Pyelonephritis in Pregnancy Presentation

7/26/2019 Pyelonephritis in Pregnancy Presentation

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NILOY CHATTERJEEUMHS, MS-3

PYELONEPHRITIS IN

PREGNANCY


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EPIDEMIOLOGY

2% of pregnancies wi e!perience p"eonep#ri$is

&% of p"eonep#ri$is cases in pregnanc" occ'r inn'iparo's wo(en

)*% of p"eonep#ri$is cases occ'r +'ring $#e secon+

$ri(es$er2% of p"eonep#ri$is cases wi res'$ in ARDS

,p $o -*% of pregnancies wi$# as"(p$o(a$ic.ac$eri'ria wi res'$ in p"eonep#ri$is

Ris/ of rec'rrence ,p $o 01% wi$# ongoing $#erape'$icprop#"ac$ic $rea$(en$ ,p $o )*% wi$#o'$ ongoing $#erape'$icprop#"ac$ic $rea$(en$


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INTROD,CTION

3#a$ is p"eonep#ri$is4 In5a((a$ion of $#e /i+ne"s6 (os$ co((on" +'e $o an ascen+ing

.ac$eria infec$ion fro( $#e 'rinar" $rac$ 7(os$ co((on +irec$so'rce is $#e .a++er8

Mos$ co((on 'rinar" $rac$ co(pica$ion in pregnanc"

More co((on" occ'rs in pregnan$ wo(an $#an non9pregnan$wo(en

Of$en consi+ere+ a (i+9a$e pregnanc" iss'e Ma$erna 're$era an+ ca"cea +ia$a$ion occ'rs aro'n+ $#e 0*$#

wee/ of ges$a$ion an+ progressi:e" worsens $#ro'g#o'$ pregnanc"

Hence6 $#e ra$es of p"eonep#ri$is; 0s$Tri(es$er; 2%

2n+Tri(es$er; &2%


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O$#er p#"sioogic c#anges occ'rring inpregnanc" $#a$ pre+ispose wo(en $op"eonep#ri$is;

Increase+ .a++er capaci$" wi$# inco(pe$e :oi+ing =esico're$era re5'! H"+ronep#rosis


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MOST COMMON PATHOGENS

Mos$ co((on .ac$eria i(pica$e+; E> coi7?1*% o:era8

E> coi @ e.siea @ S> a're's @ Pro$e's

Gra( posi$i:e infec$ions 7inc'+ing GBS8acco'n$ for ?0*% of cases


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SIGNS AND SYMPTOMS

So(e wo(en +on$ e!perience an"s"(p$o(s of infec$ion6 w#ie o$#er wo(en +o

Co((on signs an+ s"(p$o(s

Cos$o:er$e.ra ange $en+erness an/ pain 7(os$ co((on" on rig#$ si+e8

Na'sea an+ :o(i$ing

Increase+ fre'enc"6 'rgenc" an+ +"s'ria

He(a$'ria

e:er @ -F8 C#is

Anore!ia


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MILD PYELONEPHRITIS

Mi+ P"eonep#ri$is S!; Low fe:er Nor(a $o sig#$" ee:a$e+ 3BC co'n$ A.sence of na'sea or :o(i$ing

O'$pa$ien$ (anage(en$ (a" .e consi+ere+ if; Ini$ia inpa$ien$ o.ser:a$ion +i+ no$ pro+'ce concern Inpa$ien$ I= an$i.io$ic co'rse was co(pe$e+

0-9+a" ora an$i.io$ic $#erap" pos$9inpa$ien$o.ser:a$ion


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SE=ERE PYELONEPHRITIS

Se:ere P"eonep#ri$is S!; Hig# fe:er Low 'rine o'$p'$ Respira$or" ins'cienc"

Sepsis ,na.e $o $oera$e an$i.io$ics No i(pro:e(en$ +'ring ini$ia inpa$ien$ o.ser:a$ion

Manage(en$

Cooing .an/e$ an+ ace$a(inop#en (a" .e in+ica$e+ I(por$an$ $o (ain$ain ower core $e(pera$'re $o pro$ec$

fe$'s fro( increase+ ris/ of ano(aies +'e $o #ig#er$e(pera$'re


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,p $o 2*% of se:ere p"eonep#ri$iscases ea+ $o a co(.ina$ion of;

Sep$ic s#oc/

Ac'$e respira$or" co(pica$ions

Rena co(pica$ions


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RIS ACTORS

I(('nos'ppression

Dia.e$es

Sic/e ce ane(ia

Ne'rogenic .a++er

Cac'i

De#"+ra$ion

H! of rec'rren$persis$en$ 'rinar" $rac$ infec$ions prior$o pregnanc"

Trea$(en$ nonco(piance

,rinar" 7ana$o(ica8 ano(aies

Poor #"giene


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COMPLICATIONS

Pre$er( +ei:er"

