicillin-clavulanic acid. In this article we will be looking the causes and management of acute pyelonephritis.

Management of acute pyelonephritis in the emergency department observation unit.

This study aimed to assess the effectiveness of the emergency department observation unit (EDOU) for patients with acute pyelonephritis in a Singapore tertiary academic medical centre. We reviewed the clinical records of consecutive patients who presented with pyelonephritis between 1 July 2012 and 31 October 2014 to collect information on demographics, symptoms, signs, laboratory and radiological results, treatment, and clinical outcomes. Of 459 emergency department (ED) patients who were identified as having pyelonephritis, 164 (35.7%) were managed in the EDOU. Successful management in the EDOU was achieved in 100 (61.0%) patients. Escherichia coli was the predominant (64.6%) micro-organism in urine cultures and was positive in 106 patients. Patients diagnosed with acute pyelonephritis who were successfully managed in the EDOU had a lower incidence of nausea (32.0% vs. 60.9%, p < 0.001) and vomiting (15.0% vs. 50.0%, p < 0.001) compared to those who were not successful. EDOU is useful for both observation and treatment of patients with acute pyelonephritis. Urine cultures are sufficient for the identification of the culprit micro-organism. Patients who present with prominent symptoms of vomiting should have routine administration of antiemetics, while consideration for second-line antiemetics is recommended for those with persistent symptoms.

Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report

BackgroundAcute appendicitis and acute pyelonephritis are the most common diseases admitted to emergency departments. Both conditions have common symptoms such as flank pain, abdominal pain, and fever. Patients’ history, physical examination, laboratory evaluation, and imaging methods are used to differentiate these two conditions. Diverticulitis, colitis, gynecological pathologies, and ureteral stones that mimic acute appendicitis should be kept in mind as differential diagnoses. Cases of pyelonephritis mimicking acute appendicitis have been reported in the literature, but there has not been a reported case in which acute appendicitis occurs during management of acute pyelonephritis. In this article, a case report which can cause such a diagnostic dilemma has been presented.Case presentationA 42-year-old female patient presented with clinical features suggestive of acute appendicitis that developed after a diagnosis of acute pyelonephritis. She underwent laparoscopic appendectomy on account of acute appendicitis during medical treatment for acute pyelonephritis. Physical examination showed only right costovertebral tenderness without any rebound tenderness at McBurney’s point at the first admission, but during treatment rebound tenderness at McBurney’s point was also detected. The Alvarado score of the patient was 5 at the first admission and 7 when acute appendicitis was diagnosed. The patient fully recovered and was discharged after both diseases were completely treated.ConclusionsAs seen in this case, it should be remembered that both diseases can be seen together which causes a diagnostic dilemma. If clinical or biochemical progression is detected in a patient under treatment, imaging methods should be repeated and additional ones with higher resolutions should be used.

VP51.04: Maternal renal ultrasound in the management of acute pyelonephritis in pregnancy

VP51.04: Maternal renal ultrasound in the management of acute pyelonephritis in pregnancy

Epidemiological profile and management of acute pyelonephritis in the emergency department of a tertiary hospital: A retrospective observational study

Objective: To assess the clinical and microbiological characteristics as well as the risk factors of early readmission ( Methods: The medical records of patients discharged with a diagnosis of APN between January 1, 2014 and December 31, 2015 were reviewed. Epidemiological, clinical, ultrasound results, and laboratory characteristics were collected, and the risk factors of prompt readmission and non-prompt readmission were assessed. Results: A total of 423 APN patients were included. The mean age was (44.3±19.0) years. The bulk of the patients were women (79.9%), and 20% of cases had episodes previously. Urine cultures were requested in 77.5% of cases, with Escherichia coli being the most frequently isolated bacterium (80.1%). Resistance to one or more antibiotics was found in 68.1% of the bacteria. The most widely used antibiotics were beta-lactam with beta-lactamases inhibitor (46%), and aminoglycosides in 24.4% of cases. Altogether, 73.5% of the patients received antibiotic treatment in the ED, and 46.8% of the patients were discharged. Furthermore, 6.1% of the patients discharged from the ED had re-admission without associated risk factors. Conclusions: Given the high rate of resistance, it is important to know the profile of antibiotics in different areas. Likewise, the administration of antibiotics in the ED is useful in the prevention of early readmissions of APN (<72 h).

