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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.


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

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.


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.


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

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