Pyelonephritis, acute

• Urinary tract infections (UTI)

• 590.9 Infection of kidney, unspecified

• 315.4 Developmental coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)
• 718.45 Contracture of joint, pelvic region and thigh
• 719.70 Difficulty in walking
• 728.2 Muscular wasting and disuse atrophy
• 728.89 Other disorders of muscle, ligament, and fascia
• 729.9 Other disorders of soft tissue
• 780.7 Malaise and fatigue
• 781.2 Abnormality of gait
• 782.3 Edema
• 786.0 Dyspnea and respiratory abnormalities
• 786.05 Shortness of breath

• N15.9 Renal tubulo-interstitial disease, unspecified

As of January, 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology. Therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

Description

• Kidney and renal pelvis infection
• Severe pain, with or without attempts at urination, in adult males and females; no pain at all, especially in the elderly and children
• Pain in the low back with possible tenderness to palpation of the kidneys

Essentials of Diagnosis

• May be indicative of serious medical conditions
• May mimic colon cancer or tumors, irritable bowel, colitis or, in females, gynecological problems such as endometriosis, uterine fibroids, or ectopic pregnancies
• Recognize the possibility of UG pathology in the differential diagnosis process, especially when findings are not consistent with conditions commonly treated (i.e., musculoskeletal, neuromuscular, integumentary, cardiopulmonary)

General Considerations

• Diagnosis for more occult problems may take time and require intensive medical diagnostic testing
• Possible referred pain to back, pelvic region, or rectal area (in men)
• Symptoms are frequently referred to the back and abdominal areas, so it may be common to have patients inappropriately referred to PT

Demographics

• Females more susceptible than males to cystitis secondary to the anatomical proximity of the urethra to the anus and the bladder
• Females more susceptible than males to urethritis because of anatomical proximity of the urethra to the vagina; urethritis can also be caused by sexually transmitted diseases (e.g., herpes, gonorrhea, chlamydia)
• Approximately 50% of all women will have a urinary tract infection (UTI) in their lifetimes
• Children are at greater risk, with ~ 3% annually having a UTI

Signs and Symptoms

• Urethra (urethritis)
  • Burning with urination
  • Difficulty urinating
• Bladder (cystitis)
  • Pelvic pressure
  • Lower abdomen discomfort
  • Frequent, painful urination
  • Blood in urine
• Kidneys (acute pyelonephritis)
  • Upper back and side (flank) pain
  • High fever
  • Shaking and chills
  • Nausea
  • Vomiting
  • Painful urination
  • Malodorous urine
  • Change in color of urine
  • Positive cultures
• Possible secondary problems may, depending on severity, indicate the need for physical therapy intervention
  • Impairment of aerobic capacity and muscle endurance
  • Sarcopenia
  • Weakness or impaired muscle performance
  • Musculoskeletal problems
  • Neuromuscular problems
  • Weight loss or weight gain

Functional Implications

• Severe symptoms, such as urgent need to urinate, may be ...