Common tests & procedures
Pyelonephritis is an infection, however, and this infection can spread and become very severe. Complications of untreated or poorly controlled pyelonephritis can be serious, even life threatening in some cases.
How dangerous is pyelonephritis?
Most patients with uncomplicated cases of pyelonephritis find that their symptoms begin to improve after one to two days of treatment with antibiotics. However, even after symptoms improve, antibiotics are usually prescribed to complete a 10 to 14 day course. To help prevent pyelonephritis if you have had a previous episode or are at risk:
How long should you treat pyelonephritis?
Rarely, pyelonephritis can develop into a serious infection that threatens the afflicted kidney, and possibly the patient’s life. Severe or untreated pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. What Causes Pyelonephritis?
How serious is pyelonephritis?
The following variations in vital signs can be seen in pyelonephritis:
- Fever may be present
- High Blood pressure as an early finding of kidney involvement
- Hypotension
What are the symptoms and physical findings of pyelonephritis?
How do they diagnose pyelonephritis?
To diagnose acute pyelonephritis, physicians must rely on evidence of UTI from urinalysis or culture, along with signs and symptoms suggesting upper UTI (fever, chills, flank pain, nausea, vomiting, costovertebral angle tenderness).
Can urine test detect pyelonephritis?
Two common laboratory tests are performed to diagnose kidney infections (pyelonephritis). A urine sample is examined under a microscope to determine if white and/or red blood cells are present. The urine is also sent to the lab to see if bacteria grow in a urine culture.
How can you tell the difference between UTI and pyelonephritis?
A urinary tract infection is inflammation of the bladder and/or the kidneys almost always caused by bacteria that moves up the urethra and into the bladder. If the bacteria stay in the bladder, this is a bladder infection. If the bacteria go up to the kidneys, it is called a kidney infection or pyelonephritis.
What is the physical test for pyelonephritis?
The following features can be found during a physical examination of a patient with pyelonephritis....GenitourinarySuprapubic tenderness.Urethral discharge (if the cause is urethritis)Inguinal lymphadenopathy.Examination of the scrotum and the pubic area must be done.
What does pyelonephritis pain feel like?
A burning feeling or pain when urinating. Having to urinate often. A strong, lasting urge to urinate. Back, side or groin pain.
What is the most common cause of pyelonephritis?
Bacteria such as E. coli often cause the infection. However, any serious infection in the bloodstream can also spread to the kidneys and cause acute pyelonephritis.
Is pyelonephritis an emergency?
Emphysematous pyelonephritis is a surgical emergency. Most patients are septic, and fluid resuscitation and broad-spectrum antimicrobial therapy are essential. If the kidney is functioning, medical therapy can be considered [5, 6].
What is the first line treatment for pyelonephritis?
Fluoroquinolones (FQ) are the first line empiric treatment for acute pyelonephritis. Fluoroquinolones (FQ) are the first line empiric treatment for acute pyelonephritis. An effective modality along when given IV or IM or given as a first dose in outpatient treatment.
What is the best antibiotic for pyelonephritis?
The penicillins (amoxicillin) and first-generation cephalosporins are the drugs of choice for chronic pyelonephritis because of good activity against gram-negative rods and good oral bioavailability.
When should you suspect pyelonephritis?
Acute pyelonephritis should be suspected in people with signs or symptoms of a urinary tract infection (for example, dysuria, frequency, urgency) accompanied by any new signs or symptoms of pyelonephritis (including fever, nausea, vomiting, or flank pain).
Will blood work show a kidney infection?
To check for a kidney infection, you may be asked to provide a urine sample to test for bacteria, blood or pus in your urine. Your health care provider might also take a blood sample for a culture. A culture is a lab test that checks for bacteria or other organisms in your blood.
Can you have pyelonephritis without fever?
Up to 20% of patients do not have bladder symptoms, and some patients do not have fever. Clinical presentations and disease severity vary widely, from mild flank pain with low-grade or no fever to septic shock.