Role of emergency ultrasound screening in the management of acute pyelonephritis in emergency department: A large observational study from a tertiary care center of South India

Background: Role of emergency ultrasound screening (EUS) in the evaluation of all patients with clinically suspected acute pyelonephritis (APN) in the emergency department (ED) remains unclear. The aim of the study was to describe the frequency of abnormal EUS findings in APN presenting to ED and ascertain the laboratory abnormalities associated with significant abnormal findings to identify the subgroup of patients who will benefit from EUS in ED. Methodology: In this retrospective study, electronic medical records were searched to identify all adult patients who underwent EUS screening from ED for initial clinical diagnosis of APN over 1 year. The EUS findings were categorized into normal, major abnormalities (hydronephrosis, renal abscess, and emphysematous pyelonephritis), and mild abnormalities (cysts, calculi, and renal edema). Results: A total of 1218 patients with initial clinically diagnosed APN underwent EUS. Nearly 49% had a normal EUS while 51% had at least one major or minor abnormality. The frequency of hydroureteronephrosis, renal calculi emphysematous changes, and renal abscess was 19.1%, 8.9%, 2.1%, and 1.9%, respectively. Only 72 (5.9%) patients required emergency percutaneous nephrostomy or drainage of an abscess. Among these patients, EUS was able to identify a major abnormality in sixty (83.3%) patients. Male gender, presence of diabetes mellitus, peripheral white blood cell (WBC) count >10,000 cells/cumm, serum creatinine >1.4 mg%, and urine WBC count >100 cells/hpf were found to independently predict the presence of an abnormality on an EUS. Conclusion: A large proportion of APN patients have only normal or minor abnormalities and do not need additional screening and intervention.

Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up?

To assess reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) in the management of acute pyelonephritis (APN) foci in transplanted kidneys. In the 2012-2014 period, 24 kidney-transplanted patients underwent MR screening for clinical suspicion of APN. Two readers independently analyzed all images, establishing presence and location of APN foci. The 22 patients who were positive at the MR exam constituted the study population. For each patient the apparent diffusion coefficient (ADC) was measured in the APN foci and in three sites of the healthy parenchyma (case-control comparison). The data were matched to the laboratory measurements for white blood cell, C-reactive protein, and serum creatinine. Forty-six APN foci were found in 22/24 patients. At the acute stage, the difference in ADC between healthy parenchyma and APN foci was significant (2.06±0.16 vs. 1.43±0.32×10(-3)mm(2)/s; p<0.0001). The performance of ADC as APN indicator was tested by the receiving operating characteristics (ROC) curve: the area under curve AUC=0.99 witnessed an excellent discriminatory ability, with threshold APN/normal parenchyma 1.9×10(-3)mm(2)/s. At the 1-month follow-up 43/46 APN foci were no longer visible, with ADC values significantly higher than at the acute stage; all laboratory data were physiological, with WBC significantly reduced from the acute phase (5.2±1.6×10(9)/L vs. 10.6±4.8×10(9)/L; p<0.0001). The other 3 patients underwent further therapy and exams, including a third MR. DW-MRI with ADC measurement seems to be a reliable tool in diagnosing and monitoring APN foci in transplanted kidneys, with clinical impact on patient management.

Factors influencing length of stay and suitability for early community discharge in the management of acute pyelonephritis

Objectives:We assessed factors influencing length of stay and suitability for early discharge to community care in acute pyelonephritis (APN).Methods:APN patients admitted in 2011–2012 to a tertiary hospital were included in a retrospective study. Data collected included patient demographics, Charlson Comorbidity Index (CCI), admitting speciality, imaging, length of stay and any intervention.Results:A total of 266 patients were analysed with 83.1% managed by urologists and the rest by other specialties. Urology patients had a shorter mean stay of 4.7 days compared to 8.8 days for non-urology patients ( p &lt; 0.001). The mean time to imaging was 0.5 days and 1.4 days for urology and other specialties, respectively ( p &lt; 0.001). Twenty per cent of patients had urinary tract abnormalities on imaging but only 2.0% required intervention; 9.4% (25/266) had repeated imaging following an initial scan but none resulted in an intervention. A high CCI was a predictor of longer stays regardless of admitting speciality ( p &lt; 0.001). Admission to non-urological specialities remained a significant predictor both of delayed imaging ( p = 0.001) and longer stays ( p &lt; 0.001) even after correction for CCI.Conclusion:Time to imaging, comorbidity and admitting speciality are key factors influencing APN management. Rapid urological review and imaging could identify patients suitable for safe early discharge to community management.

