Pyelonephritis

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Obesity, Sleep & Internal medicine
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Pyelonephritis
Synonyms	Kidney infection
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, chills, flank pain, nausea, vomiting, urinary frequency, dysuria
Complications	Sepsis, kidney abscess, chronic kidney disease
Onset	Sudden
Duration	Days to weeks
Types	N/A
Causes	Bacterial infection, commonly Escherichia coli
Risks	Urinary tract infection, vesicoureteral reflux, urinary catheterization, diabetes mellitus
Diagnosis	Urinalysis, urine culture, imaging studies
Differential diagnosis	Cystitis, pelvic inflammatory disease, appendicitis, nephrolithiasis
Prevention	Adequate hydration, urinary tract infection prevention
Treatment	Antibiotics, hospitalization in severe cases
Medication	Ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole
Prognosis	Good with treatment
Frequency	Common
Deaths	Rare with treatment

Pyelonephritis refers to an inflammatory condition of the kidney, predominantly as a result of a bacterial infection. This medical condition primarily involves the kidney's tubules, interstitium, and the renal pelvis, while it can occasionally affect the glomeruli.

Depiction of a man suffering from a Kidney Infection

Etiology and Pathophysiology

The most common causative agent of pyelonephritis is the bacterium Escherichia coli, although other bacteria such as Proteus mirabilis, Klebsiella pneumoniae, and Enterococcus faecalis can also cause the condition. The bacteria typically reach the kidneys from the lower urinary tract, mainly the bladder, in a process called ascending infection. Less commonly, bacteria can reach the kidneys through the bloodstream, in a condition known as hematogenous spread. The bacterial invasion triggers an inflammatory response within the kidney, leading to the characteristic symptoms of pyelonephritis.

Clinical Presentation

Patients with pyelonephritis often present with a triad of symptoms: fever, flank pain, and dysuria. Other symptoms may include nausea, vomiting, frequency of urination, and cloudy or foul-smelling urine.

Diagnosis

Diagnosis of pyelonephritis is based on a combination of history, physical examination, and laboratory studies. Urine culture is the gold standard for diagnosing the condition, providing information on the causative organism and its antibiotic sensitivity.

Treatment

Treatment for pyelonephritis primarily involves antibiotic therapy to eliminate the bacterial infection. The choice of antibiotic depends on the bacteria identified from the urine culture and their susceptibility.

Complications and Prognosis

If left untreated, pyelonephritis can lead to serious complications, including renal scarring, sepsis, and renal failure. However, with prompt diagnosis and appropriate treatment, the prognosis for pyelonephritis is generally good.

See Also

• Kidney disease
• Urinary tract infection

References

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