Acute pyelonephritis

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A 36 yr old female presented with fever (40 degrees Celsius), chills and rigors for 2 days.  She had urinary frequency with burning sensation and the urine appeared cloudy.  Mild left costovertebral tenderness was elicited.

1.    What is the most likely pathological process based on the clinical evidence?

Bacteria infection of the kidneys.

2.    List the key histopathological features in the slide.

Patchy, interstitial suppurative inflammation with focal necrosis

3.    Account for the naked eye appearance in the slide.

Aggregation of lymphocytes produces the naked eye appearance

4.    What simple test can be performed in the GP�s clinic and what are your expected findings?

Leukocyte esterase dipstick to test for pyuria.  Findings should be positive.

5.    What is the next investigation the GP should ask for and why?

Quantitative urine culture to confirm the suspicion and antimicrobial susceptibility testing so that a proper treatment regime can be planned

6.    What is the gross appearance of the kidney?

Kidney is enlarged, with depressions due to fibrosis.  Abscesses may be present.

7.    What is the relationship of the renal lesion to the symptoms of frequency and burning sensation?

Left costovertebral pain due to stretching of renal capsule as microabscesses form under it.

Symptoms of frequency and burning sensation are due to infection of bladder and urethra, causing irritation to these structures. 

8.    Do you expect any long term sequelae?

No.  In uncomplicated pyelonephritis, treatment ordinarily results in complete resolution of symptoms.

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Copyright � Joseph Ong 2003