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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 I: Introduction01:26

Urinary Tract Infection I: Introduction

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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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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 Infection II: Pathophysiology01:25

Urinary Tract Infection II: Pathophysiology

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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...
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Pneumonia IV: Management01:28

Pneumonia IV: Management

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The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
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Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
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Emphysematous pyelonephritis: classification, management, and prognosis.

Shu-Yu Wu1, Stephen Shei-Dei Yang1,2, Shang-Jen Chang1,2

  • 1Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.

Tzu Chi Medical Journal
|August 1, 2022
PubMed
Summary

Emphysematous pyelonephritis (EPN) is a severe kidney infection. Early diagnosis via CT scans and prompt antibiotic treatment with drainage are key to avoiding nephrectomy and improving patient outcomes.

Keywords:
Emphysematous pyelonephritisGas-forming infectionNecrotizing pyelonephritisPrognostic factorsUrinary tract infections

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Area of Science:

  • Urology
  • Infectious Diseases
  • Radiology

Background:

  • Emphysematous pyelonephritis (EPN) is a severe, necrotizing kidney infection, a serious complication of urinary tract infections.
  • EPN presents with nonspecific symptoms, commonly including fever, flank pain, and nausea, and is associated with significant renal loss and mortality.
  • Risk factors include diabetes, obstructive uropathy, and hypertension, often requiring concurrent management.

Purpose of the Study:

  • To provide comprehensive, evidence-based recommendations for the diagnosis and management of EPN.
  • To review current diagnostic tools, classification systems, and treatment strategies for EPN.
  • To emphasize conservative management approaches over emergent nephrectomy.

Main Methods:

  • Diagnosis and classification rely on computed tomography (CT) scans, utilizing the Huang and Tseng classification system (Class 1-4).
  • Common pathogens include *Escherichia coli*, *Klebsiella pneumoniae*, and *Proteus mirabilis*.
  • Treatment involves broad-spectrum antibiotics (e.g., cephalosporins, carbapenems) and emergent drainage, preferably CT-guided.

Main Results:

  • The Huang and Tseng CT-based classification system stratifies EPN severity, with higher classes indicating more severe disease.
  • Conservative management, including antibiotics and drainage, is increasingly favored over immediate nephrectomy.
  • CT-guided drainage demonstrates higher success rates compared to ultrasonography-guided insertion.

Conclusions:

  • Optimal management of EPN involves prompt diagnosis using CT, broad-spectrum antibiotics, and timely drainage.
  • Nephrectomy should be reserved for cases refractory to conservative treatment.
  • A multidisciplinary approach addressing underlying risk factors is crucial for successful EPN management.