Pyelonephritis Acute
Disease Details
Family Health Simplified
- Description
- Acute pyelonephritis is a sudden and severe infection of the kidneys characterized by inflammation, which can lead to pain, fever, and potential kidney damage.
- Type
- Acute pyelonephritis is an infectious disease. It is not typically associated with genetic transmission but is rather caused by bacterial infection, most commonly Escherichia coli (E. coli), ascending from the lower urinary tract to the kidneys.
- Signs And Symptoms
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Signs and symptoms of acute pyelonephritis typically include:
- Fever
- Chills
- Flank pain (pain in the side or back)
- Nausea and vomiting
- Frequent and painful urination
- Urgency to urinate
- Hematuria (blood in the urine)
- Pyuria (pus in the urine)
- General malaise or feeling unwell
These symptoms indicate an infection of the kidneys and warrant prompt medical attention. - Prognosis
- The prognosis for acute pyelonephritis is generally good with prompt and appropriate treatment, which usually involves antibiotics. Most patients recover within a few days to weeks, although some may require hospitalization if they have severe symptoms or complications. Delayed or inadequate treatment can lead to complications such as sepsis, renal abscesses, or chronic kidney disease. Early diagnosis and adherence to prescribed treatment are crucial for a favorable outcome.
- Onset
- The onset of acute pyelonephritis is typically sudden. Symptoms can develop rapidly over a few hours to days.
- Prevalence
- The prevalence of acute pyelonephritis is not typically expressed in nan (nanoliters or another metric involving nanotechnology). Prevalence refers to the proportion of individuals in a population who have a specific disease at a given time. In the context of acute pyelonephritis, it is estimated that there are around 15-17 cases per 10,000 females and 3-4 cases per 10,000 males annually in the general population. It is more common in women than in men, and the risk increases with factors such as urinary tract obstruction, diabetes, and immunosuppression.
- Epidemiology
- Acute pyelonephritis is a bacterial infection of the kidneys. It is more common in women than men, with a higher incidence in young adult females, attributed primarily to the shorter female urethra and its proximity to the anus. The elderly, individuals with urinary tract abnormalities, and those with weakened immune systems are also at increased risk. In the United States, there are about 250,000 cases annually, with around 100,000 hospitalizations.
- Intractability
- Acute pyelonephritis is generally not considered intractable. With timely and appropriate antibiotic treatment, most patients recover fully. However, if left untreated or if underlying health conditions complicate the infection, it can lead to more serious complications which may be harder to manage.
- Disease Severity
- The severity of acute pyelonephritis can vary widely depending on the individual's overall health, the presence of any underlying conditions, and the timeliness and effectiveness of treatment. It is generally considered a serious condition that requires prompt medical attention to prevent complications. Severe cases can lead to sepsis, kidney abscesses, or permanent kidney damage if not treated adequately. Common symptoms include high fever, chills, flank pain, nausea, vomiting, and urinary symptoms like dysuria or frequent urination.
- Healthcare Professionals
- Disease Ontology ID - DOID:559
- Pathophysiology
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Acute pyelonephritis is a sudden and severe kidney infection that primarily involves the renal pelvis and interstitial tissue. The pathophysiology of acute pyelonephritis typically begins with a bacterial infection, most commonly Escherichia coli, that ascends from the lower urinary tract through the ureters to the kidneys.
Key points include:
1. **Bacterial Ascension:** Pathogens from the bladder travel up to the kidneys.
2. **Inflammatory Response:** The kidneys' response involves the recruitment of white blood cells to the site of infection, leading to inflammation and edema.
3. **Tissue Damage:** Persistent infection and inflammatory response can cause destruction of renal parenchyma and formation of renal abscesses.
4. **Potential for Bacteremia:** If the infection spreads from the kidneys into the bloodstream, it can cause systemic sepsis, which is potentially life-threatening.
Prompt diagnosis and treatment are essential to prevent complications such as chronic kidney disease or renal scarring. - Carrier Status
- Acute pyelonephritis is a bacterial infection of the kidneys. Carrier status is not applicable to this condition as it is an acute bacterial infection typically caused by bacteria such as Escherichia coli (E. coli) that enter the urinary tract.
- Mechanism
-
Pyelonephritis acute is an infection of the kidneys typically caused by bacteria, most commonly Escherichia coli.
**Mechanism:**
1. **Ascension of Bacteria:** The infection often starts as a lower urinary tract infection where bacteria ascend from the urethra to the bladder and then to one or both kidneys.
2. **Inflammation:** The bacteria trigger an immune response in the kidneys, leading to inflammation and damage to kidney tissues.
**Molecular Mechanisms:**
1. **Bacterial Virulence Factors:** E. coli and other bacteria have virulence factors like fimbriae (e.g., Type 1 and P fimbriae), which help them adhere to the epithelial cells of the urinary tract.
2. **Toxins and Enzymes:** Pathogens produce toxins (e.g., hemolysins) and enzymes (e.g., urease in Proteus species), which cause cellular damage and facilitate infection.
3. **Host Immune Response:**
- **Cytokines and Chemokines:** Once the epithelial cells detect bacteria, they release signaling molecules (e.g., IL-6, IL-8) that attract immune cells like neutrophils to the site of infection.
