ACUTE PYELONEPHRITIS
Zainab Aliyu 1904B
Acute pyelonephritis is a bacterial infection of the renal
pelvis and the renal parenchyma with fever, flank pain and
bacteriuria.
Symptoms include; flank pain, flank tenderness and/or
fever. Ascending infection is the most common cause for
acute pyelonephritis. It is more common in women than in
men. Vesicourethral reflux (VUR) leads to refluxing urine,
which becomes infected.
Pyelonephritis in VUR tends to causes renal scarring, since
intrarenal reflux is common. The incidence of bacteriuria in
pregnancy is 4–7%, comparable to the rate of bacteriuria
without pregnancy.
PATHOLOGY
Enlarged kidney with inflammatory edema
Small subcapsular abscesses with hemorrhagic
rim
Pus-filled tubules
The urothelium of the renal pelvis is thick and
covered with exudate
SIGNS AND SYMPTOMS
Sudden fever and chills, malaise and weakness
Constant flank pain. Children often complain about abdominal pain.
Flank tenderness
Frequency, dysuria, (micro)-hematuria
Possible symptoms: nausea, vomiting, diarrhea, abdominal tenderness, decreased
bowel sounds. Tachycardia, hypotension and further symptoms of urosepsis
COMPLICATIONS OF ACUTE PYELONEPHRITIS
Renal scarring, especially in children, with the development of chronic pyelonephritis
Renal abscess
Urosepsis with septic shock
Emphysematous pyelonephritis in diabetes mellitus (high mortality)
The diagnosis is mainly based on the triad of fever, flank pain and symptoms of
bacterial cystitis. Radiological signs are discreet and ambiguous, they are found only
in every fourth patient.
DIAGNOSIS OF PYELONEPHRITIS
Blood tests
Leukocytosis
Elevated ESR, elevated CRP
Blood culture: pathogen can be detected in severe disease (high fever, signs of
urosepsis)
Appropriate antibiotics are fluoroquinolones,
aminopenicillin in combination with beta-lactamase
inhibitor and cephalosporins. In children,
cephalosporins are preferred. Because of high
resistance rates up to 40%, ampicillin or
cotrimoxazole alone are inadequate. Duration of
treatment: 7–14 days depending on severity and
improvement Nephrectomy should be kept in mind, if
urosepsis cannot be stabilized with the help of
intensive medical care.
SYMPTOMATIC TREATMENT OF PYELONEPHRITIS:
Bed rest
Analgesics with antipyretic effect, e.g. metamizol,
for children paracetamol Increased fluid intake.