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Related Concept Videos

Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

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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 Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

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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 Infection IV: Nursing Management01:17

Urinary Tract Infection IV: Nursing Management

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In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs...
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Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

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AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
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Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Related Experiment Video

Updated: Jan 5, 2026

Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
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Emphysematous pyelonephritis: Does a standard management algorithm and a prognostic scoring model optimize patient

Amit Jain1, Ramanitharan Manikandan1, Lalgudi Narayanan Dorairajan1

  • 1Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Urology Annals
|October 26, 2019
PubMed
Summary

A standardized algorithm for emphysematous pyelonephritis (EPN) management improves survival and kidney salvage. Key risk factors for mortality include thrombocytopenia, low BMI, multiple comorbidities, high leukocyte count, and hypoalbuminemia.

Keywords:
Algorithm for the management of emphysematous pyelonephritisemphysematous pyelonephritisprognostic scoring of emphysematous pyelonephritis

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney.
  • Effective risk stratification and management are crucial for improving patient outcomes.

Purpose of the Study:

  • To identify risk factors for adverse outcomes in EPN patients.
  • To develop a prognostic scoring model for risk stratification.
  • To evaluate the effectiveness of a standardized management algorithm.

Main Methods:

  • Retrospective review of 72 EPN patients (February 2012 - January 2018).
  • Data collected included demographics, clinical, radiographic, and laboratory findings.
  • Patients were managed with a standardized protocol and categorized by outcome (conservative survival, nephrectomy survival, mortality).

Main Results:

  • Overall survival was 90%, with an 80% kidney salvage rate.
  • Diabetes mellitus was the most common comorbidity (86%).
  • Thrombocytopenia, low BMI, >2 comorbidities, high total leukocyte count (TLC), and hypoalbuminemia were significant mortality predictors.
  • A prognostic score stratified patients into favorable (0% mortality), intermediate (19% mortality), and poor (100% mortality) risk groups.

Conclusions:

  • A standardized management algorithm for EPN reduces mortality and avoids unnecessary nephrectomies.
  • Identifying and managing key risk factors can significantly improve patient prognosis.
  • The developed prognostic scoring model aids in effective risk stratification for EPN patients.