Pyelonephritis

PART I

INTRODUCTION

1.1 Background
Urinary tract infections (UTI) are common and attack humans regardless of age, especially women. UTIs are responsible for approximately seven million patient visits to physicians each year in the United States (Stamm, 1998). Micro biology UTI stated there if there is a significant bacteriuria (105 ml of pathogenic microorganisms found in the middle of the jet of urine collected in the right way).

Abnormalities can only colonizes bacteria from urine (bacteriuria asymptomatic) or bacteriuria may be accompanied simtomatikndari infections of the urinary tract structures / UTI generally divided into two major sub-categories: UTI bottom (urethritis, cystitis, prostatitis) and upper UTI (acute pyelonephritis) , Acute cystitis (bladder infection) and acute pyelonephritis (infection and interstitial renal pelvis) is an infection that is most instrumental in causing morbidity but rarely ended as progressive renal failure.
Pyelonephritis is an infection of the kidneys trophies, tubules and interstitial tissue of one or both kidneys. Bacteria reach the bladder through the urethra and ascend to the kidney. Although the kidneys receive 20% to 25% of cardiac output, the bacteria rarely reaches the kidneys via the bloodstream; cases of hematogenous spread of less than 3%.
Pyelonephritis often as a result of reflux ureterivesikal, wherein the valve incompetent uretevesikal meynyebabkan urine to flow back (reflux) into the ureter. Obstruction of the urinary tract (kidneys which increases susceptibility to infection), bladder tumors, strictures, benign prostatic hyperplasia and urinary stone is the cause of another. Can be acute and chronic pyelonephritis.
Writing Purpose
1. Medical Students can explain the definition of pyelonephritis, pyelonephritis etiology, epidemiology pyelonephritis, pyelonephritis clinical symptoms, pathophysiology pyelonephritis, pyelonephritis physical examination, investigation pyelonephritis, management pyelonephritis, pyelonephritis diagnosis, differential diagnosis of pyelonephritis, pyelonephritis complications, prognosis pyelonephritis
2. Improving the ability in scientific writing / paper in the medical field.
3. Meet one of the graduation requirements Registrar of Clinics
4. Method review of literature with reference to some literature.

CHAPTER II

LITERATURE REVIEW

2.1 Definition of pyelonephritis
Pyelonephritis is inflammation of the renal pelvis and renal parenchyma caused due to infection by bacteria. Bacterial infection of the kidney tissue at the start of the lower urinary tract continue up to the kidneys. This infection can be about parenchym and renal pelvis (kidney pyelum = cup).

2.2 Causes of pyelonephritis

Bacteria E. Coli.
Resistant to antibiotics.
Ureteral obstruction which results in hydronephrosis.
Active infection.
Decreased kidney function.
Urethral reflux.
The bacteria spread to the kidneys, blood, the lymphatic system.

2.3 Pathophysiology pyelonephritis

Entry into the renal pelvis and inflammation. This causes inflammation Swelling of the area, starting from the papillae and spread to regions of the cortex. Infection occurs after the cytitis, prostatitis (asccending) or due to infection steptococcus derived from blood (descending).
Pyelonephritis is divided into two kinds:
Acute pyelonephritis.
Chronic pyelonephritis.
Acute pyelonephritis
Acute pyelonephritis usually brief and often recurring infections due but not perfect or new infections. 20% of recurrent infections occurred after two weeks after completion of therapy. Bacterial infections of the lower urinary tract in the direction of the kidney, this will affect renal function. Urinary tract infection or associated with selimut.abses can be encountered in the kidney capsule and at the junction kortikomedularis. In the end, atrophy and tubular and glomerular damage occurs.
Chronic pyelonephritis Chronic also derived from the bacteria, but may also be due to other factors such as urinary tract obstruction and urinary reflux. Chronic pyelonephritis can permanently damage the kidney tissue inflammation due to repeated and the emergence of scar and can cause faiure renal (kidney failure) which chronicles. Kidneys also form scar tissue progressively, contract and not functioning. The process of the development of chronic kidney failure from kidney infection and over the last several years, or after a serious infection. The division of acute pyelonephritis often found in pregnant women, usually beginning with hydro Pyelonefrosis ureter and ureteral obstruction due to enlarged uterus.

2.4 Clinical Signs and Symptoms of pyelonephritis

Acute pyelonephritis is characterized by swelling of the kidney or renal passenger widening.
In the assessment on get high fever, chills, nausea, pain in the waist, headache, muscle pain and physical weakness.
On percussion in areas characterized by CVA tenderness.
Client usually accompanied dysuria, frequency, urgency within a few days.
On examination of urine obtained cloudy urine or hematuria with a pungent odor, but it is also an increase in white blood cells.
Chronic pyelonephritis
Chronic pyelonephritis caused by repeated infection. So both kidneys slowly becoming damaged. Acute pyelonephritis attacks repeatedly usually do not have symptoms sfesifik. Their fatigue. Headache, low appetite and weight loss. The existence of polyuria, excessive thirst, azotemia, anemia, acidosis, proteinuria, pyuria, and urine concentrations decreased. The patient's health declining, eventually patients experience kidney failure. Kalik abnormalities and the presence of injury in the area of ​​the cortex. Kidney nephron ability to shrink and decline due to tissue injury. Suddenly when it was discovered the existence of hypertension.

2.5 Examination Support pyelonephritis

Diagnostic evaluation. An intravenous urogram and ultrasound can be performed to determine the location of the obstruction in the urinary tract, eliminating the obstruction is important for saving kidney from destruction. Cult urine and sensitivity tests performed to determine the causative organism so that appropriate antimicrobial agent can diresepkana.
Diagnosis of chronic pyelonephritis
In the past almost always used when an abnormality is found Tubulo this, the notion of the degree of heavy Vur can cause scarring of the kidneys, atrophy, and dilatation Calix (refluks0 nephropathy, which is commonly diagnosed as chronic pyelonephritis, now it has been very well received. The mechanism causing network grated believed to be a combination of effects: (1) Vur, (2) intrarenal reflux, and (3) infection (Kunin, 1997; tolkoff-Rubin, 2000; Rose, Rennke, 1994). The severity Vur is the only deciding factor most important of kidney damage. Much evidence menyongkong the notion that renal involvement at reflux nephropathy occurs in early childhood before the age of 5 to 6 years, since the establishment of the new scar tissue uncommon after this age. The explanation of these observations is that the intrarenal reflux stalled when children become bigger (most likely due to the development of kidney), however Vur continues.
In adults. Vur and reflux nephropathy may be associated with obstructive disorders and neoruligik that cause blockage of the drainage of urine (such as kidney stones or urinary bladder due to neurologic diabetes or brain stem injury). However, most adults who have scarring of the kidney due to chronic pyelonephritis got these lesions early in kana-kanaknya. Bkti-reflux mechanism supporting evidence of this infection came from experiments on animals and observations in humans with the following results: 85% to 100% of children and 50% of adults with renal scarring suffer Vur (Tolkoff-Rubin, 2000).
Reflux nephropathy revelation mechanism that began in early childhood can njelskan bagmenjelaskan scarring and kidney damage in many patients, it is still difficult to explain how a trip progressive kidney damage due to a number of the adults with pyelonifritis final stage can not reflux and UTI , Some patients even can not remember at all had experienced recurrent UTIs. The most popular theory to explain progisif renal failure that occurs in patients with reflux are already corrected with sterile urine is intrarenal hemodynamic theory or hypothesis hiperfitrasi (Rose, Rennke, 1994). According to this theory, the initial infection causes damage to the nephron resulting in an increase in capillary pressure compensation glomelurus (PGC) and hiperperfusi the residual nephrons are still relatively normal. This seems hypertension intraglomerulus cause injury to the glomerular sclerosis and ultimately lead. Diperantaikeadaan concept hemodynamic glomerular injury is supported by a growing body of experimental evidence shows that the control of systemic hypertension mainly by administering inhibitors of angiotensin converting enzyme (ACE) inhibitors such as enalapril maleate koptopril or slow the decline in GFR in many patients with kidney failure. These drugs decrease the PGC with the work against angiotensin II and dilatation of efferent arterioles. Decrease in PGC also occur if the protein foods is limited only 20 to 30g / day, supplemented with amino acids and analog ketonya.

2.6 Management of pyelonephritis

Pyelonifritis acute patients at risk of bacteremia and require intensive therapy antimikrobisl arrives. Parental therapy given se; long 24 till 28 hours until the patient afrebil. At that time, oral agents dspst given. Patients with the condition are a little critical success if dealt only with oral agents. For mrncega perkemban biakannyabakteri remaining, then the treatment of acute pyelonephritis lebi usually longer than in the synthesis.
Problems that may arise in the handling of chronic or recurrent infections which appear up to several months or years without symptoms. After the initial antimicrobial program, patients maintained to continue diwah antimicrobial treatment until evidence of any evidence of infection does not happen, all the causes have been addressed and controlled, and stable renal function. Keratininserum levels and blood count monitored patients on therapy long-term duration.

Management agents antimokrobial selection is based on the identification of the pathogen through urine culture. If bacteria can not disappear from the urine, or a combination nitrofurantion sulfametoxazole and trimetrhopim can be used to suppress the growth of bacteria. Strict renal function, particularly if a potential medication for kidney toxin.