Pyelonephritis is an ascending urinary tract infection that has reached the ''pyelum'' (pelvis) of the kidney (''nephros'' in Greek language). If the infection is severe, the term "urosepsis" is used interchangeably. It requires antibiotics as therapy. == Pathology == Acute pyelonephritis is an ''exudative purulent localized inflammation'' of kidney and renal pelvis. 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, glomeruli and vessels are normal. Photo at: [http://www.pathologyatlas.ro/Interstitial%20Pyelonephritis1.html Atlas of Pathology] ==Signs and symptoms== It presents with high spiking fever, backache, vomiting dysuria (painful voiding), rigor (medicine) and often also with confusion. There may be renal angle tenderness on physical examination. ==Diagnosis== Nitrite and leukocytes on a urine dipstick are often detected, which may be an indication for empirical treatment. Formal diagnosis is with microbiological culture of the urine and blood cultures. In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteric reflux (urine from the bladder flowing back into the ureter). ==Treatment== Treatment is with antibiotics, which are often administered intravenously to improve the effect. Trimethoprim (or co-trimoxazole) or nitrofurantoin are often used first-line, although in full-blown pyelonephritis amoxicillin (with or without clavulanic acid), gentamycin (with or without ampicillin) or a third generation cefalosporins are often favoured. Urology Nephrology
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Pyelonephritis
Pyelonephritis
Pyelonephritis is an ascending urinary tract infection that has reached the ''pyelum'' (pelvis) of the kidney (''nephros'' in Greek language). If the infection is severe, the term "urosepsis" is used interchangeably. It requires antibiotics as therapy. == Pathology == Acute pyelonephritis is an ''exudative purulent localized inflammation'' of kidney and renal pelvis. 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, glomeruli and vessels are normal. Photo at: [http://www.pathologyatlas.ro/Interstitial%20Pyelonephritis1.html Atlas of Pathology] ==Signs and symptoms== It presents with high spiking fever, backache, vomiting dysuria (painful voiding), rigor (medicine) and often also with confusion. There may be renal angle tenderness on physical examination. ==Diagnosis== Nitrite and leukocytes on a urine dipstick are often detected, which may be an indication for empirical treatment. Formal diagnosis is with microbiological culture of the urine and blood cultures. In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteric reflux (urine from the bladder flowing back into the ureter). ==Treatment== Treatment is with antibiotics, which are often administered intravenously to improve the effect. Trimethoprim (or co-trimoxazole) or nitrofurantoin are often used first-line, although in full-blown pyelonephritis amoxicillin (with or without clavulanic acid), gentamycin (with or without ampicillin) or a third generation cefalosporins are often favoured. Urology Nephrology
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Pyelonephritis
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