Figure 734

A general algorithm for the investigation and treatment of acute pyelonephritis. Treatment of acute pyelonephritis is based on antibiotics selected from the list in Figure 7-11. Preferably, initial treatment is based on parenteral administration. It is debatable whether common forms of simple pyelonephritis initially require both an aminoglycoside and another antibiotic. Initial parenteral treatment for an average of 4 days should be followed by about 10 days of oral therapy based on bacterial sensitivity tests. It is strongly recommended that urine culture be carried out some 30 to 45 days after the end of treatment, to verify that bacteriuria has not recurred. APN—acute pyelonephritis; ESR—erythrocyte sedimentation rate; CRP—C-reactive protein; UTI—urinary tract infection; IVP—intravenous pyelography. (From Meyrier and Guibert [5]; with permission.)

FIGURE 7-35 (see Color Plate)

Renal abscess. Like acute pyelonephritis, one third of cases of renal abscess occur in a normal urinary tract; in the others it is a complication of a urologic abnormality. The clinical picture is that of severe pyelonephritis. In fact, it can be conceptualized as an unfavorably developing form of acute pyelonephritis that progresses from presuppurative to suppurative renal lesions, leading to liquefaction and formation of a walled-off cavity. The diagnosis of renal abscess is suspected when, despite adequate treatment of pyelonephritis (described in Fig. 7-34), the patient remains febrile after day 4. Here, necrotic renal tissue is visible close to the abscess wall. The tubules are destroyed, and the rest of the preparation shows innumerable polymorphonuclear leukocytes within purulent material.

0 0

Post a comment