The pielonefritis or high urinal infection is an infection of the kidney and of the urinary tract – the routes of exit of the urine from the kidney towards the bladder–.
To classify a pielonefritis we must bear in mind if complications exist or not. The two most common types of pielonefritis are:
- Not complicated sharp Pielonefritis: Sudden development of an inflammation of the kidney. The sharp pielonefritis happens normally like result of an infection of common urine (a "cystitis" or infection of low routes), and although it is one more infection the fact would be that a cystitis, he manages without problems, in general, with the correct treatment. It can be much severer in persons of the third age or with immunodeficiencies (for example, those who endure cancer or AIDS).
- Chronic Pielonefritis. Complicated urinary tract infection. The most fearsome complications are the sepsis or infection spread by the whole body, and the renal insufficiency or incapability of the kidney to make urine.
The pielonefritis happens of much more frequent form when the called ebb exists vesico-ureteral (persistent urine ebb "backwards"). The typical thing in these cases is to present pielonefritis sharp repeated or a chronic pielonefritis.
INCIDENCE AND FACTORS OF RISK
As well as the cystitis is quite common, the pielonefritis is rarer (3 to 7 cases for every 10.000 persons). The risk increases in several situations, of which the most common are:
- ebb vesico-ureteral: persistent urine ebb "backwards", from the bladder to the urinary tract in ascending sense, with urine stagnations in the called "renal pelvis" (the highest area of the urinary tract, in his exit of the kidney).
- uropatía obstructive: it is any situation that stops up the urinary tract doing that the urine stagnates. There are many causes of obstructive uropatía (pregnancy, abdominal masses, etc), but the most frequent cause is the urolitiasis (stones in the kidney and/or in the urinary tract).
On the other hand, different bacteria can cause the pielonefritis, someone much more harmful than others.
The rapid and finished treatment of the cystites (infections of the bladder) and urinal infections in general, especially if they are chronic or appellants, might prepare the development of many cases of pielonefritis.
Also, the treatment previous to the situations that increase the risk, like the ebb vesico-ureteral or the obstructive uropatía, they prepare this situation.
- general discomfort
- major of 39°C (102°F)
- he persists during more than two days
- pain of the side or of back
- abdominal pain (it happens occasionally)
- morning sickness and vomiting
- pain on having urinated
- need to urinate very often, in the night, etc...
- cloudy or abnormal color of the urine
- blood in the urine
- strong smell of the urine
Physical examination. Pain and sensibility on having felt the area of the kidney.
Urine analysis. He attends in the urine of white and red cells of the blood, which should not be there.
Cultivation. The urine cultivation reveals the existence of a bacterium in the urine. The blood cultivation usually shows the same bacterium. Generally it will be a question of called bacteria "gram (-)".
Abdominal ultrasound scan. Painless study of the abdomen with ultrasounds. It shows signs typical of pielonefritis.
Urografía I.V. Radiographies of the kidney with intravenous injection previous to an iodized substance that gives very much contrast to the kidney. In the pielonefritis a very diminished contrast excretion exists. Also, they can turn fundamental illnesses that chronicle or appellant justify the presence of pielonefritis.
The targets of the treatment are the control (priest) of the infection and the reduction of the sharp symptoms, which, generally, persist even more than 48 hours after the beginning of the treatment. They go to use:
1. Antibiotics. To control the bacterial infection. If the infection is serious and the complications risk is high, the antibiotics will give themselves intravenous route. It is possible that it is necessary to be with antibiotic during a long period of time.
2. Analgesic - non-conducting. Medicines to control the pain, the fever and the discomfort.
3. Liquid intravenous (wheys) in the first days of treatment, to hydrate the possible best thing and to try that the medicines come soon to the kidneys.
On the other hand, the treatment of any complication must be rapid and finished. It can include hospitalization with intensive cares, medication to improve the cardiovascular state, or other treatments. The fundamental causes must be treated. The treatment usually bears urine cultivation to make sure that the bacterium has been eliminated completely.
Most of the cases of pielonefritis resolve themselves without complications after the treatment. Sometimes the treatment can turn out to be long and aggressive. In any case, the target is to avoid complications like:
- the recurrence,
- the sepsis or infection spread by the whole body, and
- the renal insufficiency or incapability of the kidney to make urine.
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