obsolete chronic pyelonephritis with lesion of renal medullary necrosis

Chronic Pyelonephritis and Renal Medullary Necrosis

Chronic pyelonephritis is a complex renal disorder characterized by chronic tubulointerstitial inflammation and deep segmental cortical renal scarring. It can lead to renal medullary necrosis, which is a type of damage that occurs in the kidneys.

Definition and Causes

• Chronic pyelonephritis represents established and often progressive damage to the kidneys and ureters, initiated and possibly perpetuated by infection of the urinary tract [12].
• Renal papillary necrosis (RPN) is a rare entity defined as ischemic necrosis of the papilla in the medulla of the kidneys, which can be caused by various etiological factors such as analgesic nephropathy, diabetes mellitus, urinary obstruction, and sickle cell hemoglobinopathy [11].
• Chronic pyelonephritis may progress to chronic kidney disease, and patients with this condition may have residual foci of infection that may predispose to bacteremia or seed the urinary tract and transplanted kidney in kidney transplant patients [10].

Symptoms and Complications

• Renal papillary necrosis is an uncommon severe complication of pyelonephritis (2–5%) that occurs most often with underlying structural renal abnormalities or other conditions [6].
• Chronic pyelonephritis may lead to chronic kidney disease, and patients with this condition may experience symptoms such as mild azotemia, which can progress to more severe complications if left untreated.
• Xanthogranulomatous pyelonephritis (XPN) is an unusual variant of chronic pyelonephritis that appears to represent a distinct clinical entity.

References

[10] Chronic pyelonephritis may progress to chronic kidney disease. Patients with chronic pyelonephritis may have residual foci of infection that may predispose to bacteremia or, among kidney transplant patients, seed the urinary tract and transplanted kidney. [11] Renal papillary necrosis (RPN) is a rare entity, which is defined as ischemic necrosis of the papilla in the medulla of the kidneys. It is recognized that a variety of etiological factors, such as analgesic nephropathy, diabetes mellitus, urinary obstruction and sickle cell hemoglobinopathy, may cause papillary necrosis. [12] CHRONIC PYELONEPHRITIS A working definition, taken from Black with slight modification, is that chronic pyelonephritis represents established and often progressive damage to the kidneys and ureters, initiated and possibly perpetuated by infection of the urinary tract.1 The renal lesion is a chronic interstitial nephritis. [6] Renal papillary necrosis is an uncommon severe complication of pyelonephritis (2–5%) that occurs most often with underlying structural renal abnormalities or other conditions.

Based on the search results, I was able to find some relevant information about the signs and symptoms of chronic pyelonephritis with lesion of renal medullary necrosis.

Common Signs and Symptoms:

• Fever and chills [4]
• Pain and/or tenderness in the flank or abdominal area [3, 5]
• Nausea and vomiting [5]
• Dysuria (painful urination) may not be present [5]

Additional Signs and Symptoms:

• Large kidney calculi [6]
• Nonfunctioning kidneys [6]
• Contrast enhancement around low-attenuation areas [6]
• Thickening of the Gerota fascia [6]
• Spherical or oval-shaped lesions in the renal medulla, which may be associated with renal medullary necrosis [6]

Clinical Presentation:

• Patients typically present with fever, chills, and flank or abdominal pain [5]
• Two-thirds of patients have nausea and vomiting [5]
• The area over the affected kidney (in the flank) may feel tender during an exam [7]
• There may be a history of urinary tract infections [7]

Complications:

• Chronic pyelonephritis may progress to chronic kidney disease [12]
• Patients with chronic pyelonephritis may have residual foci of infection that may predispose to bacteremia or seed the urinary tract and transplanted kidney in kidney transplant patients [12]

Please note that these signs and symptoms are based on the search results provided, and it's essential to consult a medical professional for an accurate diagnosis and treatment plan.

Diagnostic Tests for Obsolete Chronic Pyelonephritis with Renal Medullary Necrosis

Chronic pyelonephritis is a complex renal disorder characterized by chronic tubulointerstitial inflammation and deep segmental cortical renal scarring and clubbing of the renal medulla. The diagnosis of this condition can be challenging, but various diagnostic tests can help confirm the presence of renal medullary necrosis.

