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Acute pyelonephritis


Definition

  • Acute suppurative inflammation of the kidney caused by bacterial infection, due most commonly to ascent from a lower urinary tract infection and less commonly to hematogenous spread in septic patients

Clinical features

Epidemiology

  • Common, with 15–17 cases annually per 10,000 population in women and 3–4 cases per 10,000 in men

  • Incidence varying with age

    • A trimodal distribution in females, with an elevated incidence in girls aged 0–4 years, a peak in women aged 15–35 years, and a gradual increase after age 50 years to peak at 80 years of age; incidence of 28 cases per 10,000 in US women aged 18–49 years

    • Bimodal distribution in males with a first peak at 0–4 years; gradual increase after 35 years of age and the second peak at 85 years of age

  • Predisposing conditions:

    • Urinary obstruction, congenital or acquired

    • Instrumentation of urinary tract

    • Vesicoureteral reflux

    • Pregnancy: develops in 20%–30% of pregnant women with untreated asymptomatic bacteriuria

    • Preexisting renal lesions

    • Diabetes mellitus

    • Immunosuppression and immunodeficiency

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