In 60% of cases of chronic pyelonephritis, there is a history of acute inflammation (kidney infection – acute pyelonephritis), which often becomes chronic if treated incorrectly.
The clinical history of chronic pyelonephritis consists of urinary infections lasting more than three months, or common cystitis, acute pyelonephritis episodes (more common in women), birth defects, kidney stones, urinary catheterization.
The appearance of a kidney infection that will not heal but extends as vascular and suppurative lesions is the most common cause of chronic pyelonephritis.
Chronic pyelonephritis symptoms
Chronic pyelonephritis may be discovered in appearance of acute pyelonephritis in bout of overheating or as specific clinical picture of chronic pyelonephritis.
Discrete signs: pallor, fatigue, headache, feverish, dyspeptic disorders.
Suggestive symptoms: kidney pain (back pain), micturition disorders with polyuria (urinating more) and nocturia (urinating at night) and occasional appearances of polaki-disuria, pain during urination, pyuria (urine with pus).
At the palpation of costo-vertebral and costo-muscular points they are painful, also the maneuver Giordano is also positive. They may be present unilaterally or bilaterally.
On examination of the urine usually reveals bacteriuria, leukocytes in urine with proteins in urine less than 1 g per 24 hours. At urography or ultrasound of the kidney in chronic pyelonephritis kidney are unequal in size (kidney with chronic pyelonephritis is smaller), and changes in basin and shape of the affected kidney.
Complications of chronic pyelonephritis
Chronic pyelonephritis may develop as papillary necrosis, acute renal failure, chronic renal failure, kidney stones, hypertension in 30% of patients after more than 9-10 years of evolution.
Bibliography: 1. Braunwald's Heart Disease; 2. Harrison's Principles of Internal Medicine; 3. European Society of Cardiology - Clinical Practice Guidelines.