{"paper_id":"d0252752-5258-4db2-8af2-ceabbf00e63d","body_text":"Acute pyelonephritis with acute kidney injury complicated by Pott spine: Diagnostic and therapeutic considerations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acute pyelonephritis with acute kidney injury complicated by Pott spine: Diagnostic and therapeutic considerations Dr. Rahul Shil This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9079789/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Acute pyelonephritis (APN) associated with acute kidney injury (AKI) is generally considered rare if there are no anatomical abnormalities and predisposing factors identified. It is generally reversible with early and appropriate management. This case report describes a case of APN secondary to API, which was complicated by Pott’s spine in a 51-year-old male. Neurology Acute pyelonephritis Acute kidney injury complication pott’s spine chronic kidney disease Figures Figure 1 Figure 2 INTRODUCTION Acute pyelonephritis (APN) is a well-documented disease with a long history. Although its earliest description dates back to ancient Egypt, highlighting the destruction of the kidney parenchyma, the nomenclature of APN remains controversial, leading to semantic ambiguities that can cause confusion. 1 APN is a bacterial infection that causes inflammation in the kidney. Certain populations, such as pediatric patients, renal transplant recipients, and pregnant women, require special attention. Common symptoms include fever, flank pain, nausea, vomiting, burning during urination, increased urinary frequency, and urgency. Despite its prevalence, the incidence rate varies across countries. A Danish study revealed a 6.8% increase in women and a 2.7% increase in men affected by APN. 2 Young, sexually active women are most commonly affected due to their higher incidence of urinary tract infections (UTIs), while men are more susceptible to mortality rates due to diabetes, nephrolithiasis, kidney disease, and advanced age. 3 , 4 Pott disease, also known as tuberculous spondylitis, is a form of infection caused by tuberculosis. If left untreated, it can result in spinal cord compression, paraplegia, localized back pain, arthritis, and abscess formation. 5 Spinal tuberculosis accounts for approximately 50% of all skeletal tuberculosis infections. The World Health Organization (WHO) reported an incidence of 10.4 million new cases of tuberculosis in 2016, with 46.5% of cases originating from the Southeast Asian region alone. India contributed 23% of the global tuberculosis burden. Spinal tuberculosis typically develops secondary to hematogenous spread from a primary site of infection, most commonly the lungs. The paradiscal vessels supply the subchondral bone on either side of the disc space, making the paradiscal the most common site of vertebral involvement. 6 Although acute pyelonephritis and pott’s spine are distinct diseases, they can sometimes be associated due to the spread of the tuberculosis bacterium to the kidneys, resulting in renal tuberculosis, which can manifest as pyelonephritis. Therefore, it is crucial for healthcare teams to accurately diagnose patients using appropriate diagnostic criteria to prevent treatment-related complications. In this study, we present a case of a 51-year-old male admitted to the hospital with acute pyelonephritis and acute kidney injury (AKI) complicated by pott’s spine. CASE REPORT On September 10, 2025, a 51-year-old male presented to the nephrology department with complaints of high fever, persistent vomiting for three consecutive days, sleep disturbances characterized by irritability, disorientation regarding time, place, and individuals, inability to recognize medical staff, and resistance to medical procedures. Additionally, he reported flank pain for six days and hematuria. A two-month history of tuberculosis was discovered. Upon questioning, the patient denied any prior head injuries and did not have any known comorbidities such as diabetes mellitus or hypertension. However, he was an alcoholic and chronic smoker for 30 years. Initially, the patient was provisionally diagnosed with acute kidney injury secondary to sepsis. However, subsequent clinical tests revealed acute pyelonephritis (API) with acute kidney injury (AKI) which later became complicated by pott’s spine. CLINICAL SIGNS: Upon examination, the patient’s body temperature was 98 degrees Fahrenheit, pulse rate was 104 beats per minute, blood pressure was 96/58 millimeters of mercury, and respiration rate was 16 breaths per minute, with a SpO2 of 