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Related Concept Videos

Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

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 as Proteus,...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

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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Urinary Tract Infection II: Pathophysiology

The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
Pneumonia I: Introduction01:29

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Urinary Tract Infection I: Introduction01:26

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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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Chronic Obstructive Pulmonary Disease II: Emphysema

Emphysema, a major phenotype of chronic obstructive pulmonary disease (COPD), is characterized by irreversible destruction of alveolar walls and permanent enlargement of distal airspaces. Unlike chronic bronchitis, which primarily affects the airways, emphysema predominantly involves the lung parenchyma, where structural damage leads to airflow limitation.PathophysiologyIt most commonly results from prolonged exposure to cigarette smoke and other toxic gases, particularly cigarette smoke.

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Bilateral extensive emphysematous pyelonephritis. A case report.

Ing-Kit Lee1, Ching-Jung Hsieh, Jien-Wei Liu

  • 1Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre
|February 11, 2009
PubMed
Summary

This case study shows that early antibiotic therapy and nephrostomy can successfully treat bilateral emphysematous pyelonephritis (EPN) in diabetic patients, potentially avoiding surgery. Prompt diagnosis via radiography is crucial for managing this condition.

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Radiology

Background:

  • Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma.
  • Diabetes mellitus is a significant risk factor for EPN, often associated with poor glycemic control.
  • Bilateral EPN presents a complex clinical challenge due to the involvement of both kidneys.

Observation:

  • A 54-year-old diabetic male presented with abdominal pain, acute renal failure, and hyperglycemic hyperosmolar state.
  • Radiography and CT scans revealed gas within the bilateral kidneys, ureters, bladder, prostate, and scrotum.
  • Blood and urine cultures identified Escherichia coli as the causative pathogen.

Findings:

  • The patient received successful treatment with antibiotics and nephrostomy.
  • This conservative management approach avoided the need for nephrectomy.
  • Early diagnosis and intervention are key to favorable outcomes in bilateral EPN.

Implications:

  • Timely antibiotic therapy and nephrostomy can be curative for bilateral EPN, preserving renal function.
  • Radiographs are essential for early diagnosis in diabetic patients presenting with abdominal pain and suspected urinary tract infections.
  • Non-specific symptoms of EPN necessitate a high index of suspicion, particularly in diabetic populations.