Woodrow G, Patel S, Berman P, Morgan A G, Burden R P
Department of Renal Medicine, City Hospital, Nottingham, UK.
Postgrad Med J. 1993 Mar;69(809):211-3. doi: 10.1136/pgmj.69.809.211.
Urinary tract infections in the elderly are common, often asymptomatic and usually benign. We report three patients who presented with acute renal failure due to acute pyelonephritis in the absence of clinical findings of infection or urinary tract obstruction. Blood and urine cultures grew Escherichia coli in two of the patients and in two patients renal biopsy confirmed acute pyogenic pyelonephritis. Antimicrobial therapy and haemodialysis led to improvement, though one patient subsequently died from an unrelated cause. We suggest that acute bacterial pyelonephritis should be considered as a cause of acute renal failure in the elderly. Clinical features of infection may be absent despite bacteraemia. Prompt diagnosis and intervention may avoid chronic renal failure in a group that has a less favourable outcome with long-term dialysis.
老年人尿路感染很常见，通常无症状且一般为良性。我们报告了三名患者，他们在没有感染的临床表现或尿路梗阻的情况下，因急性肾盂肾炎出现急性肾衰竭。两名患者的血培养和尿培养培养出大肠杆菌，两名患者的肾活检证实为急性化脓性肾盂肾炎。抗菌治疗和血液透析使病情有所改善，不过有一名患者随后死于无关原因。我们建议，应将急性细菌性肾盂肾炎视为老年人急性肾衰竭的一个病因。尽管存在菌血症，但可能没有感染的临床特征。及时诊断和干预可能避免这一群体出现慢性肾衰竭，而这一群体长期透析的预后较差。