98%. A positive systemic examination, including a cardiovascular system assessment, revealed a soft abdomen during per abdominal palpation. Additionally, the patient exhibited disorientation, with a score of E3V4M3. However, after initiating treatment, the score improved to E4V4M5, and the B/L PERL was normal. INVESTIGATION Relevant investigations were conducted. The hematology report indicated a hemoglobin concentration of 8.9%, a red blood cell count of 3.06 million/cumm, a platelet count of 0.68 lacks/cumm, and a total white blood cell count of 26,120 cells/cumm. Neutrophils accounted for 86%, while lymphocytes comprised 7%. The renal function test revealed a urea level of 206 mg/dl, a serum creatinine concentration of 71 mg/dl, a serum sodium level of 120 mmol/l, and a serum potassium level of 6.1 mmol/l. The liver function test indicated a total bilirubin level of 2.2 mg/dl, a direct bilirubin level of 2.0 mg/dl, a total protein level of 5.5 g/dl, a serum albumin level of 2.1 g/dl, and an alkaline phosphatase level of 330 U/L. Further biochemical analysis revealed a ferritin level of 962 ng/ml, an ammonia plasma level of 71 mol/l, a uric acid level of 12.0 mg/dl, a C-reactive protein level of 162.01 mg/dl, a serum cortisol level of 34.6 ug/dl, and a negative serology result. Ultrasonography (USG) of the abdomen and pelvis revealed a bulky left kidney with an altered echo texture (R: 9.7 x 1.2 cm, L: 11.8 x 2.1 cm). It also showed gallbladder sludge, a thin rim of perinephric free fluid, and suggestive cystitis. A contrast-enhanced computed tomography (CECT) of the abdomen was also conducted, and the report indicated an active Pott’s spine and a paradiscal abscess radiating up to the psoas muscle. Additionally, a large necrotic prostate abscess (tubercular/neoplastic) was observed. Furthermore, the electrocardiogram (ECG) report revealed a right-sided ST segment elevation. Consequently, color Doppler echocardiography was performed, which indicated normal chambers and dimensions with no regional wall motion abnormalities. The left ventricular systolic function ejection fraction (EF) was 55%, with mild mitral regurgitation and tricuspid regurgitation. The inferior vena cava (IVC) diameter was 14 mm, which collapsed with inspiration. THERAPEUTIC INTERVENTION Upon confirmation of the diagnosis, the patient was initially administered intravenous fluids (NS) in a 2-pint bolus, followed by a 150 ml/hour infusion. Injured meropenem (500 mg) was administered intravenously once daily, injured pan (40 mg) was administered intravenously once daily, injured emeset (4 mg) was administered intravenously once daily, injured PCT (1 gm) was administered slowly intravenously over 10 minutes, tab nodosis (500 mg) was administered twice daily, K bind sachet (15 gm) was administered twice daily, asthalin nebulizer (10 mg) was administered every 3 hours, injured Human actrapid (10 units) was administered in 25% dextrose intravenously every 3 hours, injured calcium gluconate (10 mg) was administered slowly intravenously over 10 minutes, injured optineuron (100 ml NS) was administered intravenously once daily, injured hydrocort (100 mg) was administered intravenously twice daily, injured vit K (10 mg) was administered intravenously once daily, injured thiamine (100 mg) was administered intravenously twice daily, tab levoday (250 mg) was administered twice daily, and syp cremaffin (30 ml) was administered twice daily. However, after a day, injured Human actrapid, injured vit K, and nebulizer asthalin were discontinued. After a week, the patient was prescribed injured Lasix (20 mg stat) in a 0.2 ml/hr infusion, injured noradrenaline (2 ml/hr), and tab haloperidol (0.5 mg OD). Additionally, the patient underwent cystoscopy followed by double J stenting surgical procedures. No postoperative complications were observed, including bleeding, infection, ureteral, or bladder injury. DISCUSSION Acute pyelonephritis is a prevalent upper urinary tract bacterial infection that affects the renal parenchyma and pelvis. It can develop complications such as renal abscess, septic shock, and renal impairment. Studies indicate that patients with baseline chronic kidney disease (CKD) are at higher risk of developing severe acute kidney injury (AKI) compared to individuals with normal renal function. 