Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder.

Acute pyelonephritis is an exudative purulent localized inflam mation of the renal pelvis (collecting system ) and kidney. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, the glomerulus and vessels are normal. Gross often reveals pathognomonic radiations of bleeding and suppuration through the renal pelvis to the renal cortex .

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Need to urinate at night (nocturia) Cloudy or abnormal urine color Blood in the urine Foul or strong urine odor

Diagnostic test: Diagnosis requires a urinalysis and culture and sensitivity testing. Typical findings include:
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pyuria. Urine sediment reveals leukocytes singly, in clumps, and in casts and, possibly, a few red blood cells. significant bacteriuria. Urine culture reveals more man 100,000 organisms/l of urine. low specific gravity and osmolality. These findings result from a temporarily decreased ability to concentrate urine. slightly alkaline urine pH. proteinuria, glycosuria, and ketonuria. These conditions occur less frequently.

Causes Pyelonephritis most often occurs as a result of urinary tract infection , particularly in the presence of occasional or persistent backflow of urine from the bladder into the ureters or kidney pelvis. Signs and symptoms
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Blood tests and X-rays also help in the evaluation of acute pyelonephritis. A complete blood count shows an elevated white blood cell count (up to 40,000/l) and an elevated neutrophil count. The erythrocyte sedimentation rate is also elevated. Kidney-ureter-bladder radiography may reveal calculi, tumors, or cysts in the kidneys and the urinary tract. Excretory urography may show

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Flank pain or back pain Severe abdominal pain (occurs occasionally) Fever o Higher than 102 degrees Fahrenheit o Persists for more than 2 days Chills with shaking Warm skin Flushed or reddened skin Moist skin Vomiting, nausea Fatigue General ill feeling Painful urination Increased urinary frequency or urgency

asymmetrical kidneys, possibly indicating a high frequency of infection. TREATMENT Treatment centers on antibiotic therapy appropriate to the specific infecting organism after identification by urine culture and sensitivity studies. For example, Enterococcus requires treatment with ampicillin, penicillin G, or vancomycin. Staphylococcus requires penicillin G or, if the

bacterium is resistant, a semisynthetic penicillin such as nafcillin, or a cephalosporin. Escherichia coli may be treated with sulfisoxazole, nalidixic acid, or nitrofurantoin; Proteus, with ampicillin, sulfisoxazole, nalidixic acid, or a cephalosporin; and Pseudomonas, with gentamicin, tobramycin, or carbenicillin When the infecting organism can't be identified, therapy usually consists of a broad-spectrum antibiotic, such as ampicillin or cephalexin. Antibiotics must be prescribed cautiously for elderly patients because of the combined effects of aging and pyelonephritis on renal function. Antibiotics also are used with caution in pregnant patients. In these patients, urinary analgesics such as phenazopyridine can help relieve pain. Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy ranges from 10 to 14 days. Follow-up treatment includes reculturing urine 1 week after drug therapy stops and then periodically for the next year to detect residual or recurring infection. A patient with an uncomplicated infection usually responds well to therapy and doesn't suffer reinfection If infection results from obstruction or vesicoureteral reflux, antibiotics may be less effective and surgery may be necessary to relieve the obstruction or correct the anomaly. A patient at high risk for recurring urinary tract and kidney infections - for example, a patient with a long-term indwelling catheter or on maintenance antibiotic therapy - requires lengthy follow-up care. PREVENTION: To help prevent pyelonephritis if you have had a previous episode or are at risk:
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bacteria by flushing out your urinary tract. This flushing also helps to prevent kidney stones, which can increase the risk of pyelonephritis.
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If you are a woman, wipe from front to back. To prevent the spread of intestinal and skin bacteria from the rectum to the urinary tract, women should always wipe toilet tissue from the front to the back after having a bowel movement or urinating. Decrease the spread of bacteria during sex. Women should urinate after sexual intercourse to flush bacteria from the bladder. Some women who have frequent urinary tract infections after sexual activity can take antibiotics around the time of intercourse to prevent an infection.

If there is a structural problem with the urinary system, such as blockage from a stone, or a developmental abnormality, then surgery can be done to restore normal urinary function and prevent future episodes of pyelonephritis. Chronic... Chronic pyelonephritis is characterized by scarring and shrunken volume (atrophy) of the kidneys. chronic pyelonephritis is a kidney condition that develops over time due to damage of kidney tissue. In adults, infection usually plays a role, but the underlying disorder usually involves an underlying structural or functional abnormality in the urinary tract that predisposes an individual to kidney infections. It results in decreased ability of the kidneys to function (renal failure). Chronic pyelonephritis is characterized by scarring and shrunken volume (atrophy) of the kidneys. Unlike acute pyelonephritis in which there is bacterial infection of the kidney, chronic pyelonephritis is a kidney

