Complications
Related to haemodynamic instability, medications, and from being acutely ill with EPN.
Develops due to hypocalcaemia, hyperphosphataemia, and 1,25-dihydroxy vitamin D deficiency in late-stage chronic kidney disease.[54]
If the urine culture is positive, treatment is based on that for acute pyelonephritis.
Treatment regimens depend first on the severity of the patient's symptoms and then on the urine culture sensitivities. Antibiotics are given orally for mild to moderate infection, and intravenously when the patient is severely ill or septic. Duration of therapy depends on the severity of the illness. Eliminating recurrent urinary tract infections can prevent further renal damage, although in general antibiotic treatment is not helpful in these patients unless ongoing infection is documented.[8] Infections are due to the common organisms that cause acute pyelonephritis (e.g., Escherichia coli, Klebsiella, Proteus species).
If the urine culture is negative, treatment with antibiotics is not indicated.
Urological consultation should be obtained in patients with renal or ureteral obstruction.
Obstruction generally requires treatment; important considerations are aetiology and duration. Relief of chronic long-standing obstruction may not produce any improvement in renal function. For patients with more acute obstruction or in whom residual kidney function is present, surgical repair of congenital lesions, removal of stones, or percutaneous/stent placement for drainage of calyceal/ureteral obstruction may be necessary.
In children, evaluation for vesicoureteral reflux with ultrasound, cortical renal nuclear scanning, or voiding cystourethrogram is important to eliminate a risk factor for recurrent pyelonephritis and renal scarring. Rarely, removal of the affected kidney may be necessary due to hypertension or a large stone burden in a non-functioning kidney.
Nephrectomy related to xanthogranulomatous pyelonephritis (XGP) or EPN leads to immediate loss of GFR unless the involved kidney was completely non-functional. The remaining kidney may become hypertrophied as it attempts to compensate for some of the loss of GFR.
Worsening renal function may also occur if treatment of vesicoureteral reflux, renal stones, or urinary tract infections is inadequate, and may lead to end-stage renal disease.[53]
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