7 AKI is a significant clinical concern in patients with infectious diseases, affecting approximately 5% to 51% of sepsis patients. Risk factors associated with AKI in acute pyelonephritis include advancing age, bilateral kidney involvement, and initial shock. A recent study has identified older age, diabetes mellitus, and upper urinary tract infection (UTI) as independent risk factors for AKI in patients with UTI. 8 Urine culture and analysis are essential for confirming the diagnosis of acute pyelonephritis. While patients with acute pyelonephritis traditionally require hospital admission, outpatient oral therapy has demonstrated promising results for those with uncomplicated pyelonephritis and who can tolerate oral intake. Penicillin-based antibiotics, such as amoxicillin, amoxicillin-clavulanate (Augmentin), and pipracillin, cephalosporin antibiotics like cefotaxime and ceftriaxone, and fluroquinolones such as ciprofloxacin, levofloxacin, and aminoglycosides are commonly used to treat acute pyelonephritis. 9 In recent decades, the incidence of acute kidney injury (AKI) has risen, particularly among critically ill patients, resulting in a relatively high mortality rate. Consequently, early diagnosis, hemodynamic stabilization, and prompt identification of complications are crucial in mitigating the mortality rate. Effective treatment strategies include fluid therapy, vasopressors, diuretics, remote ischemic conditioning 10 , and renal replacement therapy. In our case, the patient presented with acute pyelonephritis and AKI, which is generally uncommon. However, similar cases have been reported in previous studies. 7 , 11 Notably, men exhibit a higher mortality rate from pyelonephritis compared to women. Regardless of the underlying predisposing factors, pyelonephritis can induce acute renal injury by disrupting tubular function through interstitial inflammation and edema, leading to eventual tubular obstruction characterized by cellular debris and increased vasoconstriction of the renal microvasculature. This cycle of heightened inflammation and edema results in further tubular obstruction. 12 In our case, the patient also developed pott’s disease, a type of tuberculosis affecting the spine. According to World Health Organization (WHO) guidelines, patients with pott’s spine should undergo a two-phase treatment approach. The initial phase spans two months, followed by a continuation of seven to ten months of treatment with the first line of drugs, including isoniazid, rifampicin, pyrazinamide, and streptomycin. Subsequently, the second line of drugs, such as isoniazid and rifampicin, is administered. 13 , 14 In our case, the patient was diagnosed with tuberculosis two months prior to our intervention. Despite being registered under directly observed treatment short course (DOTS) therapy, he failed to adhere to the prescribed antitubercular medication regimen. This lack of adherence may have ultimately contributed to the development of pott’s spine, which subsequently led to acute kidney injury (AKI). Given the compromised renal function of the patient, the initial treatment priority was to stabilize his condition. Subsequently, the antitubercular therapy will be resumed. CONCLUSION AKI is a prevalent complication of acute pancreatitis APN. Early and appropriate management typically renders AKI reversible. However, certain risk factors increase the likelihood of developing AKI, including male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed hospital presentation. These risk factors are associated with heightened risks of dialysis, hospitalization duration, and mortality. the participant’s consent was obtained prior to the publication of his clinical case. Declarations ACKNOWLEDGEMENTS: We thank the patient for allowing us to share his case. ETHICAL APPROVAL: Ethical approval were taken as per international standards. CONFLICTS OF INTERESTS: None declared FUNDING: The authors receive no funding for this work. the participant’s consent was obtained prior to the publication of his clinical case. References Umesha L, Shivaprasad S, Rajiv E, Kumar MS, Leelavathy V, Sreedhara C et al (2018) Acute pyelonephritis: A single-center experience. Indian J Nephrol 28(6):454 Svingel LS, Christiansen CF, Birn H, Søgaard KK, Nørgaard M (2023) Temporal changes in incidence of hospital-diagnosed acute pyelonephritis: A 19-year population-based Danish cohort study. IJID Reg 9:104–110 Bono MJ, Leslie SW Uncomplicated Urinary Tract Infections. [Updated 2025 Feb 21]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/ Belyayeva M, Leslie SW, Jeong JM, Acute Pyelonephritis [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519537/ Jose A, Hidalgo (2025) sep. Pott disease (Tuberclulous spondylitis). Accessed on 11 https://emedicine.medscape.com/article/226141-overview?form=fpf Viswanathan VK, Subramanian S (2023) Pott Disease [Internet]. StatPearls - NCBI Bookshelf. