Acute pyelonephritis

Case report:

A 68-year-old patient comes into practice and complained of left flank pain radiating into the lower abdomen, and for two days existing Fever with chills, significant night sweats, headaches, nausea and a marked malaise. A history of a prostatic hyperplasia is known in this patient, which has already led to repeated Restharnanstiegen.
Physical examination confirms the increased body temperature 38.8 � C, the left-renal capsule is highly knock and pressure-sensitive, the heart rate is 105 / min and blood pressure at 110/60 mmHg. As a result of carried out immediately Urinalysis there are a high number of granulocytes as well as a significant protein excretion.

Diagnosis:

The history with the tendency to urinary retention and the typical symptoms of fever and flank pain and the physical examination findings indicate an acute pyelonephritis. Whereas the analysis, in addition to the urinalysis bacteriological examination of urine results in a significant number of microbes more than 10 5 E. coli / ml in urine. The additional urological ultrasound examination shows a small residual urine.

Pathogenesis:

Acute pyelonephritis are usually caused by anatomic or functional disorders in the urinary tract. In more than 90% are referred to as pathogens E. coli, Proteus mirabilis, Klebsiella, occasionally detected as mixed infections with enterococci. An intensive urological diagnosis with ultrasound or computed tomography is necessary in order to potentially provide the indication for surgical removal of the prostate hyperplasia.

Therapy:

The antibiotic therapy should be guided by the microbiological resistance patterns. As substances Oral cephalosporins, penicillins with amino Betalaktamaseinhibitoren and fluoroquinolones group II, such. As ofloxacin (Tarivid others) or ciprofloxacin (Cipro, etc.) into consideration. The duration of treatment should be at least ten to fourteen days, a monitoring of the patient in short intervals is required.