Antibiothérapie de l’infection urinaire : orale ou parentérale ?

Management of acute pyelonephritis has long been discussed. The French drug agency (Agence Française de Sécurité Sanitaire des Produits de Santé [AFSSAPS]) has published guidelines for clinical practice in 2007: two to four days of initial parenteral antibiotic therapy followed by oral antibiotics, for a total duration of 10 to 14 days. However, recent data are conflictable and oral antibiotic therapy may be sufficient in some cases. Clinical trials on oral therapy of acute pyelonephritis in selected groups of children are currently ongoing. We suggest following AFSSAPS recommendations in clinical practice until the results of such trials become available. In the future, we can speculate that antibiotic therapy may be reduced in some low risk patients, keeping in mind that around 15% of children with acute pyelonephritis will develop renal scars which may lead to hypertension and microalbuminuria in adulthood.

Preventive Effect of Rolipram, a Phosphodiesterase 4 Enzyme Inhibitor, on Oxidative Renal Injury in Acute Ascending Pyelonephritis Model in Rats

To evaluate the effects of rolipram, a phosphodiesterase 4 enzyme inhibitor, on Escherichia coli-induced renal oxidative damage in an acute pyelonephritis (PYN) rat model. A total of 35 male Wistar albino rats were randomly divided into 7 groups (n = 5) as follows: control (uninfected), PYN 24 hours, PYN 48 hours, PYN 72 hours, PYN + rolipram 24 hours, PYN + rolipram 48 hours, and PYN + rolipram 72 hours. Ascending PYN was induced in the study groups by E. coli inoculation into the bladder, and the urethras were then occluded by collodium for 4 hours. Rolipram injections (1 mg/kg) were started before bacterial inoculation and repeated at 24-hour intervals in the PYN + rolipram groups until death. The rats were killed at the indicated times. Malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were determined in kidney homogenates. Histopathologic examinations were also performed. Tissue malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were significantly increased in the kidneys from the PYN groups. However, rolipram administration reduced renal malondialdehyde and nitric oxide levels and enhanced superoxide dismutase and catalase activities. The histopathologic examinations demonstrated that rolipram treatment reduced the inflammation grade in the kidney specimens. The results of our study have shown that rolipram has a protective effect on renal tissue from E. coli-induced oxidative injury. Therefore, phosphodiesterase 4 inhibitors might be a novel therapeutic option for the prevention and/or management of acute PYN.

Attitude of Nigerian paediatricians towards the management of acute pyelonephritis

Attitude of Nigerian paediatricians towards the management of acute pyelonephritis

Prise en charge des pyélonéphrites aiguës du nourrisson de plus de 3 mois et de l'enfant : enquête effectuée parmi les services d'urgences pédiatriques d'Île de France en 2004

Objectives. – To describe the different modalities of ambulatory management of acute pyelonephritis in patients older than 3 months of age in paediatric emergency units of the Ile de France region in 2004. Methods. – Between October 2003 and April 2004, referents of 39 paediatric emergency units of the Ile de France region were questioned through a written questionnaire concerning the management of acute pyelonephritis: in or outpatient modalities, antibiotic regimen (molecule and route of administration), investigations and follow-up. Results. – Thirty-one questionnaires (79.5%) were returned and analysed. A written protocol was available in 60% of the units. Outpatient management was performed in 24/31 centres. Young age, poor clinical tolerance, urological abnormalities and social difficulties were the major contra-indications for such management. Ultrasonic echography at diagnosis (within 24 h) was performed in 50% of the units. Antibiotics were started using IV route in 18/24 units (75%) and ceftriaxone and aminoside were respectively prescribed in 100% and 29.4% of the units for a duration of 1 to 5 days before switching to the oral route. Antibiotherapy was started orally in 6 units and cefixime was chosen by 5 of them. Follow-up consultations were scheduled in 100% of the units but with various delay after initiation of the treatment. The total duration of treatment was mostly 10 days and oral prophylactic antibiotherapy was prescribed by 10/24 centres after completion of the treatment. Cystoureterography was systematically realized by 83.3% of the units. Conclusions. – Despite important differences in the management of acute pyelonephritis in Ile-de-France, a majority of the units follows similar therapeutic modalities. In the absence of consensus, new recommendations are necessary concerning the management of pyelonephritis in infants and children in France.