Does kidney infection show up in urine culture?
To check for a kidney infection, you may be asked to provide a urine sample to test for bacteria, blood or pus in your urine. Your health care provider might also take a blood sample for a culture. A culture is a lab test that checks for bacteria or other organisms in your blood.
Can you have a kidney infection with a negative urine test?
Diagnostic Tests A urine culture is performed, but it is not uncommon for culture of urine collected from the bladder to be negative despite infection in the kidney. Abdominal x-rays and an ultrasound may be recommended.
Can you have kidney infection without bacteria in urine?
Some kidney infections can develop without a bladder infection and are due to a problem within the kidney itself. As an example, people with kidney stones or an abnormality of the kidney are more susceptible to kidney infections.
What shows up in urine test for UTI?
Either nitrites or leukocyte esterase — a product of white blood cells — in your urine might indicate a urinary tract infection.
When to do urine culture for pyelonephritis?
To prevent pyelonephritis in pregnant women, a urine culture should be conducted between the 12th and 16th weeks of pregnancy. A UTI that doesn’t have symptoms can lead to the development of pyelonephritis. Detecting the UTI early can prevent kidney infection.
What is a pyelonephritis?
Understanding pyelonephritis. Acute pyelonephritis is a sudden and severe kidney infection. It causes the kidneys to swell and may permanently damage them. Pyelonephritis can be life-threatening. When repeated or persistent attacks occur, the condition is called chronic pyelonephritis.
What causes pyelonephritis in children?
Chronic forms of the condition are more common in people with urinary obstructions. These can be caused by UTIs, vesicoureteral reflux, or anatomical anomalies. Chronic pyelonephritis is more common in children than in adults.
What is the most common cause of acute pyelonephritis?
Acute pyelonephritis. Any problem that interrupts the normal flow of urine causes a greater risk of acute pyelonephritis. For example, a urinary tract that’s an unusual size or shape is more likely to lead to acute pyelonephritis.
What is the first course of action against acute pyelonephritis?
Antibiotics are the first course of action against acute pyelonephritis. However, the type of antibiotic your doctor chooses depends on whether or not the bacteria can be identified. If not, a broad-spectrum antibiotic is used.
How many trips to the doctor for pyelonephritis?
Pyelonephritis in children. According to the American Urological Association, in the United States, more than one million trips to the pediatrician are made each year for pediatric UTIs. Girls are at increased risk if over one year old. Boys are at greater risk if under one, especially if they’re uncircumcised.
Is pyelonephritis a serious condition?
Pyelonephritis can be a serious condition. Contact your doctor as soon as you suspect that you have pyelonephritis or a UTI. This condition requires prompt medical attention, so the earlier you start treatment, the better. Last medically reviewed on April 4, 2018.
How can pyelonephritis be prevented?
Can kidney infections (pyelonephritis) be prevented? Kidney infections can be prevented by keeping bacteria out of the urinary tract and bladder. Infections in the kidney often start as a lower tract infection in the bladder. By preventing these infections, you may be able to prevent kidney infections.
What are the symptoms of kidney infection?
Symptoms of a kidney infection include: Sudden onset of chills. Fever over 100 degrees Fahrenheit. Pain in the groin, lower back or side. Nausea. Vomiting.
Can you take all the medication for pyelonephritis?
You may begin feeling better shortly after beginning a treatment, but still need to take the entire prescribed treatment.
Does urine flush out bacteria?
Normally, bacteria are flushed out by the flow of urine. However, several problems can increase the risk of a kidney infection. These problems can include:
How to diagnose acute pyelonephritis?
