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Kidney: pyelonephritis
Introduction
- Inflammation of renal parenchyma and pelvis.
- Cause: usually bacterial infection ascending from lower urinary tract (but can have other infectious etiologies, eg fungal).
- Signs: often preceded or accompanied by dysuria/stranguria with signs of systemic illness: pyrexia, acute abdominal pain, lethargy and inappetence, vomiting; occasionally insidious onset.
- Diagnosis: ultrasound, urinalysis, aspiration biopsy pelvis (including bacterial culture), histopathology.
- Treatment: prolonged antimicrobials, preferably based on sensitivity.
- Prognosis: good if early treatment, otherwise permanent and often progressive renal damage or even septicemia.
Presenting signs
- Depression, inappetence.
- Sublumbar abdominal pain.
- Polyuria/polydipsia.
- Urinary tract infection; pollakiuria/dysuria.
- Vomiting Vomiting.
Acute presentation
- Septicemia Shock: septic.
Age predisposition
- Young (breed predisposition for anatomical disorders of lower urinary tract, eg ectopic ureter Ureter: ectopic ).
- Older (secondary to other changes in urine content, eg micturation (sphincter incompetence) and/or renal anatomy).
Breed/Species predisposition
- Boxer Boxer.
Public health considerations
- Exposure of owner/environment to prolonged antibiotic use: increase of risk selection for multiresistent bacteria.
Cost considerations
- Long-term or recurrent treatment of resistant bacteria may be expensive.
Special risks
- Patients with a poor immune system, eg hyperadrenocorticism Hyperadrenocorticism , are at increased risk.
- CKD Kidney: chronic kidney disease (CKD).
- Incontinence Urinary incontinence.
- Urolithiasis Urolithiasis.
Pathogenesis
Etiology
- Ascending bacterial infection.
- Hematogenous spread of infection or embolus.
Predisposing factors
General- Incontinence, eg due to abnormal anatomy: ectopic ureter, or function; sphincter incompetence.
- Lower urinary tract infection Cystitis.
- Vesico-ureteral reflux.
- Urethral catheterization (particularly indwelling) Urethral catheterization: male.
- Glucosuria Urinalysis: glucose.
- Renal urolithiasis Nephrolithiasis.
- Renal neoplasia Kidney: neoplasia.
- Bacterial endocarditis Endocarditis: bacterial.
- Renal scarring.
- Systemic immunosuppression, eg chemotherapy, glucocorticoids or hyperadrenocorticism.
Pathophysiology
- Bacterial infection of renal pelvis → white blood cell influx → renal failure (chronic Kidney: chronic kidney disease (CKD) or acute Kidney: acute kidney injury (AKI) ) via a number or routes:
- E.Coli Escherichia coli infection can → vasoconstriction and ischemia.
- White cell infiltration → lysosomal enzyme release.
- Chronic damage may → nephrolithiasis Nephrolithiasis or end stage renal disease.
Timecourse
- Days (but may be weeks).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Weese J S , Blondeau J M, Boothe D, Breitschwerdt E B, Guardabassi L, Hillier A, Lloyd D H, Papich M G, Rankin S C, Turnidge J D, Sykes J E (2011) Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the international society for companion animal infectious diseases. Vet Med Int 2011, 263768 PubMed.
- Kolbjørnsen O, Heggelund M, Jansen J H (2008) End-stage kidney disease probablt due to reflux nephropathy with segmental hypoplasia (Ask-Upmark kidney) in young Boxer dogs in Norway. A retrospective study. Vet Pathol 45 (4), 467-474 PubMed.
- Szatmári V, Osi Z & Manczur F (2001) Ultrasound-guided percutaneous drainage for treatment of pyonephrosis in two dogs. JAVMA 218 (11), 1796-1799 PubMed.
- Gookin J L, Stone E A, Spaulding K A, Berry C R (1996) Unilateral nephrectomy in dogs with renal disease: 30 cases (1985-1994). JAVMA 208 (12), 2020-2026 PubMed.
- Ginder D R (1974) Urinary tract infection and pyelonephritis due to Escherichia coli in dogs infected with canine adenovirus. J Infect Dis 129 (6), 715-719 PubMed.