Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review

Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by Escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.