Acute pyelonephritis

Acute suppurative inflammation of the kidney caused by bacterial and some viral infections by hematogenous spread or ascending and associated vesicourethral reflux.

Predisposing conditions include: urinary tract obstruction, instrumentation, vesicourethral reflux, pregnancy, preexisting renal lesions with associated scarring and obstruction, diabetes mellitus, the presence of immunodeficiency and immunosuppression, higher frequency in females up to the age of 40 years and advanced age in men.

Onset is usually sudden with pain in the costovertebral angle and with fever and malaise, dysuria, urinary frequency and urgency.

Associated with pyuria and leukocyte casts formed in the renal tubules.

Diagnosis established by urine culture.

Uncomplicated disease usually follows a benign course with resolution of symptoms within a few days of the initiation of appropriate antibiotic management.

In the presence of unrelieved urinary obstruction, diabetes, impaired immunity recurrent episodes may occur and lead to repeated septic events.

The superimposition of papillary necrosis may lead to the onset of acute renal failure.

An inflammation of the kidney tissue, calyces, and renal pelvis.

Caused by bacterial infection that has spread up the urinary tract or travelled through the bloodstream to the kidneys.

Pyelitis term means inflammation of the pelvis and calyces.

Severe cases can lead to accumulation of pus around the kidney, sepsis kidney failure and death.

Patients present with fever, tachycardia, pain in the back, nausea, and tenderness at the costovertebral angle on the affected side.

Of it progresses to urosepsis may be accompanied by signs of septic shock, including rapid breathing, decreased blood pressure, chills, and occasionally delirium.

Requires antibiotic therapy, and sometimes intervention such as ureteroscopy, percutaneous nephrostomy or percutaneous nephrolithotomy, as well as treatment of any underlying causes to prevent its recurrence.

Signs and symptoms generally develop rapidly over a few hours or a day.

May be associated with fever, dysuria, abdominal pain that radiates along the flank towards the back, and vomiting.

Chronic pyelonephritis causes persistent flank or abdominal pain, fever, unintentional weight loss, malaise, decreased appetite, lower urinary tract symptoms and blood in the urine.

Chronic pyelonephritis can be responsible for fever of unknown origin.

Chronic pyelonephritis cause the condition amyloidosis.

Most cases of pyelonephritis are due to bowel organisms that enter the urinary tract.

70-80% of cases related to E. coli and Enterococcus faecalis.

Hospital-acquired infections may be due to coliform bacteria and enterococci, as well as other organisms uncommon in the community.

Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis.

Any structural abnormalities in the urinary tract, vesicoureteral reflux, kidney stones, urinary tract catheterization, ureteral stents or drainage procedures, pregnancy, neurogenic bladder and prostate disease in men, diabetes mellitus, immunocompromised states, change in sexual partner within the last year, spermicide use, close family members with frequent urinary tract infections.

A urinalysis may show signs of urinary tract infection, specifically, the presence of nitrite and white blood cells on a urine test strip in patients with typical symptoms are sufficient for the diagnosis.

Complete blood count may show neutrophilia.

Culture of the urine, with or without blood cultures and antibiotic sensitivity testing are useful for establishing a diagnosis.

Urine cultures are considered mandatory.

With recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux or polycystic kidney disease.

A DMSA scan using dimercaptosuccinic acid in assessing the kidney morphology. is now the most reliable test for the diagnosis of acute pyelonephritis.

Acute pyelonephritis refers to an exudative purulent localized inflammation of the renal pelvis and kidney.

Renal tubules are damaged by exudate and may contain neutrophil casts.

Gross findings often reveals pathognomonic radiations of bleeding and suppuration through the renal pelvis to the renal cortex.

Chronic pyelonephritis implies recurrent kidney infections and can result in scarring of the renal parenchyma and impaired function.

Chronic pyelonephritis occurs in the setting of obstruction.

A perinephric abscess may develop in severe cases of pyelonephritis.

Xanthogranulomatous pyelonephritis is characterized by granulomatous abscess formation, severe kidney destruction, and a clinical picture that may resemble renal cell carcinoma and other inflammatory kidney parenchymal diseases.

Most affected patients with xanthogranulomatous pyelonephritis present with recurrent fevers and urosepsis, anemia, and a painful kidney mass.

Common manifestations of xanthogranulomatous pyelonephritis include kidney stones and impaired kidney function.

With pyelonephritis antibiotic therapy is tailored on the basis of the infecting organism found on urine culture.

Antibiotics are the mainstay of treatment, and include fluoroquinolones, cephalosporins, aminoglycosides, or trimethoprim/sulfamethoxazole, either alone or in combination.

Acute pyelonephritis is accompanied by fever and leukocytosis.

Typically patients are admitted to the hospital for hydration and intravenous antibiotic treatment.

Treatment of xanthogranulomatous pyelonephritis involves antibiotics as well as surgery.

For xanthogranulomatous pyelonephritis removal of the kidney is the best surgical treatment in the overwhelming majority of cases, although partial nephrectomy has been effective for some.

The incidence is approximately 12–13 cases annually per 10,000 population in women receiving outpatient treatment and 3–4 cases requiring admission.

In men, 2–3 cases per 10,000 are treated as outpatients and 1– cases/10,000 require admission.

Young women are most often affected, probably reflecting sexual activity in that age group.

Infants and the elderly are also at increased risk, reflecting anatomical changes and hormonal status.

Xanthogranulomatous pyelonephritis is most common in middle-aged womPolyoma infections may cause pyelonephritis in patient undergoing kidney allografts.

Polyomavirus infection is characterized by viral infection of tubular epithelial cell nuclei, leading to nuclear enlargement and intranuclear inclusions visible with light microscopy.

Treatment of polyoma viral pyelonephritis includes the reduction in immunosuppression.

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