Risk factors

• Bladder obstruction
• Incompetent ureterovesicular valve
• Bladder tumors
• Urinary stones

Pathophysiology

• Infection spreads from bladder to ureters and then to the kidneys; may occur due
to vesicoureteral reflux
• Vesicoureteral reflux may result from congenital weakness at the junction of the
ureter and the bladder
• Bacteria refluxed to intrarenal tissues may create colonies of infection within 24
to 48 hours
• Abscesses form on renal capsule and at the corticomedullary junction.
• Eventually atrophy and destruction of tubules and glomeruli may result
• Kidney becomes enlarged

The kidney usually is enlarged because of inflammatory PMNs and edema. Infection
is focal and patchy, beginning in the pelvis and medulla and extending into the cortex
as an enlarging wedge. Chronic inflammatory cells appear within a few days, and
medullary and subcortical abscesses may develop. Normal parenchymal tissue
between foci of infection is common. Papillary necrosis may be evident in acute
pyelonephritis associated with diabetes, obstruction, sickle cell disease, pyelonephritis
in renal transplants, pyelonephritis due to candidiasis, or analgesic nephropathy.
Although acute pyelonephritis is frequently associated with renal scarring in children,
similar scarring in adults is not detectable in the absence of reflux or obstruction.

Causes
• Bacterial infection of kidneys caused by
o E. Coli (most common)
o Klebsiella
o Proteus
o Pseudomonas
o S. aureus
o E. faecalis

Manifestations
• Urinary urgency and frequency
• Dysuria, nocturia, hematuria, pyuria and bacteuria
 • Cloudy urine that has ammonia-like odor ( due to by products of bacteria)
• Fever with shaking chills
• Nausea and vomiting
• Flank pain
• Anorexia
• General fatigue

Complications
• Septic shock
• Chronic pyelonephritis
• Chronic renal insufficiency

Prognosis

With treatment, most kidney infections get better without complications. However, the
treatment may need to be aggressive or prolonged.

Pregnant women and persons with diabetes or spinal paralysis should have a urine culture
after finishing antibiotic therapy to make sure that the bacteria are no longer present in
the urine.

In rare cases, permanent kidney damage can result when:

• Chronic kidney infections occur in a transplanted kidney

• Many kidney infections occur during infancy or childhood

Acute kidney injury (acute renal failure) may occur if a severe infection leads to
significantly low blood pressure (shock). The elderly, infants, and persons with a
weakened immune system have an increased risk for developing shock and a severe
blood infection called sepsis. Often, such patients will be admitted to the hospital for
frequent monitoring and IV antibiotics, IV fluids, and other medications as necessary.

Severe episodes of acute kidney injury may result in permanent kidney damage and lead
to chronic kidney disease.