Submitted to: Dr.

ASHIROVA AICHOLPON
MAISALBEKOVNA
Subject: Pathophysiology

RENAL INFECTION OR
PYELONEPHRITIS

Submitted by:
Naqash Noble
Semester 5th
Group 11

"INTERNATIONAL UNIVERSITY OF KYRGYZSTAN"

INTERNATIONAL SCHOOL OF MEDICINE
 1. What Is a Kidney Infection?
A kidney infection, also called pyelonephritis, is when bacteria or viruses cause problems in
one or both of your kidneys. It’s a type of urinary tract infection (UTI).
Your kidneys’ main job is to remove waste and take extra water from your blood. They’re
part of your urinary tract, which makes liquid waste (urine) and removes it from your body.
If any of these parts gets germs in it, you can get a UTI. Most often, your bladder gets
infected first. This can be painful but isn’t usually serious.
But if the bad bacteria or viruses travel up your ureters, you can get a kidney infection. If left
untreated, a kidney infection can cause life-threatening problems.

2. Symptoms
 Blood or pus in your pee
 Fever and chills
 Loss of appetite
 Pain in your lower back, side, or groin
 Upset stomach or vomiting
 Weakness or fatigue

You may also have some of the symptoms of a bladder infection, such as:

 Burning or pain when you pee

 A constant urge to urinate, even soon after you empty your bladder
 Cloudy or bad-smelling urine
 Pain in your lower belly
 Peeing much more often than usual

3. Etiology & Pathophysiology

Escherichia coli is the most frequent cause of pyelonephritis. Its possible virulence factors
include the ability to adhere and colonize the urinary tract, an imporant initiating factor in
all urinary tract infections (UTIs). Acute pyelonephritis during the first 3 years of life more
often produced the renal damage that could lead to end-stage renal disease. Thus, the
prevention of end-stage renal disease that may occur from acute pyelonephritis during
infancy depends on early diagnosis and rapid and effective antibiotic treatment. This will
eradicate the bacteria and stop the destructive reperfusion damage and that associated
with the inflammatory response.
Hospital-acquired infections may be due to coliform bacteria and enterococci, as well as
other organisms uncommon in the community (e.g., Pseudomonas aeruginosa and various
species of Klebsiella). Most cases of pyelonephritis start off as lower urinary tract infections,
mainly cystitis and prostatitis. E. coli can invade the superficial umbrella cells of the bladder
to form intracellular bacterial communities (IBCs), which can mature into biofilms. These
biofilm-producing E. coli are resistant to antibiotic therapy and immune system responses,
and present a possible explanation for recurrent urinary tract infections, including
pyelonephritis. Risk is increased in the following situations:

Mechanical: any structural abnormalities in the urinary tract, vesicoureteral reflux (urine
from the bladder flowing back into the ureter), kidney stones, urinary tract
catheterization, ureteral stents or drainage procedures
(e.g., nephrostomy), pregnancy, neurogenic bladder (e.g., due to spinal cord damage, spina
bifida or multiple sclerosis) and prostate disease (e.g., benign prostatic hyperplasia) in men.
Constitutional: diabetes mellitus, immunocompromised states
Behavioral: change in sexual partner within the last year, spermicide use
Positive family history (close family members with frequent urinary tract infections).

4. Diagnosis
Urinalysis. A sample of your urine will be tested to look for signs of infection. High counts
of white blood cells and bacteria mean that there is an infection.
Urine culture. In a urine culture, bacteria in urine may grow on a culture dish within a few
days. This information will help the doctor determine the best antibiotic to use.
Blood cultures. A blood culture can tell if your infection has spread to your blood.
Computed tomography (CT scan). A CT scan is not necessary to diagnose kidney infection,
but it shows detailed 3D images of the urinary tract and kidneys to detect problems. A CT
would also see if there is a blockage that needs treatment.
Kidney ultrasound. Ultrasound can create images of the kidneys and ureters to show if
there are wounds, stones, or other things that block the urinary tract. This information can
help guide treatment decisions.
Voiding cystourethrogram (VCUG) is an x-ray image of the bladder and urethra taken while
the bladder is full and during urination. It uses a contrast dye. This test can show problems
in the urethra and bladder.
Digital rectal examination (DRE). A DRE is a physical exam of the prostate. Men who may
have kidney infection may have a DRE to see if a swollen prostate is blocking the neck of
the bladder.
Dimercaptosuccinic acid (DMSA) scintigraphy. This test uses small amounts of a
radioactive material to look closely at how well the kidneys work. Special cameras and
computers create images to see if the kidneys are infected, scarred or damaged.

5. Treatment & Management

Fluoroquinolones are the preferred empiric antimicrobial class in communities where the
local prevalence of resistance of community-acquired E. coli is 10 percent or less.
Although not all clinical microbiology laboratories serving outpatient medical practices
provide reports on the source of specimens tested for antibiotic resistance (i.e.,
community-acquired versus hospital-acquired), physicians should consider contacting
their local laboratory to obtain the best available susceptibility data.
In people suspected of having pyelonephritis, a urine culture and antibiotic sensitivity test
is performed, so therapy can eventually be tailored on the basis of the infecting organism.
As most cases of pyelonephritis are due to bacterial infections, antibiotics are the
mainstay of treatment.
If the prevalence of fluoroquinolone resistance among relevant organisms does not
exceed 10 percent, patients not requiring hospitalization can be treated with oral
ciprofloxacin (Cipro; 500 mg twice per day for seven days), or a once-daily oral
fluoroquinolone, such as ciprofloxacin (1,000 mg, extended-release, for seven days) or
levofloxacin (Levaquin; 750 mg for five days). These can be given with or without an initial
intravenous dose of the corresponding agent (e.g., 400 mg ciprofloxacin or 500 mg
levofloxacin).

6. Risk Factors
Risk factors for acute pyelonephritis in nonpregnant women include sexual intercourse
three or more times per week during the previous 30 days, UTIs in the previous 12
months, diabetes, stress incontinence in the previous 30 days, a new sex partner in the
previous year, recent spermicide use, and a history of UTIs in the patient's mother. Older
women, women who are menopausal or pregnant, and women who have preexisting
urinary tract structural abnormalities or obstructions have a higher risk of UTI, but not
necessarily of acute pyelonephritis.

7. Kidney Infection Complications

If you don’t get treatment, a kidney infection can cause serious problems like:
Kidney damage. Pus might collect and create an abscess inside the kidney tissue. The
bacteria may spread to other parts of your body. Your kidneys can also become scarred,
which can lead to high blood pressure, chronic kidney disease, and kidney failure.
Blood poisoning (septicemia). When bacteria from a kidney infection get into your
blood, they can spread through your body and into your organs. This is a medical
emergency and needs treatment right away.
Severe infection. An infection called emphysematous pyelonephritis (EPN) may destroy
kidney tissue and make toxic gas build up there. It usually happens in people who have
diabetes.
Problems in pregnancy. Women who have kidney infections while pregnant are more
likely to have babies born early or at a low weight. They’re also more likely to have
kidney complications.
8. Prevention
In people who experience recurrent urinary tract infections, additional investigations may
identify an underlying abnormality. Occasionally, surgical intervention is necessary to
reduce the likelihood of recurrence. If no abnormality is identified, some studies suggest
long-term preventive treatment with antibiotics, either daily or after sexual activity.] In
children at risk for recurrent urinary tract infections, not enough studies have been
performed to conclude prescription of long-term antibiotics have a net positive
benefit. Drinking cranberry juice does not appear to provide much if any benefit in
decreasing urinary tract infections.