Talk:Pyelonephritis

Trimethoprim

Trimethoprim is NOT a suitable treatment for pyelonephritis. Although it works very well for cystitis when the causative bacterium is susceptible, it cannot work when the kidney is infected in cases of pyelonephritis. This is because it acts to block folic acid synthesis in bacteria. The bloodstream, which supplies the kidney, is a rich source of folic acid. Any bacteria that are present in the kidney are supplied with folic acid, overcomimg the block imposed by trimethoprim. The same is true for the combination of trimethoprim and a sulphonamide (co-trimoxazole): sulphonamides also act to block bactieral folic acid synthesis.

Micjh

Still according to PMID 10589881 it is an acceptable alternative to fluoroquinolone for susceptible organisms. --WS 20:23, 8 January 2006 (UTC)

From Trimethoprim: Bacteria are unable to take up folic acid from the environment (i.e. the infection host) thus are dependent on their own de novo synthesis - inhibition of the enzyme starves the bacteria of two bases necessary for DNA replication and transcription. So folic acid from the blood is no good for them. --WS 20:28, 8 January 2006 (UTC)

• In our area we tend to use cefalosporins for pyelonephritis with systemic symptoms (e.g. fever, rigors, lassitude). With the most common cause being coliforms one could certainly make a case for trimethoprim, but rapidly progression urosepsis usually makes clinicians choose a broader spectrum, which may include ceph or fluoroquinolones. We seem to be growing a lot of trimethoprim-resistant coli strains around here these days. JFW | T@lk 21:09, 8 January 2006 (UTC)

PBC

The article suggested that PBC was a predisposing state for pyelonephritis. Searching PubMed I can only find some Japanese case reports that suggest the coliforms cause PBC through molecular mimicry, but nothing on an increase of UTIs. It bears noting that PBC is often treated with immunosuppression, and that this independently increases the risk for UTIs. JFW | T@lk 20:52, 25 July 2007 (UTC)

Descending

can also be blood born. Something about this should be added too. (utc)

Guideline

http://journals.lww.com/greenjournal/Citation/2008/03000/ACOG_Practice_Bulletin_No__91__Treatment_of.37.aspx

ACOG have issued a guideline for UTI/pyelonephritis in non-pregnant patients. Sadly, the document is not free (which is a bit silly, given that guidelines are meant to be disseminated). JFW | T@lk 22:03, 29 December 2008 (UTC)

Pyelonephritis is a SYMPTOM, not an infection.

Pyelonephritis is a description of inflammation of the renal pelvis and kidney. It is a consequence of an ascending urinary tract infection, not the infection itself. Pyelonephritis can be caused by a number of things. —Preceding unsigned comment added by 159.92.232.193 (talk) 16:16, 2 May 2011 (UTC)

It's not a symptom, but one could call it a syndrome. At the same time, it is usually caused by infection so it is not wrong to refer to it as an infection. JFW | T@lk 15:21, 5 June 2011 (UTC)

A short course in medical terminology

Collins, CE (2006). A Short Course in Medical Terminology (1st ed.). Baltimore: Lippincott Williams & Wilkins. ISBN 0781747678. Retrieved 2011-06-05.

This reference entered the article after the merge with xanthogranulomatous pyelonephritis, and DiverDave (talk · contribs) reinserted it after I took it out. I cannot see a precedent for using this as a source in any other medical articles. Occasionally we make specific references to Dorland's, but only when a definition is required and no other sources are available (e.g. in hypopituitarism). JFW | T@lk 15:21, 5 June 2011 (UTC)

Hey, Dave!

I was looking for a secondary source to replace Czaja2007, and stumbled upon the 2010 IDSA guidelines (doi:10.1093/cid/ciq257). This is an absolutely perfect source, and it can probably replace quite a few primary research studies that we are currently using. I'll be reading this over the next day or two, and hopefully do something useful with it. JFW | T@lk 06:22, 6 June 2011 (UTC)

Thanks for finding this excellent, up-to-date source which reflects a global approach to the subject. I have just finished reading it, and I see this source as being useful in replacing the inline citations for paragraph #1 of the ==Management== section. I would like to add though that IMHO the pyelonephritis article goes into far too much detail with respect to the dosing of antibiotics, coming dangerously close to giving medical advice. Seems to me it should be more general, simply stating which antibiotics are most useful under which set of circumstances. For example, we might include a statement such as:

In patients not requiring hospitalization where there is a low prevalence of antibiotic-resistant uropathogens, a once-daily oral fluoroquinolone such as ciprofloxacin or levofloxacin is an appropriate initial choice for therapy. In areas where there is a higher prevalence of fluoroquinolone resistance, a long-acting intravenous antibiotic such as ceftriaxone or an aminoglycoside is preferred.

What are your thoughts? DiverDave (talk) 01:53, 10 June 2011 (UTC)

References

πήληξ – pyelum

Eh? How can πήληξ, pḗlēx, become "pyelum"? — Preceding unsigned comment added by 83.226.139.228 (talk) 20:01, 1 January 2014 (UTC)

NEJM review

doi:10.1056/NEJMcp1702758 JFW | T@lk 13:03, 4 January 2018 (UTC)

NICE about antibiotics

https://www.nice.org.uk/guidance/NG111 JFW | T@lk 21:44, 11 June 2019 (UTC)