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Home :: Urinary Disorders

Acute Pyelonephritis


Acute Kidney Failure
Acute Pyelonephritis
Kidney Stones
Nephrotic Syndrome
Polycystic Kidney Disease

It is a potentially organ- and/or life-threatening infection that characteristically causes some scarring of the kidney with each infection and may lead to significant damage to the kidney, kidney failure, abscess formation, sepsis, or sepsis syndrome/shock/multiorgan system failure. It affects the women more than men. The most common etiologic cause is infection with Escherichia coli. There are approximately 250,000 cases of acute pyelonephritis each year, resulting in more than 100,000 hospitalizations. Its onset is usually sudden, with symptoms that often are mistaken as the results of straining the lower back. Pyelonephritis often is complicated by systemic infection. It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. Chronic pyelonephritis is associated with progressive renal scarring, which can lead to end-stage renal disease (ESRD), eg, reflux nephropathy. Intrarenal reflux of infected urine is suggested to induce renal injury, which heals with scar formation. The infection may start in a lower place in the urinary tract, such as a bladder infection. The infection then travels up the urinary tract to one or both kidneys.

Acute pyelonephritis also must be distinguished from chronic pyelonephritis. It usually occurs after an uncontrolled episode of UTI; the incidence of progression is higher in pregnant women and in patients with catheters. It is a complex, there is no consistent set of signs and symptoms that are both sensitive and specific for the diagnosis; therefore, clinicians must maintain a high index of suspicion. This disease is most common in patients who are predisposed to recurrent acute pyelonephritis, such as those with urinary obstructions or vesicoureteral reflux. Risk factors for complicated acute pyelonephritis are those that increase susceptibility or reduce host response to infections. Sometimes, this diagnosis is established based on radiologic evidence obtained during an evaluation for recurrent urinary tract infection in young children. Misdiagnosis can lead to sepsis, renal abscesses, and chronic pyelonephritis that may cause secondary hypertension and renal failure. The kidneys are bean-shaped organs that remove unwanted chemicals and waste from the blood. These wastes are turned into urine by the kidneys.

Causes of Acute Pyelonephritis

The comman causes of Acute Pyelonephritis include the following:

  • Pyelonephritis most often occurs as a result of urinary tract infection , particularly in the presence of occasional or persistent backflow of urine from the bladder into the ureters or kidney pelvis.
  • Germs called bacteria usually cause urinary tract infections (UTI's), including pyelonephritis.
  • Obstruction in the collecting system usually due to a calculus.
  • Kidney infection sometimes results from urine that becomes stagnant due to obstruction of free urinary flow.
  • Other risk factors include diabetes mellitus, pregnancy, chronic bladder infections, a history of analgesic abuse, paralysis from spinal cord injury, or tumors.
  • Catheters, tubes, or surgical procedures may also trigger a kidney infection.

Symptoms of Acute Pyelonephritis

Some sign and symptoms related to Acute Pyelonephritis are as follows:

  • Increased urinary frequency or urgency.
  • Flank pain or back pain.
  • High body temperature (fever) .
  • Shaking chills.
  • Dysuria.
  • Vomiting and nausea.
  • Severe abdominal pain (occurs occasionally).
  • Acute Cystitis symptoms ( Dysuria , frequency, urgency).
  • Nausea (upset stomach) and vomiting (throwing up).
  • Need to urinate at night (nocturia).
  • Cloudy or abnormal urine color.
  • On exam, costovertebral angle tenderness may be present.

Treatment of Acute Pyelonephritis

Here is list of the methods for treating Acute Pyelonephritis:

  • The antibiotics used most often include ciprofloxacin (Cipro), ampicillin (Omnipen), or trimethoprim-sulfamethoxazole (Bactrim, Septra).
  • Intravenous (IV) antibiotics may be used initially to control the bacterial infection if your infection is severe or you cannot take antibiotics by mouth.
  • Radical nephrectomy for emphysematous pyelonephritis.
  • You may use over-the-counter (OTC) pain medicines, such as ibuprofen or acetaminophen, for pain or swelling. These medicines may be bought without a caregiver's order.
  • Percutaneous drainage of abscesses.
  • Some OTC medicines used for your pain can also be used to decrease a high body temperature (fever).
  • In some patients, surgery may be necessary to relieve obstruction or correct an anatomical anomaly.