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Chronic Pyelonephritis

 Syn. Chronic interstitial nephritis , Reflux nephropathy , Chronic atrophic pyelonephritis

Signs & Symptoms

 History of poorly uncontrolled diabetes mellitus #Emphysematous_pyelonephritis #EPN
Ref: Epocrates [ Vignette/etiology] Smith General Urology [ 206]
Prolonged urinary obstruction
Note: due to Urinary tract abnormalities, due to benign prostatic hypertrophy, due to renal stones, due to staghorn calculi
Ref: Epocrates [ Etiology/key factors/risk factors]
Impaired host immune mechanisms #Emphysematous_pyelonephritis
Ref: Epocrates [ Etiology]
Posterior urethral valve Gr. children
Ref: Harrison [ 2160] Epocrates [ Chronic pyelonephritis: tests] Smith General Urology [ 206]

Physical Examination

 Elevated blood pressure
Note: due to Renal insufficiency
Ref: Epocrates [ Vignette/other factors] Smith General Urology [ 206]
Costovertebral tenderness
Note: More common in acute infections or EPN
Ref: Epocrates [ Vignette/other factors]

Lab / Serology

 High levels of HbA1c #Emphysematous_pyelonephritis #EPN
Ref: Epocrates [ Vignette/etiology] Smith General Urology [ 206]
Moderate proteinuria
Note: More frequent in EPN
Ref: Harrison [ 2160] Epocrates [ Tests]
Mild proteinuria
Note: More frequent in EPN
Ref: Harrison [ 2160] Epocrates [ Tests]

Imagin Study

 Thinning of the renal cortex
Note: due to Chronic inflammatory proccess, due to infection
Ref: Harrison [ 2160] Epocrates [ Pathophysiology/tests]
Anatomical urinary tract abnormalities Gr. children
Ref: Harrison [ 2160] Epocrates [ Chronic pyelonephritis: tests] Smith General Urology [ 206]
Mislocated ureterovesical valves Gr. children
Ref: Harrison [ 2160] Epocrates [ Chronic pyelonephritis: tests] Smith General Urology [ 206]

Complication

 Asymmetric small kidney
Ref: Harrison [ 2160] Epocrates [ Pathophysiology]
Visual impairment
Note: due to Renal insufficiency
Ref: Smith General Urology [ 206]
Hyperkalemia
Ref: Epocrates [ Pathophysiology]

Risk Factors

Cause

 Inadequate treatment of acute pyelonephritis
Ref: Epocrates [ Etiology/key factors/risk factors]
Recurrent acute pyelonephritis
Ref: Epocrates [ Etiology/key factors/risk factors]
Recurrent urinary tract infections
Note: Strong association in children.rarely in adults, due to Anatomical urinary tract abnormalities, due to VUR
Ref: Harrison [ 2160] Epocrates [ Etiology/key factors/tests/risk factors] Smith General Urology [ 206]

Other