Urnary tract infectin,
Acute pyelonephritis
Renal and perirenal abscess
Sep, 22, 2005
Dr. Chien-Lung Chen
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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
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1. Definition
2. Risk factors
3. Clinical presentation..
4. Diagnosis
5. Treatment
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Definition
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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
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flank pain, fever,chills
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1) cystitis
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2) APN
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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
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conduit, indwelling catheter, prostatitis, …..
• 2) Immune compromised: DM, C/T, neutropenia
• 3) Virulent organism: metastatic Staphylococcus
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aureus, Proteus mirabilis
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• 4) Male
Risk factors
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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,
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dysuria, burning, suprapubic pain, cloudy
• urine, incontinence
• 1) vaginitis: leukorrhoea, candida albicans
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trichomonas vaginalis, gardnerella
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vaginalis, G(-) bacilli
• 2) Urethritis: chlamydia, herpes virus
• 3) Prostatitis
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Clinical features
• 2. UTI
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1) Cystitis: dysuria,frequency, pelvic pain
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bacteriuria, hematuria
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2) APN: flank pain, fever, malaise, ……
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3) Cx:
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a. abscess formation
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b. Xanthogranulomatous pyelonephritis
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c. Emphysematous pyelonephritis
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d. CRF
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Diagnosis
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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:
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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
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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- gasforming organism.
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Treatment
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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.
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