Pyelonephritis

Pathology:  Pyelonephritis, also known as a “kidney infection”, is a specific type of ascending urinary tract infection that usually begins in the urethra and travels to the bladder typically caused by a bacterial infection (U.S. HHS Website).

Possible causes:
  • Infections in the bladder
  • Use of a catheter to drain urine from the bladder
  • Use of a cystoscope to examine the bladder and urethra
  • Surgery on the urinary tract
  • Conditions such as prostate enlargement and kidney stones that prevent the efficient flow of urine from the bladder
  • Defects or abnormalities in the urinary tract that block the flow of urine

Red Flags:
  •  Recent or co-existing urinary tract infection
  •  Enlarged prostate
  •  Kidney stone or past kidney stone  (Dutton, 2008)

Demographics:  The incidence of pyelonephritis is approximately 12–13 cases annually per 10,000 in women receiving outpatient treatment with 3–4 requiring admission. In men, 2–3 per 10,000 are treated as outpatients and 1–2/10,000 requires admission.  Young women are most commonly affected due to sexual activity.  Infants and the elderly are also at increased risk, reflecting anatomical changes and hormonal status (Czaja, 2007).

Clinical Presentation: 
Signs and symptoms include:
  • High fever
  • Pain with urination
  • Flank pain that radiates to the back
  • Nausea
  • Vomiting
  • Pus and blood in urine (U.S. HHS Website)

The patient may present with lower quadrant pain on the involved side accompanied by ipsilateral shoulder pain.  The shoulder pain is due to the anatomic position of the kidney relative to the diaphragm.

Differential Diagnosis:  Murphy’s Percussion Test – assesses for costovertebral tenderness to rule out involvement of the kidney.  Patient positioned in prone.  Therapist places one palm on the patient’s costovertebral angle while the therapist uses the other fisted hand to apply a percussive thump with the ulnar side.  The patient will feel a thump along with reproduction or exacerbation of pain with a positive test which is indicative of kidney involvement (Goodman & Snyder, 2007).

Please refer to video below for demonstration of the Murphy's Percussion Test. 

Clinical Bottom Line: Refer out
Refer to physician for further testing for renal involvement.

References:
Please refer to the "Pyelonephritis" section in the reference list.