Acute Pyelonephritis Questions & Answers

Updated: Jun 14, 2019
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Questions & Answers

Overview

What is acute pyelonephritis (kidney infection)?

What are the signs and symptoms of acute pyelonephritis (kidney infection)?

What is the occurrence of gross hematuria (hemorrhagic cystitis) in acute pyelonephritis (kidney infection)?

What is the initial course of symptoms of acute pyelonephritis (kidney infection)?

What are the signs and symptoms of acute pyelonephritis (kidney infection) in children?

What are the signs and symptoms of acute pyelonephritis (kidney infection) in elderly patients?

How is acute pyelonephritis (kidney infection) diagnosed?

What is the role of urinalysis in the diagnosis of acute pyelonephritis (kidney infection)?

When is urine culture indicated in patients with acute pyelonephritis (kidney infection)?

What is the role of imaging studies in the assessment of acute pyelonephritis (kidney infection)?

How is acute pyelonephritis (kidney infection) managed?

How is complicated pyelonephritis (kidney infection) managed?

When is outpatient care indicated for the treatment of acute pyelonephritis (kidney infection)?

What is included in the inpatient care for acute pyelonephritis (kidney infection)?

When is surgery indicated in the management of pyelonephritis (kidney infection)?

What is acute pyelonephritis (kidney infection)?

What is the incidence of acute pyelonephritis (kidney infection)?

Which factors make diagnosis and management of acute pyelonephritis (kidney infection) challenging?

What are the signs and symptoms of acute pyelonephritis (kidney infection)?

How is pyelonephritis identified in women?

What is the presentation of acute pyelonephritis (kidney infection) in elderly patients and infants?

Which signs and symptoms are both sensitive and specific for the diagnosis of acute pyelonephritis (kidney infection)?

What are the effective antibiotic options and therapy duration for acute pyelonephritis (kidney infection)?

Can acute pyelonephritis (kidney infection) be managed successfully on an outpatient basis?

What is complicated pyelonephritis (kidney infection) and how should it be managed?

What is the pathophysiology of acute pyelonephritis (kidney infection)?

What is the role of uropathogenic E coli (UPEC) in the pathogenesis of acute pyelonephritis (kidney infection)?

What is the role of mannose-resistant adhesins in the pathogenesis of acute pyelonephritis (kidney infection)?

What is the role of P fimbriae adhesins in the pathogenesis of acute pyelonephritis (kidney infection)?

What is the role of siderophores and protectins in the pathogenesis of acute pyelonephritis (kidney infection)?

Which toxins have a role in the pathogenesis of acute pyelonephritis (kidney infection)?

Which virulence factors promote the pathogenesis of acute pyelonephritis (kidney infection)?

What is the role of asymptomatic bacteriuria (ABU) strains in acute pyelonephritis (kidney infection)?

Which microorganisms are commonly isolated in acute pyelonephritis (kidney infection)?

What is the 2-step path in the pathogenesis of acute pyelonephritis (kidney infection)?

Which factors reduce the efficacy of antibiotics for complicated urinary tract infection (UTI)?

What is the role of obstruction in the pathogenesis of acute pyelonephritis (kidney infection)?

What is the role of staghorn calculi in acute pyelonephritis (kidney infection)?

What are the adverse effects of untreated staghorn calculi?

Which agent inhibits the growth of lactobacilli?

What predisposes the colonization of urinary tract pathogens in postmenopausal women?

What are the less common organisms in complicated urinary tract infection (UTI)?

What is the role of urea-splitting organisms in complicated urinary tract infection (UTI)?

What are possible complications of obstruction in urinary tract infection (UTI)?

How does pregnancy affect the pathophysiology of acute pyelonephritis (kidney infection)?

How does diabetes mellitus affect the pathophysiology of acute pyelonephritis (kidney infection)?

What is the etiology of acute pyelonephritis (kidney infection)?

What is the incidence of pyelonephritis (kidney infection) in the US?

What is the prevalence of acute pyelonephritis in pregnant women and infants and children?

What are the race-, sex-, and age-related predilections of acute pyelonephritis (kidney infection)?

Is there seasonal variation in the incidence of acute pyelonephritis (kidney infection)?

What is the prognosis of acute pyelonephritis (kidney infection)?

