Name

: Rini Yuliyani

NIM

: P1337420214046

Class

: 2B
SUMMARIZE OF OBSTRUCTIVE PYELONEPHRITIS AS A RESULT OF
UROLITHIASIS (OPU)
Urolithiasis are common complications in patients with UTI. Flank pain, nausea or

vomiting are the main symptoms of urothiliasis and induced by the obstruction of the upper
urinary tract. In addition to the symptoms of the obstruction of the upper urinary tract,
patient will feel high fever, chills and fatigue as experience symptoms of pyelonephritis. To
patients with common complications, physicians can observe bacteremia, sepsis with or
without septic shock, DIC status, renal abscess, and perinephric abscess. Then, to patients
care in ICU or fatal conditions should be treated by both urologists and physicians working in
emergency rooms or the ICU. Obstructive pyelonephritis as a result of urolithiasis (OPU) is
the condition of pyelonephritis with obstruction of the upper urinary tracts by Urolithiasis.
Antimicrobial therapies against acute infection, and another is the drainage to the upper
urinary tract are the treatment of patients with OPU.
The purpose and methods of this project was a retrospective and multicenter survey of
patients with OPU, were sent to urologists who worked at the urological departments of 1180
hospitals and The participants were patients who were hospitalized between January and
December 2009 for acute OPU. Patients who evidently showed obstruction of the upper
urinary tract as a result of urinary stones, patients who were diagnosed with pyelonephritis by
urologists and patients with infectious staghorn caliculi of the kidney are the criteria of
OPU. The criteria of OPU were analyzed and discussed with members of the Japanese
Research Group for Urinary Tract Infection. Sex, age, dates of hospitalization and discharge,
dates of disease onset and the resolution of pyelonephritis, past medical history or
complications,the use of drugs, the situation in which patients entered the hospital and the
method of arrival at the hospitals, history of disease treatment, the symptoms at
hospitalization, physical examination, body temperature, pulse or respiratory rates and blood
pressure at the time of hospitalization are the following patient characteristics were examined
in the survey form. The results of laboratory or bacterial examination, the methods for
diagnosis and radiological findings were requested in our survey. The dilatation of the renal
pelvis or renal calyx by radiological or ultrasonic findings was definition of Hydronrphrosis.

Univariate analysis were analyzed the risk factors for the disease death of acute OPU. Then,
multivariate analysis were analyzed The predictive risk factors for disease death of patients
condition at hospitalization.
The result according participant characteristics and states at visiting hospital or at
hospitalization, among 1180 hospitals invited to participate in the present study, 325 agreed to
participate, 1469 cases were reported and 1363 were ultimately analyzed. According
microbiological examination, bacterial cultures were attempted in 1114 patients, bacteria or
fungi were detected in 798 patients, and 46 other specimens.

According Radiological

finding, the locations of urinary stones for obstruction included the ureters in 1114, the
average size of the stones was 10.1 mm 8.7 mm and in all cases hydronephrosis was
finding in the radiological test.

According Clinical course and treatments, all patients

received antimicrobial therapies. Carbapenems, third-generation cephalosporins, penicillins

combined with beta-lactamase inhibitors, and secondgeneration cephalosporins were used ss
the initial treatment. For urinary stones, surgical procedures including ESWL, TUL, PNL or
nephrectomy were reported in 57.4% patients. According Prognosis of patients and risk
factors for mortality, older age, solitary kidney, ambulance use to visit hospital, disturbance of
consciousness, severe appetite loss, higher performance status, disseminated intravascular
coagulation status or systemic inflammatory response syndrome, vasopressors and antidisseminated intravascular coagulation therapies, increased pulse rates, lower hemoglobin,
lower serum albumin, and high blood urea nitrogen values were identified as the risk factors
related to disease death by univariate analysis. Then, the predictive risk factors for disease
death of patients status at hospitalization were age over 80 years, systemic inflammatory
response syndrome, disseminated intravascular coagulation status, disturbance of
consciousness and solitary kidney by multivariate analysis.
The conclusion, obstructive pyelonephritis as a result of urolithiasis represents an
emergent disease in the urological field with relatively high mortality. Patients with older age
or poor conditions should be hospitalized, and intervention by a urology specialist is likely to
be required. Patient with OPU should treatment with antimicrobial therapies against acute
infection, and another is the drainage to the upper urinary tract.