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538331/ Seth S, Bhat NA, Sheikh RY, Keshwani P, Mehta P (2022) Occurrence and Risk Factors for Acute Kidney Injury in Patients Hospitalized with Acute Pyelonephritis, and their Clinical Outcomes: A Single Center Study from Northern India. APIK J Intern Med 11(2):101–106 Jeon DH, Jang HN, Cho HS, Lee TW, Bae E, Chang SH et al (2019) Incidence, risk factors, and clinical outcomes of acute kidney injury associated with acute pyelonephritis in patients attending a tertiary care referral center. Ren Fail 41(1):204–210 Ramakrishnan K, Scheid DC Diagnosis and management of acute pyelonephritis in adults. Am Family Phys, 71(5), 933–942 Hausenloy DJ, Yellon DM (2008) Remote ischaemic preconditioning: underlying mechanisms and clinical application. Cardiovascular Res 79(3):377–386 Gameiro J, Fonseca JA, Outerelo C, Lopes JA (2020) Acute Kidney injury: From diagnosis to prevention and treatment Strategies. J Clin Med 9(6):1704 Mainali A, Adhikari S, Chowdhury T, Gousy N, Uprety N, Arora A et al (2022) Acute Non-Obstructive bilateral pyelonephritis with acute kidney injury requiring hemodialysis. Cureus 14(7):e26746 Kooman J (2000) Acute pyelonephritis: a cause of acute renal failure? Neth J Med 57(5):185–189 Manesh A, Garg D, Radhakrishnan D, Agrawal U, Vanjare H, Gandham E (2022) Tuberculosis of the spinal cord. Ann Indian Acad Neurol 26(2):112 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9079789\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":603572229,\"identity\":\"4eb2d1e5-be11-4583-b250-9ad9e4892a83\",\"order_by\":0,\"name\":\"Dr. Rahul Shil\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCcbGA0AqgYGdsfHBByCLjZ2wlgaIFmbmw4YzQFqYCWphYIBqYUsT5gGJENIiP7u54QDjHrs8g8M8Zsw2v7bJ8zEzMH74mINbi8Gdg0CHPUsuBml5nNt327CNmYFZcuY2PFokEoFaDjAnbjjMY26c23ObEaiFjZkXjxb5GWAt9SAtZtKWPbftCWphuAHWchiohS1NmuHH7USCWgxAWhIOHE+ceRgYyL0Nt5PbmBmb8fpFfkb6wwcfDlQn9h1vbHzw489t2/ntzQc/fMTnMBBIgDEY28BkAwH1KOAPKYpHwSgYBaNgpAAAyC9XtQ9SwmcAAAAASUVORK5CYII=\",\"orcid\":\"https://orcid.org/0000-0001-8917-7723\",\"institution\":\"PES University\",\"correspondingAuthor\":true,\"prefix\":\"Dr.\",\"firstName\":\"Rahul\",\"middleName\":\"\",\"lastName\":\"Shil\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-10 06:20:43\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":true,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":true,\"vertebrateSubjectEthicalGuidelines\":true},\"doi\":\"10.21203/rs.3.rs-9079789/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9079789/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104582919,\"identity\":\"020b8edf-5c4c-4ede-8db6-8a46c6255da3\",\"added_by\":\"auto\",\"created_at\":\"2026-03-13 15:16:39\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2798824,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePatchy opacities in bilateral lower lung zone with mild elevation of the right hemidiaphragm\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Screenshot20250929at12.36.58PM.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9079789/v1/783bc2c3aa58bd4591314b28.png\"},{\"id\":104582918,\"identity\":\"130f9736-a388-4a11-b8ce-b8969215950e\",\"added_by\":\"auto\",\"created_at\":\"2026-03-13 15:16:39\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3297136,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCECT of the abdomen\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Screenshot20250929at12.37.44PM.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9079789/v1/f8fba4557d7c9cdc061b990e.png\"},{\"id\":104782431,\"identity\":\"43d19016-63dc-400b-959c-49352903d474\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 07:57:17\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":6125334,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9079789/v1/89829873-e6de-4caf-9f0d-1b92f6f7d119.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcute pyelonephritis with acute kidney injury complicated by Pott spine: Diagnostic and therapeutic considerations\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eAcute pyelonephritis (APN) is a well-documented disease with a long history. Although its earliest description dates back to ancient Egypt, highlighting the destruction of the kidney parenchyma, the nomenclature of APN remains controversial, leading to semantic ambiguities that can cause confusion.