Acute Pyelonephritis

Renal & Urinary System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute pyelonephritis (APN) is a common bacterial infection of the renal pelvis and kidney that is typically seen in young women who are sexually active. Escherichia coli is the organism most often implicated."}]}
{"ops":[{"insert":"Fever"},{"insert":"\n"}]}
{"ops":[{"insert":"Fever \u003E100.4\u00b0F (38.0 \u00b0C) accompanied by chills is a characteristic feature. However, this may be mild or even absent in the elderly and immunocompromised. The pathophysiology involves endogenous pyogens released by the underlying inflammatory process."}]}
{"ops":[{"insert":"Flank pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Flank pain is the other characteristic feature of APN; if absent, an alternate diagnosis should be entertained. The pain is felt in this region due to the retroperitoneal location of the kidneys."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are common. These too are due to the systemic release of inflammatory mediators."}]}
{"ops":[{"insert":"Lower urinary tract symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Lower urinary tract symptoms include dysuria, frequency, and urgency. They occur if there is a co-existing (lower) urinary tract infection (UTI)."}]}
{"ops":[{"insert":"Symptoms of complications"},{"insert":"\n"}]}
{"ops":[{"insert":"Complications include sepsis and abscess formation. Sepsis occurs when severe infection leads to an uncontrolled systemic inflammatory response. Renal and perinephric abscesses occur due to the local spread of infection."}]}
{"ops":[{"insert":"Risk factors"},{"insert":"\n"}]}
{"ops":[{"insert":"In nonpregnant women, risk factors for the development of acute pyelonephritis include:\n\n- Sexual intercourse three or more times per week during the previous 30 days,\n- A UTI within the previous 12 months,\n- Stress incontinence in the previous 30 days,\n- A new sex partner in the previous year,\n- Recent spermicide use,\n- Diabetes mellitus, and,\n- A maternal history of UTIs.\n\nNote that pregnancy, menopause, and structural abnormalities or obstructions of the urinary tract confer an increased risk for UTIs, but not necessarily for acute pyelonephritis."}]}
{"ops":[{"insert":"Complicated pyelonephritis"},{"insert":"\n"}]}
{"ops":[{"insert":"The term \u0022complicated\u0022 acute pyelonephritis is used if one or more of the following is present:\n\n- Pregnancy,\n- Uncontrolled diabetes mellitus,\n- Immunocompromise,\n- Renal transplanation,\n- Structural abnormalities of the urinary tract,\n- Acute kidney injury,\n- Chronic kidney disease, or,\n- Hospital-acquired infections.\n\nThis identifies patients who are at increased risk of a poor outcome."}]}
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute pyelonephritis (APN) is a common bacterial infection of the renal pelvis and kidney that is typically seen in young women who are sexually active. Escherichia coli is the organism most often implicated."}]}
{"ops":[{"insert":"Fever"},{"insert":"\n"}]}
{"ops":[{"insert":"Fever \u003E100.4\u00b0F (38.0 \u00b0C) accompanied by chills is a characteristic feature. However, this may be mild or even absent in the elderly and immunocompromised. The pathophysiology involves endogenous pyogens released by the underlying inflammatory process."}]}
{"ops":[{"insert":"Flank pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Flank pain is the other characteristic feature of APN; if absent, an alternate diagnosis should be entertained. The pain is felt in this region due to the retroperitoneal location of the kidneys."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are common. These too are due to the systemic release of inflammatory mediators."}]}
{"ops":[{"insert":"Lower urinary tract symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Lower urinary tract symptoms include dysuria, frequency, and urgency. They occur if there is a co-existing (lower) urinary tract infection (UTI)."}]}
{"ops":[{"insert":"Symptoms of complications"},{"insert":"\n"}]}
{"ops":[{"insert":"Complications include sepsis and abscess formation. Sepsis occurs when severe infection leads to an uncontrolled systemic inflammatory response. Renal and perinephric abscesses occur due to the local spread of infection."}]}
{"ops":[{"insert":"Risk factors"},{"insert":"\n"}]}
{"ops":[{"insert":"In nonpregnant women, risk factors for the development of acute pyelonephritis include:\n\n- Sexual intercourse three or more times per week during the previous 30 days,\n- A UTI within the previous 12 months,\n- Stress incontinence in the previous 30 days,\n- A new sex partner in the previous year,\n- Recent spermicide use,\n- Diabetes mellitus, and,\n- A maternal history of UTIs.\n\nNote that pregnancy, menopause, and structural abnormalities or obstructions of the urinary tract confer an increased risk for UTIs, but not necessarily for acute pyelonephritis."}]}
{"ops":[{"insert":"Complicated pyelonephritis"},{"insert":"\n"}]}
{"ops":[{"insert":"The term \u0022complicated\u0022 acute pyelonephritis is used if one or more of the following is present:\n\n- Pregnancy,\n- Uncontrolled diabetes mellitus,\n- Immunocompromise,\n- Renal transplanation,\n- Structural abnormalities of the urinary tract,\n- Acute kidney injury,\n- Chronic kidney disease, or,\n- Hospital-acquired infections.\n\nThis identifies patients who are at increased risk of a poor outcome."}]}

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