Gestational pyelonephritis

Case report:

A 23-year-old female is five months pregnant and is due to the practice for several days increasing right-sided flank pain, dysuria, lethargy, lack of appetite and low-grade fever. From the history of the patient no urinary or kidney infections are known, special travel or other infectious disorders also do not exist.

Diagnosis:

The physical examination initially confirmed an increased body temperature of 38 � C measured axillary. Furthermore, a significant knock and tenderness of the right kidney camp is detectable. The cardiovascular conditions are normal; ultrasonography of the kidneys gives no indication of congestion in both the renal pelvis.
The investigation urine sediment results in a significant leucocyturia and bacteriuria. In midstream urine 104 E. coli can be detected per ml of urine. Microbiological determination is no resistance to all commonly effective chemotherapy drugs.

Pathogenesis:

The anatomical, functional and immunological changes in the urinary tract during pregnancy predispose relatively common infections of the upper and lower urinary tract. Not infrequently also solves a pregnancy from the acute episode a long-standing, but previously undetected chronic pyelonephritis. The germ count of 104 / ml of a typical infectious agent is now accepted as significant.

Therapy:

Treating a urinary tract infection during pregnancy in principle not different from the therapy of acute pyelonephritis. You will, however, complicated by the fact that some antimicrobial substances also reasons of drug tolerance in pregnancy can not be administered (aminoglycosides, doxycycline, cotrimoxazole, nitrofurantoin, fluoroquinolones, sulfonamides). The therapy is therefore based during pregnancy on aminobenzyl penicillins with or without Betalaktamaseinhibitoren and Oralcephalosporine. The patient shown here, an eight-day treatment with twice 750 mg amoxicillin (Amoxypen etc.) has been made.