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e APN is a bacterial infection that causes inflammation in the kidney. Certain populations, such as pediatric patients, renal transplant recipients, and pregnant women, require special attention. Common symptoms include fever, flank pain, nausea, vomiting, burning during urination, increased urinary frequency, and urgency. Despite its prevalence, the incidence rate varies across countries. A Danish study revealed a 6.8% increase in women and a 2.7% increase in men affected by APN.\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e Young, sexually active women are most commonly affected due to their higher incidence of urinary tract infections (UTIs), while men are more susceptible to mortality rates due to diabetes, nephrolithiasis, kidney disease, and advanced age.\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e Pott disease, also known as tuberculous spondylitis, is a form of infection caused by tuberculosis. If left untreated, it can result in spinal cord compression, paraplegia, localized back pain, arthritis, and abscess formation.\\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e Spinal tuberculosis accounts for approximately 50% of all skeletal tuberculosis infections. The World Health Organization (WHO) reported an incidence of 10.4\\u0026nbsp;million new cases of tuberculosis in 2016, with 46.5% of cases originating from the Southeast Asian region alone. India contributed 23% of the global tuberculosis burden. Spinal tuberculosis typically develops secondary to hematogenous spread from a primary site of infection, most commonly the lungs. The paradiscal vessels supply the subchondral bone on either side of the disc space, making the paradiscal the most common site of vertebral involvement.\\u003csup\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/sup\\u003e Although acute pyelonephritis and pott\\u0026rsquo;s spine are distinct diseases, they can sometimes be associated due to the spread of the tuberculosis bacterium to the kidneys, resulting in renal tuberculosis, which can manifest as pyelonephritis. Therefore, it is crucial for healthcare teams to accurately diagnose patients using appropriate diagnostic criteria to prevent treatment-related complications. In this study, we present a case of a 51-year-old male admitted to the hospital with acute pyelonephritis and acute kidney injury (AKI) complicated by pott\\u0026rsquo;s spine.\\u003c/p\\u003e\"},{\"header\":\"CASE REPORT\",\"content\":\"\\u003cp\\u003eOn September 10, 2025, a 51-year-old male presented to the nephrology department with complaints of high fever, persistent vomiting for three consecutive days, sleep disturbances characterized by irritability, disorientation regarding time, place, and individuals, inability to recognize medical staff, and resistance to medical procedures. Additionally, he reported flank pain for six days and hematuria. A two-month history of tuberculosis was discovered. Upon questioning, the patient denied any prior head injuries and did not have any known comorbidities such as diabetes mellitus or hypertension. However, he was an alcoholic and chronic smoker for 30 years. Initially, the patient was provisionally diagnosed with acute kidney injury secondary to sepsis. However, subsequent clinical tests revealed acute pyelonephritis (API) with acute kidney injury (AKI) which later became complicated by pott\\u0026rsquo;s spine.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCLINICAL SIGNS:\\u003c/h2\\u003e \\u003cp\\u003eUpon examination, the patient\\u0026rsquo;s body temperature was 98 degrees Fahrenheit, pulse rate was 104 beats per minute, blood pressure was 96/58 millimeters of mercury, and respiration rate was 16 breaths per minute, with a SpO2 of 98%. A positive systemic examination, including a cardiovascular system assessment, revealed a soft abdomen during per abdominal palpation. Additionally, the patient exhibited disorientation, with a score of E3V4M3. However, after initiating treatment, the score improved to E4V4M5, and the B/L PERL was normal.