Toco"$ics are in+ica$e+ on" if; Cer:ica c#anges an+ '$erine con$rac$ions H"+ra$ion an+ an$i.io$ic $#erap" oer no reso'$ion

Toco"$ics an+ s$eroi+s are con$rain+ica$e+ in

pa$ien$s wi$# se:ere respira$or" s"(p$o(s an+#e(o+"na(ic ins$a.ii$"


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ARDS Occ'rs in 2% of p"eonep#ri$is cases +'ring pregnanc" Especia" associa$e+ wi$# $#e foowing;

0> Tac#"car+ia @ 00*.p(

2> e:er 0* Toco"$ic $#erap"

Ane(ia +'e $o #e(o"sis 7'p $o 2< of cases8

I(paire+ rena f'nc$ion 7'p $o 2*% of cases

Disse(ina$e+ In$ra:asc'ar Coag'a$ion

Sep$ic S#oc/


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DIAGNOSIS

His$or" an+ p#"sica e!a( are i(por$an$

Lower 'rinar" $rac$ S!; ,rgenc"

re'enc" D"s'ria

S"s$e(ic S!; Cos$o:er$e.ra ange $en+erness

an/ pain 7(os$ co((on" on $#e rig#$ si+e8 e:er @ -F8 Na'sea =o(i$ing


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Cos$o:er$e.ra ange $en+erness is ra$#erspeciJc for p"eonep#ri$is

an/ pain aso occ'rs in nep#roi$#iasis an+

're$eroi$#iasis


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LABS

,rina"sis 7cean ca$c#8 Presen$

3BC cas$s

I$ is s'gges$e+ $o cen$rif'ge $#e se+i(en$ sa(pe a$ K26***rp( $o a:oi+ r'p$'ring $#e 3BC cas$s

Bac$eria

Ni$ri$es

Ma" .e presen$; Microscopic #e(a$'ria 7.'$ is (ore s'gges$i:e of cac'i8

Pro$ein'ria 'p $o 2g+a" 7if @


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,rine c'$'re I(por$an$ for +e$er(ining possi.ii$" of an$i.io$ic

resis$ance

Boo+ c'$'re 7.ac$ere(ia8

CBC 7ne'$rop#iia8

Crea$inine 7rena f'nc$ion8

Eec$ro"$es


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MANAGEMENT

P"eonep#ri$is in pregnanc" re'ires #ospi$aa+(ission for inpa$ien$ o.ser:a$ion for a$eas$ 2- #o'rs 7regar+ess of w#e$#er $#es"(p$o(s are (i+ or se:ere8

,$raso'n+

P'se o!i(e$r"

Ar$eria .oo+ gas 7especia" if respira$or"

s"(p$o(s are presen$8


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Trea$(en$

P"eonep#ri$is in pregnanc" nee+s $o .e$rea$e+ aggressi:e"

0> Hospi$a a+(ission

2> I= #"+ra$ion

I= an$i.io$ics

-> Ora an$i.io$ics

&> Pos$9infec$ion prop#"a!is


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I= H"+ra$ion I= 5'i+s Saine6 Lac$a$e+ ringer

I(por$an$ $o (ain$ain a 'rine o'$p'$ of @


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I= An$i.io$ics I= an$i.io$ics are in+ica$e+ 'n$i $#e pa$ien$ is .o$#

afe.rie an+ as"(p$o(a$ic for a$ eas$ 2-9-1 #o'rs Dr'g of c#oice; I= Cef$ria!one6 092g2-#

A$erna$i:e I= singe an$i.io$ic $#erap"; Cefaoin6 Cefo$e$an6 Cefo$a!i(e

Disa+:an$age; Re'ire @ 0 +ose per +a"

A$erna$i:e I= co(.ina$ion an$i.io$ic $#erap";

A(piciin Gen$a(icin6 A(piciin S'.ac$a(6Piperaciin Tao.ac$a(


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Ora An$i.io$ics Pa$ien$ can .e swi$c#e+ o:er $o ora an$i.io$ics once

$#e pa$ien$ is .o$# afe.rie an+ as"(p$o(a$ic for a$eas$ 2-9-1 #o'rs

Dr'g of c#oice; A'g(en$in 7A(o!iciin Ca:'ana$e8

A$erna$i:e ora an$i.io$ic $rea$(en$; Bac$ri( 7Tri(e$#opri( S'fa(e$#o!aoe8

Pos$9infec$ion prop#"a!is Ni$rof'ran$oin


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PRE=ENTION

,ni:ersa screening an+ pro(p$ $rea$(en$ ofas"(p$o(a$ic .ac$eri'ria +'ring pregnanc"

A+(inis$ra$ion of prop#"ac$ic $rea$(en$

7Ni$rof'ran$oin8 for $#e +'ra$ion of pregnanc"if an" of $#e foowing cri$eria are (e$;0> 0 episo+e of p"eonep#ri$is

