Parenchymal Disease, also known as peritubular nephritis, is a progressive, complicated disease of the kidney (renal parenchymal disease). Such disease can either be congenital or acquired; common causes for renal failures are diabetes and uncontrolled hypertension. In severe conditions, renal parenchymal disorders may lead to renal failure, which is fatal. While such a condition may require no treatment, there are several treatments available to slow down its progress and eventually reverse it.
Patients with chronic pyelonephritis (CP) experience frequent, recurrent urinary tract infections. Chronic pyelonephritis is considered a primary or secondary disorder, with symptoms arising after exposure to an environmental factor (e.g., infection by a virus) that alters the pH of the urine stream or after exposure to certain drugs (e.g., corticosteroids). Common clinical manifestations of CP include frequency and severity of urination, hematuria (redness of the skin), bladder discomfort, and lower urinary tract function. When these symptoms occur along with signs and symptoms of kidney disease (e.g., blood in the urine), chronic pyelonephritis is considered a significant risk factor for long-term complications.
Urinary Pain and Pains Related to Persistent Renal Parenchymal Injury
A few other diseases that may co-occur with the signs and symptoms of renal parenchymal disorders are cystic fibrosis, multiple sclerosis, and pituitary gland dysfunction. These diseases are not considered significant risk factors for developing chronic pyelonephritis. Patients with cystic fibrosis and/or multiple sclerosis, however, must be under the care of a physician experienced with these conditions. Pituitary gland dysfunction is a potential source of nephrotoxicity. Cysts of the gland can form either inside the bladder or in other areas of the urinary tract and these may precipitate painful urinary symptoms.
Although rare, some causes of urinary focal renal failure may be related to subacute or chronic kidney disease. Some of these include congenital heart disease, portal hypertension, chronic kidney failure, malignancy, renal artery disease, and osteoporosis. Obesity may also contribute to UTI-related distress. The fluid that does not flow through the kidneys can accumulate in the urinary tract causing this condition. Certain medications, including some steroid medications and some antibiotics, can cause significant levels of urinary fluids to build up, resulting in this condition.
It is sometimes necessary to make a differential diagnosis between conditions that may co-exist. Because most of these conditions are of clinical and not laboratory diagnostic interest, differential diagnosis is not usually required. Generally, however, the differential diagnosis between acute and chronic renal parenchymal disorders is made on the basis of clinical presentation and microbiology. Systemic medications can cause fluid retention, which may lead to a false differential diagnosis.
Parenchymal Disease Treatments
There are several treatment regimens available for patients with acute and chronic renal parenchymal injury. Most such treatments are initiated after observation during a blood draw at the time of a urinary tract function test. Patients generally receive the recommended initial antibiotic therapy and then may receive one or more secondary therapies. Surgery may be indicated for very acute cases and for patients whose underlying metabolic cause is not known. Treatment is often limited to reducing urine volume and treating symptoms and diseases.