Урология - Pyelonephritis
.pdfPrimary acute pyelonephritis
No diseases of upper urinary tract in anamnesis
General symptoms: fever more than 38 C, chillswith shaking, reddened skin, moist skin, vomiting,nausea, general ill feeling, rapid pulsus
Local symptoms: pain at lumbal area, pain on shaking the lumbal area (be careful), frequent painful urination (if cystitis is also present)
Secondary acute pyelonephritis
Appears on the basis of another urological disease which leads to the impaired urine outflow or bloodflow impairments (stones of urinary tract, urinary tract abnormalities, pregnancy, constrictions of uretra and ureter, benigh prostatic hyperplasia).
General and local symptoms are the same as in acute pyelonephritis
Apostematous pyelonephritis
Acute purulent imflammation with formation of multiple little pyogenic absesses
General appearance |
On section |
Chronic pyelonefhritis
Can be an outcome of acute pyelonephritis
Causes:
Non diagnosed and non removed inpairments of urine outflow
Incorrect treatment of acute pyelonephritis
Formation of L-forms of bacteria
Concomittant diseases (diabetes mellitus, obesity, tonsilltis etc)
Immunodeficient conditions
Active inflammation
Leucocytes 25000 and more in 1 ml of urine
Bacteriuria 100000 and more in 1 ml of urine
Active leucocytes 30 % and more at all patients
Steihaimer-Malbine cells 25-50% of patients
Erytocyte sedimentation rate 12 mm/hour and more at 50-70 % of patients.
Active leucocytes
Large, light-blue leucocytes with big nucleus, poor coloured protoplasm and active grains with brownian mowement. They have high ingestion activity regarding bacteria
Latent inflammation
Leucocytes up to 2500 in 1 ml of urine
Up to 10000 in 1 ml of urine
Active leucocytes – 15-30% at 50-70% of patients
Stenhaimer-Malbine cells are absent
ESR not more than 12 mm/hour
Remission
Leucocytes are absent
Bacteria are absent
Active leucocytes are absent
Stenhaimer-Malbine cells are absent
ESR less than 12 mm/hour
Diagnostics
Anamnesis
Blood test ( leucocytosis with left shift)
Urinalysis ( leucocytes, bacteriuria, false proteinuria, active leucocytes)
Positive shaking symptom
Ultrasound
Plain X-Ray
IVU
CT
Chromocystoscopy
Arteriography
PHSYCAL SIGNS
1.Among general signs increased temperature, pulse rate.
2.In local examination, tenderness at the renal angle in the back and over the affected kidney.
3.Percussion over the renal angle may be painful.