Chronic Pyelonephritis
No Results
No Results
processing….
Chronic pyelonephritis is characterized by renal inflammation and fibrosis induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction. The diagnosis of chronic pyelonephritis is made based on imaging studies such as ultrasound or CT scanning. It occurs almost exclusively in patients with major anatomic anomalies, most commonly in young children with vesicoureteral reflux (VUR). [1]
VUR is a congenital condition that results from incompetence of the ureterovesical valve due to a short intramural segment. VUR is present in 30-40% of young children with symptomatic UTIs and in almost all children with renal scars. It may also be acquired by patients with a flaccid bladder due to spinal cord injury. VUR is classified into 5 grades (I-V), according to the increasing degree of reflux. (See Treatment.) The diagnosis of VUR is frequently established on the basis of radiologic evidence obtained during an evaluation for recurrent urinary tract infection (UTI) in young children.
For patient education information, see Urinary Tract Infections (UTIs).
Chronic pyelonephritis is associated with progressive renal scarring, which can lead to end-stage renal disease (ESRD). For example, in reflux nephropathy, intrarenal reflux of infected urine is suggested to induce renal injury, which heals with scar formation. [2] In some cases, scars may form in utero in patients with renal dysplasia with perfusion defects. Infection without reflux is less likely to produce injury. Dysplasia may also be acquired from obstruction. Scars of high-pressure reflux can occur in persons of any age. In some cases, normal growth may lead to spontaneous cessation of reflux by age 6 years.
Factors that may affect the pathogenesis of chronic pyelonephritis are as follows: (1) the sex of the patient and his or her sexual activity; (2) pregnancy, which may lead to progression of renal injury with loss of renal function; (3) genetic factors; (4) bacterial virulence factors; and (5) neurogenic bladder dysfunction. In cases with obstruction, the kidney may become filled with abscess cavities (see Pyonephrosis).
In the United States, VUR may be present in 30-40% of children with UTIs. The prevalence rate of VUR in siblings of patients with chronic pyelonephritis is approximately 35%. VUR and chronic pyelonephritis are less common in African American children than in white children, with chronic pyelonephritis occurring 3 times more often in white children. [3] Chronic pyelonephritis is also twice as common in females as it is in males.
Chronic pyelonephritis occurs more often in infants and young children (younger than 2 y) than it does in older children and adults.
The Birmingham Reflux Study clearly showed that medical and surgical management are equally effective in preventing renal damage from VUR. [4] Almost all children should receive a trial of medical management.
Although most children with chronic pyelonephritis due to VUR may experience spontaneous resolution of reflux, approximately 2% can still progress to renal failure, and 5-6% can have long-term complications, including hypertension. [5]
Hypertension contributes to the accelerated loss of renal function in persons with chronic pyelonephritis. Reflux nephropathy is the most common cause of hypertension in children, occurring in 10-20% of children with VUR and renal scars. The resolution of reflux does not appear to correct hypertension.
Complications of chronic pyelonephritis can also include the following:
Proteinuria
Focal glomerulosclerosis
Progressive renal scarring leading to end-stage renal disease [6]
Xanthogranulomatous pyelonephritis (XPN) – May occur in approximately 8.2% of cases and in 25% of patients with pyonephrosis; XPN can be confused with renal cancer [7, 8, 9, 10, 11, 12, 13]
Pyonephrosis – May occur in cases of obstruction
Progressive renal scarring (reflux nephropathy)
Guarino N, Casamassima MG, Tadini B, et al. Natural history of vesicoureteral reflux associated with kidney anomalies. Urology. 2005 Jun. 65(6):1208-11. [Medline].
Dillon MJ, Goonasekera CD. Reflux nephropathy. J Am Soc Nephrol. 1998 Dec. 9(12):2377-83. [Medline].
Chand DH, Rhoades T, Poe SA, Kraus S, Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urol. 2003 Oct. 170 (4 Pt 2):1548-50. [Medline].
