Pielonefrite

Pielonefrite it is an illness of infectious origin that afecta .

The pielonefrite afecta almost all the structures of the kidney, including túbulos, recolector system e . Only glomérulo it is exception, at least until an advanced phase. Two forms of pielonefrite exist, the acute, caused for one bacterial, and the crónica, in the which infections of repetition if conjugates with the reaction of imunitário system to these infections to produce the picture of injuries.

Table of content

Acute Pielonefrite

It is a supurativa infection (with production of ). It is almost always caused by bacteria and only rare for virús (type Polioma) or fungos as albicans.

Epidemiologia

Afecta more frequent three populations: bébés with less of one year and congenital anomalies of urinário system; aged women of half age and men with hiperplasia of prostate.

Fisiopatologia

The pielonefrite frequent is caused by bacteria Gram- negative that they are normal flora in the intestine. These bacteria (Escherichia coli, Enterobacter, Proyours Mirabillis, Klebsiella) they cause the infections of tracto urinário (ITUs), more frequent in the women. The pielonefrites are almost always decurrent complications of these infections of , and/or - called ascending infection. Rare the infection of the kidney if only gives for settling from the blood (bacterémia).

Normally ureteres does not receive piss in return from the bladder, which had the mecânismos anti-refluxo. However if these mechanisms due the congenital anomalies or will not be efficient, refluxo of piss can carry bacteria that infectem the bladder or uretra for the kidney. Another condition that frequent leads to the pielonefrite is the blockage of ureter. The blockage can be divides litíase renal ("rock of the kidneys") or in aged of the masculine sex the benign hiperplasia of prostate (an almost universal condition from the 70 years) it can also provoke sufficient blockage. In this situation, estase of piss above of the blockage allows the bacterial growth, that normally would be hindered for the constant flow. cateterização of acamados sick people or with other problems of the urinárias ways also is a risk factor.

Clinic (symptoms)

The ínicio is abrupt, with pain in the micção (disúria) and greater frequency and urgency, inclusively waking up the sick person to the night (noctúria). As in any infection, it has , sweats, malaise. They are detectaveis in cylindrical masses in piss (piúria), had to have been dragged of the cylindrical túbulos for piss.

Pathology

Microscopically supurativa inflammation is observed, with first infiltration of neutrófilos, later of macrofagos e . It has of the cells of the renais túbulos. It can have or not formation of . After resolution has extensive fibrosação of the afectadas regions

Treatment

The resolution after initiates some days of therapy with . Infrequentemente, and mainly in weak or diabetic individuos can occur complications. These include septicémia, bacterial multiplication in the serious, frequent mortal blood, or the necrosis of pelve renal, with crónica.

Pielonefrite Crónica

The crónica pielonefrite is derived from multiple attacks of acute pielonefrite, that can be more or less serious, and that they occur frequent during a widened period.

Fisiopatologia

The cause most frequent is the insufficience of the mecânismos anti-refluxo, with refluxo of piss of the bladder for the kidney. Another frequent cause is litíase renal, with obstrutivos of the flow of piss.

Clinic (symptoms)

The ínicio can be gradual or to give attack of acute pielonefrite. Symptoms are similar to this last one but they more tend softer but to be dragged. It can complicate with sprouting of of renal cause; sindrome nefrótico; e renal insufficience.

Pathology

Macroscopicamente has atrophy of the afectado kidney. and is damaged and for times they obstruct the ticket of piss. With the microscope, extensive fibrosação of the kidney, a reply provoked for the imunitário system to the constant infection is seen. It has atrophy of some túbulos, dilatação of others, with hialino content due to restrained protein.

Treatment

The crónica pielonefrite not rare results in crónica renal insufficience, with necessity of . The therapy with antibiotics decides the acute episodes but it does not hinder its recurrence.

 

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