• Imaging Tests: Imaging studies such as ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) can help identify the extent of renal damage and scarring. These tests can also detect any abnormalities in the renal vasculature [3].
• Urinalysis: Urinalysis is a crucial diagnostic tool for chronic pyelonephritis. It involves examining the urine for signs of infection, inflammation, or bleeding. The presence of blood, protein, or other abnormal substances in the urine can indicate renal damage [11].
• Blood Tests: Blood tests such as blood urea nitrogen (BUN) and creatinine levels can help assess kidney function and detect any abnormalities in renal function [1].
• Renal Biopsy: A renal biopsy is a minimally invasive procedure that involves taking a small sample of kidney tissue for examination. This test can provide valuable information about the extent of renal damage and scarring, as well as the presence of any underlying conditions such as chronic pyelonephritis [13].

It's worth noting that the diagnosis of chronic pyelonephritis with renal medullary necrosis often requires a combination of these diagnostic tests to confirm the presence of this condition.

References:

[1] Blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood. [2] [3] Magnetic resonance imaging (MRI) can detect kidney infection or masses and urinary obstruction, and it can evaluate the kidney vasculature. [4] [11] Diagnosis of pyelonephritis is made by combining the clinical signs, rectal palpation findings, vaginal palpation findings, and urinalysis. Fever usually is present. [5] [13] Clinical utility of kidney biopsies in the diagnosis and management of renal disease. Am J Nephrol 9:309–315, 1989.

Based on the search results, it appears that there is no specific treatment for renal papillary necrosis, which can be a complication of chronic pyelonephritis. However, treatment depends on the underlying cause.

• If analgesic nephropathy is the cause, stopping the use of analgesics may lead to stabilization or even improvement of renal function [4].
• In cases where pyelonephritis is the underlying condition, treatment typically involves antibiotics and correction of any structural disorders [15].

It's worth noting that in some cases, surgical intervention may be necessary if the pyelonephritis is accompanied by complications such as abscesses or calculi (stones) [13]. However, this does not directly address the issue of renal medullary necrosis.

In terms of drug treatment specifically for chronic pyelonephritis with lesion of renal medullary necrosis, there is limited information available. However, it's generally recommended to adjust antibiotic dosages in patients with renal insufficiency [8]. Additionally, antimicrobials with potential systemic toxicity and nephrotoxicity should be used with caution [8].

It's also worth noting that the use of certain medications such as trimethoprim-sulfamethoxazole versus fluoroquinolones has been studied in the treatment of community-acquired urinary tract infections, but this does not directly address the issue of renal medullary necrosis [5].

Based on the search results, it appears that differential diagnosis of chronic pyelonephritis is a complex process that involves considering various factors and conditions.

Possible Differential Diagnoses:

• Renal Papillary Necrosis (RPN): This condition can cause damage to the middle part of the kidneys, leading to reduced kidney function and potentially kidney failure [13]. It may be difficult to differentiate RPN from chronic pyelonephritis based on clinical findings alone.
• Sponge Kidney: This is a benign condition characterized by multiple small cysts in the renal parenchyma. While it can cause mild azotemia, it is not typically associated with the same level of kidney damage as chronic pyelonephritis [15].
• Vesicoureteral Reflux (VUR): This condition can lead to recurrent urinary tract infections and may be a risk factor for developing chronic pyelonephritis. However, VUR itself is not typically considered a differential diagnosis for chronic pyelonephritis.
• Obstructive Uropathy: This condition can cause damage to the kidneys due to blockage of urine flow. While it can lead to similar symptoms as chronic pyelonephritis, it is not typically considered a differential diagnosis.

Key Considerations:

• Clinical Presentation: Patients with chronic pyelonephritis may present with nonspecific signs of kidney disease, such as mild azotemia or pyuria [6].
• Imaging Studies: Radiographic techniques, including CT scanning and ultrasonography, can be useful in differentiating between various space-occupying lesions, including those caused by chronic pyelonephritis.
• Laboratory Findings: Urinalysis may reveal pyuria or other abnormalities that suggest kidney disease.

Conclusion:

Differential diagnosis of chronic pyelonephritis with lesion of renal medullary necrosis requires careful consideration of various factors and conditions. Renal papillary necrosis, sponge kidney, obstructive uropathy, and vesicoureteral reflux are all potential differential diagnoses that should be considered in the evaluation of patients with suspected chronic pyelonephritis.

References:

[6] Chronic pyelonephritis occurs in patients at risk for repeated bouts of acute pyelonephritis. [15] Chronic non-obstructive pyelonephritis is rarer than formerly thought if stri …