小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热
其他诊断因素
- 恶心和呕吐
- 排尿困难、尿频或尿急
- 胁腹痛或肋脊角压痛
危险因素
- 泌尿道感染
- 糖尿病
- 压力性尿失禁
- 尿路异物（例如结石、导管
- 解剖性/功能性泌尿系统异常
- 免疫抑制状态（例如，HIV、移植、化疗、使用皮质类固醇
- 妊娠
- 频繁性交
- 母亲具有泌尿道感染病史
- 新的性伴侣
- 使用杀精剂
- 年龄 18~50 岁
- 年龄 60 岁以上
诊断性检查
首要检查
- 尿液分析
- 革兰氏染色
- 尿液培养
- 全血细胞计数
- 红细胞沉降率
- C 反应蛋白
- 降钙素原
- 血液培养
需考虑的检查
- 肾脏超声
- 增强螺旋 CT
- 磁共振成像 (magnetic resonance imaging, MRI)
新兴检查
- 白细胞介素
- 和肽素
治疗流程
高度疑似轻至中度症状和单纯性疾病
症状重或复杂性疾病或妊娠患者要高度怀疑
单纯性疾病轻度至中度症状
重度症状或复杂性疾病或妊娠患者
1 至 2 周内复发性疾病
撰稿人
作者
Lynda A. Frassetto, MD
Professor of Medicine
Division of Nephrology
University of California
San Francisco
CA
利益声明
LAF declares that she has no competing interests.
鸣谢
Dr Lynda A. Frassetto would like to gratefully acknowledge the assistance of Donna M. Frassetto. DMF declares that she has no competing interests.
同行评议者
John Lam, MD
Attending Urologist
Providence Saint Joseph Medical Center
Burbank
Assistant Clinical Professor of Urology
Department of Urology
David Geffen School of Medicine at UCLA
Los Angeles
CA
利益声明
JL declares that he has no competing interests.
Robert Mactier, MD, FRCP
Consultant Nephrologist/Lead Clinician
Renal Unit
Glasgow Royal Infirmary
NHS Greater Glasgow and Clyde
Glasgow
UK
利益声明
RM declares that he has no competing interests.
参考文献
关键文献
Scholes D, Hooton TM, Roberts PL, et al. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med. 2005 Jan 4;142(1):20-7. 摘要
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20.全文 摘要
Stunell H, Buckley O, Feeney J, et al. Imaging of acute pyelonephritis in the adult. Eur Radiol. 2007 Jul;17(7):1820-8. 摘要
European Association of Urology. Guidelines on urological infections. 2020 [internet publication].全文
Glaser AP, Schaeffer AJ. Urinary Tract Infection and Bacteriuria in Pregnancy. Urol Clin North Am. 2015 Nov;42(4):547-60.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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