Urinary Tract Pathology Case Studies


CASE 2: Acute pyelonephritis


Clinical History:

This is a 56-year-old woman who has had a history of episodes of dysuria in the past. She has had another episode for the past four days, but in the past day she has developed decreased urine output with fever to 38.9 C (102 F). On physical examination, she has costophrenic angle tenderness on the right.
  1. What is the diagnosis?

    2. This is acute pyelonephritis.

  2. How does an infectious agent reach the kidney?

    3. Most urinary tract infections are ascending infections, but hematogenous spread can also occur. Urinary tract stasis from obstruction is a common antecedent. Women are more prone to infections because of a shorter urethra.

  3. How do you explain the findings present on urinalysis?

    4. With acute inflammation of the lower urinary tract, increased numbers of white cells would be present. White cell casts would indicate acute pyelonephritis of the kidney.

  4. How do you treat this condition?

    5. Urine culture can be obtained to determine the organism(s) present. Typical findings include bacteria such as coliforms, Streptococcus, Proteus, and Providencia. Antibiotic therapy can be initiated based upon sensitivity patterns of the infectious agent(s). Patients whose course appears complicated, with possible sepsis, require blood cultures and urinary tract imaging studies. Abscess formation may require percutaneous nephrostomy drainage.