pyelonephritis

Pyelonephritis, also known as kidney infection, is a type of urinary tract infection (UTI) that affects one or both kidneys. It is usually caused by bacteria that ascend from the lower urinary tract to the kidneys.

Causes and Symptoms

• Pyelonephritis is typically caused by bacteria such as E. coli, which can enter the urinary tract through the urethra and travel up to the kidneys.
• Symptoms of pyelonephritis often begin suddenly with:
  • Chills [5]
  • Fever [5]
  • Pain in the lower part of the back on either side [5]
  • Nausea [5]
  • Vomiting
  • Frequent or painful urination

Types and Complications

• Pyelonephritis can be acute (sudden and severe) or chronic (long-lasting or recurrent).
• If left untreated, pyelonephritis can lead to complications such as:
  • Kidney scarring [3]
  • Organ damage
  • Life-threatening infections

Treatment and Prevention

• Pyelonephritis is usually treated with antibiotics.
• To prevent pyelonephritis, it's essential to practice good hygiene, drink plenty of water, and urinate when you feel the need to avoid holding urine for long periods.

References: [1] Overview of kidney infection [2] Overview of pyelonephritis [3] Acute pyelonephritis is a potentially organ- and/or life-threatening infection that characteristically causes scarring of the kidney. [4] Pyelonephritis is a kidney infection that can be acute (sudden and severe) or chronic (long lasting or recurrent). [5] Symptoms of Kidney Infection [6] Primary acute pyelonephritis represents the inflammation of the renal parenchyma and affects one or both kidneys. [7] Pyelonephritis is a bacterial infection of the kidney parenchyma.

Pyelonephritis, a type of urinary tract infection (UTI), can cause various signs and symptoms in individuals. Here are some common ones:

• Fever: A high temperature is often the first sign of pyelonephritis [2].
• Chills: Feeling cold or shivery due to the body's response to the infection [3].
• Pain in your lower back or side: This can be a sharp, stabbing pain that radiates from the kidneys down to the lower abdomen [4].
• Pain when you pee (urinate): This is often accompanied by bloody or cloudy urine [5].
• Bloody or cloudy urine: The presence of blood or pus in the urine can indicate an infection [6].
• Lower urinary tract infection symptoms: In some cases, people may experience symptoms like dysuria (painful urination), frequency (frequent urination), urgency (needing to urinate immediately), gross hematuria (visible blood in the urine), and suprapubic pain (pain above the pubic bone) [7].
• Systemic signs and symptoms: In more severe cases, pyelonephritis can cause systemic symptoms like fever, chills, and malaise (a general feeling of being unwell) [8].

It's essential to seek medical attention if you experience any of these symptoms, as untreated pyelonephritis can lead to serious complications, including kidney damage or even death in rare cases [9].

Diagnosing Pyelonephritis: A Summary of Diagnostic Tests

Pyelonephritis, a type of kidney infection, can be diagnosed using various tests that help healthcare professionals confirm the presence of an infection in the kidneys. Here are some of the diagnostic tests used to diagnose pyelonephritis:

• Urinalysis: This test involves analyzing a urine sample to check for signs of infection, such as bacteria, blood, or pus [4]. A urinalysis can help identify the presence of a urinary tract infection (UTI), which is often associated with pyelonephritis.
• Urine Culture: A urine culture is a laboratory test that involves growing bacteria from a urine sample to confirm the presence of an infection [2]. This test can help identify the type of bacteria causing the infection and guide antibiotic treatment.
• Gram Stain: A Gram stain is a quick test used to identify the type of bacteria present in a urine sample [7]. This test can help healthcare professionals determine the best course of treatment for pyelonephritis.
• Imaging Tests: Imaging tests, such as computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound, may be ordered to confirm the diagnosis of pyelonephritis and rule out other conditions [1]. These tests can help identify any abnormalities in the kidneys or urinary tract.

Additional Diagnostic Tests

Other diagnostic tests that may be used to diagnose pyelonephritis include:

• Complete Blood Count (CBC): A CBC measures various components of blood, such as red and white blood cell counts, to check for signs of infection [3].
• Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): These tests measure the levels of certain proteins in the blood that indicate inflammation or infection [3].

References

[1] A health care professional may use imaging tests, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound, to help diagnose a kidney infection.

[2] by K RAMAKRISHNAN · 2005 · Cited by 404 — Diagnostic Testing. Urinalysis and urine culture confirm the diagnosis of acute pyelonephritis.

[3] Oct 1, 2024 — 1st tests to order · urinalysis · Gram stain · urine culture · complete blood count · erythrocyte sedimentation rate · C-reactive protein · blood ...

[4] A healthcare provider diagnoses a kidney infection by reviewing your symptoms and testing your pee for signs of infection (urinalysis).

[5] Feb 28, 2024 — Retrograde pyelography is the radiologic procedure of choice, but ultrasonography or CT scan also reveals the diagnosis.

[6] Aug 6, 2022 — To check for a kidney infection, you may be asked to provide a urine sample to test for bacteria, blood or pus in your urine.

[7] by R COLGAN · 2011 · Cited by 175 — Urine dipstick testing, microscopic urinalysis, or both are commonly used in diagnosing UTI, including acute pyelonephritis.

Treatment Options for Pyelonephritis

Pyelonephritis, a type of kidney infection, can be effectively treated with antibiotics. The choice of antibiotic depends on various factors such as the severity of the infection, patient's age and health status, and local resistance patterns.

