This document provides information about pyelonephritis (kidney infection) including: 1. It defines pyelonephritis as an infection of the kidney and ureters that can be life-threatening. 2. Causes include urinary tract infections ascending from the bladder or entering via the bloodstream. 3. Symptoms vary depending on age but usually include fever, flank pain, nausea, and urinary symptoms. 4. Diagnosis involves urinalysis, urine culture, blood tests and imaging. Treatment is usually antibiotics selected based on likely causative organisms.

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2. Kidney infection or pyelonephritis

3. Kidney infection or pyelonephritis
• Definition:
Pyelonephritis is an infection of the
kidney and the ureters.

4. Introduction

5. Introduction
• Acute pyelonephritis is a potentially organ-
and/or life-threatening infection that often
leads to renal scarring.
• Acute pyelonephritis results from bacterial
invasion of the renal parenchyma. Bacteria
usually reach the kidney by ascending from
the lower urinary tract.
• Bacteria may also reach the kidney via the
bloodstream.

6. Causes

7. Causes
• 1- urinary tract infection, in the presence of
occasional or persistent back flow of urine
from the bladder into the ureters or kidney
pelvis (vesicoureteric reflux), calculous or
obstruction to urine flow
• 2.Hematogenous – via blood supply.

8. Classification of pyelonephritis

9. Classification of pyelonephritis
Acute uncomplicated pyelonephritis
sudden development of kidney
inflammation).
Chronic pyelonephritis (a long-standing
infection that does not clear

10. Clinical features

11. Clinical features
• More common in females.

12. Classic presentation

13. Classic presentation
• Fever - This is not always present, but when it is, it
is not unusual for the temperature to exceed 103°F
(39.4°C)
• Costovertebral angle pain - Pain may be mild,
moderate, or severe; flank or costovertebral angle
tenderness is most commonly unilateral over the
involved kidney, although bilateral discomfort may
be present
• Nausea and/or vomiting - These vary in frequency
and intensity, from absent to severe; anorexia is
common in patients with acute pyelonephritis

14. Clinical features

15. Clinical features
• Symptoms of acute pyelonephritis usually
develop over hours or over the course of a
day but may not occur at the same time. If
the patient is male, elderly, or a child or has
had symptoms for more than 7 days, the
infection should be considered complicated
until proven otherwise.

16. Clinical features
• Followed by lower tract sypmtoms-
– Frequency
– Dysuria

17. Child

18. Child
• The classic manifestations of acute
pyelonephritis observed in adults are often
absent in children, particularly neonates and
infants. In children aged 2 years or younger,
the most common signs and symptoms of
urinary tract infection (UTI) are as follows:
• Failure to thrive
• Feeding difficulty
• Fever
• Vomiting

19. Elderly

20. Elderly
Elderly patients may present with typical
manifestations of pyelonephritis, or they
may experience the following:
• Fever
• Mental status change
• Decompensation in another organ system
• Generalized deterioration

21. Complicated pyelonephritis

22. Complicated pyelonephritis
• A history of the following indicates an
increased risk of complicated
pyelonephritis:
– Structural abnormalities of the urinary tract
– Functional abnormalities of the urinary tract
– Metabolic abnormalities predisposing to UTIs
– Recent antibiotic use
– Recent urinary tract instrumentation

23. DD

24. DD
• Acute Abdomen and Pregnancy
• Acute Bacterial Prostatitis
• Appendicitis
• Cervicitis
• Chronic Bacterial Prostatitis
• Chronic Pyelonephritis
• Cystitis in Females
• Endometritis
• Pelvic Inflammatory Disease
• Urethritis

25. Diagnostic studies
•
• -A urinalysis commonly reveals white blood
cells (WBCs) or red blood cells (RBCs),
Bacteriuria>Gram’s stain
• -A urine culture may reveal bacteria in the
urine> Antibiotic sensitivity test
• A blood culture may show an infection.
• -An intravenous pyelogram (IVP) or CECT
scan of the abdomen may show enlarged
kidneys with poor flow of dye through the
kidneys.
• Abd. USG
• Scintigraphy

26. Diagnostic studies
• Experience with magnetic resonance
imaging (MRI) in evaluating acute
pyelonephritis is limited but growing. MRI
can detect renal infection or masses and
urinary obstruction, and it can evaluate the
renal vasculature.
• In perinephric abscess, MRI may help
define extension better than CT scan. As
there is no radiation exposure, MRI can be
used in pregnancy.

27. Diagnostic studies
• CT urography and MR urography are evolving
modalities that surpass intravenous urography,
which was the prior mainstay of urinary tract
imaging.
• CT urography provides a detailed anatomic
depiction of the urinary tract.
• MR urography has the advantage of not using
ionizing radiation and has the potential to provide
more functional information than CT. However, MR
urography is less established than CT urography and
is less reliable in providing diagnostic image quality.

28. Pathology of Ac. Pyelonephritis

29. Pathology of Ac. Pyelonephritis
• Histologic Findings
– Features of acute pyelonephritis include
suppurative necrosis or abscess formation
within the renal substance.

