23. Describe the possible causes, symptoms and treatment of the pyelonephritis?.

Symptoms (acute) – develop rapidly over a period of a few hours or a day or two. The characteristic are aching pain in the lumbar region and fever which may be high often with shaking chills. There may be nausea, vomiting, diarrhea or constipation. Dysurea and frequency are also common. On physical examination generalized tenderness of the muscles found (tenderness on deep pressure in kidney region). Syptoms usually subsidr within few days without any specific treatment. If attack is severe proper antibiotic treatment should be started. Most patients recover after few attacks but considerable proportion of cases there are repeated attacks, at irregular intervals. Between attacks – symptom-free. (only bacteriuria and pyuria can be found during the analysis)

Chronic – hard to diagnose. Urinary obstruction is also usually present, elevated blood pressure which leads to renal ischemia. Azotemia, nocturia, polyuria, hyperchloremic acidosis, dehydration, weakness, fatigue. Antibiotic course

• Back pain or flank pain

• Fever (usually present) and/or chills

• Feeling sick (malaise)

• Nausea and vomiting

• Confusion (especially in the elderly)

Pyelonephritis may cause noticeable changes in the urine, such as:

• Blood in the urine (hematuria)

• Cloudy or foul-smelling urine

• Pain when urinating

• Increased frequency or urgency of urination

Most often, the bacteria that cause pyelonephritis are the same as those that cause ordinary urinary tract infections. Conditions that create reduced urine flow make pyelonephritis more likely. When urine flow slows or stops, bacteria can more easily travel up the ureters. Some causes of urine obstruction include:

• Benign prostatic hypertrophy (BPH)

• Stones in the bladder, ureters, or kidneys

Kidney stones contribute to pyelonephritis by providing a place for bacteria to grow while evading the body's defenses.

People with diabetes or conditions that impair the immune system are more likely to get pyelonephritis.

24. What is acute renal failure? Why may the condition develop?

Renal failure – loosely include all forms of acute urinary suppression, generally secondary to acute parenchimal damage. Acute tubular necrosis indicates the clinical and pathologic syndrome which results when renal excretory function is temporally los because of renal tubule degeneration caused by renal ischemia or toxic agents. Acute kidney failure usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute failure include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure. A sudden, serious drop in blood flow to the kidneys. (Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.)The most common causes of are diabetes mellitus and long-term, uncontrolled hypertension.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney failure.