Acute Pyelonephritis

Acute Pyelonephritis

• Etiology and Pathophysiology
  • Inflammation of renal parenchyma and collecting system (including the renal pelvis)
  • Most common cause is bacterial infection
  • Fungi, protozoa, or viruses can also infect kidneys
  • Cortical surface shows grayish white areas of inflammation and abscess formation

• • Urosepsis

• • • Systemic infection from urologic source
    • Prompt diagnosis/treatment critical
      • Can lead to septic shock and death unless promptly treated
  • Usually begins with colonization and infection of lower tract via ascending urethral route
  • Frequent causes
    • Escherichia coli
    • Proteus
    • Klebsiella
    • Enterobacter
  • Preexisting factor usually present
    • Vesicoureteral reflux
      • Retrograde (backward) movement of urine from lower to upper urinary tract
    • Dysfunction of lower urinary tract
      • Obstruction from BPH
      • Stricture
      • Urinary stone
    • CAUTI
• Clinical manifestations
  • Mild fatigue
  • Chills
  • Fever
  • Vomiting
  • Malaise
  • Flank pain
  • LUTS characteristic of cystitis
    • Dysuria, urgency, frequency
  • Costovertebral tenderness to percussion typically present on affected side
  • Manifestations may subside in a few days, even without therapy
    • Bacteriuria and pyuria still persist