A good history and physical is the mainstay of evaluating acute pyelonephritis, but laboratory and imaging studies can be helpful. A urinary specimen should be obtained for a urinalysis. On urinalysis, one should look for pyuria as it the most common finding in patients with acute pyelonephritis. Nitrite production will indicate that the causative bacteria is E.coli. Proteinuria and microscopic hematuria may be present as well on urinalysis. If hematuria is present, then other causes may be considered such as kidney stones. All patients with suspected acute pyelonephritis should also have urine cultures sent for proper antibiotic management. Blood work such as a complete blood cell count (CBC) is sent to look for an elevation in white blood cells. The complete metabolic panel can be used to search for aberrations in creatinine and BUN to assess kidney function. The imagining study of choice for acute pyelonephritis is abdominal/pelvic CT with contrast. Imaging studies will usually not be required for the diagnosis of acute pyelonephritis but are indicated for patients with a renal transplant, patients in septic shock, those patients with poorly controlled diabetes, complicated UTIs, immunocompromised patients, or those with toxicity persisting for longer than 72 hours. Ultrasonography can be used to detect pyelonephritis, but a negative study does not exclude acute pyelonephritis. Regardless, ultrasound can still be a useful study when evaluating for acute pyelonephritis because it can be done bedside, has no radiation exposure and may reveal renal abnormalities, which can prompt further testing or definitive treatment.
How is pyelonephritis treated?
Overall the majority of cases of pyelonephritis are managed in an outpatient setting with most patients improving with oral antibiotics. Usually, young women are among those most likely to be treated as outpatients.[1] Despite pyelonephritis improving in most cases, there is still significant morbidity and mortality that can be associated with severe cases of this disease. Overall mortality has been reported around 10% to 20% in some studies with a recent study from Hong Kong finding a mortality rate closer to 7.4%. More importantly, this study found that old age (older than 65 years), male gender, impaired renal function, or presence of disseminated intravascular coagulation were associated with increased mortality. With the proper recognition of the underlying etiology and prompt intervention with adequate treatment, even patients with severe pyelonephritis generally have a good outcome. [3]
What are the complications of acute pyelonephritis?
Acute pyelonephritis can have several complications such as renal or perinephric abscess formation, sepsis, renal vein thrombosis, papillary necrosis, or acute renal failure, with one of the more serious complications being emphysematous pyelonephritis (EPN).[4] Emphysematous pyelonephritis is a necrotizing infection of the kidney usually caused by E. colior Klebsiella pneumoniae and is a severe complication of acute pyelonephritis. EPN is usually seen in the setting of diabetes and occurs more frequently in women. The diagnosis can be made with ultrasound, but CT is typically necessary. Overall the mortality rate is estimated to be approximately 38% with better outcomes associated with patients who receive both medical and surgical management versus medical management alone. [5]
What is the bacterial infection that causes a burning sensation in the kidneys?
Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys. Pyelonephritis occurs as a complication of an ascending urinary tract infection which spreads from the bladder to the kidneys. Symptoms usually include fever, flank pain, nausea, vomiting, burning with urination, increased frequency, and urgency. This activity outlines the clinical presentation, diagnosis, and management of acute pyelonephritis , and highlights the role of the interprofessional team in caring for patient with the condition.
What is the most common bacterial infection that causes pyelonephritis?
E. coliis the most common bacteria causing acute pyelonephritis due to its unique ability to adhere to and colonize the urinary tract and kidneys. E.colihas adhesive molecules called P-fimbriae which interact with receptors on the surface of uroepithelial cells. Kidneys infected with E. colican lead to an acute inflammatory response which can cause scarring of the renal parenchyma. Though the mechanism in which renal scarring occurs is still poorly understood, it has been hypothesized that the adhesion of bacteria to the renal cells disrupts the protective barriers, which lead to localized infection, hypoxia, ischemia, and clotting in an attempt to contain the infection. Inflammatory cytokines, bacterial toxins, and other reactive processes further lead to complete pyelonephritis and in many cases systemic symptoms of sepsis and shock.
When diagnosing acute pyelonephritis, keeping the differential broad is a wise idea?
When diagnosing acute pyelonephritis, keeping the differential broad is a wise idea. Physicians should consider other disorders as well when patients present with fever, flank pain, and costovertebral angle tenderness. Because symptoms can be variable (unilateral, bilateral, radiating, sharp, dull) and because pyelonephritis can progress to sepsis and shock the differential diagnoses associated with pyelonephritis can be extensive. Common mimics of acute pyelonephritis can include but is not limited to:
Can pyelonephritis be treated as an outpatient?
