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Pyelonephritis

Pyelonephritis
Other namesKidney infection[1]
A color photomicrograph, demonstrating macrophages and giant cells in a case of xanthogranulomatous pyelonephritis.
CD68 immunostaining on this photomicrograph shows macrophages and giant cells in a case of xanthogranulomatous pyelonephritis
Pronunciation
SpecialtyInfectious disease, urology, nephrology
SymptomsFever, flank tenderness, nausea, burning with urination, frequent urination[2]
CausesBacterial infection[2]
Risk factorsSexual intercourse, prior urinary tract infections, diabetes, structural problems of the urinary tract, spermicide use[2][3]
Diagnostic methodBased on symptoms and supported by urinalysis[2]
Differential diagnosisEndometriosis, pelvic inflammatory disease, kidney stones[2]
PreventionUrination after sex, drinking sufficient fluids[1]
MedicationAntibiotics (ciprofloxacin, ceftriaxone)[4]
FrequencyCommon[5]

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection.[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] Risk factors include sexual intercourse, prior urinary tract infections, diabetes, structural problems of the urinary tract, and spermicide use.[2][3] The mechanism of infection is usually spread up the urinary tract.[2] Less often infection occurs through the bloodstream.[1] Diagnosis is typically based on symptoms and supported by urinalysis.[2] If there is no improvement with treatment, medical imaging may be recommended.[2]

Pyelonephritis may be preventable by urination after sex and drinking sufficient fluids.[1] Once present it is generally treated with antibiotics, such as ciprofloxacin or ceftriaxone.[4][6] Those with severe disease may require treatment in hospital.[2] In those with certain structural problems of the urinary tract or kidney stones, surgery may be required.[1][3]

Pyelonephritis affects about 1 to 2 per 1,000 women each year and just under 0.5 per 1,000 males.[5][7] Young adult females are most often affected, followed by the very young and old.[2] With treatment, outcomes are generally good in young adults.[3][5] Among people over the age of 65 the risk of death is about 40%, though this depends on the health of the elderly person, the precise organism involved, and how quickly they can get care through a provider or in hospital.[5]

  1. ^ a b c d e "Kidney Infection (Pyelonephritis)". NIDDK. April 2017. Archived from the original on 4 October 2017. Retrieved 30 October 2017.
  2. ^ a b c d e f g h i j k l m n Colgan R, Williams M, Johnson JR (September 2011). "Diagnosis and treatment of acute pyelonephritis in women". American Family Physician. 84 (5): 519–526. PMID 21888302.
  3. ^ a b c d e f Lippincott's Guide to Infectious Diseases. Lippincott Williams & Wilkins. 2011. p. 258. ISBN 9781605479750. Archived from the original on 2017-11-05.
  4. ^ a b "Antibiotic therapy for acute uncomplicated pyelonephritis in women. Take resistance into account". Prescrire International. 23 (155): 296–300. December 2014. PMID 25629148.
  5. ^ a b c d Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1097. ISBN 9780323529570. Archived from the original on 2017-11-05.
  6. ^ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. (March 2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clinical Infectious Diseases. 52 (5): e103–e120. doi:10.1093/cid/ciq257. PMID 21292654.
  7. ^ Lager DJ, Abrahams N (2012). Practical Renal Pathology, A Diagnostic Approach E-Book: A Volume in the Pattern Recognition Series. Elsevier Health Sciences. p. 139. ISBN 978-1455737864. Archived from the original on 2017-11-05.

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