Acute pyelonephritis

Acute pyelonephritis

The typical clinical manifestations of acute pyelonephritis abrupt onset, recurrent attacks of chills, fever, back pain (costovertebral angle has obvious percussion pain), often accompanied by abdominal cramps, nausea, vomiting, dysuria, urinary frequency and nocturia. The disease can occur in all ages, but the most common women of childbearing age, mainly the following symptoms.

1 general symptoms of high fever, chills, temperature of more than 38 to 39 degrees, can be as high as 40 degrees C. Heat is not the same, is also a type of relaxation, intermittent or missed type. Accompanied by headache, body aches, sweating, etc..

2 urinary symptoms in patients with low back pain, mostly dull pain or ache, degree, there are a few cramps, along the direction of radiation to the bladder ureter; physical examination in the point of upper ureter (intersection of rectus abdominis and outside the umbilicus line) or lumbocostal point (intersection of psoas muscle and twelve outer ribs) have tenderness, positive kidney pain. The patient often has frequent micturition, urgency, dysuria, bladder irritation, in ascending infection, systemic symptoms may precede.

3 gastrointestinal symptoms may be loss of appetite, nausea, vomiting, inpidual patients may have upper abdominal or abdominal pain.

4 bacteremia and sepsis have symptoms of acute pyelonephritis patients in the disease process can be bacteremia, but this bacteremia and more serious gram negative sepsis (i.e., coagulation and complement activation of the kinin system in septic shock, induced by DIC or both) there was no significant correlation.

5 shock and DIC must be ruled out when a shock or DIC occurs in pyelonephritis. One of the most important is the acute renal papillary necrosis associated with obstructive nephropathy, which can be caused by the loss of renal papilla caused by ureteral obstruction. If diabetic patients with severe pyelonephritis or bacteremia, especially in patients with poor response to treatment, should be highly suspected of the possibility of renal papillary necrosis.

6 children patients with urinary tract symptoms are often not obvious, in addition to the onset of high fever and other systemic symptoms, often convulsions, seizures. Children under 2 years of age, such as fever, vomiting, non-specific abdominal discomfort or not active, may be acute pyelonephritis; inpidual only meaningful evidence may not be active. UTI accounts for about 10% of febrile diseases, and its clinical manifestations are similar to those of older children. When children with recurrent enuresis, hypothyroidism often suggest that urine concentration associated with renal infection.

 

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