Type:
Educational Exhibit
Keywords:
Kidney, Urinary Tract / Bladder, CT, Ultrasound, Diagnostic procedure, Infection, Acute, Abscess
Authors:
M. D. C. CRUZ CONDE, E. Martínez Chamorro, S. Borruel Nacenta, C. Casado Pérez, J. García Prieto, J. Alonso Sanchez, I. NAVAS FERNANDEZ-SILGADO, G. GARCIA GALARRAGA; madrid/ES
DOI:
10.26044/ecr2019/C-2574
Background
Pyelonephritis is a severe urinary tract infection that affects both the parenchyma and the collecting system.
The annual incidence is estimated in around 10.5 million to 25.9 million people in the world [1],
with more prevalence amongst women.
The most frequent bacteria responsible is Escherichia Coli.
Renal affection may arise from haematogenous spread or more commonly from the urinary tract [2],
where bacteria colonise the urine in the bladder and are able to migrate upwards to the collecting system and parenchyma.
Diagnosis is clinical and analytical.
One should suspect pyelonephritis when urinary tract infection symptoms (dysuria,
frequency and emergency) combine with lumbar back pain and fever,
although some patients may have digestive symptoms that may confuse diagnosis.
Blood analysis may show leucocytosis and elevation of acute phase reactants.
Urine analysis is very helpful to confirm the diagnosis or orientate in patients with vague symptoms,
high nitrate levels and pyuria are normally found.
Urine culture should be taken before empiric antibiotic treatment is given.
After correct treatment is received,
urine culture can appear negative within the hour,
symptoms may disappear in 24-48 hours and the infection can be resolved in 5-6 days.
Some patients may persist with symptoms or have risk factors for complications; this is where imaging procedure is recommended.