Pyelonephritis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pyelonephritis may be classified according to the duration of disease and etiology into 4 subtypes: acute, chronic, emphysematous, and xanthogranulomatous pyelonephritis.

Classification

There are four different types of pyelonephritis:

• Acute Pyelonephritis

• Acute pyelonephritis is a common clinical diagnosis in patients who present with fever, chills, and flank tenderness.
• Infections typically result from ascending retrograde spread through the collecting ducts into the renal parenchyma.
• Patients are referred for CT evaluation of acute pyelonephritis when symptoms are poorly localized or complications are suspected.

• Chronic Pyelonephritis

• Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. It is unclear that, whether it is an active chronic infection, arises from multiple recurrent infections, or represents stable changes from a remote single infection.
• Hypertension is frequently a long-term sequela.

• Emphysematous Pyelonephritis

• Emphysematous pyelonephritis represents a severe life-threatening infection (overall mortality rate of approximately 50%) of the renal parenchyma with gas-forming bacteria.
• Underlying poorly controlled diabetes mellitus is present in up to 90% of patients who develop emphysematous pyelonephritis.
• Patients present clinically with varying degrees of renal failure, lethargy, acid-base irregularities, and hyperglycemia.
• E coli is the causative bacterial source in approximately 70% of cases

• Xanthogranulomatous Pyelonephritis

• Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma.
• XGP is associated with a staghorn calculus in approximately 70% of cases.
• Patients with diabetes are particularly predisposed to the formation of XGP.
• Treatment is nephrectomy.
• At histologic analysis, the inflammatory mass is composed of lipid-laden macrophages and chronic inflammatory cells.