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Abstract: The patient developed urinary frequency, urinary urgency and painful urination 1 week ago. After self-medication for 2 days and self-relieved symptoms, he found urinary frequency and urgency on the 3rd day after stopping medication. He was diagnosed with acute pyelonephritis, which is a kind of urinary tract infection, through physical examination, CT and ultrasound. After medication, she was discharged from the hospital with normal blood and urine count, normal body temperature and lumbago.
Basic information】Female, 45 years old
Disease Type】Acute pyelonephritis
Hospital】Zhengzhou First People’s Hospital
Date of Consultation】December 2021
Treatment plan】Medication (levofloxacin hydrochloride injection, cefoxitin sodium for injection, feverfew granules, ibuprofen extended-release capsule, sodium lactate ringer injection, compound electrolyte injection)
Treatment period】7 days of hospitalization
Treatment effect】The symptoms disappeared, urine routine and urine culture were normal, and the patient was discharged successfully.
I. Initial consultation
The patient had fever for 2 days with a maximum temperature of 39.0℃, and novel coronavirus pneumonia had been excluded. Blood routine: leukocytes 17.73×10^9/L, neutrophil count 87.90%. Urine routine: leukocytes were 1138/μL. Considering urinary tract infection, the patient was admitted to the hospital. Detailed medical history: 1 week ago, urinary frequency, urinary urgency and painful urination appeared. 2 days after taking levofloxacin hydrochloride tablets and Jin Shui Bao capsule, he felt that his symptoms were relieved and did not take any more medicine. 3 days after stopping the medicine, he felt frequent and urgent urination, but he was busy at work and did not care. 2 days ago, he started to have back pain and fever.
He was admitted to the hospital for physical examination: mild percussion pain in the right kidney area and negative percussion pain in the left kidney. Ultrasound: mild hydronephrosis in the right kidney, no dilatation of the ureters bilaterally, no hydronephrosis in the left kidney. To exclude the possibility of ureteral stones, further urological CT was performed: no urinary stones were seen, and mild hydronephrosis was observed in the right kidney. Preliminary diagnosis: acute pyelonephritis.
II. Treatment history
The patient had no history of antibiotic allergy, and was given levofloxacin hydrochloride infusion and febrifugal granules. The patient was advised to drink more water, rest and strengthen nutrition. He remained hyperthermic for 3 days after hospitalization and complained of nausea and regurgitation, unable to eat except for water. He was given ibuprofen extended-release capsules to control body temperature and intravenous infusion of sodium lactate Ringer injection and compound electrolyte injection for fluid supplementation to prevent hypovolemic shock and electrolyte disturbance. Since the last 3 days, the patient’s body temperature gradually decreased, the highest temperature of 38.3℃ per day, and the interval of fever lengthened, rechecked blood routine: leukocytes 15×10^9/L, neutrophil count 85%, urine routine: leukocytes 468/μL. 3 days later, blood and urine culture results back to show: Escherichia coli infection, levofloxacin intermediary, cefoxitin sensitive, replaced with injectable cefoxitin sodium infusion treatment .
III. Treatment effect
The patient’s body temperature dropped to normal 2 days after replacing cefoxitin sodium for injection, and no more ibuprofen extended-release tablets were used to control the body temperature, and the blood routine was rechecked: leukocyte 12.24×10^9/L, neutrophil count 80%; urine routine: leukocyte 69/uL. The patient no longer had nausea, regurgitation, back pain, and the amount of diet was better than before, and the intravenous infusion was gradually stopped. According to the treatment principle of acute pyelonephritis, anti-infection treatment is needed for 10-14 days. After continuing the infusion of cefoxitin sodium for injection for 5 days, the blood and urine routine inflammation indexes were normal on recheck. The patient was discharged successfully after 7 days of hospitalization, and the discomfort disappeared at the time of discharge, and the urine routine and urine culture were normal.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to pay attention to some matters in daily life.
1. the best way to promote the recovery of acute nephritis and avoid recurrence is to drink more water and insist on drinking > 2000ml daily to help flush the urinary system and prevent excessive and long-term attachment of bacteria to the mucosa of the urinary tract and promote recovery from inflammation.
2, poor resistance is also an important cause of acute pyelonephritis, especially in patients who have just been discharged from the hospital, pay attention not to overwork, keep a relaxed mood, avoid anxiety, exercise properly, strengthen nutrition, reasonable diet, do not drink alcohol, do not eat spicy stimulating food, etc., to improve their resistance, immunity.
3, although some patients are cured after discharge, at that time, due to the poor resistance of patients in the short term, there will be the possibility of recurrence, once patients again appear fever, back pain, to promptly seek medical attention again. There are also patients who do not want to continue infusion treatment in the hospital after their body temperature has normalized and go home on their own to take oral medication. Such patients must follow the doctor’s instructions and regularly visit the doctor for blood and urine tests.
V. Personal insight
Acute pyelonephritis is mainly caused by inflammation of the lower urinary tract upstream, patients may suddenly appear urinary frequency, urinary urgency, painful urination, hematuria and other symptoms, we must consider the possibility of acute cystitis, must go to medical institutions for treatment in a timely manner, do not delay or home self-medication, if acute cystitis is not cured in a timely manner, bacteria will travel to the renal pelvis, causing acute pyelonephritis.
Acute pyelonephritis patients generally have symptoms of back pain, high fever, and even infectious shock in severe cases. The acute phase usually lasts 3-5 days, and patients will have repeated high fever, fatigue, nausea, and vomiting, and the painful process can make patients anxious and even distrustful of doctors. It takes at least 10 days to heal, so that the patient can cooperate.