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 Internal Medicine, Renal Disease

Kidney infection (pyelonephritis)

Kidney infection (pyelonephritis)

Tuberculosis in the kidney
Tuberculosis in the kidney
Anatomical landmarks, back view
Anatomical landmarks, back view
Anatomical landmarks, side view
Anatomical landmarks, side view
Kidney anatomy
Kidney anatomy
Kidney - blood and urine flow
Kidney - blood and urine flow

Definition:

Pyelonephritis is an infection of the kidney and the ducts that carry urine away from the kidney (ureters).

Alternative Names:
Urinary tract infection - complicated; Infection - kidney; Complicated urinary tract infection; Pyelonephritis
Causes, incidence, and risk factors:

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 (vesicoureteric reflux).

Pyelonephritis can be further classified as follows:

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

Although cystitis (bladder infection) is common, pyelonephritis occurs much less often. The risk is increased if there is a history of cystitis, renal papillary necrosis, kidney stones, vesicoureteric reflux, or obstructive uropathy.

The risk is also increased when there is a history of chronic or recurrent urinary tract infection and when the infection is caused by a particularly aggressive type of bacteria.

Acute pyelonephritis can be severe in the elderly and in people who are immunosuppressed (for example, those with cancer or AIDS).

Symptoms:
* Sometimes in the elderly, mental changes or confusion are the only signs of a urinary tract infection.
Signs and tests:

An examination may show tenderness on palpation (pressing) over the kidney.

  • A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs) in the urine.
  • A urine culture from aclean catch or urine culture (catheterized specimen) may reveal bacteria in the urine.
  • A blood culture may show an infection.
  • An intravenous pyelogram (IVP) or CT scan of the abdomen may show enlarged kidneys with poor flow of dye through the kidneys. IVP and CT scan of the abdomen can also indicate underlying disorders.
Underlying abnormalities of the kidney that put a patient at high risk for acute pyelonephritis may be discovered by additional tests and procedures, including the following:

Review Date: 7/25/2006
Reviewed By: David M. Charytan, M.D., M.Sc., Department of Medicine, Division of Nephrology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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