Acute pyelonephritis
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Acute pyelonephritis p. 625
labs/findings p. 723
renal papillary necrosis and p. 625
WBC casts in p. 618
Chronic pyelonephritis p. 625
labs/findings p. 723
Diabetes mellitus p. 352-360
pyelonephritis and p. 625
Pregnancy p. 657
pyelonephritis p. 625
Proteus spp.
xanthogranulomatous pyelonephritis p. 625
Pyelonephritis p. 625
kidney stones p. 628
labs/findings p. 723
urinary tract infections p. 179
WBC casts in p. 618
Renal papillary necrosis p. 625
pyelonephritis and p. 625
Urinary tract infections (UTIs) p. 179, 625
pyelonephritis p. 625
Urosepsis p. 625
Vesicoureteral reflux p. 603
pyelonephritis p. 625
Xanthogranulomatous pyelonephritis p. 625
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With acute pyelonephritis, pyelo- means pelvis, and -neph- refers to the kidney, so in this case it’s the renal pelvis, which is the funnel-like structure of the kidney that drains urine into the ureter, and -itis means inflammation. So acute pyelonephritis describes an inflamed kidney that develops relatively quickly, usually as a result of a bacterial infection.
Now a urinary tract infection, or UTI, is any infection of the urinary tract, which includes the upper portion of the tract—the kidneys and the ureters, and the lower portion of the tract—the bladder and urethra. So acute pyelonephritis is a type of upper urinary tract infection.
Acute pyelonephritis is most often caused by ascending infection, meaning bacteria start by colonizing the urethra and bladder, which would be a lower urinary tract infections, and make their way up the ureters and kidney, therefore upper UTI shares a lot of the same risk factors as lower UTI, things like female sex, sexual intercourse, indwelling catheters, diabetes mellitus, and urinary tract obstruction.
One major factor that increases the risk of an upper UTI from a lower UTI spreading upward is vesicoureteral reflux, or VUR, which is where urine is allowed to move backward up the urinary tract, which can happen if the vesicoureteral orifice fails. The vesicoureteral orifice is the one-way valve that allows urine to flow from each ureter into the bladder, but not in the reverse direction.
Summary
Acute pyelonephritis is a sudden, severe infection of the kidney. The infection may be caused by bacteria that travel up from the bladder or bacteria circulating in the blood (bacteremia). Symptoms of acute pyelonephritis can include fever, chills, nausea, vomiting, and pain in the lower back and sides. If left untreated, acute pyelonephritis can lead to serious complications like sepsis (a potentially life-threatening condition caused by infection).
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases" Clinical Infectious Diseases (2011)
- "Renal ultrasound and DMSA screening for high-grade vesicoureteral reflux" Pediatrics International (2016)
- "EAU Guidelines on Vesicoureteral Reflux in Children" European Urology (2012)
- "International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases" Clinical Infectious Diseases (2011)
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