30. Treatment

31. Treatment
• The goals of treatment are control of the
infection and reduction of symptoms.
• Acute symptoms usually resolve within 48 to 72
after appropriate treatment.
• Due to the high mortality rate in the elderly
population and the risk of permanent kidney
damage prompt treatment is recommended.

32. Treatment
• Ambulatory younger women who present with
signs and symptoms of uncomplicated acute
pyelonephritis may be candidates for outpatient
therapy.
• They must be otherwise healthy and must not be
pregnant.
• Vigorous oral or IV fluids, antipyretic, pain
medication, and a dose of parenteral antibiotics.

33. Treatment
• Admission is usually appropriate for
patients who are severely ill, pregnant, or
elderly or who have co morbid disorders

34. Treatment
• Emergency surgery
– fever or positive blood culture results
persisting longer than 48 hours;
– in a patient whose condition deteriorates
– patient who appears toxic for longer than 72
hours

35. Treatment
• After recovery –
Elective surgery for
congenital anomalies,
fistulae involving the urogenital tract,
prostatic hypertrophy,
renal calculi,
vesicoureteric reflux.

36. Treatment
• Antibiotics are selected to treat the infection.

37. Organisms implicated

38. Organisms implicated
• E.coli
• Proteus
• Klebsiella
• Pseudomonas

39. Treatment
Antibiotic selection is typically empirical
The pathogen in community-acquired
infections is usually E coli or other
Enterobacteriaceae.
fluoroquinolones,
cephalosporins,
penicillins,
extended-spectrum penicillins,
carbapenems,
and aminoglycosides.

40. Treatment
If enterococci are suggested on the basis of
Gram stain results,
ampicillin
vancomycin
If any doubt exists as to the diagnosis,
coverage of both Enterobacteriaceae and
enterococci is acceptable.

41. Treatment
• There is a higher incidence of enterococcal
infections in hospitalized and other
institutionalized patients.
– Ampicillin or amoxicillin
– If the patient is allergic to penicillin,
vancomycin should be substituted.

42. Treatment
• In choosing an empirical antibiotic regimen,
consideration should include the local anti-
biogram and drug-resistance rates.

43. Treatment
• Patient characteristics should also be
considered. For example, patients who have
been frequently exposed to antibiotics (e.g.,
solid-organ transplant and hematopoietic
transplant patients) or are from institutional
facilities are at a greater risk for infection
with drug-resistant pathogens, such as
extended-spectrum beta-lactamase–
producing or carbapenemase-producing
organisms.

44. Treatment
• Regimens for complicated cases
• With complicated acute pyelonephritis, treat
patients parenterally until defervescence
and improvement in the clinical condition
warrants changing to oral antibiotics.
Complete the course of therapy with an oral
agent selected on the basis of culture .

45. Treatment
• Regimens for complicated cases
• Ampicillin and an aminoglycoside
• Cefepime
• Imipenem
• Meropenem
• Piperacillin-tazobactam
• Ticarcillin-clavulanate
• If the patient is allergic to penicillin-
vancomycin.
• Vancomycin or linezolid are options if
enterococci are a consideration.

46. Treatment
• Outpatient Treatment for Pyelonephritis
First-line therapy
• ciprofloxacin
If fluoroquinolone resistance
• ceftriaxone
• gentamicin or tobramycin or amikacin

47. Treatment
• Second-line therapy
– trimethoprim/sulfamethoxazole
• Alternative therapy
– Amoxicillin-clavulanate
– Cefaclor

48. Treatment
• Acute pyelonephritis has customarily been
treated with 14 days of antibiotics.
However, evidence suggests that in young,
healthy women who are receiving a
fluoroquinolone, including ciprofloxacin,
the course of treatment can be shortened to
7 days.
• Young, healthy males should complete a
14-day course.

49. Operative Therapy

50. Operative Therapy
• Drainage of perinephric abscess.
• Nephrectomy

51. Calculi-Related Infections
In the presence of acute infection, calculi must
be removed immediately using cystoscopy
or open surgical procedure.Mere
observation is not recommended,
Options include extracorporeal shockwave
lithotripsy (ESWL), endoscopic methods,
percutaneous methods, and open surgery.

52. • Complications:

53. • Complications:
• Recurrence of pyelonephritis.
• Perinephric abscess (infection around
the kidney).
• Sepsis .
• Acute renal failure.
• Chronic renal failure.

54. Gram negative septicemia

55. Gram negative septicemia
• Septic Shock
• SIRS
• Sepsis

56. Prevention

57. Prevention
• Increasing the intake of fluids to
encourage frequent urination that
flushes bacteria from the bladder.
• Chemoprophylaxis

58. prevention
• Prompt and complete treatment of cystitis
pyelonephritis. Chronic or recurrent urinary tract
infection of the kidneys.
•
• Preventive measures may reduce symptoms and
prevent recurrence of infection. Keeping the
genital area clean and remembering to from front
to back
• Urinating immediately after sexual intercourse
may help eliminate any bacteria

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