Suppurative tubulo-interstitial inflammation

bacterial infection causing inflammation of the kidney tubules, interstitium and renal pelvis.

• Chronic pyelonephritis describes recurrent or persistent pyelonephritis

Aetiology

• Unilateral*
• Secondary to UTI / UTO, DM, Pregnancy...
• Vesicoureteral reflux – defective sphincter. commonest cause
• Papillary necrosis (rare) – poor prognosis.

Clinical Features

Acute

• Classic triad: Flank pain, Costovertebral angle tenderness, High grade fever
• Other symptoms:
  • Pain may radiate to iliac fossa
  • Dysuria (painful urination)
  • Urinary frequency & urgency
  • Incontinence (>65 or children)
  • Fatigue / malaise
  • Nausea and vomiting
  • Confusion/delirium

Chronic

• Acute recurrent pyelonephritis or asymptomatic
• Gradual onset renal insufficiency and hypertension
• Polyuria and nocturia (loss of tubular function)