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"INVESTIGATION\",\"content\":\"\\u003cp\\u003eRelevant investigations were conducted. The hematology report indicated a hemoglobin concentration of 8.9%, a red blood cell count of 3.06\\u0026nbsp;million/cumm, a platelet count of 0.68 lacks/cumm, and a total white blood cell count of 26,120 cells/cumm. Neutrophils accounted for 86%, while lymphocytes comprised 7%. The renal function test revealed a urea level of 206 mg/dl, a serum creatinine concentration of 71 mg/dl, a serum sodium level of 120 mmol/l, and a serum potassium level of 6.1 mmol/l. The liver function test indicated a total bilirubin level of 2.2 mg/dl, a direct bilirubin level of 2.0 mg/dl, a total protein level of 5.5 g/dl, a serum albumin level of 2.1 g/dl, and an alkaline phosphatase level of 330 U/L. Further biochemical analysis revealed a ferritin level of 962 ng/ml, an ammonia plasma level of 71 mol/l, a uric acid level of 12.0 mg/dl, a C-reactive protein level of 162.01 mg/dl, a serum cortisol level of 34.6 ug/dl, and a negative serology result. Ultrasonography (USG) of the abdomen and pelvis revealed a bulky left kidney with an altered echo texture (R: 9.7 x 1.2 cm, L: 11.8 x 2.1 cm). It also showed gallbladder sludge, a thin rim of perinephric free fluid, and suggestive cystitis. A contrast-enhanced computed tomography (CECT) of the abdomen was also conducted, and the report indicated an active Pott\\u0026rsquo;s spine and a paradiscal abscess radiating up to the psoas muscle. Additionally, a large necrotic prostate abscess (tubercular/neoplastic) was observed. Furthermore, the electrocardiogram (ECG) report revealed a right-sided ST segment elevation. Consequently, color Doppler echocardiography was performed, which indicated normal chambers and dimensions with no regional wall motion abnormalities. The left ventricular systolic function ejection fraction (EF) was 55%, with mild mitral regurgitation and tricuspid regurgitation. The inferior vena cava (IVC) diameter was 14 mm, which collapsed with inspiration.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"THERAPEUTIC INTERVENTION\",\"content\":\"\\u003cp\\u003eUpon confirmation of the diagnosis, the patient was initially administered intravenous fluids (NS) in a 2-pint bolus, followed by a 150 ml/hour infusion. Injured meropenem (500 mg) was administered intravenously once daily, injured pan (40 mg) was administered intravenously once daily, injured emeset (4 mg) was administered intravenously once daily, injured PCT (1 gm) was administered slowly intravenously over 10 minutes, tab nodosis (500 mg) was administered twice daily, K bind sachet (15 gm) was administered twice daily, asthalin nebulizer (10 mg) was administered every 3 hours, injured Human actrapid (10 units) was administered in 25% dextrose intravenously every 3 hours, injured calcium gluconate (10 mg) was administered slowly intravenously over 10 minutes, injured optineuron (100 ml NS) was administered intravenously once daily, injured hydrocort (100 mg) was administered intravenously twice daily, injured vit K (10 mg) was administered intravenously once daily, injured thiamine (100 mg) was administered intravenously twice daily, tab levoday (250 mg) was administered twice daily, and syp cremaffin (30 ml) was administered twice daily. However, after a day, injured Human actrapid, injured vit K, and nebulizer asthalin were discontinued. After a week, the patient was prescribed injured Lasix (20 mg stat) in a 0.2 ml/hr infusion, injured noradrenaline (2 ml/hr), and tab haloperidol (0.5 mg OD). Additionally, the patient underwent cystoscopy followed by double J stenting surgical procedures. No postoperative complications were observed, including bleeding, infection, ureteral, or bladder injury.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eAcute pyelonephritis is a prevalent upper urinary tract bacterial infection that affects the renal parenchyma and pelvis. It can develop complications such as renal abscess, septic shock, and renal impairment. Studies indicate that patients with baseline chronic kidney disease (CKD) are at higher risk of developing severe acute kidney injury (AKI) compared to individuals with normal renal function.\\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e AKI is a significant clinical concern in patients with infectious diseases, affecting approximately 5% to 51% of sepsis patients. Risk factors associated with AKI in acute pyelonephritis include advancing age, bilateral kidney involvement, and initial shock. A recent study has identified older age, diabetes mellitus, and upper urinary tract infection (UTI) as independent risk factors for AKI in patients with UTI.\\u003csup\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e Urine culture and analysis are essential for confirming the diagnosis of acute pyelonephritis. While patients with acute pyelonephritis traditionally require hospital admission, outpatient oral therapy has demonstrated promising results for those with uncomplicated pyelonephritis and who can tolerate oral intake. Penicillin-based antibiotics, such as amoxicillin, amoxicillin-clavulanate (Augmentin), and pipracillin, cephalosporin antibiotics like cefotaxime and ceftriaxone, and fluroquinolones such as ciprofloxacin, levofloxacin, and aminoglycosides are commonly used to treat acute pyelonephritis.