IM

ACUTE PYELONEPHRITIS

It is infection of the renal parenchyma
Mostly due to ascending infection from below
S/S: Same as lower UTI + fever, loin pain
Invest:
- Urine analysis
- *Urine C/S
- Blood C/S, Imaging studies if needed
Rx:
1. Co-amoxiclav (Augmentin)
2. Cipro/levofloxacin
3. i.v. gentamycin, 3^rd gen. cephalosporins

Depending on the severity, patient may need oral or iv antibiotics.

Severe infectious inflammatory disease of the renal parenchyma, calyces, and pelvis.

Acute Pyelonephritis: Sudden development of kidney infection.
Chronic Pyelonephritis: Long-standing infection that doesn’t clear and can result in kidney scarring. Occurs only in patients with major anatomic abnormalities.
Xanthogranulomatous Pyelonephritis: Chronic pyelonephritis that occurs in obstruction due to infected or renal stones. Affected patients usually have massive destruction of the kidney (confused with renal malignancy).

is an unusual variant of chronic pyelonephritis that occur in the setting of obstruction due to infected renal stones. Affected patients usually have massive destruction of the kidney due to granulomatous tissue containing lipid-laden macrophages; the appearance may be confused with renal malignancy. with a history of recurrent urinary tract infections. The typical presenting symptoms include flank pain, fever, malaise, anorexia and weight loss. A unilateral renal mass can usually be palpated on physical examination. The most common organisms associated with XPN are E. coli, Proteus mirabilis, Pseudomonas, Enterococcus faecalis and Klebsiella
Recurrent Pyelonephritis: ≥2 infections in six months or ≥3 infections in one year.

UTIs

Feature/Aspect	Cystitis (Bladder infection)	Pyelonephritis (Kidney infection)
Symptoms	- Increased urinary frequency - Urgency - Dysuria (painful urination) - Pain above the pubic region - WBCs & bacteria in urine - Possible hematuria - More common in women	- Flank pain - High fever - Malaise - WBCs & bacteria in urine - Urinary symptoms similar to cystitis
Empiric Rx	- Nitrofurantoin (resistance is uncommon) - Localized to urine, little systemic effect - Alternatives: - TMP/SMX (if not resistant) - Fosfomycin (less efficacious, Pseudomonas & Acinetobacter may be resistant)	- IV ceftriaxone (3rd Gen Ceph) - Penetrates tissue, ~good spectrum - Alternative: - Piperacillin/Tazobactam (Zosyn ®)
Pathogens		- E. coli (75-95%) - Proteus - Klebsiella - Enterobacter - Staph (less common)
ESBLs		- Rx Carbapenems (meropenem, ertapenem)