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
- 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