Nonobstructive Pyelonephritis Initially Seen as Acute Renal Failure

Acute Renal Failure due to Acute Pyelonephritis

“…The findings that this patient had in common with other cases proved by biopsy were positive urine culture and leukocytosis [2][3][4][5][6][7][8], positive blood cultures [2,5,7,8], enlarged kidneys [2][3][4][5][6], no preceding history of urinary tract infections or renal disease [2,[4][5][6]8] and the absence of loin ten derness [3][4][5][6][7][8], Also, although uncertain in this patient because of his confused state, symptoms of urinary tract infection are not always present [3-5, 7, 8]. In this case, well-developed histological changes of acute py elonephritis were present despite 2 weeks of appro priate antibiotic therapy, and similar findings have been noted in other cases [2,3,8], This accords with the slow and incomplete resolution of renal failure seen in this and other cases [2-4, 7, 8], and suggests that a prolonged course of antibiotic therapy is necessary when acute pyelonephritis is complicated by acute renal failure.…”

“…Alcoholism may have predisposed to this complication [8,[10][11][12], al though diffuse blunting of the calyceal system has been described after acute renal failure due to acute pyelone phritis when alcoholism was not implicated [3]. Renal morphology was not defined prior to acute renal failure, but the smooth renal outline and substantial kidney enlargement shown on the initial intravenous urogram, as well as the lack of evidence of chronic disease in an adequate biopsy specimen, would suggest that papillary necrosis was not present beforehand.…”

“…There have been few cases described where the diagnosis has been confirmed by biopsy [2][3][4][5][6][7][8]. We describe such a case.…”