It is important to seek medical care quickly if you think you have a kidney infection. Although the urinary system is designed to keep bacteria out, problems can occur. Escherichia coli E. These bacteria can travel up into the bladder. When this happens it can cause cystitis inflammation of the bladder. It can also cause a urinary tract infection UTI. If the infection continues up to the kidneys, it can cause kidney infection.
This problem is rare but it can be severe. About 1 in every 30 cases of UTI leads to a kidney infection. You are more likely to get a kidney infection if you have frequent bladder infections or have a structural problem in the urinary tract. Urine normally flows only in one direction—from the kidneys to the bladder.
If the flow of urine is blocked or flows in the wrong direction, infections can happen. Urine flow can be blocked by many things, including:. People with diabetes or a weak immune system are at high risk for infections. Pregnant women with UTIs should be seen by their health care provider and treated as soon as possible. A kidney infection in a pregnant woman can be very serious. Many problems in the pelvis and abdomen can cause symptoms that look like kidney infection. Your doctor will also look for problems that can cause kidney infection, such as kidney stones or birth defects.
These things can be treated to prevent future infections. Your treatment will be based on a clear diagnosis of the problem. Kidney infections are treated with antibiotics. This medicine is offered as a pill to be taken at home. If the infection is very bad, or if the patient is vomiting, then you may need to go to a hospital to get antibiotics in your vein IV. To heal the infection and stop it from returning, it is common to get two or more weeks of antibiotics. If it does, two more weeks of medicine is offered.
If the resistance rate exceeds 10 percent, an initial intravenous dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen. Several antibiotic regimens can be used for inpatient treatment, including fluoroquinolones, aminoglycosides, and cephalosporins.
Abstract Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidney most often seen in young adult women. Publication types Review. Initial treatment of women with acute pyelonephritis who require hospitalization should include an intravenous antimicrobial regimen, such as a fluoroquinolone, an aminoglycoside with or without ampicillin , an extended-spectrum cephalosporin or penicillin with or without an aminoglycoside , or a carbapenem.
By definition, acute pyelonephritis is an infection of the renal pelvis and kidney that usually results from ascent of a bacterial pathogen up the ureters from the bladder to the kidneys. It is estimated that acute pyelonephritis accounts for approximately , office visits and , hospital admissions each year in the United States, and approximately 11 hospitalizations per 10, Canadian women each year.
Accordingly, this review focuses on diagnosis and treatment of acute pyelonephritis in nonpregnant women. In 80 percent of acute pyelonephritis cases, Escherichia coli is the responsible pathogen in women, although it is not as common in older persons. The spectrum of pathogens involved in acute pyelonephritis is similar to that of cystitis but with a lower frequency of Staphylococcus saprophyticus Table 1 4.
Other Enterobacteriaceae e. Information from reference 4. During the previous decade, community-acquired bacteria particularly E. The most common risk factors for contracting these uropathogens include visits to health care centers, recent use of antimicrobial agents particularly cephalosporins and fluoroquinolones , older age, and presence of comorbid conditions, such as diabetes mellitus and recurrent urinary tract infections UTIs. Risk factors for acute pyelonephritis in nonpregnant women include sexual intercourse three or more times per week during the previous 30 days, UTIs in the previous 12 months, diabetes, stress incontinence in the previous 30 days, a new sex partner in the previous year, recent spermicide use, and a history of UTIs in the patient's mother.
Uncomplicated acute pyelonephritis typically occurs in healthy, young women without structural or functional urinary tract abnormalities and without relevant comorbidities. Complicated acute pyelonephritis occurs in patients with a structurally or functionally abnormal genitourinary tract, or a predisposing medical condition. Compared with uncomplicated acute pyelonephritis, complicated acute pyelonephritis is characterized by a broader spectrum of clinical presentations, a wider variety of infecting organisms including a greater likelihood of antimicrobial resistance , and a greater risk of progression to a complication, such as intrarenal or perinephric abscess or emphysematous pyelonephritis.
History and physical examination are the most helpful tools for diagnosing acute pyelonephritis Table 2 Physicians should consider acute pyelonephritis in women presenting with lower urinary tract symptoms e. Flank pain is nearly universal in patients with acute pyelonephritis; its absence should raise suspicion of an alternative diagnosis. On physical examination, the key finding is tenderness to palpation of the costovertebral angle.
Patients with nephrolithiasis and ureterolithiasis, which also cause flank pain, do not usually present with costovertebral angle tenderness. Urinalysis showing positive leukocyte esterase test, microscopic pyuria or hematuria, or white blood cell casts. Information from reference Fever greater than Fever may also be absent in frail, older persons or in immunocompromised persons, who also may not exhibit other classic manifestations of acute pyelonephritis.
Physicians should consider other disorders that may arise from or mimic acute pyelonephritis Table 3 Intrarenal and perinephric abscesses, which usually are complications of acute pyelonephritis, are more common than emphysematous pyelonephritis, which is a necrotizing infection that produces intraparenchymal gas within the kidney that is identifiable by renal imaging. Additional complications of acute pyelonephritis that may benefit from urologic or infectious disease subspecialty consultation are listed in Table 4.
