CHAPTER I
INTRODUCTION
1.1 Background
Urinary tract infections (UTIs) are common and attack people regardless of age, especially women. UTIs are responsible for approximately seven million patient visits to physicians each year in the United States (Stamm, 1998). UTI expressed in micro biology there if there are significant bacteriuria (105 ml pathogenic microorganisms found in urine collected at the beam middle right way).
Abnormalities can only colonizes bacteria from urine (asymptomatic bacteriuria) or bacteriuria can be accompanied simtomatikndari infection of the urinary tract structures / UTIs are generally divided into two major sub-categories: lower UTI (urethritis, cystitis, prostatitis) and upper UTI (acute pyelonephritis) . Acute cystitis (bladder infection) and acute pyelonephritis (infection and interstitial renal pelvis) is an infection that is most instrumental in causing morbilitas but rarely end up as progressive renal failure.
Pyelonephritis is an infection of the kidneys trophy, tubules and interstitial tissue of one or both kidneys. Bacteria reach the bladder through the urethra and ascend to the kidneys. Although the kidneys receive 20% to 25% of cardiac output, bacteria rarely reaches the kidneys through the bloodstream; cases of hematogenous spread of less than 3%.
Pyelonephritis often as a result of reflux ureterivesikal, wherein the valve incompetent uretevesikal meynyebabkan urine to flow back (reflux) into the ureter. Obstruction of the urinary tract (kidneys which increases susceptibility to infection), bladder tumors, strictures, benign prostatic hyperplasia, urinary stones, and is the cause of another. Acute and chronic pyelonephritis can.
Purpose
1. Medical Students can explain the definition of pyelonephritis, pyelonephritis etiology, epidemiology pyelonephritis, pyelonephritis clinical symptoms, pathophysiology of pyelonephritis, pyelonephritis physical examination, investigation pyelonephritis, pyelonephritis management, diagnosis pyelonephritis, pyelonephritis diagnosis, complications of pyelonephritis, pyelonephritis prognosis
2. Improving ability in scientific writing / papers in the field of medicine.
3. Fulfilling one of the graduation requirements Registrar of Clinic
4. Methods review of literature with reference to some literature.
CHAPTER II
LITERATURE REVIEW
2.1 Definition of pyelonephritis
Pyelonephritis is an inflammation of the renal pelvis and renal parenchyma due to an infection caused by bacteria. Bacterial infection of the kidney tissue at the start of the lower urinary tract to the kidneys continue to rise. This infection can affect parenchym and renal pelvis (kidney pyelum = trophy).
2.2 Causes of pyelonephritis
Bacteria E. Coli.
Resistant to antibiotics.
Ureteral obstruction resulting in hydronephrosis.
Active infection.
Decreased renal function.
Urethral reflux.
The bacteria spread to the kidneys, blood, lymphatic system.
2.3 Pathophysiology pyelonephritis
Entry into the renal pelvis and inflammation. This inflammation causes crusting of the area, starting from the papillae and spread across the cortex. Infection occurs after the cytitis, prostatitis (asccending) or due to infection from blood steptococcus (descending).
Pyelonephritis is divided into two kinds:
Acute pyelonephritis.
Chronic pyelonephritis.
Acute pyelonephritis
Acute pyelonephritis is usually short and frequent recurrent infections due but not perfect or new infections. 20% of recurrent infections occurred after two weeks after therapy is completed. Bacterial infections of the lower urinary tract toward the kidneys, this will affect kidney function. Urinary tract infection or associated with selimut.abses can be encountered in the kidney capsule and the link kortikomedularis. In the end, atrophy, and glomerular and tubular damage occurs.
Chronic pyelonephritis Chronic also comes from the presence of bacteria, but can also be due to other factors such as urinary tract obstruction and urinary reflux. Chronic pyelonephritis can permanently damage the kidney tissue due to repeated inflammation and scarring and can lead to the onset of the faiure renal (kidney failure) are chronic. Kidney was formed progressive scarring, contract and does not work. The process of development of chronic renal failure kidney infection repeated last several years or after a severe infection. Distribution of acute pyelonephritis often found in pregnant women, usually beginning with hydro Pyelonefrosis ureter and ureteral obstruction due to enlarged uterus.
2.4 Clinical Signs and Symptoms of pyelonephritis
Acute pyelonephritis is characterized by swelling of the kidney or renal passenger widening.
In studies on get high fever, chills, nausea, pain in the waist, headache, muscle pain and physical weakness.
On percussion in the area marked by the presence of CVA tenderness.
Client usually accompanied dysuria, frequency, urgency within a few days.
On examination of urine obtained colored urine or hematuria cloudy with a pungent odor, but it is also an increase in white blood cells.