Does acute pyelonephritis (kidney infection) increase the risk of premature labor?

What are the possible morbidities of acute pyelonephritis (kidney infection)?

What are the mortality and morbidity rates in patients with acute pyelonephritis (kidney infection)?

What is the prognosis of uncomplicated pyelonephritis (kidney infection)?

When does pyelonephritis become a potentially fatal disease?

What are the mortality rates in emphysematous pyelonephritis and emphysematous pyelitis?

What is the mortality rate for patients with sepsis and acute pyelonephritis (kidney infection)?

Can acute pyelonephritis (kidney infection) cause acute renal failure (ARF)?

What is the prevalence of renal scarring in children with acute pyelonephritis (kidney infection)?

What is the prevalence of renal scarring in women with acute pyelonephritis (kidney infection)?

What are the possible complications of acute pyelonephritis (kidney infection) during pregnancy?

Does acute pyelonephritis (kidney infection) after renal transplantation increase the risk of graft failure?

How are antibiotics administered in patients with acute pyelonephritis (kidney infection)?

How does dehydration occur in patients with acute pyelonephritis?

Presentation

What is the typical presentation of acute pyelonephritis (kidney infection)?

What is the prevalence of gross hematuria (hemorrhagic cystitis) in patients with acute pyelonephritis (kidney infection)?

What is the presentation of pain in patients with acute pyelonephritis (kidney infection)?

How is fever characterized in patients with acute pyelonephritis (kidney infection)?

What is the presentation of GI symptoms in patients with acute pyelonephritis (kidney infection)?

What are the signs and symptoms of acute pyelonephritis (kidney infection) in children?

What is the presentation of acute pyelonephritis (kidney infection) in elderly patients?

Which history increases the risk of complicated pyelonephritis (kidney infection)?

What are the physical findings in patients with acute pyelonephritis (kidney infection)?

What are the physical findings of fever in patients with acute pyelonephritis (kidney infection)?

What are blood pressure findings in patients with acute pyelonephritis (kidney infection)?

Which abdominal exam findings indicate acute pyelonephritis (kidney infection)?

How is flank or costovertebral angle (CVA) tenderness characterized in patients with acute pyelonephritis (kidney infection)?

Which pelvic exam findings indicate acute pyelonephritis (kidney infection)?

In which patient groups is the risk for complication increased from acute pyelonephritis (kidney infection)?

What are the possible complications of acute pyelonephritis (kidney infection)?

Which abscesses may be present in patients with acute pyelonephritis (kidney infection)?

What is the presentation of corticomedullary abscess in acute pyelonephritis (kidney infection)?

What is the pathogenesis of corticomedullary abscess in patients with acute pyelonephritis represent?

What is the presentation of perinephric abscess in acute pyelonephritis (kidney infection)?

What is the prevalence of perinephric abscess in acute pyelonephritis (kidney infection)?

What is the pathogenesis of renal cortical abscess (renal carbuncle) in acute pyelonephritis (kidney infection)?

What is the presentation of renal cortical abscess (renal carbuncle) in acute pyelonephritis (kidney infection)?

What is emphysematous pyelonephritis?

What is emphysematous pyelitis (pneumopyonephrosis)?

What is emphysematous cystitis (cystitis emphysematosa)?

What is xanthogranulomatous pyelonephritis?

What is the presentation of TB in acute pyelonephritis (kidney infection)?

How is TB managed in patients with acute pyelonephritis (kidney infection)?

DDX

What are the differential diagnoses for Acute Pyelonephritis?

Workup

How is acute pyelonephritis (kidney infection) diagnosed?

When is acute pyelonephritis (kidney infection) easily diagnosed and when might it present with an insidious onset?

What is the role of imaging studies in the diagnosis of acute pyelonephritis (kidney infection)?

Which collection methods are used for urine specimens for acute pyelonephritis (kidney infection)?

When is a suprapubic needle aspiration for collecting a urine specimen indicated in the diagnosis of acute pyelonephritis (kidney infection)?

Who can perform a clean-catch technique for urine sample collection in acute pyelonephritis (kidney infection)?

How is the clean-catch technique for collecting urine specimen performed in female patients with acute pyelonephritis?

