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Urnary tract infectin, Acute pyelonephritis
Renal and perirenal abscessSep, 22, 2005
Dr. Chien-Lung Chen
壢新醫院畢業後一般醫學內科訓練課程教案
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學習目標
1. Complete history, physical examination and laboratory analysis
2. Differential diagnosis.
3. Adequate management and treatment
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Contents
• 1. Definition
• 2. Risk factors
• 3. Clinical presentation..
• 4. Diagnosis
• 5. Treatment
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Definition
• Upper UTI: pyelonephritis
• Lower UTI: cystitis, urethritis, prostatitis
• UTI Relapse: same organism, <2wks
• UTI reinfection: different organism, >2wks
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Definition
• Symptomatic: frequecy, urgency, dysuria
• flank pain, fever,chills
• 1) cystitis
• 2) APN
• 3) prostatitis
• Asymptomatic UTI: s/s(-), pyeuria(+)
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Definition
• Uncomplicated: • 1) normal urinary tract• 2) normal renal function• Complicated:• 1) Abnormal urinary tract: stone, VUR, ileal • conduit, indwelling catheter, prostatitis, ….. • 2) Immune compromised: DM, C/T, neutropenia• 3) Virulent organism: metastatic Staphylococcus• aureus, Proteus mirabilis• 4) Male
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Risk factors
• 1. Age
• 2. Pregnancy
• 3. Diaphragm use
• 4. Sexual activity
• 5. Chronic disease, DM, H/T, CVA
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Clinical features
• 1. Acute urethral syndrome: frequency, • dysuria, burning, suprapubic pain, cloudy• urine, incontinence• 1) vaginitis: leukorrhoea, candida albicans• trichomonas vaginalis, gardnerella • vaginalis, G(-) bacilli• 2) Urethritis: chlamydia, herpes virus• 3) Prostatitis
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Clinical features
• 2. UTI• 1) Cystitis: dysuria,frequency, pelvic pain• bacteriuria, hematuria• 2) APN: flank pain, fever, malaise, ……• 3) Cx: • a. abscess formation• b. Xanthogranulomatous pyelonephritis• c. Emphysematous pyelonephritis• d. CRF
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Diagnosis
• 1. Complete history
• 2. Symptoms and signs
• 3. Pyuria: WBC > 5/hpf, nitrite(+), leucyte
• esterase, bacteria
• 4. Leucocytosis
• 5. U/C
• 6. B/C
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Management
• 1. Asymptomatic UTI: no tx except
• pregnancy and URO invasive procedure
• 2. Uncomplicated lower UTI:
• Oral A/B( baktar, keflex, amoxil) x 3D
• 3. APN:
• IV A/B ( Cef +GM ) x 3-5 d fever (-)
• oral A/B x 7-10d
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Renal abscess
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Renal abscess
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Renal abscess
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Xanthogranulomatous pyelonephritis
• 1. Chronic bacterial PN• 2. Uncommon, <1%• 3. Old age, female 70%• 4. Path: unknown• 5. Mψ with PAS(+) granules• 6. P. mirabilis, E. coli, S. aureus• 7. Dx: CT• 8. Tx: local resection + antibiotics
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Perirenal abscess
• 1. Etiology: S. aureus, E.coli, P.mirabilis
• 2. Pathogenesis: pus-material in the
Gerota’s fascia.
• 3. S/S: fever, flank pain, chills, dysuria
• 4. Dx: echo, CT, angiography, Ga scan
• 5. Emphysematous pyelonephritis- gas-forming organism.
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Treatment
• 1. Early surgical drainage
• 2. Antibiotics as adjunctive treatment
• 3. Antibiotics irrigation prior to
nephrectomy.
• 4. Prognosis is poor, mortality is 20-50%
• 5. Prompt diagnosis and immediate definitive surgery.