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1. PYELONEPHRITIS
PRESENTED BY- FATIMA J. KAMARA
SECOND YEAR STUDENT, SCHOOL OF CLINICAL SCIENCES, MAKENI CITY
TUTOR:
DATE:

2. INTRODUCTION:
PYELONEPHRITIS: (Greek means
“pyelum”-renal pelvis, “nephros”-
kidney & “it is”-inflammation) is an
ascending urinary tract infection
that has reached the pelvis of the
kidney.

3. DEFINITION:
It is the inflammation of the kidney & upper
urinary tract that results from the bacterial
infection of the urinary bladder.

4. PYELONEPHRITIS

5. PYELONEPHRITIS:
-Pyelonephritis can be classified in several
different categories:
-Acute Pyelonephritis
-Chronic Pyelonephritis
-Xanthogranulomatous Pyelonephritis

6. ACUTE PYELONEPHRITIS

7. ACUTE PYELONEPHRITIS:
-Acute pyelonephritis is a sudden
development of kidney inflammation. It can
be severe in elderly & people who have
cancer or AIDS.

8. CAUSES:
1. ( Vesicourethral reflux) backward flow of
infected urine from the bladder to the upper
urinary tract
2. Kidney stones
3. Urinary tract catherization
4. Pregnancy
5. Neurogenic bladder (spinal bifida)
6. Benign prostate hyperplasia (BPH)
7. Diabetes mellitus

9. 1. MORPHOLOGY
GROSS ANATOMY:
-It shows enlarged & swollen kidney that bulges on
section
-Yellowish raised abscesses are seen on renal surface on
histology.
2. MICROSCOPIC EXAMINATION
-It involves the interstitium & causing destruction of the
tubules.
-The renal blood vessels shows considerable resistance
to infection & are spared.

10. CLINICAL FEATURES:
-Acute onset of pain
-Fiver with chills
-Lumber tenderness
-Dysuria
-Frequency of micturition
-On examination urine will show bacteria in
excess of 100,000/ml, pus cells.

11. COMPLICATIONS:
-Papillary necrosis
-Pyonephrosis
-Perinephric abscess

12. CHRONIC PYELONEPHRITIS

13. CHRONIC PYELONEPHRITIS:
It implies kidney infection & chronic
tubulointerstitial disease resulting in repeated
attacks of inflammation & scarring.

14. ETIOPATHOGENESIS:
It can be of two types:
1. CHRONIC OBSTRUCTIVE PYELONEPHRITIS:
Obstruction to the outflow of urine at different levels
predisposes the kidney to infection.
2. REFLUX PYELONEPHRITIS:
Reflux of urine from the bladder into one or both the
ureters during micturition is the major cause of chronic
pyelonephritis.

15. CAUSES:
1. Flank pain
2. Abdominal pain
3. Blood in urine
4. Signs of infection
5. Fiver
6. Unintentional weight loss
7. Malaise
8. Decreased appetite

16. MORPHOLOGY
1 . GROSS ANATOMY:
-Kidney is small & contracted. The show unequal
contraction at various places & this differentiates it from
symmetrical contracted kidneys seen in benign
nephrosclerosis. The scars cause adhesion of capsule of
kidney to cortex
2. MICROSCOPIC EXAMINATION:
-It involves the interstitium & causing destruction of the
tubules.
-The renal blood vessels show considerable resistance
to infection & are spared.

17. CLINICAL FEATURES:
1. Acute onset of pain
2. Fiver with chills
3. Lumber tenderness
4. Dysuria
5. Frequency of micturition
6. On examination urine will show bacteria in
excess of 100,000/ml, pus cells.

18. COMPLICATIONS:
-Papillary necrosis
-Pyelonephrosis
-Perinephric abscess

19. XANTHOGRANULOMATOUS PYELONEPHRITIS

20. XANTHOGRANULOMATOUS PYELONEPHRITIS
-It is an unusual form of chronic
pyelonephritis characterised by
granulomatous abscess formation, severe
kidney destruction & clinical pictures that
may resemble renal cell carcinoma & other
inflammatory renal parenchymal diseases

21. CLINICAL MANIFESTATION:
- Urosepsis
-Anaemia
-Painful renal mass
-Kidney stones
-Loss of function of the affected kidney

22. MORPHOLOGY:
There are granulomas & lipid laden
macrophages. It is found roughly 20% of
specimens from surgical managed causes of
pyelonephritis.

23. DIAGNOSIS:
1. LABORATORY EXAMINATION:
-Urinalysis may show sign of UTI
-Blood test
-Antibiotic sensitive testing
-Intra venous pyelography

24. 2. THE URINE DEEPSTICK TEST:
- Rapid diagnostic test
- Appearance of WBC in urine
- Test for nitrite & leukocyte esterase (family
Enterobacteriaceae, is detected in urine
PMN)
- Negative outcome, it’s not sufficient for
pregnant women

25. 3. URINANALYSIS:
-WBC in Cast shape due to pyelonephritis
-No WBC, No infection
4. URINE CULTURE:
- It is positive with colony count equal or more
than 10 power 2 in women with dysuria & pyuria
-It is positive with colony count >10 power 3 in
men

26. MANAGEMENT:
- To control the infection & reduce the
symptoms
-Urine culture & antibiotic sensitivity test is
performed on the basis of infection.
- Use antibiotics
-Like-aminoglycosides( eg. , cephalosporin &
sulphamenthoxazole etc.

27. PREVENTION:
- If pyelonephritis is not treated immediately,
permanent kidney damage can occur
- Increasing fluid intake, consuming blueberry juice
& fermented milk products containing probiotic
bacteria have all been shown to inhibit adherence
of bacteria to the epithelial cells of urinary tract &
reduce the recurrence of UTI.

28. SUMMARY
ACUTE PYELONEPHRITIS
• MICROBIOLOGY
1. ASCENDING (most common)
- E. Coli (75% to 95%)
- Proteus Mirabillis
- Klebsilla Pneumoniae
- Staphylococcus saprophyticus
2. DESCENDING (less common)
- Septicemia
- Infective endocarditis
Fever
Chills
Dysuria
Frequency
Urgency
MANAGEMENT
1. ORAL (outpatient)
- Ciprofloxacin. Levofloxacin
- Trimethoprim-sulfamethoxazole
2. PARENTERAL (mild to moderate)
- Ceftriaxone
- Ciprofloxacin, Levofloxacin
- Aztreonam
3. PARENTERAL (Severe)
- Cefepime
- Pipercillin-tazobactam
- Meropenem

29. THANK YOU ALL FOR YOUR ATTENTION