How is the clean-catch technique for collecting urine specimen performed in male patients with acute pyelonephritis (kidney infection)?

When is urethral catheterization for collecting a urine specimen indicated for diagnosis of acute pyelonephritis (kidney infection)?

How is pyuria defined?

Which tests are used for pyuria screening in the diagnosis of acute pyelonephritis (kidney infection)?

Which disorders should the included in the differential diagnosis acute pyelonephritis when gross hematuria (hemorrhagic cystitis) is present?

What is the presentation of microscopic hematuria in patients with acute pyelonephritis (kidney infection)?

What is the significance of a proteinuria finding in the urinalysis of patients with acute pyelonephritis (kidney infection)?

What does the presence of a single bacterium in an unspun urine specimen indicate in the evaluation of acute pyelonephritis (kidney infection)?

What is the role of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of acute pyelonephritis (kidney infection)?

When is a urine culture indicated in the evaluation of acute pyelonephritis (kidney infection)?

When is a blood culture indicated in the evaluation of acute pyelonephritis (kidney infection)?

What is the role of imaging studies in the diagnosis of acute pyelonephritis (kidney infection)?

What are the benefits of early imaging in acute pyelonephritis (kidney infection)?

When are imaging studies indicated in the evaluation of acute pyelonephritis (kidney infection)?

How are imaging studies used in the management of acute pyelonephritis (kidney infection)?

What is the imaging study of choice in the evaluation of acute pyelonephritis?

What is the role of noncontrast helical/spiral CT scanning in the evaluation of acute pyelonephritis (kidney infection)?

When is a noncontrast CT scan of the kidneys, ureters, and bladder (KUB) or a CT urogram indicated in the evaluation of acute pyelonephritis (kidney infection)?

Which CT scan findings indicate complications of acute pyelonephritis?

What is the role of MRI in the evaluation of acute pyelonephritis (kidney infection)?

What is the role of ultrasonography (US) in the evaluation of acute pyelonephritis (kidney infection)?

Which ultrasonography (US) findings indicate complications of acute pyelonephritis?

What are the disadvantages of diagnostic ultrasonography (US) for acute pyelonephritis and when is renal angiography indicated?

What is the role of scintigraphy in the evaluation of acute pyelonephritis (kidney infection)?

What is the role of CT urography or MR urography in the evaluation of acute pyelonephritis (kidney infection)?

Which studies are helpful in the diagnosis of papillary necrosis in acute pyelonephritis (kidney infection)?

Which findings suggest early renal papillary necrosis in acute pyelonephritis (kidney infection)?

What are the histologic findings of acute pyelonephritis (kidney infection)?

Treatment

When is outpatient therapy indicated for acute pyelonephritis?

What is the role of analgesics in the treatment of acute pyelonephritis (kidney infection)?

When is hospitalization indicated for the treatment of acute pyelonephritis (kidney infection)?

When is emergency surgery indicated for acute pyelonephritis (kidney infection)?

When is elective surgery indicated for acute pyelonephritis (kidney infection)?

How is antibiotic selection guided for acute pyelonephritis (kidney infection)?

Which antibiotics should be used to treat community-acquired acute pyelonephritis (kidney infection)?

Which antibiotics should be used to treat enterococcal infections in hospitalized and other institutionalized patients with acute pyelonephritis (kidney infection)?

Which factors should be considered when choosing an empirical antibiotic regimen for acute pyelonephritis (kidney infection)?

Is oral administration of antibiotics more effective than other regimens for the treatment of acute pyelonephritis (kidney infection)?

When is oral therapy indicated for the treatment of acute pyelonephritis (kidney infection)?

What are the IDSA recommendations for inpatient treatment of women with pyelonephritis (kidney infection)?

When should the empirical use of TMP-SMZ be avoided for treatment of acute pyelonephritis (kidney infection)?

Which antibiotics are used for the treatment of complicated acute pyelonephritis (kidney infection)?

What is the efficacy of antibiotic therapy for acute pyelonephritis treatment?

What is the IDSA recommendation for duration of antibiotic therapy for acute pyelonephritis?

When is outpatient treatment indicated for acute pyelonephritis?

What are the IDSA recommendations for management of a female patient suspected of having acute pyelonephritis (kidney infection)?