Acute pyelonephritis can be managed as either outpatient or inpatient. Healthy, young, non-pregnant women who present with uncomplicated pyelonephritis can be treated as outpatients. Inpatient treatment is usually required for those who are very young, elderly, immunocompromised, those with poorly controlled diabetes, renal transplant, patients, patients with structural abnormalities of the urinary tract, pregnant patients, or those who cannot tolerate oral intake. The mainstay of treatment of acute pyelonephritis is antibiotics, analgesics, and antipyretics. Nonsteroidal anti-inflammatory drugs (NSAIDs) work well to treat both pain and fever associated with acute pyelonephritis. The initial selection of antibiotics will be empiric and should be based on the local antibiotic resistance. Antibiotic therapy should then be adjusted based on the results of the urine culture. Most uncomplicated cases of acute pyelonephritis will be caused by E. colifor which patients can be treated with oral cephalosporins or TMP-SMX for 14 days. Complicated cases of acute pyelonephritis require intravenous (IV) antibiotic treatment until there are clinical improvements. Examples of IV antibiotics include piperacillin-tazobactam, fluoroquinolones, meropenem, and cefepime. For patients who have allergies to penicillin, vancomycin can be used. Follow up for non-admitted patients for resolution of symptoms should be in 1 to 2 days. Follow up urine culture results should be obtained only in patients who had a complicated course and are usually not needed in healthy, non-pregnant women. Any patient that had a complicated UTI should be sent for follow up imaging to identify any abnormalities that predispose the patient to further infections.
How to diagnose pyelonephritis?
To diagnose pyelonephritis, your doctor will order urine tests to look for white cells in the urine and for culture to determine the type of bacteria causing the infection.
What is Pyelonephritis?
Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder.
Why does pyelonephritis occur in children?
Children sometimes develop pyelonephritis because of an abnormality in the bladder that allows urine there to flow backward (reflux) into the ureter , the connection between the kidney and bladder. This can lead to scarring of the kidney.
What is the term for the backflow of urine from the bladder to the kidneys?
Abnormal backflow of urine from the bladder to the kidneys, called vesicoureteral reflux. An obstruction related to an abnormal development of the urinary tract. Tests or procedures that involve the insertion of an instrument into the bladder also increase the risk of urinary tract infections and pyelonephritis.
What age is pyelonephritis most common?
A man is more likely to develop the problem if his prostate is enlarged, a common condition after age 50. Both men and women are more likely to develop pyelonephritis if they have any of the following conditions: An untreated urinary tract infection. Diabetes. Nerve problems that affect the bladder.
How long does it take for pyelonephritis to be adjusted?
People with pyelonephritis may have bacteria in their blood as well as their urine. Antibiotics are started prior to the culture results and will be adjusted once the bacterial species is identified in 24 to 48 hours.
Is pyelonephritis life threatening?
Rarely, pyelonephritis is so severe that it is life threatening, especially in older people or in people with an impaired immune system.
How do health care professionals treat kidney infections?
If you have a kidney infection, a health care professional will prescribe antibiotics. Even before your test results are in, the health care professional may prescribe an antibiotic that fights the most common types of bacteria. Although you may feel relief from your symptoms, make sure to take the entire antibiotic treatment that your health care professional prescribes.
What to do if kidney stone blocks urinary tract?
If something such as a kidney stone or an enlarged prostate is blocking your urinary tract, a doctor can sometimes treat the problem with surgery or another procedure. If you think you have a kidney infection, see a health care professional right away.
How can I make sure my kidney infection is completely gone?
If you recently had a kidney infection, the health care professional will often repeat urine cultures after your treatment ends to make sure your infection has completely gone away and has not come back. If a repeat test shows infection, you may take another round of antibiotics. If your infection comes back again, he or she may prescribe antibiotics for a longer time period.
