Acute pyelonephritis develops when pathogenic microorganisms penetrate the kidney and pelvis. Usually, it happens in three ways:
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- Through the general blood flow (the hematogenous, descending pathway).
- From the bladder through the lumen of the ureter (the urogenital, ascending pathway).
- Through the lymphatic system of the pelvis and ureter (lymphogenic pathway).
Hematogenous pyelonephritis can be facilitated by many acute infectious diseases such as flu, typhoid fever, and so on, as well as the presence of chronic infections in the organism: furunculosis, chronic tonsillitis, osteomyelitis (Fogo & Kashgarian, 2017).
The acute ascending pyelonephritis develops with the genitourinary diseases characterized by the difficulties in urine outflow, e.g., congenital abnormalities of the urinary tract, ureteral stones, strictures, etc. It is primarily associated with those forms of bacteria which are mobile, such as E. coli (Fogo & Kashgarian, 2017). As for the lymphogenic pathway, the presence of a significant amount of anastomoses between the lymphatic vessels of the ascending colon, vermicular appendix, and the ureter facilitates the penetration of microbes (usually E. coli) into the lymphatic system of the pelvis that is interconnected with the lymphatic system of the ureter (Fulop, 2016).
Infection and interstitial inflammation damage primarily the medulla of the kidney – the part that comprises the collecting tubules and some of the distal tubules. The death of these nephron segments disrupts the functioning of the tubules located in the cortical layer of the kidney. At the same time, the inflammatory process moving to the cortical layer can lead to a secondary impairment of glomerular function and contribute to the development of renal failure (Fogo & Kashgarian, 2017).
Symptoms and Signs
The clinical picture is represented by pain (localized in the abdomen or the lower back, usually aggravated by a sharp change in the position of the body); urinary syndrome (the urine is turbid, with an unpleasant smell, characterized by neutrophilic leukocyturia, bacteriuria, a large number of renal epithelium); dysuric disorders; symptoms of intoxication (fever with chills, headache, lethargy, weakness, poor appetite, pallor, etc.) (Fulop, 2016).
Acute Bacterial Prostatitis
The most common cause of ABP is the infection that affects the urinary system. Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa are the common bacteria associated with the disease (Deem, 2016). The bacteria may penetrate the organism during sexual intercourse. The history of transferred sexually transmitted infections increases the likelihood of the development of acute inflammation in the prostate. Hematogenous and lymphogenic pathways of infections are also possible but less common.
Intraprostatic urinary reflux is considered one of the most widespread causes of ABP. The disease may occur when the infected urine refluxes into the ejaculatory and prostatic ducts (Deem, 20016). The physiological factors, i.e., the anatomical structure of the prostate gland, facilitate the urine reflux, and contribute to the development of the infections in the peripheral area.
Symptoms and Signs
Multiple inflammatory cells (neutrophils, macrophages, lymphocytes) in the glandular epithelium, the lumen of the ducts of the gland, the tissues around the prostate can be observed in patients (Coker & Dierfeldt, 2016). The common symptoms include the increase in temperature and fever that develops as a response to the penetration of bacterial toxins and other inflammatory cell products, discomfort, pain, and burning sensations in the lower abdomen, lower back, or scrotum; frequent urination, erection disorders, etc. The patient is usually pale; tachycardia and nausea can be observed. During transrectal palpation, the prostate gland is enlarged, tense, sharply painful. In some cases, patients may develop acute retention of urine (Coker & Dierfeldt, 2016).
Coker T.J, & Dierfeldt D.M. (2016). Acute bacterial prostatitis: Diagnosis and management. American Family Physician, 93(2), 114-120.
Deem, S. G. (2016). Acute bacterial prostatitis. MedScape. Web.
Fogo, A. B., & Kashgarian, M. (2017). Diagnostic atlas of renal pathology. Philadelphia, PA: Elsevier.
Fulop, T. (2016). Acute pyelonephritis. MedScape. Web.