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Pyelonephritis affects about 1 to 2 per 1,000 women each year and just under 0.5 per 1,000 males. [5] [7] Young adult females are most often affected, followed by the very young and old. [2] With treatment, outcomes are generally good in young adults.
This constellation of symptoms contrasts with the classical presentation of nephrotic syndrome (excessive proteinuria >3.5 g/day, low plasma albumin levels (hypoalbuminemia) <3 g/L, generalized edema, and hyperlipidemia). [8] [10] Signs and symptoms that are consistent with nephritic syndrome include: Hematuria (red blood cells in the urine) [11]
Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are generally first-line agents for blood pressure control, as they slow progression of the kidney disease and the risk of heart disease. [15] Loop diuretics may be used to control edema and, if needed, to further lower blood pressure.
Emergency treatment is not needed if the person is asymptomatic or minimally symptomatic. [34] Treatment of chronic symptomatic bradycardia first necessitates correlation of symptoms. [5] Once symptoms have been clearly linked to bradycardia, permanent cardiac pacing can be provided to increase heart rate and symptoms will improve. [5]
Norepinephrine (Levophed) is the most common first-line vasopressor for people who don't respond well to other hypotension treatments such as fluid resuscitation. Atropine is administered for bradycardia. It acts on the vagus nerve so it's not effective in heart transplant patients as the vagus nerve is severed during the transplant.
Phenazopyridine is a medication which, when excreted by the kidneys into the urine, has a local analgesic effect on the urinary tract.It is often used to help with the pain, irritation, or urgency caused by urinary tract infections, surgery, or injury to the urinary tract.
Urinary tract symptoms are frequently lacking in the elderly. [11] The presentations may be vague and include incontinence, a change in mental status, or fatigue as the only symptoms, [10] while some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. [7]
The scarring of the small blood vessels, called capillary sclerosis, is the initial lesion of analgesic nephropathy. [7] Found in the renal pelvis, ureter, and capillaries supplying the nephrons, capillary sclerosis is thought to lead to renal papillary necrosis and, in turn, chronic interstitial nephritis.