genitourinary disorders
Chronic Pyelonephritis
Introduction
Chronic pyelonephritis is continuing pyogenic infection of the kidney that occurs almost exclusively in patients with major anatomic abnormalities. Symptoms may be absent or may include fever, malaise, and flank pain. Diagnosis is with urinalysis, culture, and imaging tests. Treatment is with antibiotics and correction of any structural disorders. (See also Introduction to Urinary Tract Infections (UTIs) .) Reflux of infected urine into the renal pelvis is the usual mechanism. Causes include Obstructive Uropathy , struvite Pathologically, there is atrophy and calyceal deformity with overlying parenchymal scarring. Chronic pyelonephritis may progress to Chronic Kidney Disease . Patients with chronic pyelonephritis may have residual foci of infection that may predispose to (XPN) is an unusual variant that appears to represent an abnormal inflammatory response to infection. Giant cells, lipid-laden macrophages, and cholesterol clefts account for the yellow color of the infected tissue. The kidney is enlarged, and perirenal fibrosis and adhesions to adjacent retroperitoneal structures are common. The disorder is almost always unilateral and most often occurs in middle-aged women with a history of recurrent UTIs. Long-term urinary tract obstruction (usually by a Urinary Calculi ) and infection increase risk. The most common pathogens are 