2> 2 episo+es of as"(p$o(a$ic .ac$eri'ria

C"s$i$is


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3ORS CITED

Ac'$e P"eonep#ri$is; Are Yo' Pas$ $#e Danger4 Healthline> E+> Do(inic Marc#iano6 MD> Hea$#ine6 0&Mar> 2*02> 3e.> 0 No:> 2*0-> Q$#$$p;www>#ea$#ine>co(#ea$#pregnanc"infec$ions9ac'$e9p"eonep#ri$isO:er:iew0Qg$>

Cogan MD6 Ric#ar+> Diagnosis an+ Trea$(en$ of Ac'$e P"eonep#ri$is in 3o(en> American Association ofFamily Physician> A(erican Associa$ion of a(i" P#"sicians6 0 Sep$> 2*00> 3e.> 0 No:> 2*0-> Q$#$$p;www>aafp>orgafp2*00**0p&0>#$(Qg$>

Eio$$ MD6 B"ron> P"eonep#ri$is an+ Co(pica$ions of Pregnanc"> Resi+en$ Lec$'re> Se$on Me+ica Cen$er6A's$in6 TU6 ,SA> Lec$'re>

'op MD6 Ti.or> Ac'$e P"eonep#ri$is >Acute Pyelonephritis> Me+scape6 01 Apr> 2*0-> 3e.> 0 No:> 2*0->Q$#$$p;e(e+icine>(e+scape>co(ar$ice2-&&&9o:er:iewQg$>

Gr'ne.a'( MD6 A(os> P"eonep#ri$is D'ring Pregnanc"> BabyMed> Ba."Me+> 3e.> 0 No:> 2*0-> Q$#$$p;www>.a."(e+>co(infec$ionsp"eonep#ri$is9+'ring9 pregnanc"Qg$>

Hi MD6 Wa(es6 Weanne S#ee+ MD6 Dona+ McIn$ire P#D6 an+ George 3en+e MD> Ac'$e P"eonep#ri$is inPregnanc" ; O.s$e$rics Q G"necoog">Journals LWW> Lippinco$$ 3iia(s Q 3i/ins6 00 W'" 2**-> 3e.> 0No:> 2*0->Wo#nson6 MD6 E(iie> ,rinar" Trac$ Infec$ions in Pregnanc" > ,rinar" Trac$ Infec$ions inPregnanc"> Me+scape6 & e.> 2*0-> 3e.> 0 No:> 2*0-> Q$#$$p;e(e+icine>(e+scape>co(ar$ice-&2)*-9o:er:iewa*0*-Qg$>

Na$iona i+ne" an+ ,roogic DiseasesInfor(a$ion Cearing#o'se 7N,DIC8> National Kidney and Uroloic!iseases "nformation #learinhouse> Na$iona Ins$i$'$e of Hea$#6 00 W'ne 2*02> 3e.> 0 No:> 2*0-> Q$#$$p;/i+ne">ni++/>ni#>go:,Diseasesp'.sp"eonep#ri$isin+e!>asp!Qg$>

S#ar(a P#D6 P> Ac'$e P"eonep#ri$is in Pregnanc"; A Re$rospec$i:e S$'+"> National #enter forBiotechnoloy "nformation> ,>S> Na$iona Li.rar" of Me+icine6 0 A'g> 2**> 3e.> 0 No:> 2*0-> Q$#$$p;www>nc.i>n(>ni#>go:p'.(e+0)2)1Qg$>
http://www.healthline.com/health/pregnancy/infections-acute-pyelonephritishttp://www.healthline.com/health/pregnancy/infections-acute-pyelonephritishttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://emedicine.medscape.com/article/452604-overviewhttp://emedicine.medscape.com/article/452604-overviewhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://www.ncbi.nlm.nih.gov/pubmed/17627687&gthttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://kidney.niddk.nih.gov/KUDiseases/pubs/pyelonephritis/index.aspxhttp://emedicine.medscape.com/article/452604-overviewhttp://emedicine.medscape.com/article/452604-overviewhttp://emedicine.medscape.com/article/452604-overviewhttp://emedicine.medscape.com/article/452604-overviewhttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://www.babymed.com/infections/pyelonephritis-during-pregnancy&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://emedicine.medscape.com/article/245559-overview&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.aafp.org/afp/2011/0901/p519.html&gthttp://www.healthline.com/health/pregnancy/infections-acute-pyelonephritishttp://www.healthline.com/health/pregnancy/infections-acute-pyelonephritishttp://www.healthline.com/health/pregnancy/infections-acute-pyelonephritishttp://www.healthline.com/health/pregnancy/infections-acute-pyelonephritis

Pyelonephritis in Pregnancy Presentation

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