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Acute Pyelonephritis Overview

Acute Pyelonephritis is caused by an ascending urinary tract infection, usually from E. coli, that leads to inflammation of the renal parenchyma and pelvis. Signs include fever, flank pain, dysuria, and increased urination. Diagnosis is made clinically but imaging can show enlarged kidneys and wedge-shaped areas of decreased perfusion on CT. Treatment involves antibiotics for uncomplicated cases and drainage or nephrectomy for abscesses or emphysematous pyelonephritis.

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Freddy Panjaitan
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177 views2 pages

Acute Pyelonephritis Overview

Acute Pyelonephritis is caused by an ascending urinary tract infection, usually from E. coli, that leads to inflammation of the renal parenchyma and pelvis. Signs include fever, flank pain, dysuria, and increased urination. Diagnosis is made clinically but imaging can show enlarged kidneys and wedge-shaped areas of decreased perfusion on CT. Treatment involves antibiotics for uncomplicated cases and drainage or nephrectomy for abscesses or emphysematous pyelonephritis.

Uploaded by

Freddy Panjaitan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

Acute Pyelonephritis

Etiology Inflammation of the renal parenchyma and renal pelvis due to an infectious source Most often secondary to an ascending lower urinary tract infection from gram-negative bacteria o E. coli o Klebsiella o Proteus o Pseudomonas. Exception is S. aureus, which is spread hematogenously Pathologic Causes Vesicoureteral reflux Obstruction in the collecting system usually due to a calculus Signs and Symptoms Fever Chills Flank pain Dysuria Increased frequency of urination. On exam, costovertebral angle tenderness may be present. Clinical Findings CBC o Elevated white blood cell count. Urinalysis o Bacteriuria o Pyuria o White blood cell casts Acute pyelonephritis is clinical diagnosis, o Radiographic imaging is used to evaluate underlying pathology o Rule out any complications. Complications Abscess Emphysematous pyelonephritis o Most often occurs in diabetics Can produce gas in the collecting system and renal parenchyma. Radiographic Imaging Findings Enlarged kidneys (U/S and CT)

Hydronephrosis (U/S and CT) Wedge shaped areas of low attenuation secondary to decreased perfusion (CT) Loss of the ability to distinguish the corticomedullary border (CT) Perinephric stranding (CT)

Bagan 1. Right kidney is markedly enlarged and has a wedge-shaped area of low attenuation

Treatment Antibiotics for non-complicated pyelonephritis. Radical nephrectomy for emphysematous pyelonephritis. Percutaneous drainage of abscesses

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