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Related Concept Videos

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
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The kidneys are intricate organs with millions of working units known as nephrons. Each nephron features two major structures: the renal corpuscle, which facilitates blood plasma filtration, and the renal tubule, which handles the glomerular filtrate. Blood supply is directly linked to the nephrons. The renal corpuscle consists of the glomerulus, a capillary network, and the Bowman's capsule, a double-walled epithelial structure that encases the glomerulus. The filtering of blood plasma...
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Encrusted pyelitis of native kidneys.

Alexandre Hertig1, Christian Duvic2, Yves Chretien3

  • 1Department of Nephrology, Necker Hospital, Paris, France.

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Summary

Encrusted pyelitis is a severe kidney infection often linked to urinary issues and prolonged antibiotic use. Early diagnosis via CT scans and prompt treatment with antibiotics and chemolysis can prevent kidney destruction and end-stage renal failure.

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Area of Science:

  • Nephrology
  • Urology
  • Infectious Diseases

Background:

  • Encrusted pyelitis is a rare but serious kidney infection affecting native kidneys.
  • Predisposing factors include underlying urologic conditions, debilitating illnesses, hospitalization, and extended antibiotic use.

Observation:

  • Four cases of encrusted pyelitis in native kidneys were analyzed.
  • Clinical presentations varied, including renal failure and cystitis symptoms.
  • Computed tomography (CT) scans were crucial for diagnosis, revealing struvite crystals and, in one case, Corynebacterium urealyticum infection.

Findings:

  • Diagnosis requires identifying predisposing factors, CT imaging, crystalluria, and urea-splitting bacteria.
  • Treatment success was achieved with intravenous vancomycin and local acidification in two patients.
  • Poor outcomes, including death and end-stage renal failure, occurred in patients undergoing surgery or palliative diversion.

Implications:

  • Encrusted pyelitis poses a significant threat to native kidney function, potentially leading to end-stage renal failure.
  • Early and accurate diagnosis is critical for effective treatment.
  • Chemolysis combined with targeted antibiotics offers a promising treatment strategy for encrusted pyelitis.