Acute Pyelonephritis with Acute Kidney Injury Complicated by Pott’s Spine: Diagnostic and Therapeutic Considerations

Abstract

The development of acute kidney injury (AKI) in patients with acute pyelonephritis (APN) is relatively uncommon in the absence of structural urinary tract abnormalities or other known risk factors. With timely diagnosis and appropriate treatment, the condition is usually reversible and associated with a favorable renal outcome. This case report describes a 51-year-old male presenting with acute pyelonephritis (APN) associated with acute kidney injury (AKI) in the setting of underlying tuberculosis and the subsequent identification of Pott’s spine, highlighting the diagnostic complexity encountered in tuberculosis-endemic settings.

Acute pyelonephritis (APN) is a well-documented disease with a long clinical history. Although its earliest description dates back to ancient Egypt, where the destruction of kidney parenchyma was recognized, the nomenclature of APN remains controversial, leading to semantic ambiguities that may cause confusion.^[1] APN is a bacterial infection that causes inflammation of the kidney. Certain populations, including paediatric patients, renal transplant recipients, and pregnant women, require special attention due to their increased susceptibility to and risk of complications. Common symptoms of APN include fever, flank pain, nausea, vomiting, a burning sensation during urination, increased urinary frequency, and urinary urgency. Despite its prevalence, the incidence of APN varies across different countries. A Danish study reported an incidence of 6.8% in women and 2.7% in men affected by APN.^[2] Urinary tract infections (UTIs) occur more frequently in young, sexually active women, making them more susceptible to conditions such as acute pyelonephritis. In contrast, men often experience poorer outcomes and a higher risk of mortality, largely due to the presence of comorbidities including diabetes mellitus, renal calculi, chronic kidney disease, and older age.^[3,4] Pott disease, or spinal tuberculosis, is a form of extrapulmonary tuberculosis that primarily affects the vertebral column. If not diagnosed and treated promptly, it can lead to serious complications such as spinal cord compression, paraplegia, chronic back pain, joint involvement, and abscess formation.^[5] Among skeletal manifestations of tuberculosis, spinal involvement is the most common, accounting for nearly half of all cases. According to the World Health Organization (WHO), an estimated 10.4 million new tuberculosis cases were reported worldwide in 2016, with almost half occurring in the Southeast Asian region. India contributes a substantial proportion of the global tuberculosis burden, representing approximately 23% of all reported cases. Spinal tuberculosis typically arises from hematogenous dissemination of Mycobacterium tuberculosis from a primary focus, most often the lungs. Due to the vascular supply of the subchondral bone adjacent to the intervertebral disc, the paradiscal region is the site most frequently affected by vertebral tuberculosis.^[6] Acute pyelonephritis and Pott’s disease are two separate medical conditions; however, when they occur together, the clinical presentation may become complex and pose significant diagnostic difficulties, especially in regions where tuberculosis is highly prevalent. Determining whether these conditions are manifestations of disseminated tuberculosis or represent independent coexisting diseases requires thorough clinical, laboratory, and radiological evaluation. Prompt and accurate diagnosis is crucial to ensure timely management and to reduce the risk of adverse outcomes. Here, we report the case of a 51-year-old man who presented with acute pyelonephritis complicated by acute kidney injury (AKI), in whom concurrent Pott’s spine was also identified.