It is relatively hard to diagnose until the consequences of the elevated pulmonary arterial pressures (systemic edema (how does this happen), chest pain, and fatigue) are fairly well advanced.

Right-sided heart failure resulting from chronic pulmonary hypertension is called cor pulmonale. Although there is a genetic component to its incidence, it seems to be highly correlated with conditions involving chronic hypoxia (eg, chronic obstructive pulmonary disease, cystic fibrosis, and pneumoconiosis).9 The increased prevalence of obesity with accompanying obstructive sleep apnea may account for a recent increase in reported incidence of this disease. There is no cure at present and strategies for treatment of systemic hypertension have little or no effect on pulmonary hypertension. However, three pharmacological approaches are useful: (1) endothelin receptor antagonists block the biological activities of the vasoconstrictor, endothelin; (2) phosphodiesterase-5 inhibitors prevent breakdown of cyclic guanosine monophosphate, thus promoting the vasorelaxing effects of nitric oxide; and (3) prostacyclin derivatives provide an exogenous supply of the vasodilator, prostacyclin.

It can be caused by either structural alterations in the lung vasculature (associated with smoking, environmental toxins, left heart failure with pulmonary congestion) or by altered vascular smooth muscle reactivity.

Although there is a genetic component to its incidence, it seems to be highly correlated with conditions involving chronic hypoxia (e.g., chronic obstructive pulmonary disease, cystic fibrosis, and pneumoconiosis). 11 The increased prevalence of obesity with accompanying obstructive sleep apnea may account for a recent increase in reported incidence of this disease. It is relatively hard to diagnose until symptoms appear as the consequences of the elevated pulmonary arterial pressures. These symptoms may include systemic edema, pulmonary congestion, shortness of breath, chest pain, and fatigue.

There is no cure for pulmonary hypertension at present and strategies used for treatment of systemic hypertension have had little or no effect on the pulmonary bed. However, several pharmacological approaches are proving to be useful: (1) endothelin receptor antagonists block the biological activities of the vasoconstrictor, endothelin; (2) phosphodiesterase-5 inhibitors prevent breakdown of cyclic guanosine monophosphate, thus promoting the vasorelaxing effects of nitric oxide; and (3) prostacyclin derivatives provide an exogenous supply of the vasodilator, prostacyclin, or drugs that activates a prostacyclin receptor.

Chronic pulmonary hypertension causes right-sided heart failure and is called cor pulmonale.

Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.

In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.

Infection in the kidneys may spread to the bloodstream—a serious condition called sepsis—though this is also uncommon.