The spleen was removed and biopsies were obtained from the polar regions of the left kidney. The histopathologic report for the spleen indicated a grade 3 hemangiosarcoma and renal biopsies showed evidence of severe chronic interstitial nephritis.
Natural host defenses against ascending urinary tract infection include mucosal defense barriers, ureteral peristalsis, ureterovesical flap valves and an extensive renal blood supply. Pyelonephritis usually occurs by ascension of bacteria causing lower urinary tract infection.
Hematogenous seeding of the kidneys does not usually cause pyelonephritis. In addition, an upper urinary tract infection is frequently accompanied by lower urinary tract infection. Ascending urinary tract infections probably occurs much more commonly than is recognized clinically - because many older dogs with pyelonephritis are asymptomatic or have signs limited to lower urinary tract infection. The physical examination may show no abnormalities or pain on palpation of kidneys and a fever.
The ascending urinary tract infection may be caused by aerobic bacteria - most common bacterial isolates are Escherichia coli and Staphylococcus species and less common bacterial isolates may include Proteus, Streptococcus, Klebsiella, Enterobacter and Pseudomonas species, which frequently infect the lower urinary tract and may ascend into the upper urinary tract.
Ectopic ureters, vesicoureteral reflux, congenital renal dysplasia and lower urinary tract infection increases the risk of an ascending urinary tract infection. Medical conditions that often predispose the dog to a urinary tract infection are diabetes mellitus, hyperadrenocorticism, exogenous steroid administration, renal failure, urethral catheterization, urine retention, uroliths and urinary tract neoplasia.
Clinical diagnosis of pyelonephritis is often presumptive - based on results from CBC, serum chemistry profile, urinalysis, urine culture and imaging procedures. A definitive diagnosis is not usually required for planning treatment. Because many dogs lack specific signs attributable to pyelonephritis, any dog with urinary tract infection could potentially have pyelonephritis.
The CBC results are often normal with chronic pyelonephritis, but leukocytosis and neutrophilia with a left shift may be detected in some dogs. The serum chemistry profile is usually normal unless chronic pyelonephritis is contributing to chronic renal failure azotemia with an inappropriate urinary specific gravity. The urinalysis may reveal hematuria, pyuria, proteinuria, bacteriuria and leukocyte casts.
Leukocyte casts are diagnostic for renal inflammation and usually result from pyelonephritis. Remember that dilute urine specific gravity in dogs with nephrogenic diabetes insipidus may occur secondary to pyelonephritis and absence of abnormalities does not rule out pyelonephritis.
Dogs with chronic pyelonephritis may have a negative urine culture and require multiple urine cultures to confirm urinary tract infection. The new IndicatoRx device IDEXX is excellent for obtaining immediate bacterial urine culture results — results are obtained overnight and done in-hospital. Small numbers of bacteria may be recovered with this system. Ultrasonography and excretory urography are the preferred imaging procedures done for presumptively differentiating between upper and lower urinary tract infection.
Excretory urography may show dilation and blunting of the renal pelvis with lack of filling of the collecting diverticula, and dilation of the proximal ureter. In dogs with acute pyelonephritis, the kidneys may be large; in dogs with chronic pyelonephritis, the kidneys may be small with an irregular surface contour.
Concomitant nephroliths may be seen in some dogs evaluated by survey radiography, ultrasonography or excretory urography. Definitive diagnosis requires urine cultures obtained from the renal pelvis or parenchyma or histopathology from a renal biopsy.
Pyelocentesis can be performed percutaneously using ultrasound guidance or during exploratory surgery and immediately transferred to the IndicatoRx device. American Journal of Kidney Diseases , 69, Environmental Toxicology and Chemistry , 35, Journal of Clinical Microbiology , 47, Gross and histological changes. Journal of Comparative Pathology , 89, Journal of Veterinary Internal Medicine , 33, Kunin CM.
Australian veterinary journal , 65, Lucke VM. The Journal of pathology and bacteriology , 95, The Journal of antimicrobial chemotherapy , 73, Journal of Feline Medicine and Surgery , 9, Veterinary Medicine: Research and Reports , Volume 9, Documenta Ophthalmologica , , Morales-Alvarez MC.
