Pielonefritis

Bacterial infection of pielum,

tubular, and interstitial tissue
of one or both kidneys

Epidemiology, Classification, and

Etiology
Epid : is more common in women
Classification: acute and chronic
Etiology : Escherichia coli is the most
common cause of kidney infection.
Other bacteria: Klebsiella and
streptokous class. Bacteria can enter
through reflux vesicoureteric or blood
flow to the kidneys.

Pathophysiology
Starting from bacterial invasion into the
lower urinary tract, low immune
conditions, urinary tract obstruction, Vur
can inhibit bacterial elimination into the
urine so bacteria can infect the urinary
tract.
If the body is not able to cope with
fluctuations in the bacteria, the bacteria
will rise to the upper urinary tract.

 Inflammatory reaction will cause the body

to release of endogenous pyrogens
mediator so that an increase in body
temperature fever Inflammation also
can cause pain
Disorders of the kidney medulla disturb
the concentration of urine plus the
increase in GFR due to kidney
inflammation polyuria and urinary
elimination disorders

Clinical Manifestations
Acute
Fever
Shiver
pelvic pain
CVAtenderness
Lekositosis
Kidney enlargementaccompanied byinflammatory cell infiltration
Chronic
Fatigue
Low appetite
Polyuria
Excessive thirst
Scarringin the kidney

Diagnosis
Physical examination
Palpable enlarged kidneys and no tenderness
Forehead and body heat
looks chills
Voice on the CVA tenderness
Bowel sounds weak
Laboratory tests
Urinalysis: pyuria, bacteriuria, hematuria
Blood: leukocytosis
Urine culture: determine the type of bacteria and its
sensitivity to antibiotics

Management
empirical antibiotic
Parenteral: ceftriaxone, cefepime, and
fluoroquinolone. Can be switched to oral after
24-48 hours.
Oral: fluoroquinolone for gram-negative
bacilli. Can be administered for 7 days
symptomatic
analgesics
antipyretics