Pyelonephritis is a bacterial infection of the kidney, usually caused by bacteria such as E. coli climbing up from the bladder. Most patients do well with prompt antibiotics, but it can progress to sepsis or a kidney abscess.
Key symptoms
- Fever and chills
- Flank or back pain, usually on one side
- Nausea and vomiting
- Burning urination, urgency and frequency
- Feeling generally unwell
What you find on exam
- Fever and fast heart rate; check blood pressure for sepsis
- Tenderness at the costovertebral angle
- Abdominal exam to look for other causes
- Signs of dehydration
Tests
- Urinalysis: white cells, nitrites, sometimes white cell casts
- Urine culture before antibiotics
- Blood count, kidney function; blood cultures if very ill
- Pregnancy test in women who could be pregnant
- CT or ultrasound if severe, no better in 48 to 72 hours, or a stone is suspected
Treatment basics
- Antibiotics chosen by local resistance, such as ciprofloxacin or ceftriaxone, then adjusted to the culture
- Admit if vomiting, septic, pregnant or not improving
- IV fluids, pain and fever control
- Urgent drainage of an obstructed, infected kidney
Red flags
- Low blood pressure or confusion
- No improvement after 48 to 72 hours of antibiotics
- Pregnancy, a single kidney or a blocked urinary tract
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.