1. Clinical Presentation

2.  Inflammation  Kidney  Renal pelvis

3.  Chills  Fever  Costovertebral angle tenderness (CVAT)  Dysuria  Frequency  Urgency  Sepsis (20-30%)  Urinalysis (WBC & RBC)  Blood Analysis:  Leukocytosis  Increased ESR  Increased C-reactive CHON  E coli  most common organism (80%)  Klebsiella  Proteus  Enterobacter  Pseudomonas  Serratia  Citrobacter  Gram (+) bacteria:  S. faecalis  S. aureus

4.  Contrast-enhanced CT Scan  Perfusion defects ( signal density) Segmental Multifocal Diffuse  Renal enlargement  Attenuateed parenchyma  Compressed collecting system  Radionuclide study

5.  Severity of infection  IV Ampicillin & Aminoglycoside: Enterococci & pseudomonas species  Bacteremia: parenteral therapy  Addt’l. 7 – 10 days  Switched to oral for 10-14 days  Adults: Fluoroquinolones & TMP-SMX

6.  Necrotizing infection  Presence of gas  Renal parenchyma  Perinephrituc tissue  80-90% - w/ DM  Findings  Fever  Flank pain  Vomiting  Pneumaturia  E coli, Klebsiella, Enterobacter

7.  Radiographic Imaging  KUB Gas over affected kidney  CT Scan More sensitive Gas in renal parenchyma  Management  Fluid resuscitation  3-4 wks IV antibiotics  Control of blood glucose  Relief of urinary obstruction  Percutaneous drainage  Nephrectomy

8.  Repeated renal infection  Scarring, atrophy & renal insufficiency  Radiologic or pathologic

9.  Findings  Asymptomatic  Hx of frequent UTI’s  Children: Age dependent renal susceptibility Rare in adults  Urinalysis: Leukocytes Proteinuria  Serum creatinine levels (severity)  Radiographic Imaging  IV pyelogram  CT scan Focal coarse renal scarring Clubbing of calyx  Ultrasound  DMSA Best for renal scarring

10.  Irreversible  Eliminate recurrent UTIs  Correcting obstruction or urolithiasis  Children:  Vesicoureteral reflux – voiding cystourethrogram  Long-term prophylactic antibiotic therapy

11.  Liquefaction of renal tissue  Perinephric abscess  Paranephric abscess  beyond Gerota’s fascia  E coli & Proteus  Renal cortex: hematogenous  Corticomedullary jxn:  Gram (-) bacteria  Stones  Obstruction

12.  Findings (>2wks)  Fever  Flank/abdominal pain  Chills  Dysuria  Urinalysis: WBCs  Radiographic Imaging  Ultrasound Anechoic mass Echogenic fluid collection  CT scan Enlarged jkidfney “ring sign” Thickening of Gerota’s fascia Stranding of perinephritic fat Obliteration of soft tissue

13.  Antibiotic therapy  Ampicillin or vancomycin + aminoglycoside or 3 rd gen cephalosporins  No response w/in 48 hrs: percutaneous drainage  Open surgical drainage or nephrectomy

14.  Chronic bacterial infection  Hydronephrotic & obstructed  Unilateral  Xanthoma cells  Foamy lipid-laden histiocytes  E coli & Proteus

15.  Findings  Flank pain  Fever  Chills  Bacteriuria  Hx of urolithiasis (35%)  Urinalysis: WBC & CHON  Anemia & hepatic dysfunction (50%)  Radiographic Imaging  CT Scan Large, heterogenous reniform mass Parenchyma: multiple water density lesions Renal calculi  Ultrasonography Enlarged kidney Large central echogenic area Anechoic parenchyma

16.  Accurate diagnosis  Antibiotic therapy with percutaneous drainage  Kidney-sparing surgery  partial nephrectomy

17.  Bacterial infection of hydronephrotic, obstructed kidney  Suppurative destruction of renal parenchyma  Loss of renal function

18.  Findings  High grade fever  Chills  Flank pain  Absent lower tract symptoms  Radiographic Imaging  Ultrasonography Persistent echoes Dependent echoes Strong echoes Weak echoes Renal or ureteral calculi

19.  Broad spectrum antimicrobials  Drainage of obstruction – ureteral stent  Percutaneous nephrostomy tube