Prognosis
In children, the common combination of vesicoureteral reflux (VUR), congenital anomalies, and infection appears to lead to significant renal parenchymal damage; moreover, the paediatric kidney appears to be more susceptible to damage than the adult kidney.[11]
In patients with pyelonephritic scars, focal segmental glomerulosclerosis with significant proteinuria may develop years after scarring has occurred. This may occur without continued infection or persistent VUR. Proteinuria and focal segmental glomerulosclerosis are poor prognostic indicators, and patients with these findings may develop end-stage chronic kidney disease.[52] The prognosis depends on the status of renal function, and when the disease is contracted in childhood progressive deterioration of renal function may occur. Improved glucose control and treatment of elevated blood pressure is helpful in slowing the progression of chronic kidney disease.
Xanthogranulomatous pyelonephritis
Disease is usually unilateral and surgical excision is curative. In patients with bilateral disease, removal of both kidneys means that the patient will require long-term dialysis postoperatively.
Emphysematous pyelonephritis
This is a life-threatening condition. A sub-set of patients with this disease will have rapidly progressive necrotising infection and sepsis. The mortality rate in this group, even with urgent nephrectomy, may be 80% to 90%.[17] The mortality rate is approximately 40% in patients treated with intravenous antibiotics alone.[1] However, operative treatment, including nephrectomy and drainage along with antibiotics, decreases mortality.[1]
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