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Chronic Pyelonephritis Treatment & Management

  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Dec 06, 2015
 

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.[17]

Renal ultrasonography is recommended for siblings of patients with VUR.[18] If an abnormality is found, then perform a voiding cystourethrogram (VCUG).

 
 
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, Central Society for Clinical and Translational Research

Disclosure: Partner received salary from Alexion for employment.

Coauthor(s)

Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College

Chike Magnus Nzerue, MD, FACP 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, National Kidney Foundation

Disclosure: Nothing to disclose.

Anupama Gowda, MBBS, MD Consulting Staff, Peachtree Nephrology, PC

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

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
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