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e In recent decades, the incidence of acute kidney injury (AKI) has risen, particularly among critically ill patients, resulting in a relatively high mortality rate. Consequently, early diagnosis, hemodynamic stabilization, and prompt identification of complications are crucial in mitigating the mortality rate. Effective treatment strategies include fluid therapy, vasopressors, diuretics, remote ischemic conditioning\\u003csup\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e, and renal replacement therapy. In our case, the patient presented with acute pyelonephritis and AKI, which is generally uncommon. However, similar cases have been reported in previous studies.\\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e Notably, men exhibit a higher mortality rate from pyelonephritis compared to women. Regardless of the underlying predisposing factors, pyelonephritis can induce acute renal injury by disrupting tubular function through interstitial inflammation and edema, leading to eventual tubular obstruction characterized by cellular debris and increased vasoconstriction of the renal microvasculature. This cycle of heightened inflammation and edema results in further tubular obstruction.\\u003csup\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e In our case, the patient also developed pott\\u0026rsquo;s disease, a type of tuberculosis affecting the spine. According to World Health Organization (WHO) guidelines, patients with pott\\u0026rsquo;s spine should undergo a two-phase treatment approach. The initial phase spans two months, followed by a continuation of seven to ten months of treatment with the first line of drugs, including isoniazid, rifampicin, pyrazinamide, and streptomycin. Subsequently, the second line of drugs, such as isoniazid and rifampicin, is administered.\\u003csup\\u003e\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e In our case, the patient was diagnosed with tuberculosis two months prior to our intervention. Despite being registered under directly observed treatment short course (DOTS) therapy, he failed to adhere to the prescribed antitubercular medication regimen. This lack of adherence may have ultimately contributed to the development of pott\\u0026rsquo;s spine, which subsequently led to acute kidney injury (AKI). Given the compromised renal function of the patient, the initial treatment priority was to stabilize his condition. Subsequently, the antitubercular therapy will be resumed.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eAKI is a prevalent complication of acute pancreatitis APN. Early and appropriate management typically renders AKI reversible. However, certain risk factors increase the likelihood of developing AKI, including male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed hospital presentation. These risk factors are associated with heightened risks of dialysis, hospitalization duration, and mortality.\\u003c/p\\u003e\\u003cp\\u003ethe participant’s consent was obtained prior to the publication of his clinical case.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eACKNOWLEDGEMENTS:\\u0026nbsp;\\u003c/strong\\u003eWe thank the\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003epatient for allowing us to share his case.\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eETHICAL APPROVAL:\\u0026nbsp;\\u003c/strong\\u003eEthical approval were taken as per international standards.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONFLICTS OF INTERESTS:\\u0026nbsp;\\u003c/strong\\u003eNone declared\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFUNDING:\\u0026nbsp;\\u003c/strong\\u003eThe authors receive no funding for this work.\\u003c/p\\u003e\\n\\u003cp\\u003ethe participant’s consent was obtained prior to the publication of his clinical case.