- **Lipopolysaccharides (LPS):** Components of the bacterial cell wall, such as LPS, can trigger an intense immune response via Toll-like receptors (e.g., TLR4) on host cells, leading to the activation of NF-κB pathway and subsequent inflammation.
These molecular interactions and immune responses aim to eliminate the bacteria but can also lead to collateral damage to kidney tissues. - Treatment
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Treatment for acute pyelonephritis typically includes the following:
1. **Antibiotics**: The primary treatment involves the use of antibiotics to eliminate the infection. The choice of antibiotic depends on the severity of the infection, the patient's medical history, and local antibiotic resistance patterns. Common antibiotics include:
- Ciprofloxacin
- Levofloxacin
- Trimethoprim-sulfamethoxazole
- Amoxicillin-clavulanate
- Ceftriaxone (for severe cases requiring hospitalization)
2. **Supportive Measures**: These may include:
- Pain management with analgesics such as acetaminophen or NSAIDs
- Adequate hydration to help flush out the urinary system
3. **Hospitalization**: In severe cases, hospitalization may be required for intravenous antibiotics and fluids.
4. **Follow-Up**: It is essential to follow up with the healthcare provider to ensure the infection has cleared and to prevent complications. This may involve repeat urine cultures. - Compassionate Use Treatment
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Compassionate use or off-label and experimental treatments for acute pyelonephritis typically revolve around severe cases, particularly when standard treatments fail or are not suitable. Here are a few considerations:
1. **Advanced Antibiotics**: In cases where typical antibiotics (like fluoroquinolones, trimethoprim-sulfamethoxazole, or beta-lactams) aren't effective, carbapenems (e.g., meropenem) or extended-spectrum cephalosporins (e.g., cefepime) may be used off-label.
2. **Intravenous Immunoglobulin (IVIG)**: Used experimentally in multiple severe infections, though not standard.
3. **Antimicrobial Peptides**: These are still in the research phase but hold promise for treating resistant bacterial infections.
4. **Bacteriophage Therapy**: Experimental and involves using viruses that specifically target pathogenic bacteria.
5. **Biologics**: Monoclonal antibodies targeting specific bacterial pathogens or their toxins are under investigation.
Consultation with a specialist is crucial for determining suitability and access to these treatments. - Lifestyle Recommendations
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For acute pyelonephritis, some important lifestyle recommendations include:
1. **Hydration**: Drink plenty of fluids, especially water, to help flush bacteria from the urinary tract.
2. **Rest**: Ensure sufficient rest to help your body recover.
3. **Diet**: Maintain a balanced diet to support overall health and healing.
4. **Avoid Irritants**: Stay away from bladder irritants such as caffeine, alcohol, and spicy foods.
5. **Follow Medical Advice**: Strictly adhere to any prescribed medication regimen, especially antibiotics.
6. **Personal Hygiene**: Practice good personal hygiene to prevent further infections.
7. **Urinate Regularly**: Do not hold in urine for extended periods, and completely empty your bladder when you go.
8. **Avoid Scented Products**: Refrain from using scented feminine hygiene products that could irritate the urinary tract.
Always consult with a healthcare professional for personalized advice. - Medication
-
Acute pyelonephritis is typically treated with antibiotics. The choice of antibiotic can depend on various factors, including the severity of the infection and local antibiotic resistance patterns. Common options include:
1. **Ciprofloxacin** or other fluoroquinolones
2. **Trimethoprim-sulfamethoxazole** (Bactrim)
3. **Amoxicillin-clavulanate** (Augmentin)
4. **Ceftriaxone** or other third-generation cephalosporins
5. **Gentamicin** or other aminoglycosides (often used in combination in severe cases)
In severe cases, especially if hospitalization is required, initial intravenous antibiotics may be administered. Always follow healthcare provider guidance for treatment specifics. - Repurposable Drugs
-
Acute pyelonephritis is a bacterial infection of the kidneys. Repurposable drugs that are commonly used to treat this condition include antibiotics such as:
1. Ciprofloxacin
2. Levofloxacin
3. Trimethoprim-sulfamethoxazole
4. Amoxicillin-clavulanate
5. Ceftriaxone
These antibiotics are selected based on the bacterial susceptibility and patient's clinical condition. - Metabolites
- In cases of acute pyelonephritis, metabolites in the urine can include nitrites and leukocyte esterase, which are indicative of bacterial infection and the presence of white blood cells, respectively. Elevated levels of urinary excretion of proteins, glucose, and creatinine may also be observed, reflecting kidney involvement or damage.
- Nutraceuticals
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There is limited evidence to support the use of nutraceuticals in the treatment of acute pyelonephritis. The primary treatment typically involves antibiotics to address the bacterial infection. However, maintaining overall kidney health through general measures like staying well-hydrated and ensuring adequate nutritional support may be beneficial.
Always consult a healthcare provider for appropriate diagnosis and treatment options. - Peptides
- In acute pyelonephritis, antimicrobial peptides play a crucial role as part of the innate immune response. These peptides, such as cathelicidins and defensins, help to combat bacterial infections in the urinary tract by directly killing pathogens and modulating immune responses. These peptides are produced by various cells, including epithelial cells of the urinary tract and immune cells like neutrophils.