Pyelonephritis is a condition developed by a bacterial infection that causes kidney inflammation and is one of the most prevalent kidney diseases.
It is caused by an ascended UTI (Urinary tract infection), which extends from the bladder to the kidney and its collecting tubules.
Fever, nausea, flank pain, vomiting, burning micturition, increased urgency, and frequency are common symptoms. Fever and flank pain are the two most prevalent symptoms.
Epidemiology
The estimated prevalence of acute pyelonephritis is 15-17 cases per 10,000 females and 3-4 cases per 10,000 males in the United States annually. Sexually active young women are commonly affected.
Due to anatomical abnormalities and hormonal changes, older adults and infants risk developing acute pyelonephritis. About 20 to 30% of pregnant women develop this condition in the second or third trimester.
Anatomy
Pathophysiology
Due to its capability to inhibit the urinary tract and kidneys, E Coli is the most common bacteria causing acute pyelonephritis. It has adhesive fragments known as P-fimbriae, which then interact with the receptors of the uroepithelial cells. An acute inflammatory response is triggered following the E Coli infection and leads to the scarring of the renal parenchyma.
Though the hypothesis of renal scarring is still unknown, it has been postulated that bacterial adherence to the renal cells breaks the defensive barriers, resulting in localized infection, ischemia, hypoxia, and clotting to restrict the infection.
Pyelonephritis develops as a response to bacterial toxins, inflammatory cytokines, and other reactive mechanisms, and in a few cases, shock and sepsis also develop.
Etiology
The prevalent cause of acute pyelonephritis is gram-negative bacterial infections such as E Coli, Enterobacter, and Klebsiella. In patients with severe infection, bacterial organisms are also found in their fecal flora. Hematogenous spread is less frequent and typically affects immunosuppressed, disabled patients and patients with ureteral obstruction.
The progression of infection involves multiple stages. To penetrate the bladder via the urethra, bacteria adhere to urethral mucosal epithelial cells. Acute pyelonephritis can occur by urinary tract infections or instrumentation, common in females.
Due to shorter urethras, proximity to the anus, and hormonal fluctuations, females experience UTIs more frequently than males. Acute pyelonephritis may also result from obstruction of the urinary tract caused by a kidney stone or other similar condition.
A urine outflow obstruction can induce partial emptying and urinary stagnation, allowing bacteria to spread without being flushed. A much less common cause of acute pyelonephritis is vesicoureteral reflux, a congenital disease wherein urine flows backward from the bladder into the kidneys.
Genetics
Prognostic Factors
Younger females visit outpatient departments more than males for this condition. In some studies, the overall mortality rate was estimated to be 10-20%. Significantly death was higher in males over 65, those with poor renal function, and with extensive intravascular coagulation.
Patients with severe pyelonephritis usually have a good prognosis with the accurate identification of the underlying cause and early intervention.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK519537/
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Pyelonephritis is a condition developed by a bacterial infection that causes kidney inflammation and is one of the most prevalent kidney diseases.
It is caused by an ascended UTI (Urinary tract infection), which extends from the bladder to the kidney and its collecting tubules.
Fever, nausea, flank pain, vomiting, burning micturition, increased urgency, and frequency are common symptoms. Fever and flank pain are the two most prevalent symptoms.
The estimated prevalence of acute pyelonephritis is 15-17 cases per 10,000 females and 3-4 cases per 10,000 males in the United States annually. Sexually active young women are commonly affected.
Due to anatomical abnormalities and hormonal changes, older adults and infants risk developing acute pyelonephritis. About 20 to 30% of pregnant women develop this condition in the second or third trimester.
Due to its capability to inhibit the urinary tract and kidneys, E Coli is the most common bacteria causing acute pyelonephritis. It has adhesive fragments known as P-fimbriae, which then interact with the receptors of the uroepithelial cells. An acute inflammatory response is triggered following the E Coli infection and leads to the scarring of the renal parenchyma.
Though the hypothesis of renal scarring is still unknown, it has been postulated that bacterial adherence to the renal cells breaks the defensive barriers, resulting in localized infection, ischemia, hypoxia, and clotting to restrict the infection.
Pyelonephritis develops as a response to bacterial toxins, inflammatory cytokines, and other reactive mechanisms, and in a few cases, shock and sepsis also develop.