Chronic pyelonephritis
Chronic pyelonephritis caused by repeated infection. So both kidneys slowly becoming damaged. An attack of acute pyelonephritis repeated usually do not have symptoms sfesifik. The presence of fatigue. Headache, low appetite and weight loss. The presence of polyuria, excessive thirst, azotemia, anemia, acidosis, proteinuria, pyuria, and urine concentrations decreased. Declining health of the patient, the patient ultimately suffered kidney failure. Kalik abnormalities and the presence of injury to the cortex region. Kidney nephrons decreases and the ability to decline due to tissue injury. Suddenly when it found hypertension.
2.5 Examination Support pyelonephritis
Diagnostic Evaluation. An intravenous urogram and ultrasound can be performed to determine the site of obstruction in the urinary tract, eliminating the obstruction is critical to saving kidney from destruction. Cult urine and sensitivity tests performed to determine the causative organism so that appropriate antimicrobial agents can diresepkana.
Diagnosis of chronic pyelonephritis
It used to be almost always used when an abnormality is found tubulointerstisial this, the notion of the degree of severe VUR can cause scarring in the kidneys, atrophy, and dilatation Calix (refluks0 nephropathy, which is commonly diagnosed as chronic pyelonephritis, now it's been well received. Mechanisms cause tissue scar is believed to be a combination of effects: (1) VUR, (2) intrarenal reflux, and (3) infection (Kunin, 1997; tolkoff-Rubin, 2000; Rose, Rennke, 1994). Severity of VUR is the only one of the most important determinants of kidney damage. Much evidence menyongkong notion that renal involvement in reflux nephropathy occurs in early childhood before the age of 5 to 6 years, due to the formation of new scar tissue rarely occurs after this age. explanation of these observations is that intrarenal reflux stalled when the child becomes larger (most likely due to the development of the kidney), however VUR continues.
In adults. VUR and reflux nephropathy may be associated with obstructive disorders and neoruligik that cause blockage of the drainage of urine (such as kidney or bladder stones neurologic injury due to diabetes or brain stem). However, the majority of adults who have scarring of the kidneys due to chronic pyelonephritis got these lesions at the beginning of the kana-his childhood. Bkti-reflux mechanism supporting evidence that this infection comes from experiments on animals and observations in humans with the following results: 85% to 100% of children and 50% of adults with VUR had renal scarring (Tolkoff-Rubin, 2000).
The mechanism of reflux nephropathy revelation that began in the early childhood can njelskan bagmenjelaskan scarring and kidney damage in many patients, it is still difficult to explain how the trip progressive renal damage due to a number of adults with end stage pyelonifritis can not reflux and UTIs . Some patients can not even remember at all had experienced recurrent UTIs. The most popular theory to explain progisif renal failure that occurs in patients with reflux that has been corrected with sterile urine is intrarenal hemodynamic theory or hypothesis hiperfitrasi (Rose, Rennke, 1994). According to this theory, the initial infection causes damage to the nephrons results in compensatory increase glomelurus capillary pressure (PGC) and the rest of the nephron hiperperfusi still relatively normal. This seems to cause injury intraglomerulus hypertension in glomerular sclerosis and ultimately lead. The concept of glomerular injury diperantaikeadaan hemodynamic supported by a growing body of experimental evidence indicates that systemic hypertension control, especially with the administration of drugs inhibiting angiotensin converting enzyme (ACE) inhibitors such as enalapril maleate koptopril or slow the decline in GFR in many patients with kidney failure. These drugs decrease the PGC to work against angiotensin II and efferent arteriolar dilation. Decreased PGC also occur if the protein foods is limited only 20 to 30g/day, supplemented with amino acids and analogues ketonya.
2.6 Management of pyelonephritis
Pyelonifritis acute patients at risk of bacteremia and require intensive therapy antimikrobisl arrives. Parenteral therapy is given as; old 24 till 28 hours until the patient afrebil. At that time, oral agents dspst given. Patients with little critical conditions will be effective when treated only with oral agents. To mrncega perkemban biakannyabakteri remaining, then the treatment of acute pyelonephritis lebi usually longer than in the synthesis.
Problems that may arise in the handling is chronic or recurrent infections appear until several months or years without symptoms. After the initial antimicrobial program, the patient is maintained to continue diwah antimicrobial treatment until evidence is not evidence of infection occur, all the causes have been addressed and controlled, and stable renal function. Keratininserum levels and blood counts monitored patients on prolonged treatment duration.
Treatment options antimokrobial agents based on the identification of the pathogen through urine culture. If bacteria can not disappear from the urine, or a combination nitrofurantion trimetrhopim sulfametoxazole and can be used to suppress the growth of bacteria. Strict renal function, especially if a potential medication for kidney toxin.