Ambulatory management of acute pyelonephritis in children

Ambulatory management of acute pyelonephritis in children

Ambulatory management of acute pyelonephritis in children

Early diagnosis and treatment of acute pyelonephritis (APN) are justified by the risk of recurrent infection and renal scarring in young children (1–3). Ambulatory treatment improves patients' comfort and provides significant cost savings to the health system. This work presents our experience in ambulatory management of APN in children. This retrospective study was carried out over a period of 18 mo, from 1 January 1995 to 30 June 1996.

Attitudes of General Practitioners and Pediatricians to Management of Acute Pyelonephritis in Children

Objective: To study the attitudes of different groups of physicians toward management of acute pyelonephritis in children and the impact of such attitudes on the long-term sequelae of this problem. Materials and Methods: A questionnaire, describing a case history of a child with acute pyelonephritis, was distributed to general practitioners working in 12 primary health care centers and pediatricians working in the pediatric departments of the 6 main hospitals in Kuwait. The responses of the two groups were analyzed regarding their views toward hospitalization of the child, investigations requested, the choice of antibiotics, its route of administration, duration of treatment and the need for long-term follow-up. Results: A total of 83 general practitioners (group A) and 65 hospital pediatricians (group B) responded to the questionnaire. Hospitalization of the child was thought to be essential by 19% of group A compared to 89% of group B (p < 0.0001). Only 25% of group A decided to fully investigate the child compared to 58% of group B (p < 0.0001). Treatment with a single antibiotic was preferred by 72% of group A compared to 80% of group B. Only 6% of group A, compared to 74% of group B favored parenteral antibiotics (p < 0.0001). A 7-day course of treatment was considered by 70% of group A and 52% of group B (p < 0.02). Long-term follow-up was thought to be necessary by 63% of group A and 75% of group B. Conclusion: A marked discrepancy existed in the management of acute pyelonephritis between the two groups, indicating the need of a unified policy. Children presenting with such a problem can be managed by general practitioners on an outpatient basis provided that proper antibiotics are used, compliance is ensured and appropriate investigations and follow-up are provided.

Pulmonary injury associated with antepartum pyelonephritis: Can patients at risk be identified?

The development of pulmonary injury in cases of antepartum pyelonephritis is rare but serious. To date, factors that might identify patients at risk have not been determined. We compared 11 patients with pyelonephritis and pulmonary injury with 119 patients with pyelonephritis only. Pulmonary injury was more likely to occur in the more severe cases; however, the presence of a maternal heart rate greater than 110 beats/min and a fever to 103 degrees F 12 to 24 hours before the occurrence of respiratory symptoms in a gestation greater than 20 weeks was highly predictive of pulmonary injury. The most significant predictive factors associated with pulmonary injury were elements of treatment such as fluid overload, use of tocolytic agents, and, to a lesser extent, choice of antibiotic. Therefore, if tocolytic agents are considered at all in the management of acute pyelonephritis in pregnancy, they should be used only in patients with documented cervical change. In addition, urinary output should be monitored very closely. These data also may suggest a cause of the pulmonary edema that is occasionally seen in the management of premature labor with the use of tocolytic agents and fluids in the presence of a possible occult infection.

Management of acute pyelonephritis in an emergency department observation unit

To determine whether moderately to severely ill patients with acute pyelonephritis can be treated successfully on an outpatient basis, and whether any aspect of history, physical examination, or initial laboratory data predicts failure of outpatient therapy and the need for hospitalization. Retrospective chart review of all patients with a diagnosis of acute pyelonephritis seen during a three-year period. Emergency department observation unit of an urban teaching hospital serving residents of the city and county of Denver. Women between the ages of 15 and 50 with symptoms, physical examination, and initial laboratory data consistent with a diagnosis of pyelonephritis. Patients received IV antibiotics, rehydration, analgesics, and antiemetics in an observation unit for up to 12 hours, when they were either admitted to the hospital or discharged home on oral antibiotics. Sixty-three of 87 patients (72%) with acute pyelonephritis were managed successfully as outpatients, nine (22%) were hospitalized directly from the observation unit because they were considered to be too ill to go home, and five (6%) returned with persistent symptoms after ED therapy and were hospitalized. No clinical or laboratory variable predicted success or failure of ED observation unit therapy at the time of initial presentation. In selected patients, the observation unit may be used to initiate therapy for acute pyelonephritis. Those with an adequate clinical response to initial treatment may be discharged on oral antibiotic therapy with appropriate follow-up.