Pyelonephritis
Basics
Description
Description
- Inflammation of the renal pelvis and kidney
- Severity of illness can vary from mild symptoms to septic shock
- Frequently complication of a lower UTI by bacterial ascension into the upper urinary tract
- Primarily a clinical diagnosis
- Incidence lower in males in every age group
- >50% lifetime incidence in females in some studies
- Male/female ratio:
- 1:10 in first years of life
- 1:5 in children
- 1:50 in reproductive years
- 1:1 in fifth decade and later
- Bilateral infection in up to 25% of cases, hence no lateralizing signs (in some studies)
Etiology
Etiology
- Bacteriology:
- Escherichia coli (>90% in young women)
- Uropathogens:
- Klebsiella species
- Citrobacter species
- Enterobacter species
- Others:
- Staphylococcus saprophyticus 5–15%
- Proteus mirabilis
- Serratia species
- Pseudomonas species
- Staphylococcus aureus (increasing)
- Candida species (rare)
- Predisposing factors (consider complicated infections):
- Recent instrumentation:
- Catheterization
- Cystoscopy
- Urinary retention:
- Mechanical (see Obstruction)
- Medications (e.g., anticholinergics)
- Other infections (e.g., herpes simplex)
- Urinary obstruction:
- Stricture
- Renal calculi
- Prostatic hypertrophy
- Anatomic abnormalities:
- Hypospadias
- Ureteral ectopia
- Bifid ureter
- Renal scarring
- Ureterovesicular reflux (UVR)
- Posterior urethral valves
- Neurologic conditions:
- Neurogenic bladder
- Spinal cord injury
- Abnormal urodynamics
- Previous UTIs (in childhood, >3 in last year)
- Recent pyelonephritis (within 1 yr)
- Diabetes mellitus
- Immunosuppression
- Pregnancy
- Advanced age (>65 yr of age)
- Recent instrumentation:
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Citation
Schaider, Jeffrey J., et al., editors. "Pyelonephritis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis.
Pyelonephritis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis. Accessed December 1, 2024.
Pyelonephritis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis
Pyelonephritis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis.
* Article titles in AMA citation format should be in sentence-case
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T1 - Pyelonephritis
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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