Complications of acute - chronic pyelonephritis

The article was written by a Doctor of Nuclear Medicine - Department of Diagnostic Imaging and Nuclear Medicine, Vinmec Times City International General Hospital.

The kidneys are very susceptible to damage by many different agents, causing the functional parts of the kidney to be severely affected. In particular, acute or chronic pyelonephritis have serious health complications if not detected and treated early.

Pyelonephritis usually begins with inflammation of the ureters and bladder that spreads to the kidneys, usually by bacteria. Most cases of bacteria invade upstream from the lower urinary tract, such as in pregnant women with urine reflux phenomenon, bacteria will go upstream of urine to reach the renal pelvis and cause parenchymal damage. kidney. An estimated one-third of pregnant women develop bacterial pyelonephritis.

In addition to pregnant women, some people who have been intubated for a long time, have a retrograde urography, have surgery to plug the ureter - intestine, ureter - colon are susceptible to retrograde infection or patients with kidney stones (especially) Coral kidney stones often have a bacterial infection in the kidney). In addition, bacteria can travel from an infected area of ​​the body through the bloodstream to the kidneys to cause pyelonephritis.
Although it is known that the cause of pyelonephritis is bacteria, in many cases, the bacteria cannot be detected from where the disease is caused. The inflamed kidney will be enlarged due to inflammation, edema and uneven surface, when cut into the renal parenchyma, the boundary between the renal cortex and the medulla will be unclear, there are many small abscesses in the parenchyma. The renal pelvis mucosa is damaged. Observation on the microscope will see the foci of hemorrhage, edema and inflammatory cell infiltration.
Common symptoms of pyelonephritis are fever, sometimes high fever and chills, patient fatigue, poor appetite. Accompanied by low back pain, flank pain or hip pain. Sometimes it is abdominal pain with renal colic. Patients also have trouble urinating: frequent urination, burning sensation or pain when urinating, in some cases blood in the urine.

The signs of infection of acute pyelonephritis appear strongly. The patient has a sudden high fever, chills, rapid collapse, dry cracked lips, dirty tongue... If the patient takes fever-reducing medicine, the fever will decrease for a short period of time (several hours) after that. fever flared up again. Along with that, the patient will feel pain in the back ribs, pain on one side or pain on both sides, usually dull pain but sometimes there will be intense pain like a stabbing knife, the pain will spread to the bladder area, even spread to the external genitalia.

Not all cases of acute pyelonephritis have symptoms such as painful urination, burning sensation, frequent urination, cloudy urine, sometimes blood in urine. Elevated leukocytes, especially polymorphonuclear leukocytes, may indicate sepsis in blood tests. When blood urea and creatinine rise, it is a sign of acute renal failure or acute exacerbation of chronic kidney failure. In addition, patients with acute pyelonephritis also have anorexia, loss of appetite, nausea, vomiting, abdominal distention, and fatigue.
Acute pyelonephritis usually progresses well and fully recovers if it is treated early and with the right medicine. Usually after a few days, the fever will stop, the patient's urine will return in 1-2 weeks. But if acute pyelonephritis is treated late or improperly, the disease is easy to recur, turning into chronic pyelonephritis, kidney failure, renal knob necrosis, pyelonephritis, sepsis, and hypertension. .. these complications can lead to death of the patient.

Chronic pyelonephritis is a condition of chronic damage to the parenchyma, interstitial tissue of the kidney, this is a consequence of the process of pyelonephritis entering the kidney, which lasts and recurs many times, causing destruction and fibrosis renal failure, leading to renal failure. Clinical manifestations are quite diverse, easy to be confused with other diseases, can be seen at any age, more common in men than in women. If not diagnosed and treated promptly, chronic pyelonephritis easily leads to dangerous complications, including kidney failure.
Complications of chronic pyelonephritis are mild or severe depending on whether the disease occurs in one or both kidneys, the disease has just occurred or has recurred for a long time, the disease is caused by obstruction of the urinary tract. does not suit. If the damage is on one side of the kidney: often silently, without obvious symptoms, only discovered when there are complications such as renal colic or an outbreak of infection. If the cause of stasis is not resolved, the kidneys will become waterlogged - pus-filled, fibrous tissue will develop to replace the healthy tissue of the kidney, and the kidney will be destroyed, atrophy, and fibrosis will increase blood pressure. If the damage is on both sides: the disease progresses rapidly, leading to increased blood pressure, blood urea, and creatinine, leading to kidney failure.

Renal function scintigraphy is a commonly applied technique at the Nuclear Medicine Unit, Vinmec Times City International Hospital. This is a technique to help assess kidney function using modern, high-precision recording equipment combined with radioactive tracer. Kidney scintigraphy gives good quality images, contributing to improving the efficiency of diagnosis and treatment of kidney and urinary tract diseases.
The patient is injected intravenously with a special radioisotope, the technicians will record kinetic images and graphs of radioactivity over time of each kidney, the doctor analyzes the graphs and images images, thereby assessing the function of each kidney individually.
Renal scintigraphy is applied in the following cases:
Evaluation of the function of both kidneys or individual kidneys, before and after kidney transplantation. Monitor and evaluate kidney diseases: pyelonephritis, renal hypertension, pyelonephritis, glomerulonephritis, renal tubular necrosis, acute and chronic renal failure... Assess and monitor obstruction urinary tract obstruction. Scanning when one kidney is suspected to have congenital pathology

At Vinmec Times City, the SPECT/CT Discovery NM/CT 670 Pro system is used, with the most modern 16-sequence CT technology of the world's leading medical equipment company GE Healthcare (USA), scanning for images. High quality, helping to diagnose diseases that need to be investigated early.
The medical staff at Vinmec system are very experienced, well-trained and in-depth at home and abroad, will directly advise and support customers in the comfortable and effective shooting process, including even for foreign customers.