Chronic Pyelonephritis Treatment & Management

  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Dec 6, 2011
 

Approach Considerations

VUR Stages I and II

This is reflux of urine to the ureter or renal pelvis without ureteral dilatation. Medical therapy with antibiotics, such as amoxicillin, trimethoprim/sulfamethoxazole (Bactrim), trimethoprim alone, or nitrofurantoin, is usually sufficient.

Continue antibiotic therapy until puberty or until reflux resolves. The rule in these cases is spontaneous resolution; surgery is not indicated.

VUR Stages III and IV (severe reflux)

Data from the Birmingham Reflux Study show that medical and surgical therapies for reflux are equally effective.[4] Surgery entails the reimplantation of the ureters, with the creation of an adequate submucosal tunnel and detrusor support. The following are indications for surgical therapy:

  • Failure to comply with medical regimen, with formation of new scars
  • Breakthrough infections occurring in patients who are compliant
  • Women of childbearing age who prefer surgical therapy
  • Reflux persisting after puberty in women - Should be surgically treated to prevent possible complications (eg, pyelonephritis, abortions in pregnancy)

VUR Stage V (severe reflux)

Surgery is recommended in all children older than 1 year with bilateral reflux with or without the presence of renal scarring. Patients aged 1-5 years with unilateral reflux and no scarring may initially be treated with antibiotic prophylaxis.

Deterrence/prevention

Progressive renal injury can be reduced by dietary protein restriction, while aggressive blood pressure control aids in slowing progression of renal failure. Angiotensin-converting enzyme (ACE) inhibitors are particularly beneficial in treating hypertension.

Careful follow-up and monitoring of renal function is beneficial. Vigorously treat a UTI or bacteriuria in a patient who is pregnant to prevent renal failure, preeclampsia, and abortions.[13]

Renal ultrasonography is recommended for siblings of patients with VUR.[14] If an abnormality is found, then perform a VCUG.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

James W Lohr, MD  Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Genzyme Honoraria Speaking and teaching

Coauthor(s)

Anupama Gowda, MBBS, MD  Consulting Staff, Atlanta Nephrology Associates, PC

Disclosure: Nothing to disclose.

Chike Magnus Nzerue, MD  Associate Dean for Clinical Affairs, Vice-Chairman of Internal Medicine, Meharry Medical College

Chike Magnus Nzerue, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Guarino N, Casamassima MG, Tadini B, et al. Natural history of vesicoureteral reflux associated with kidney anomalies. Urology. Jun 2005;65(6):1208-11. [Medline].

  2. Dillon MJ, Goonasekera CD. Reflux nephropathy. J Am Soc Nephrol. Dec 1998;9(12):2377-83. [Medline].

  3. Chand DH; Rhoades T; Poe SA; Kraus S; Strife CF. Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis. J Urol 2003 Oct [serial online]. 170(4 Pt 2):1548-50. Available at [Medline].

  4. Birmingham Reflux Study Group. Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years' observation. Birmingham Reflux Study Group. Br Med J (Clin Res Ed). Jul 25 1987;295(6592):237-41. [Medline].

  5. Köhler J, Tencer J, Thysell H, et al. Vesicoureteral reflux diagnosed in adulthood. Incidence of urinary tract infections, hypertension, proteinuria, back pain and renal calculi. Nephrol Dial Transplant. Dec 1997;12(12):2580-7. [Medline].

  6. Zermann DH, Loffler U, Reichelt O, et al. Bladder dysfunction and end stage renal disease. Int Urol Nephrol. 2003;35(1):93-7. [Medline].

  7. Alan C, Ataus S, Tunc B. Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol. 2004;36(4):489-93. [Medline].

  8. Gonzalez Resina R, Barrero Candau R, Arguelles Salido E, et al. [Xanthogranulomatous pyelonephritis in childhood. A case report]. Actas Urol Esp. Jun 2005;29(6):596-8. [Medline].

  9. Oosterhof GO, Delaere KP. Xanthogranulomatous pyelonephritis. A review with 2 case reports. Urol Int. 1986;41(3):180-6. [Medline].

  10. Saavedra Jo S, Pow-Sang Godoy M, Benavente Corrales V, et al. [Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics]. Arch Esp Urol. Jul-Aug 2004;57(6):595-600. [Medline].

  11. Zugor V, Amann K, Schrott KM, et al. [Xanthogranulomatous pyelonephritis: presentation of an unusual case]. Aktuelle Urol. Jun 2005;36(3):245-8. [Medline].

  12. Hiraoka M, Hori C, Tsukahara H, et al. Vesicoureteral reflux in male and female neonates as detected by voiding ultrasonography. Kidney Int. Apr 1999;55(4):1486-90. [Medline].

  13. Dracon M, Lemaitre L. [Urinary tract infection in adult. Leukocyturia]. Rev Prat. May 15 2003;53(10):1137-42. [Medline].

  14. Noe HN. The long-term results of prospective sibling reflux screening. J Urol. Nov 1992;148(5 Pt 2):1739-42. [Medline].

 
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