Previous antibiotic treatment, although not diagnostically relevant, is important to consider when choosing a treatment regimen. For this reason, it should be included in the patient history when considering acute pyelonephritis. Most cases of uncomplicated acute pyelonephritis can be managed in the outpatient setting. However, patients who appear ill may have severe pyelonephritis or a complication of acute pyelonephritis and should be considered for hospitalization and further evaluation Table 5 The possibility of urinary obstruction or an alternative diagnosis should be considered in these patients.
Comorbid conditions e. Urine dipstick testing, microscopic urinalysis, or both are commonly used in diagnosing UTI, including acute pyelonephritis. Most women with acute pyelonephritis have marked pyuria or a positive leukocyte esterase test, which often is accompanied by microscopic hematuria or a positive heme dipstick test. In contrast, gross hematuria is rare in patients with acute pyelonephritis and is more common in patients with acute uncomplicated cystitis. The presence of white blood cell casts indicates renal-origin pyuria, supporting the diagnosis of acute pyelonephritis, but casts are not often seen.
All patients with suspected acute pyelonephritis should have a urine culture and antimicrobial susceptibility testing to guide possible adjustment of the initial antimicrobial regimen if there is no improvement and selection of step-down oral therapy for patients treated initially with intravenous therapy. A midstream urine specimen after proper cleansing of the vulva is often recommended.
Several studies, however, found no significant differences in the number of contaminated or unreliable culture results when voided urine specimens were collected with or without preparatory cleansing.
Studies have shown no differences in colony counts or organisms between samples collected by catheterization versus midstream voiding.
More than 95 percent of women with uncomplicated acute pyelonephritis will have greater than 10 5 colony-forming units of a single gram-negative organism per mL of urine. If gram-positive cocci are observed, Enterococcus species or S. Posttreatment urinalysis and urine culture are unnecessary in patients who are asymptomatic after therapy. However, repeat urine culture is advised if symptoms do not improve substantially within two to three days of initiation of therapy, or if symptoms recur within two weeks of treatment.
These patients should also undergo urinary tract imaging. Most women with acute pyelonephritis do not need imaging studies unless symptoms do not improve or there is a recurrence. Although renal ultrasonography and magnetic resonance imaging are sometimes used, computed tomography with contrast media is considered the imaging modality of choice for nonpregnant women.
Abdominal computed tomography with intravenous contrast media in a patient with acute pyelonephritis demonstrates a large right perinephric abscess crescentic low-density collection identified by arrow.
Reprinted with permission from Tanagho E. Radiography of urological infections. Smith's General Urology. Because of the risk of contrast nephropathy, caution is needed when administering contrast media to patients taking metformin Glucophage or to those with renal insufficiency.
However, patients with acute pyelonephritis and an acutely elevated baseline serum creatinine level may sometimes warrant computed tomography imaging as part of the evaluation to look for obstruction. Blood cultures are commonly obtained from patients with acute pyelonephritis who are ill enough to warrant hospital admission, although they may not routinely be necessary in patients with uncomplicated acute pyelonephritis.
Because urine culture yields a causative organism in almost all cases of acute pyelonephritis, a positive blood culture is diagnostically redundant. However, blood cultures may be the only method of identifying the causative organism in cases of suspected acute pyelonephritis that turn out to be another disorder, such as endometritis, intraabdominal or psoas abscess, or cholangitis. There is no evidence that patients with a positive blood culture should be treated differently from those with negative blood cultures with respect to agent, route, or duration of antimicrobial therapy; hospital admission; or length of hospital stay if admitted to the hospital.
The baseline evaluation of acute pyelonephritis should include a basic metabolic panel, most importantly to assess renal function. If the diagnosis is not clear, other laboratory tests e. In , the Infectious Diseases Society of America updated its guidelines on the treatment of acute uncomplicated cystitis and pyelonephritis in women. When choosing an antibiotic, physicians should consider the effectiveness, risk of adverse effects, and resistance rates in the local community.
Regardless of which antibiotic is chosen for initial empiric therapy, the regimen should be revised as necessary after urine culture susceptibility results are available. Children with UTIs often have fever, pain, and symptoms related to the urinary tract. A doctor should address these symptoms immediately before they can develop into pyelonephritis. Most children can be treated with oral antibiotics in an outpatient manner.
Learn more about UTIs in children. A possible complication of acute pyelonephritis is chronic kidney disease. If the infection continues, the kidneys may be permanently damaged.
This can result in a potentially deadly infection called sepsis. Pyelonephritis can be a serious condition. Contact your doctor as soon as you suspect that you have pyelonephritis or a UTI. This condition requires prompt medical attention, so the earlier you start treatment, the better. But certain kinds of E. Learn about the symptoms and causes of kidney infection, plus how this potentially serious condition is treated. During acute kidney failure, kidneys lose their filtering ability and body fluids can rise to dangerous levels.
Learn what causes this condition and…. Read about the causes of abdominal pain and painful urination, which include STIs, kidney stones, cancer, and more. Acute pyelonephritis is a bacterial infection of the kidneys, which affects 1 to 2 percent of pregnant women. Urinary tract infections UTIs are very common in children. Health Conditions Discover Plan Connect. Pyelonephritis Medically reviewed by Suzanne Falck, M. Symptoms Causes Risk factors Diagnosis Treatment Pregnancy In children Complications Prevention Understanding pyelonephritis Acute pyelonephritis is a sudden and severe kidney infection.
What are the symptoms? What are the causes?
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