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Septic shock is a result of a systemic response to infection or multiple infectious causes. The precipitating infections that may lead to septic shock if severe enough include but are not limited to appendicitis, pneumonia, bacteremia, diverticulitis, pyelonephritis, meningitis, pancreatitis, necrotizing fasciitis, MRSA and mesenteric ischemia.
Kidney ischemia [1] is a disease with a high morbidity and mortality rate. [2] Blood vessels shrink and undergo apoptosis which results in poor blood flow in the kidneys. More complications happen when failure of the kidney functions result in toxicity in various parts of the body which may cause septic shock, hypovolemia, and a need for surgery. [3]
Symptoms most often include fever and flank tenderness. [2] Other symptoms may include nausea, burning with urination, and frequent urination. [2] Complications may include pus around the kidney, sepsis, or kidney failure. [3] It is typically due to a bacterial infection, most commonly Escherichia coli. [2]
Sepsis is defined as SIRS in response to an infectious process. [48] Severe sepsis is defined as sepsis with sepsis-induced organ dysfunction or tissue hypoperfusion (manifesting as hypotension, elevated lactate, or decreased urine output). Severe sepsis is an infectious disease state associated with multiple organ dysfunction syndrome (MODS) [9]
Symptoms of a kidney infection, on the other hand, are more systemic and include fever or flank pain usually in addition to the symptoms of a lower UTI. [10] Rarely, the urine may appear bloody. [7] Symptoms may be vague or non-specific at the extremities of age (i.e. in patients who are very young or old). [1] [11]
This constellation of symptoms contrasts with the classical presentation of nephrotic syndrome (excessive proteinuria >3.5 g/day, low plasma albumin levels (hypoalbuminemia) <3 g/L, generalized edema, and hyperlipidemia). [8] [10] Signs and symptoms that are consistent with nephritic syndrome include: Hematuria (red blood cells in the urine) [11]
Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. In one-third of the patients, however, no primary focus can be found. [1] Multiple organ dysfunction syndrome is well established as the final stage of a continuum: SIRS + infection → sepsis → severe sepsis → Multiple organ dysfunction syndrome.
Nephritis can often be caused by infections and toxins, but it is most commonly caused by autoimmune disorders that affect the major organs like kidneys. [5]Pyelonephritis is inflammation that results from a urinary tract infection that reaches the renal pelvis of the kidney.