Papillary Necrosis

Griffin MD, Bergstralk EJ, Larson TS: Renal papillary necrosis. A sixteen year clinical experience. J Am Soc Nephrol 1995, 6:248-256.

Sabatini S, Eknoyan G, editors: Renal papillary necrosis. Semin Nephrol 1984, 4:1-106.

The concern of renal specialists for urinary tract infections (UTIs) had declined with the passage of time. This trend is now being reversed, owing to new imaging techniques and to substantial progress in the understanding of host-parasite relationships, of mechanisms of bacterial uropathogenicity, and of the inflammatory reaction that contributes to renal lesions and scarring.

UTIs account for more than 7 million visits to physicians' offices and well over 1 million hospital admissions in the United States annually [1]. French epidemiologic studies evaluated its annual incidence at 53,000 diagnoses per million persons per year, which represents 1.05% to 2.10% of the activity of general practitioners. In the United States, the annual number of diagnoses of pyelonephritis in females was estimated to be 250,000 [2].

The incidence of UTI is higher among females, in whom it commonly occurs in an anatomically normal urinary tract. Conversely, in males and children, UTI generally reveals a urinary tract lesion that must be identified by imaging and must be treated to suppress the cause of infection and prevent recurrence. UTI can be restricted to the bladder (essentially in females) with only superficial mucosal involvement, or it can involve a solid organ (the kidneys in both genders, the prostate in males). Clinical signs and symptoms, hazards, imaging, and treatment of various types of UTIs differ. In addition, the patient's background helps to further categorize UTIs according to age, type of urinary tract lesion(s), and occurrence in immunocompromised patients, especially with diabetes or pregnancy. Such various forms of UTI explain the wide spectrum of treatment modalities, which range from ambulatory, single-dose antibiotic treatment of simple cystitis in young females, to rescue nephrectomy for pyonephrosis in a diabetic with septic shock. This chapter categorizes the various forms of UTI, describes progress in diagnostic imaging and treatment, and discusses recent data on bacteriology and immunology.

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