🔴 PIELONEFRITIS AGUDA | ETIOLOGÍA, FISIOPATOLOGÍA, CUADRO CLÍNICO, DIAGNOSTICO, TRATAMIENTO.

Introduction to Acute Pyelonephritis

The introduction provides an overview of acute pyelonephritis, discussing its nature as a bacterial infection causing kidney inflammation and highlighting its prevalence and risk factors.

Epidemiology and Risk Factors

• Acute pyelonephritis is more common in women, particularly young sexually active individuals.

• Incidence: 2 men per 10,000 inhabitants and 12 women per 10,000 inhabitants.

• Risk factors include:

• Young sexually active women

• Elderly individuals and infants due to anatomical anomalies and hormonal changes

• Pregnant women (20-30% risk during the second and third trimesters)

Etiology

• Main Cause: Gram-negative bacteria, primarily Escherichia coli.

• Other bacteria involved:

• Proteus, Klebsiella, Enterobacter.

• Infection routes:

• Hematogenous spread

• Ascending infection from the lower urinary tract.

Pathophysiology of Acute Pyelonephritis

This section delves into the pathophysiology of acute pyelonephritis, exploring the mechanisms of infection spread and host defense responses.

Physiological Conditions and Defense Mechanisms

• Urinary tract is typically sterile except for urethral flora colonized by digestive, cutaneous, and genital germs.

• Host defense factors against ascending infection:

• Urethral length

• Mucosal integrity

• Urine flow in ureters

• Biochemical characteristics of urine

Immune Response

• Non-specific Defenses:

• Urine flow frequency

• Urothelial integrity

Natural Defense Mechanisms

• Protein Tan Host:

• Abundant protein in the urinary tract with potential anti-infectious properties.

Immune Response in Acute Pyelonephritis

Discusses immune responses triggered by acute pyelonephritis including inflammatory pathways, cytokine involvement, lymphocyte activation, and phagocytosis.

Immunological Responses

• Innate Immunity:

• Non-specific defenses like urine flow frequency.

Cytokine Activation

• Rapid immune response involving interleukins (IL) such as IL-1, IL-6, IL-8.

Lymphocyte Involvement

• Activation of T lymphocytes secreting enzymes that degrade extracellular matrix.

Phagocytosis Process

Understanding Pyelonephritis

In this section, the speaker discusses the colonization of the distal urethra by germs, leading to their migration to the bladder. Clinical manifestations, diagnosis, and treatment options for pyelonephritis are explored.

Superficial Colonization and Clinical Manifestations

• The colonization of the distal urethra by germs leads to their migration to the bladder through expansive growth.

• Clinical manifestations include moderate severity with symptoms such as fever (>38 degrees Celsius), chills, side pain, nausea, and vomiting.

Diagnostic Symptoms and Imaging

• Patients may experience urinary discomfort like dysuria, increased frequency (polyuria), and urgency.

• Diagnosis involves assessing flank pain or tenderness along with fever. Urinalysis may show bacteria or pus.

• Imaging techniques like ultrasound reveal enlarged kidneys while a simple urinary system X-ray can detect kidney stones.

Treatment Approaches for Pyelonephritis

This segment delves into the treatment strategies for pyelonephritis, focusing on antibiotics, analgesics, and antipyretics based on different scenarios.

Antibiotic Treatment Options

• For uncomplicated cases of E.coli infection, first-line antibiotics include trimethoprim-sulfamethoxazole or nitrofurantoin.

• Intravenous administration of piperacillin-tazobactam or fluoroquinolones is recommended for complicated infections.

Management Considerations

• Hospitalization is advised for young individuals, elderly patients, immunocompromised individuals, pregnant women, and those unable to tolerate oral intake.

• Alternative antibiotics like vancomycin are suggested for penicillin-allergic patients experiencing symptoms such as fever and flank pain.

Complications and Prognosis

The discussion shifts towards potential complications arising from pyelonephritis such as renal failure and various associated conditions.

Complications of Pyelonephritis

• Potential complications include acute renal failure, papillary necrosis, renal abscess formation, renal vein thrombosis.

Prognosis and Recovery

• Young women face a higher likelihood of developing pyelonephritis but have favorable recovery prospects post-treatment.