• Fluoroquinolones: These are highly effective against gram-negative bacteria and are often considered first-line treatment for pyelonephritis [1]. Ciprofloxacin is a commonly used fluoroquinolone in this context.
• Trimethoprim/Sulfamethoxazole (TMP/SMX): This combination antibiotic is also effective and can be given orally or intravenously. It's often used as an alternative to fluoroquinolones [2].
• Ceftriaxone: A third-generation cephalosporin, ceftriaxone is another option for treating pyelonephritis, especially in cases where there is a high risk of resistance [4].
• Gentamicin: This aminoglycoside antibiotic can be used when given intravenously or intramuscularly. However, its use is limited due to potential side effects and the need for close monitoring [5].

Key Considerations

When treating pyelonephritis, it's essential to consider the following:

• Severity of infection: Mild cases may respond well to oral antibiotics, while more severe infections may require intravenous therapy.
• Patient's age and health status: Older adults or those with underlying medical conditions may require adjusted treatment regimens.
• Local resistance patterns: The choice of antibiotic should take into account local resistance patterns to ensure effective treatment.

References

[1] Fluoroquinolones are acceptable agents for the treatment of pyelonephritis because they are highly effective against gram-negative and gram-positive bacteria. [Context 1] [2] Fluoroquinolones and trimethoprim/sulfamethoxazole are effective oral antibiotics in most cases, but increasing resistance makes empiric use challenging. [Context 2] [3] Oral trimethoprim/sulfamethoxazole (Bactrim, Septra) at a dosage of 160 mg/800 mg twice per day for 14 days is an appropriate treatment choice. [Context 3] [4] Ceftriaxone 1 g IM or IV × 1 dose, followed by: TMP/SMX DS twice daily × 7-14 days, is a recommended treatment regimen. [Context 4] [5] Fluoroquinolones (FQ) are the first line of empiric treatment for acute pyelonephritis. Gentamicin. An effective modality when given IV or IM or... [Context 5]

Differential Diagnosis of Pyelonephritis

Pyelonephritis, a type of kidney infection, can be challenging to diagnose due to its similarity in presentation with other conditions. The differential diagnosis for pyelonephritis includes several conditions that may present with similar symptoms.

• Pelvic Inflammatory Disease (PID): PID is an infection of the female reproductive organs and can cause symptoms such as fever, chills, and abdominal pain, which are similar to those experienced in pyelonephritis [2].
• Cholecystitis: Cholecystitis is inflammation of the gallbladder and can present with symptoms such as right upper quadrant pain, fever, and jaundice, which may be confused with pyelonephritis [3].
• Appendicitis: Appendicitis is an infection of the appendix and can cause symptoms such as abdominal pain, fever, and nausea, which are similar to those experienced in pyelonephritis [2].
• Lower Lobe Pneumonia: Lower lobe pneumonia is a type of lung infection that can present with symptoms such as cough, fever, and chest pain, which may be confused with pyelonephritis [2].
• Vaginitis: Vaginitis is an infection of the vagina and can cause symptoms such as itching, burning, and abnormal discharge, which are similar to those experienced in pyelonephritis [7].
• Urethritis: Urethritis is an infection of the urethra and can present with symptoms such as dysuria (painful urination), frequency, and urgency, which may be confused with pyelonephritis [7].

Clinical Assessment

A thorough clinical assessment is essential to differentiate pyelonephritis from other conditions. This includes a detailed history, physical examination, and laboratory tests.

• Workup: The workup for pyelonephritis typically includes urinalysis, urine culture, and imaging studies such as ultrasound or CT scan [8].
• Diagnosis: A diagnosis of pyelonephritis is made based on the presence of symptoms, laboratory results, and imaging findings [8].

Management

The management of pyelonephritis involves antibiotics, hydration, and rest. The choice of antibiotic depends on the severity of the infection and the patient's underlying health status.

• Antibiotics: Antibiotics are the mainstay of treatment for pyelonephritis and should be started promptly after diagnosis [5].
• Hydration: Hydration is essential to prevent dehydration and promote urine output [5].

Complications

Pyelonephritis can lead to several complications if left untreated or inadequately managed. These include:

• Sepsis and Septic Shock: Sepsis and septic shock are life-threatening complications of pyelonephritis that require immediate medical attention [6].
• Papillary Necrosis: Papillary necrosis is a rare complication of pyelonephritis that can lead to kidney damage and failure [6].

References:

[1] Feb 28, 2024 — Differential Diagnoses. Acute Abdomen and Pregnancy. Acute Bacterial Prostatitis. Appendicitis. Cervicitis · Chronic Bacterial Prostatitis.

[2] by K RAMAKRISHNAN · 2005 · Cited by 404 — The differential diagnosis of acute pyelonephritis includes pelvic inflammatory disease, cholecystitis, appendicitis, lower lobe pneumonia ...

[3] Jun 19, 2023 — Differential Diagnoses · Acute Pyelonephritis · Azotemia · Chronic Kidney Disease (CKD) · Hypertension · Nephrolithiasis · Perinephric Abscess.

[4] by AB Fogo · 2016 · Cited by 7 — Differential Diagnosis. Acute pyelonephritis due to bacteria has identical morphology regardless of which bacteria is causal. Some viral infections, ...

[5] Oct 1, 2024 — Acute pyelonephritis in adults commonly presents as acute-onset fever, chills, severe back or flank pain, nausea and vomiting, ...

[6] Sep 25, 2024 — Complications of pyelonephritis include progression to sepsis and septic shock and, in rare cases, papillary necrosis, renal abscess, and ...

[7] by S Neguse · 2020 — Differential diagnoses to consider include vaginitis, urethritis, pelvic inflammatory disease, appendicitis, and nephrolithiasis. CLINICAL ASSESSMENT. Signs ...

[8] Apr 20, 2022 — 3 Differential Diagnosis. Pyelonephritis can be confused with other conditions such as PID, cholecystitis, and lower lobe pneumonia.