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eUmesha L, Shivaprasad S, Rajiv E, Kumar MS, Leelavathy V, Sreedhara C et al (2018) Acute pyelonephritis: A single-center experience. Indian J Nephrol 28(6):454\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSvingel LS, Christiansen CF, Birn H, S\\u0026oslash;gaard KK, N\\u0026oslash;rgaard M (2023) Temporal changes in incidence of hospital-diagnosed acute pyelonephritis: A 19-year population-based Danish cohort study. IJID Reg 9:104\\u0026ndash;110\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBono MJ, Leslie SW Uncomplicated Urinary Tract Infections. [Updated 2025 Feb 21]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK470195/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.ncbi.nlm.nih.gov/books/NBK470195/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBelyayeva M, Leslie SW, Jeong JM, Acute Pyelonephritis [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK519537/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.ncbi.nlm.nih.gov/books/NBK519537/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJose A, Hidalgo (2025) sep. Pott disease (Tuberclulous spondylitis). Accessed on 11 \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://emedicine.medscape.com/article/226141-overview?form=fpf\\u003c/span\\u003e\\u003cspan address=\\\"https://emedicine.medscape.com/article/226141-overview?form=fpf\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eViswanathan VK, Subramanian S (2023) Pott Disease [Internet]. StatPearls - NCBI Bookshelf. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK538331/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.ncbi.nlm.nih.gov/books/NBK538331/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSeth S, Bhat NA, Sheikh RY, Keshwani P, Mehta P (2022) Occurrence and Risk Factors for Acute Kidney Injury in Patients Hospitalized with Acute Pyelonephritis, and their Clinical Outcomes: A Single Center Study from Northern India. APIK J Intern Med 11(2):101\\u0026ndash;106\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJeon DH, Jang HN, Cho HS, Lee TW, Bae E, Chang SH et al (2019) Incidence, risk factors, and clinical outcomes of acute kidney injury associated with acute pyelonephritis in patients attending a tertiary care referral center. Ren Fail 41(1):204\\u0026ndash;210\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRamakrishnan K, Scheid DC Diagnosis and management of acute pyelonephritis in adults. Am Family Phys, 71(5), 933\\u0026ndash;942\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHausenloy DJ, Yellon DM (2008) Remote ischaemic preconditioning: underlying mechanisms and clinical application. Cardiovascular Res 79(3):377\\u0026ndash;386\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGameiro J, Fonseca JA, Outerelo C, Lopes JA (2020) Acute Kidney injury: From diagnosis to prevention and treatment Strategies. J Clin Med 9(6):1704\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMainali A, Adhikari S, Chowdhury T, Gousy N, Uprety N, Arora A et al (2022) Acute Non-Obstructive bilateral pyelonephritis with acute kidney injury requiring hemodialysis. Cureus 14(7):e26746\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKooman J (2000) Acute pyelonephritis: a cause of acute renal failure? Neth J Med 57(5):185\\u0026ndash;189\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eManesh A, Garg D, Radhakrishnan D, Agrawal U, Vanjare H, Gandham E (2022) Tuberculosis of the spinal cord. Ann Indian Acad Neurol 26(2):112\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"PES University\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Acute pyelonephritis, Acute kidney injury, complication, pott’s spine, chronic kidney disease\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9079789/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9079789/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eAcute pyelonephritis (APN) associated with acute kidney injury (AKI) is generally considered rare if there are no anatomical abnormalities and predisposing factors identified. It is generally reversible with early and appropriate management. This case report describes a case of APN secondary to API, which was complicated by Pott\\u0026rsquo;s spine in a 51-year-old male.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Acute pyelonephritis with acute kidney injury complicated by Pott spine: Diagnostic and therapeutic considerations\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-13 15:16:32\",\"doi\":\"10.21203/rs.3.rs-9079789/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fa3b43ef-7f9a-448b-b432-2a924f89a656\",\"owner\":[],\"postedDate\":\"March 13th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":64223255,\"name\":\"Neurology\"}],\"tags\":[],\"updatedAt\":\"2026-03-13T15:16:34+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-13 15:16:32\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9079789\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9079789\",\"identity\":\"rs-9079789\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}