Advances in Chronic Kidney Disease , 27, Microbial Drug Resistance , 23, Pediatric Nephrology , 35, Advances in Chronic Kidney Disease , 13, American Journal of Veterinary Research , 54, Nicolle LE. Current Infectious Disease Reports , 9, Antimicrobial Agents and Chemotherapy , BMC Nephrology , Journal of Nephrology. Pointer E, Murray L. Journal of the American Animal Hospital Association , 47, Journal of Feline Medicine and Surgery , 19, Clinical Infectious Diseases , 37, Chemosphere , , Journal of the American Animal Hospital Association , 55, Ruiz J.
Clinical Microbiology Reviews , Pediatrics , , Kidney International , 58, Annals of Internal Medicine , , Scott JES. British Journal of Urology , 36, Urology , 79, Sreenarasimhaiah S, Hellerstein S. Pediatric Nephrology , 12, Syed-Ahmed M, Narayanan M. Advances in Chronic Kidney Disease , 26, Veterinary Microbiology , , Vedrine B. Topics in Companion Animal Medicine , 32, Veterinary Journal , , Wettimuny SG. Journal of Comparative Pathology , 77, Journal of Feline Medicine and Surgery , 15, Journal of Veterinary Internal Medicine , 29, PeerJ , IRIS Ltd.
Joanna White, Sydney Australia and Reidun Heiene, Oslo,Norway Definition: A bacterial infection, typically ascending, of the renal pelvis pyelitis or pelvis and renal parenchyma pyelonephritis Introduction: One of the main challenges for veterinarians in the diagnosis and treatment of pyelonephritis is balancing the risks of overtreating a patient with subclinical bacteriuria against the benefits of detecting and treating pyelonephritis, a potential cause of kidney disease, progression of kidney disease, other morbidities and sepsis.
Prevalence Dogs and cats with normal urogenital tracts are resistant to induction of bacterial cystitis and pyelonephritis Scott, ; Harrison et al. Treatment: Antibiotic treatment of pyelonephritis in dogs and cats needs to be supported always by urine culture and antimicrobial susceptibility tests. Recommendations Pyelonephritis is uncommon cause for AKI in otherwise previously heathy dogs and cats, therefore aggressive and sustained antimicrobial treatment is not justified to treat potential pyelonephritis in any animal with AKI without a positive urinary culture.
Consequently, it is difficult to make recommendations for empiric treatment of pyelonephritis in dogs and cats, and urine culture with plasma i. The following are potential diagnostic categories: Possible diagnosis: Patient with systemic signs of inflammation including pyrexia and Pyuria and positive culture of uropathogen from a cystocentesis sample and No clinical indication of other non-urinary tract causes of inflammation Probable diagnosis: as above plus Compatible changes on complete blood count e.
Recommendations for dogs and cats with CKD: Animals with non-obstructive CKD do not have structural risk factors for developing pyelonephritis but uraemia and possibly also age and protein energy wasting may be associated with reduced systemic immunity in our patients as it is in people.
Proposed recommendations: i clinical signs of systemic disease vomiting, abdominal pain, lethargy in combination with signs of systemic inflammation pyrexia, neutrophilia or ii clinical signs of LUT disease Urinalysis, culture, and susceptibility testing followed by antimicrobial treatment of animals with positive urine cultures should be considered in dogs and cats with kidney disease and the risks and benefits of treatment assessed on an individual basis iii at an initial diagnosis of acute or chronic kidney disease or iv during acute and unexplained deteriorations in renal function or v in patients with additional predisposing factors such as ureteral obstruction Treatment of dogs and cats with positive cultures should be undertaken with recognition that many patients with CKD and positive urine cultures have subclinical bacteriuria.
Pyelonephritis and familial nephropathies: A specific note of caution should be given for breeding recommendations in breeds with a high prevalence of renal disease and pyelonephritis. The urine should be cultured during the first 5—7 days of therapy to assess antibiotic efficacy. A urinalysis and culture should be repeated 3—7 days after therapy, and then monthly for 3 consecutive months. If all of these cultures are negative, the interval between urine cultures may be gradually lengthened.
Animals with pyelonephritis are at high risk of persistence or recurrence of infection and for secondary infections at other sites eg, bacterial endocarditis and discospondylitis. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Veterinary Manual was first published in as a service to the community.
The legacy of this great resource continues in the online and mobile app versions today. This site complies with the HONcode standard for trustworthy health information: verify here. Common Veterinary Topics. Videos Figures Images Quizzes. Test your knowledge. Most urinary tract pathogens are not considered zoonotic. However, which of the following organisms is most likely to be transmitted via infected urine from animals to humans?
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