Complications
A combination of host and organism factors may be causes. Host factors include multiple medical problems, indwelling catheters, and/or malnutrition. In many cases, urosepsis is linked to specific complicating factors (e.g., obstruction, abscesses, foreign bodies, stones) in the urinary tract. Organism factors include virulence factors and previous antibiotic treatments.[120]
Sepsis requires monitoring in an intensive care unit. Important steps include removal of precipitating factors, maintenance of hemodynamic and nutritional parameters, and appropriate antibiotic treatment.
Renal abscess is a pyogenic infection of the renal parenchyma. Many renal abscesses are due to gram-negative bacteria and are believed to be related to an ascending infection caused by tubular obstruction from prior infection or stones.
Symptoms may be vague and include fever, chills, and abdominal or flank pain. Patients with a history of complicated UTI are at risk. UTIs associated with stasis, calculi, pregnancy, neurogenic bladder, and diabetes may predispose patients to abscess formation.[121]
May be the result of a severe complicated infection, related to antibiotic treatment, or associated with multiorgan failure from sepsis. Medication doses may need to be adjusted. Nephrotoxic agents should be avoided.
People with diabetes are at risk of this acute necrotizing renal infection, in which microorganisms (most commonly Escherichia coli) produce carbon dioxide by fermenting sugar. This disease is uncommon, even among people with diabetes.
Emphysematous pyelonephritis most commonly occurs in immunocompromised older people.
Radiographic indicators are intraparenchymal or suprarenal gas on plain x-ray.
Treatment includes broad-spectrum antibiotics and aggressive blood glucose monitoring and control. If the affected renal tract is obstructed, this should be rapidly relieved by percutaneous drainage or, if unresponsive to conservative measures, consideration should be given to a nephrectomy.
XGP is a rare end-stage result of urinary obstruction and UTI. Proteus species are commonly involved and are usually similar to the organisms associated with stone formation and chronic inflammation. CT scan is the most useful imaging tool and demonstrates a large reniform mass with dilated calyces and abscesses.
This disease is called the "great imitator," as common symptoms (flank pain, fever, chills) mimic more benign infections and the disease is often radiographically perceived to be neoplastic.
Treatment consists of surgical removal of all involved renal tissue, which usually involves a nephrectomy.
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