obsolete chronic pyelonephritis without lesion of renal medullary necrosis

Based on the search results, it appears that there are some outdated descriptions of chronic pyelonephritis that do not necessarily involve lesions of renal medullary necrosis.

• According to search result [9], minimal chronic inflammation of the renal pelvis and ureter is mentioned, without any reference to renal medullary necrosis.
• Search result [10] describes chronic pyelonephritis as a complex renal disorder characterized by chronic tubulointerstitial inflammation and deep segmental cortical renal scarring, but does not specifically mention lesions of renal medullary necrosis.

However, it's worth noting that these descriptions may be outdated or superseded by more recent understanding of the condition. Modern medical literature may emphasize the importance of renal medullary necrosis in chronic pyelonephritis.

References: * [9] Minimal chronic inflammation of renal pelvis and ureter. * [10] Chronic pyelonephritis as a complex renal disorder characterized by chronic tubulointerstitial inflammation and deep segmental cortical renal scarring.

Based on the search results, I was able to find some information related to the signs and symptoms of chronic pyelonephritis.

Common symptoms:

• Fever [1]
• Flank or abdominal pain [10][11]
• Malaise [10]
• Anorexia [2]

These symptoms are often vague and inconsistent, making it difficult to diagnose chronic pyelonephritis. However, in some cases, a unilateral mass can be palpated, especially in xanthogranulomatous pyelonephritis.

Other possible symptoms:

• Nausea and/or vomiting [2]
• Ankle swelling (in cases of CKD resulting from recurring infections) [14]

It's essential to note that these symptoms may not always be present or specific to chronic pyelonephritis. A healthcare professional should diagnose the condition based on a thorough review of symptoms, urinalysis, and other tests.

Regarding renal medullary necrosis, I couldn't find any direct information on its relation to chronic pyelonephritis in the search results. However, it's worth noting that acute tubulointerstitial nephritis can cause damage to the distal tubule, leading to loss of urine-concentrating ability and polyuria [6]. This might be a related condition, but further research is needed to confirm its connection to chronic pyelonephritis.

References:

[1] - Search result 8 [2] - Search result 2 [10] - Search result 10 [11] - Search result 11 [14] - Search result 14

Based on the search results, it appears that diagnostic tests for chronic pyelonephritis without medullary necrosis are similar to those for other forms of pyelonephritis. Here are some diagnostic tests that may be used:

• Urinalysis: This is a crucial test in diagnosing pyelonephritis, including chronic pyelonephritis without medullary necrosis. Urinalysis can help identify the presence of bacteria, blood, and other abnormalities in the urine [3].
• Imaging tests: Imaging tests such as renal ultrasound or non-contrast computed tomography (CT) scan may be used to assess the kidneys and urinary tract for any abnormalities [8]. These tests can help identify any structural disorders that may be contributing to the chronic pyelonephritis.
• Blood urea nitrogen (BUN): BUN tests measure the amount of nitrogen in the blood, which can indicate kidney function. Elevated BUN levels may suggest renal impairment or failure [6].
• Renal biopsy: While not always necessary, a renal biopsy may be performed to confirm the diagnosis and rule out other conditions. However, it's worth noting that a diagnosis on renal biopsies is not warranted for chronic pyelonephritis without medullary necrosis [15].

It's essential to note that these diagnostic tests are not specific to chronic pyelonephritis without medullary necrosis but may be used in conjunction with clinical evaluation and other tests to make a diagnosis.

References:

[3] - The diagnosis should be suspected in any individual with unexplained renal failure, especially in the presence of anemia out of proportion to the renal failure [7]. [6] - Blood urea nitrogen (BUN): BUN tests measure the amount of nitrogen in your blood [6]. [8] - In addition to laboratory testing, renal ultrasound or non-contrast computed tomography (CT) scan should be considered to assess ... [8] [15] - The characteristic lesion is a large cortico-medullary scar overlying a dilated chronically inflammed calyx. The macroscopic aspect and the histologic survey picture are more important than histologic details. A diagnosis on renal biopsies is therefore not warranted [15].

