Correctly understand acute pyelonephritis

Case data: A 23-year-old woman was admitted to the hospital with left back pain, chills and fever for 1 day. The patient had left back pain with chills and fever, nausea, frequent urination, urgency, and dysuria one day before. Physical examination: T39℃, P89 times/min, R22 times/min, blood pressure 90/70mmHg; pressure and pain in the left kidney area. Urinary examination: WBC200/HPF, blood test indicated WBC16x109/L; urinary system color Doppler ultrasound: both kidneys, ureter and bladder were normal. After preliminary diagnosis, the patient was considered as acute pyelonephritis, and the patient was instructed to stay in bed, reduce fever, increase fluid intake, and be given third-generation cephalosporin intravenous infusion for anti-infection treatment. After 3 days, the patient’s symptoms improved significantly, and the symptoms disappeared after a week. After oral administration of cephalosporin for 2 weeks, the urine routine and urine culture were negative. Acute pyelonephritis is an acute bacterial inflammation of the renal pelvis and renal parenchyma. Most of it is caused by Escherichia coli, but it can also be caused by other enterobacteria, gram-positive bacteria, and a few are caused by fungi and viruses. Pathogens mostly enter the kidneys retrogradely from the urethra, and can also infect the kidneys from the blood circulation. This disease is more common in women. It may be because the female urethra is short and straight. The external orifice of the female urethra is close to the vagina and anus where bacteria naturally exist. Prognosis: Acute pyelonephritis leads to renal enlargement, scattered abscesses of various sizes on the surface, hyperemia and edema of the renal pelvic mucosa, and scattered bleeding. If treated in time, the purulent lesions will heal and form tiny fibrotic scars. After absorption, there will be no damage to kidney function, otherwise The lesions are widespread and serious, which can lead to the loss of part of the nephron function. If the pathogenic bacteria are not completely eliminated, it may turn into chronic pyelonephritis. Diagnosis points 1.&nbsp. Rapid onset and short course; 2.&nbsp.Clinical manifestations: unilateral or bilateral low back pain, chills and high fever, body temperature can reach 39 ℃ or more, may be accompanied by headache, body pain, with or without There are nausea, vomiting, fever type similar to sepsis, body temperature drops after profuse sweating and then rises, and the typical person can last for a week. Bladder irritation symptoms, such as frequent urination, urgency, dysuria, hematuria, these symptoms may not always appear. In retrograde infections, bladder irritation symptoms appear earlier than systemic symptoms such as chills and fever, while blood infections have bladder irritation later than chills and fever. And other systemic symptoms. Note, however, that often the symptoms of the elderly may not be obvious. 3. Physical examination has obvious pressure and percussion pain in the kidney area, which can be unilateral or bilateral. 4.&nbsp.&nbsp. Auxiliary examination of urine routine has white blood cells, red blood cells, proteins, casts and bacteria. Urine bacterial culture has more than 105 colonies per milliliter of urine. Blood routines indicate that white blood cells are elevated mainly by neutrophils. Most of the urinary tract color Doppler ultrasound examinations have no urinary tract obstruction. Differential diagnosis 1. Empyema nephropathy, low back pain, chills and fever may occur, if it is ureteral obstruction, pus may enter the bladder, and bladder irritation may occur; physical examination may have percussive pain in the kidney area, so it needs to be differentiated; this disease may appear Lumbar masses are caused by hydronephric calyxes caused by urinary tract obstruction and infection. They usually occur on the basis of hydronephric calyxes caused by ureteral stones, renal tuberculosis, and ureteral stenosis. Color Doppler ultrasound can be based on the echo An empyema in the renal pelvis is found, and CT scan can find that the density of fluid in the renal pelvis is higher than that of normal hydrops, which can be distinguished; 2. Multiple abscesses in the renal cortex, chills, fever, low back pain may occur, and physical examination may have pain in the kidney area. Therefore, it needs to be differentiated. It is an abscess of the renal cortex, which is prone to occur in patients with diabetes and other immunocompromised patients. Most of them have no symptoms of bladder irritation. Ultrasound and CT can show multiple abscesses in the renal cortex. The pus drawn under ultrasound or CT guidance can be clear diagnosis. 3. Perinephritis, chills, fever, low back pain, and percussive pain in the kidney area, so it needs to be differentiated. Physical examination usually has waist muscle tension and obvious local tenderness, mostly due to renal abscess, renal carbuncle, or renal colic. It directly infects the tissues around the kidney. If pus is formed, the abscess ruptures, it can spread along the psoas major muscle and stimulate the psoas major muscle to prevent the iliac joints from stretching. Ultrasound and CT examinations can find abscesses around the kidney. Treatment principles 1. Bed rest, oral fluid supplementation, intravenous fluid supplementation for nausea and vomiting patients, maintain a daily urine output of more than 1500ml to facilitate the excretion of inflammatory substances in the urine; body temperature is lower than 38.5℃, because the body temperature rises slightly and resists Strengthen, no treatment, over 38.5℃, give antipyretic, first choice physical cooling, second choice drug antipyretic