The prevalent cause of acute pyelonephritis is gram-negative bacterial infections such as E Coli, Enterobacter, and Klebsiella. In patients with severe infection, bacterial organisms are also found in their fecal flora. Hematogenous spread is less frequent and typically affects immunosuppressed, disabled patients and patients with ureteral obstruction.
The progression of infection involves multiple stages. To penetrate the bladder via the urethra, bacteria adhere to urethral mucosal epithelial cells. Acute pyelonephritis can occur by urinary tract infections or instrumentation, common in females.
Due to shorter urethras, proximity to the anus, and hormonal fluctuations, females experience UTIs more frequently than males. Acute pyelonephritis may also result from obstruction of the urinary tract caused by a kidney stone or other similar condition.
A urine outflow obstruction can induce partial emptying and urinary stagnation, allowing bacteria to spread without being flushed. A much less common cause of acute pyelonephritis is vesicoureteral reflux, a congenital disease wherein urine flows backward from the bladder into the kidneys.
Younger females visit outpatient departments more than males for this condition. In some studies, the overall mortality rate was estimated to be 10-20%. Significantly death was higher in males over 65, those with poor renal function, and with extensive intravascular coagulation.
Patients with severe pyelonephritis usually have a good prognosis with the accurate identification of the underlying cause and early intervention.
https://www.ncbi.nlm.nih.gov/books/NBK519537/
medtigo
Acute Pyelonephritis
Updated :
August 30, 2022
Pyelonephritis is a condition developed by a bacterial infection that causes kidney inflammation and is one of the most prevalent kidney diseases.
It is caused by an ascended UTI (Urinary tract infection), which extends from the bladder to the kidney and its collecting tubules.
Fever, nausea, flank pain, vomiting, burning micturition, increased urgency, and frequency are common symptoms. Fever and flank pain are the two most prevalent symptoms.
The estimated prevalence of acute pyelonephritis is 15-17 cases per 10,000 females and 3-4 cases per 10,000 males in the United States annually. Sexually active young women are commonly affected.
Due to anatomical abnormalities and hormonal changes, older adults and infants risk developing acute pyelonephritis. About 20 to 30% of pregnant women develop this condition in the second or third trimester.
Due to its capability to inhibit the urinary tract and kidneys, E Coli is the most common bacteria causing acute pyelonephritis. It has adhesive fragments known as P-fimbriae, which then interact with the receptors of the uroepithelial cells. An acute inflammatory response is triggered following the E Coli infection and leads to the scarring of the renal parenchyma.
Though the hypothesis of renal scarring is still unknown, it has been postulated that bacterial adherence to the renal cells breaks the defensive barriers, resulting in localized infection, ischemia, hypoxia, and clotting to restrict the infection.
Pyelonephritis develops as a response to bacterial toxins, inflammatory cytokines, and other reactive mechanisms, and in a few cases, shock and sepsis also develop.
The prevalent cause of acute pyelonephritis is gram-negative bacterial infections such as E Coli, Enterobacter, and Klebsiella. In patients with severe infection, bacterial organisms are also found in their fecal flora. Hematogenous spread is less frequent and typically affects immunosuppressed, disabled patients and patients with ureteral obstruction.
The progression of infection involves multiple stages. To penetrate the bladder via the urethra, bacteria adhere to urethral mucosal epithelial cells. Acute pyelonephritis can occur by urinary tract infections or instrumentation, common in females.
Due to shorter urethras, proximity to the anus, and hormonal fluctuations, females experience UTIs more frequently than males. Acute pyelonephritis may also result from obstruction of the urinary tract caused by a kidney stone or other similar condition.
A urine outflow obstruction can induce partial emptying and urinary stagnation, allowing bacteria to spread without being flushed. A much less common cause of acute pyelonephritis is vesicoureteral reflux, a congenital disease wherein urine flows backward from the bladder into the kidneys.
Younger females visit outpatient departments more than males for this condition. In some studies, the overall mortality rate was estimated to be 10-20%. Significantly death was higher in males over 65, those with poor renal function, and with extensive intravascular coagulation.
Patients with severe pyelonephritis usually have a good prognosis with the accurate identification of the underlying cause and early intervention.
https://www.ncbi.nlm.nih.gov/books/NBK519537/
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