Birmingham Reflux Study Group. Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years’ observation. Birmingham Reflux Study Group. Br Med J (Clin Res Ed). 1987 Jul 25. 295(6592):237-41. [Medline].
Köhler J, Tencer J, Thysell H, et al. Vesicoureteral reflux diagnosed in adulthood. Incidence of urinary tract infections, hypertension, proteinuria, back pain and renal calculi. Nephrol Dial Transplant. 1997 Dec. 12(12):2580-7. [Medline].
Zermann DH, Loffler U, Reichelt O, et al. Bladder dysfunction and end stage renal disease. Int Urol Nephrol. 2003. 35(1):93-7. [Medline].
Alan C, Ataus S, Tunc B. Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol. 2004. 36(4):489-93. [Medline].
Gonzalez Resina R, Barrero Candau R, Arguelles Salido E, et al. [Xanthogranulomatous pyelonephritis in childhood. A case report]. Actas Urol Esp. 2005 Jun. 29(6):596-8. [Medline].
Oosterhof GO, Delaere KP. Xanthogranulomatous pyelonephritis. A review with 2 case reports. Urol Int. 1986. 41(3):180-6. [Medline].
Saavedra Jo S, Pow-Sang Godoy M, Benavente Corrales V, et al. [Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics]. Arch Esp Urol. 2004 Jul-Aug. 57(6):595-600. [Medline].
Zugor V, Amann K, Schrott KM, et al. [Xanthogranulomatous pyelonephritis: presentation of an unusual case]. Aktuelle Urol. 2005 Jun. 36(3):245-8. [Medline].
Arrighi N, Antonelli A, Zani D, Zanotelli T, Corti S, Cunico SC, et al. Renal mass with caval thrombus as atypical presentation of xantogranulomatous pyelonephritis. A case report and literature review. Urologia. 2013 Apr 24. 80 Suppl 22:44-7. [Medline].
F Brown J, Chamberlain JC, Roth CC. The role of laparoscopic nephrectomy in pediatric xanthogranulomatous pyelonephritis: a case report. Case Rep Urol. 2013. 2013:598950. [Medline]. [Full Text].
López JI, Larrinaga G, Kuroda N, Angulo JC. The normal and pathologic renal medulla: a comprehensive overview. Pathol Res Pract. 2015 Apr. 211 (4):271-80. [Medline].
Hiraoka M, Hori C, Tsukahara H, et al. Vesicoureteral reflux in male and female neonates as detected by voiding ultrasonography. Kidney Int. 1999 Apr. 55(4):1486-90. [Medline].
Joshi P, Lele V, Shah H. Fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of xanthogranulomatous pyelonephritis. Indian J Nucl Med. 2013 Jan. 28(1):49-50. [Medline]. [Full Text].
Dracon M, Lemaitre L. [Urinary tract infection in adult. Leukocyturia]. Rev Prat. 2003 May 15. 53(10):1137-42. [Medline].
Noe HN. The long-term results of prospective sibling reflux screening. J Urol. 1992 Nov. 148(5 Pt 2):1739-42. [Medline].
Dell’Atti L. Feasibility and safety of laparoscopic nephrectomy in uremic patients with end-stage renal disease. Urologia. 2016 Jan-Mar. 83 (1):40-2. [Medline].
James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences
James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, Central Society for Clinical and Translational Research
Disclosure: Received research grant from: GSK<br/>Partner received salary from Alexion for employment.
Anupama Gowda, MBBS, MD Consulting Staff, Peachtree Nephrology, PC
Disclosure: Nothing to disclose.
Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College
Chike Magnus Nzerue, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, National Kidney Foundation
Disclosure: Nothing to disclose.
Vecihi Batuman, MD, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d’Urologie (International Society of Urology)
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
Chronic Pyelonephritis
Research & References of Chronic Pyelonephritis|A&C Accounting And Tax Services
Source