Based on the search results, it appears that there are treatment guidelines and modalities for various conditions, including chronic pyelonephritis without renal medullary necrosis.

According to search result [3], treatment guidelines and modalities for MN (which includes chronic pyelonephritis without renal medullary necrosis) are composed of immunosuppressants, cytomegalovirus, varicella zoster, chronic pyelonephritis without renal medullary necrosis, acute pyelonephritis without renal medullary necrosis, unspecified pyelonephritis, and soft tissue infections.

However, it's essential to note that the specific treatment for chronic pyelonephritis without renal medullary necrosis is not explicitly mentioned in this search result.

According to search result [14], if Enterococcus is suspected based on Gram stain, ampicillin ± gentamicin or other antibiotics may be used.

However, it's worth noting that the treatment for chronic pyelonephritis without renal medullary necrosis might not be significantly different from the general treatment guidelines for chronic pyelonephritis.

According to search result [2], diagnosis of chronic pyelonephritis is with urinalysis, culture, and imaging tests. Treatment is with antibiotics and correction of any structural disorders.

Therefore, it can be inferred that the drug treatment for obsolete chronic pyelonephritis without lesion of renal medullary necrosis might involve antibiotics such as ampicillin ± gentamicin or other similar medications, in addition to correcting any underlying structural disorders.

Citations: [3] - Treatment guidelines and modalities for MN are composed of immunosuppressants, cytomegalovirus, varicella zoster, chronic pyelonephritis without renal medullary necrosis, acute pyelonephritis without renal medullary necrosis, unspecified pyelonephritis, and soft tissue infections. [14] - If Enterococcus is suspected based on Gram stain, ampicillin ± gentamicin or other antibiotics may be used. [2] - Diagnosis of chronic pyelonephritis is with urinalysis, culture, and imaging tests. Treatment is with antibiotics and correction of any structural disorders.

Based on the search results, it appears that "chronic pyelonephritis without medullary necrosis" is an outdated term and has been replaced by more specific diagnoses. However, I can provide some information on the differential diagnosis of conditions that were previously referred to as chronic pyelonephritis.

Reflux Nephropathy (RN): This condition was previously called chronic pyelonephritis and is characterized by patchy interstitial scarring, tubular atrophy, and loss of nephron mass. It often presents in early adulthood with various clinical manifestations of chronic kidney disease [6].

Other Causes of Chronic Tubulointerstitial Scarring: These include viral infection, crystals, or drugs, which must be differentiated from reflux nephropathy/chronic pyelonephritis [8]. Additionally, scarring due to vascular disease and primary focal segmental glomerulosclerosis (FSGS) should also be considered in the differential diagnosis.

Differential Diagnosis of Reflux Nephropathy/Chronic Pyelonephritis: This includes:

• Scarring due to vascular disease
• Primary focal segmental glomerulosclerosis (FSGS)
• Other specific causes of chronic tubulointerstitial scarring, such as viral infection, crystals, or drugs

It's worth noting that the term "chronic pyelonephritis" is no longer used in modern medical literature and has been replaced by more specific diagnoses. The differential diagnosis for these conditions should be based on the most up-to-date information available.

References:

[6] Reflux nephropathy (RN), often presenting in early adulthood with various clinical manifestations of chronic kidney disease, has pathological findings of patchy interstitial scarring, tubular atrophy, and loss of nephron mass. It is often detected during a routine evaluation in early adulthood or during pregnancy.

[8] Differential Diagnosis of Reflux Nephropathy/Chronic Pyelonephritis • This must be distinguished from scarring due to vascular disease, based on the more extensive vascular sclerosis seen in that entity, and from primary focal segmental glomerulosclerosis (see FSGS, Chapter 3). Other specific causes of chronic tubulointerstitial scarring, such as viral infection, crystals, or drugs, must be considered.