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