Drink several glasses of water each day. Water discourages the growth of infection-causing

women more frequently than men. It is condition that develops over time due to damage of kidney tissue. In adults, infection usually plays a role, but the underlying disorder usually involves an underlying structural or functional abnormality in the urinary tract that predisposes an individual to kidney infections. It results in decreased ability of the kidneys to function (renal failure). more common in whites than blacks. History: Symptoms reported may vary, depending on whether or not infection is present. Individuals without infection may not have symptoms (asymptomatic) until they reach the later stages of chronic pyelonephritis Abnormalities that increase the risk of chronic pyelonephritis with repeated urinary tract infections include diabetes, kidney stones (calculi), use of certain analgesics, and urinary tract obstruction. Infection alone rarely leads to chronic pyelonephritis and loss of kidney function. Chronic pyelonephritis can develop without infection. Individuals with an abnormality of the junction between the ureter and bladder (vesicoureteral junction) in childhood may develop chronic pyelonephritis. Abnormality of the vesicoureteral junction, a congenital condition in which the juncture between the ureters and bladder is weak, allows urine to flow backward from the bladder to the ureter and up into the kidney. Severe reflux alone can lead to kidney scarring, even in the absence of other factors known to cause kidney scarring. The scarring of the kidneys associated with vesicoureteral reflux is similar to that seen with repeated infection combined with underlying structural abnormality. Some authorities theorize that kidney scarring due to reflux of urine (reflux nephropathy) may be an autoimmune process. Other noninfectious conditions that may scar the kidneys similarly to vesicoureteral reflux are longstanding high blood pressure(hypertension) and use of certain analgesics. Individuals with increased risk include those with congenital urinary tract abnormalities, and those with recurrent urinary tract infections. Risk: Chronic pyelonephritis affects with chronic kidney failure. Symptoms may be non-specific, including high blood pressure (hypertension) and signs of kidney failure such as itching (pruritus), generalized malaise, feeling tired (lassitude), forgetfulness, easy fatigability, nausea, and loss of sexual drive (libido). If infection is present, the individual may complain of symptoms similar to those of acute pyelonephritis, with rapid development of symptoms over the course of a few hours or days. Individuals may report a high fever (101 F to 104 F [38.3 C to 40 C] or higher) and shaking chills; pain in the flank, particularly in the lower back on the right side; increased frequency of urination; pain and a burning sensation upon urination (dysuria); nausea and vomiting; decreased appetite (anorexia); and general fatigue. The urine may appear cloudy or bloodtinged with a fishy odor. Some individuals may note only diffuse abdominal pain with nausea, vomiting, and diarrhea. When asked, the individual may report a history of unexplained fevers and bed-wetting during childhood.

Kidneys may appear asymmetrical, indicating severe inflammation. In some Physical exam: In the absence of acute infection, the physical examination may be essentially normal. With infection, physical exam may reveal generalized muscle tenderness and pain and tenderness when pressure is applied to the sides of the abdomen (flank or costovertebral angle tenderness). Fever, high blood pressure, and other symptoms may be confirmed during physical examination. Tests: If a urinary tract and/or kidney infection is suspected, a sample of urine collected in midstream should be cultured to determine the number and species of bacteria present. Sensitivities (to antibiotics) will be obtained. The urine sediment is examined for red blood cells or pus in the urine (hematuria or pyuria). Urinalysis may reveal protein in the urine (proteinuria, albuminuria) and whether the urine is abnormally concentrated or dilute. Laboratory testing may reveal decreased kidney functioning, with increased blood urea nitrogen (BUN) and creatinine. A 24-hour urine collection helps quantitate kidney function. Urine and blood cultures may reveal the presence of bacteria in the urine or blood. An x-rayof the kidney may reveal kidney stones (calculi), tumors, or cysts in the kidney or urinary tract. Kidney x-ray using dye injection that concentrates in the urine (intravenous pyelogram) helps visualize the kidneys and urinary tract. If a non-infectious cause is suspected, a kidney x-ray (intravenous pyelogram) or renal ultrasound procedure may be indicated. The kidneys may have an irregular outline and appear smaller than normal. If only one kidney is affected, the other kidney may be larger due to hypertrophy. An x-ray of the kidney may reveal kidney stones (calculi), tumors, or cysts in the kidneys or urinary tract. Kidney (renal) biopsy may be recommended in some cases to rule out other potential causes for the inflammation. Treatment is directed at eradicating infection if present, and at correcting underlying causes. If a urinary tract infection is the cause, antibiotics are the first line of therapy. Whenever possible, the type of bacteria causing the infection should be identified and antibiotics specific for that organism are then prescribed. A follow-up culture of the urine may be obtained 1 week after the end of drug therapy. It may be necessary to continue long-term cases, an abdominal CT scan or renal ultrasound may be indicated, especially in individuals with an unclear diagnosis or who have complicated conditions. In some cases, urine specimens may be obtained directly from the ureter for culture through an invasive ureteral catheterization procedure.

antibiotic therapy for up to 3 to 6 months.

Underlying structural abnormalities are corrected wherever possible. Surgery may be necessary to remove obstruction or to repair a stricture. A variety of surgical procedures may be performed, depending on the underlying cause of the obstruction or stricture. It may be necessary to repair the pelvis of the kidney (pyeloplasty) due to an obstruction of the ureteropelvic junction. Kidney stones may be removed through an open incision or through a transurethral approach using cystoscopy and a stone-basketing procedure. Surgical treatment of vesicoureteral reflux may involve repair of congenital abnormalities that lead to vesicoureteral reflux as a complication, or surgical treatment may involve a variety of procedures designed to correct the vesicoureteral reflux condition itself (reimplantation of ureters). Removal of a kidney (nephrectomy) may be recommended in cases in which only one kidney is severely affected (unilateral).

Other types of medical treatment may be necessary. Medications may be prescribed to control hypertension. If kidney failure has occurred, medications, diet changes, and dialysis may be necessary