What is the role of fluoroquinolones in the treatment of acute pyelonephritis?

What are the IDSA recommendations for treatment of fluoroquinolone-resistant acute pyelonephritis (kidney infection)?

Which factors increase the risk of fluoroquinolone-resistant E coli infection in patients with acute pyelonephritis (kidney infection)?

When is IV hydration indicated for the management of acute pyelonephritis?

When is reevaluation of acute pyelonephritis indicated?

What are the supportive care options for acute pyelonephritis (kidney infection)?

When is follow-up testing indicated in the management of acute pyelonephritis?

Should activity be restricted during recovery from acute pyelonephritis (kidney infection)?

Which factors should be considered in the admission decision for patients with acute pyelonephritis (kidney infection)?

Which complicating factors are indications for admission of patients with acute pyelonephritis (kidney infection)?

Which patients with uncomplicated pyelonephritis (kidney infection) should be admitted for inpatient treatment?

What should be included in inpatient treatment of acute pyelonephritis (kidney infection)?

What is the duration of inpatient antibiotic therapy for acute pyelonephritis (kidney infection)?

Which factors should be considered in the selection of an antibiotic regimen for acute pyelonephritis (kidney infection) inpatient treatment?

What are the treatment options for abscesses in patients with acute pyelonephritis (kidney infection)?

When is surgical treatment of abscesses indicated in patients with acute pyelonephritis (kidney infection)?

What is included in the treatment of renal corticomedullary abscess in patients with acute pyelonephritis (kidney infection)?

What is the mortality rate for perinephric abscesses in patients with acute pyelonephritis (kidney infection)?

What is the treatment for calculi-related infections in patients with acute pyelonephritis (kidney infection)?

What are the advantages and disadvantages of phosphorus and magnesium supplements in the treatment of calculi-related infections in patients with acute pyelonephritis (kidney infection)?

What are the treatment options for renal papillary necrosis in patients with acute pyelonephritis (kidney infection)?

Which agents are used empirically to treat renal papillary necrosis in patients with acute pyelonephritis?

What is the duration of treatment for renal papillary necrosis in patients with acute pyelonephritis (kidney infection)?

What is the treatment of choice for xanthogranulomatous pyelonephritis?

Which factors increase the risk of pyelonephritis (kidney infection) during pregnancy?

What is the prevalence of bacteriuria and symptomatic urinary tract infection (UTI) during pregnancy?

What is the recommendation for urinary tract infection (UTI) screening in pregnant women?

Which regimens are used for the treatment of asymptomatic bacteriuria during pregnancy?

What is the treatment for pregnant women with acute pyelonephritis (kidney infection)?

What is the antibiotic regimen of choice for pregnant women with pyelonephritis (kidney infection)?

What therapy is recommended for prophylaxis against recurrent infection in pregnant women with acute pyelonephritis (kidney infection)?

When is immediate urologic referral indicated for pediatric acute pyelonephritis (kidney infection)?

Which children are at increased risk for complications of acute pyelonephritis (kidney infection)?

Why is follow-up exam essential in pediatric patients with acute pyelonephritis (kidney infection)?

Which imaging studies are preferred for the urologic evaluation of pediatric patients with acute pyelonephritis?

What are age-related data for pediatric patients with acute pyelonephritis (kidney infection)?

Are dietary restrictions needed for pediatric patients with acute pyelonephritis (kidney infection)?

Are activity restrictions needed for pediatric patients with acute pyelonephritis (kidney infection)?

What are the deterrence and prevention strategies for pyelonephritis (kidney infection)?

Which specialist consultations are indicated for acute pyelonephritis (kidney infection)?

Medications

What is the role of urine culture in the treatment of acute pyelonephritis (kidney infection)?

How should patients presenting with complicated pyelonephritis (kidney infection) be managed?

Which medications in the drug class Sulfonamides are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Fluoroquinolones are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Cephalosporins, Second Generation are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Cephalosporins, Third Generation are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Cephalosporins, Other are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Penicillins, Amino are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Penicillins, Extended-Spectrum are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Carbapenems are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Aminoglycosides are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Glycopeptides are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Monobactams are used in the treatment of Acute Pyelonephritis?

Which medications in the drug class Urinary Analgesics are used in the treatment of Acute Pyelonephritis?