How do you take antibiotics for kidney infection?
You may take these antibiotics by mouth, through a vein in your arm, called by IV, or both . If you are very sick from your kidney infection, you may go to a hospital for bed rest. A health care professional may give you fluids through an IV.
Can a kidney infection be prevented?
Many kidney infections start as a bladder infection, so preventing bladder infections may help prevent kidney infections . Scientists are still trying to understand the best ways to prevent bladder infections, but these small changes in your daily habits may help:
What is the treatment for pyelonephritis?
Surgical Treatments for Pyelonephritis. In addition to antibiotics, acute pyelonephritis may also require surgery if it is accompanied by an abscess, calculi (stones), renal papillary necrosis, or xanthogranulomatous pyelonephritis (XGP).
What is pyelonephritis UTI?
Tweet. Pyelonephritis is a type of urinary tract infection (UTI) affecting one or both kidneys. It occurs when bacteria or viruses travel into the kidneys from the bladder or invade the kidneys through the bloodstream. Pyelonephritis is typically diagnosed using urinalysis and other tests, and initial treatment consists of antibiotics.
How long does it take for pyelonephritis to go away?
Doctors typically treat pyelonephritis with antibiotics to kill the invading bacteria, usually with a 10 to 14 day regimen. (Milder cases may only require a seven-day course.) Healthcare providers often send a urine sample off to a lab while simultaneously starting treatment with an antibiotic known to kill the types of bacteria that most commonly cause infection. Once the lab identifies a patient's specific bacterium and which drugs it is sensitive to, a physician may switch the antibiotic to one that more effectively targets the bacteria.
What is XGP in kidney?
XGP is a rare, serious inflammatory disorder in which a destructive mass invades the main body of the kidney . It is most often associated with Proteus or E. coli -related urinary tract infections. XGP results in a non-functioning kidney that must be removed surgically (nephrectomy) in order to prevent the infection from spreading. If possible, surgery is delayed until the patient is stable.
What is the procedure to remove an infected kidney?
In severe cases, a surgeon may need to remove part or all of the infected kidney (partial or full nephrectomy).
How long does it take for a urine culture to be repeated?
If a repeat test shows infection, a doctor usually prescribes another 14-day course of antibiotics.
Can pyelonephritis be treated with antibiotics?
Depending on the severity of the disease, treatment may consist of oral antibiotics on an outpatient basis, or it may require hospitalization and intravenous antibiotics. Some underlying causes of pyelonephritis require surgery to prevent recurring infections. Rarely, pyelonephritis can threaten the kidney (necessitating removal) or cause permanent kidney scars, which can then lead to high blood pressure, chronic kidney disease, and kidney failure.
What Is Pyelonephritis?
Symptoms
Diagnosis
Expected Duration
Prevention
- Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder. Women have more bladder infections (also called urinary tract infections) than men because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. However, the infection usually remains in the bladder. A woman is mor…
Treatment
- The two primary symptoms of pyelonephritis are pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen. There also can be shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. You may need to urinate more often than normal and urinatin…
When to Call A Professional
- If your doctor is concerned that you have a kidney infection, he or she will ask you about other medical problems, any past infections and your recent symptoms. He or she will check your vital signs (temperature, heart rate, blood pressure), and will press on your abdomen and flanks to see if there is tenderness near the kidney. In women, the sympt...
Prognosis
- Most patients with uncomplicated cases of pyelonephritis find that their symptoms begin to improve after one to two days of treatment with antibiotics. However, even after symptoms improve, antibiotics are usually prescribed to complete a 10 to 14 day course.
Further Information
- To help prevent pyelonephritis if you have had a previous episode or are at risk: 1. Drink several glasses of water each day. Water discourages the growth of infection-causing bacteria by flushing out your urinary tract. This flushing also helps to prevent kidney stones, which can increase the risk of pyelonephritis. 2. If you are a woman, wipe from front to back. To prevent the spread of in…