Pyelonephritis is infection affecting the renal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy and the renal parenchyma. This condition arises mostly as a complication of bladder infection that ascends to the upper urinary tract Urinary tract The urinary tract is located in the abdomen and pelvis and consists of the kidneys, ureters, urinary bladder, and urethra. The structures permit the excretion of urine from the body. Urine flows from the kidneys through the ureters to the urinary bladder and out through the urethra. Urinary Tract: Anatomy. Pyelonephritis can be acute or chronic (which results from persistent or chronic infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease). Typical acute symptoms are flank pain Flank pain Pain emanating from below the ribs and above the ilium. Renal Cell Carcinoma, fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, and nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics with vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia. The chronic type depends on the underlying pathology. The diagnosis is established via clinical presentation, supported by laboratory findings (in blood and urine). Imaging studies are performed if severe illness is noted or there is no response to initial treatment (antibiotics). CT is the study of choice, given its ability to detect renal abnormalities associated with the infection, including the extent of the disease. Perinephric abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease is an infection involving the perinephric space between the kidney and Gerota’s fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis. Perinephric abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease can be an extension Extension Examination of the Upper Limbs from pyelonephritis or from hematogenous Hematogenous Hepatocellular Carcinoma (HCC) and Liver Metastases spread of a systemic infection. The diagnosis is established via CT scan. The treatment includes antibiotics, with abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease drainage (which is both diagnostic and therapeutic).
Last updated: 27 Jun, 2022
Ascending hematogenous Hematogenous Hepatocellular Carcinoma (HCC) and Liver Metastases urinary tract Urinary tract The urinary tract is located in the abdomen and pelvis and consists of the kidneys, ureters, urinary bladder, and urethra. The structures permit the excretion of urine from the body. Urine flows from the kidneys through the ureters to the urinary bladder and out through the urethra. Urinary Tract: Anatomy infection
Image by Lecturio. License: CC BY-NC-SA 4.0Acute pyelonephritis Acute pyelonephritis Inflammation of the kidney involving the renal parenchyma (the nephrons); kidney pelvis; and kidney calices. It is characterized by abdominal pain; fever; nausea; vomiting; and occasionally diarrhea. Imaging of the Urinary System is the sudden-onset infectious Infectious Febrile Infant process and inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the kidney(s) from ascending infection Ascending Infection Urinary Tract Infections (UTIs) in Children or hematogenous Hematogenous Hepatocellular Carcinoma (HCC) and Liver Metastases spread of systemic infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease.
Associated with the development of pyelonephritis and perinephric abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease:
Findings suspicious for pyelonephritis:
Blood tests:
Urine studies:
Imaging studies:
Chronic pyelonephritis with reduced kidney size and focal cortical thinning:
Measurement of kidney length on the ultrasound image is illustrated by the + signs and the dashed line.
Xanthogranulomatous pyelonephritis:
CT of the abdomen and
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy with IV contrast and delayed phase demonstrating a left kidney with parenchyma replaced with multiple large hypodense collections containing fluid and gas, a left staghorn calculus, and
communication
Communication
The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups.
Decision-making Capacity and Legal Competence between the kidney and large flank collection.
Also note the 13.5-by-7.7-cm multiloculated pelvic
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast.
MRI showing pyelonephritis:
Left: T1-weighted sequence showing a large pyelonephritis
focus
Focus
Area of enhancement measuring < 5 mm in diameter
Imaging of the Breast in the right kidney
Right: The same area in
diffusion
Diffusion
The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space. Diffusion, especially facilitated diffusion, is a major mechanism of biological transport.
Peritoneal Dialysis and Hemodialysis. The large cuneiform lesion is evident because of the intense
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema.
IV urography:
Some blunting of the right upper pole calyx with some reduction in cortical thickness at the right upper pole compatible with chronic pyelonephritis is seen. Otherwise, both pelvicalyceal systems and
ureters
Ureters
One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the urinary bladder.
Urinary Tract: Anatomy appear normal.
Axial Axial Computed Tomography (CT) CT image through the upper pole of the right kidney showing perinephric abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease reaching posteriorly to the inferior vena cava Inferior vena cava The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels: Anatomy.
Image: “ Axial Axial Computed Tomography (CT) CT image through the upper pole of the right kidney showing perinephric abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease reaching posterior to IVC IVC The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels: Anatomy.” by Wani NA. License: CC BY 2.0Management depends on the severity of the clinical presentation and risk factors for drug resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing: