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Kidney infection (pyelonephritis)
Alternative namesUrinary tract infection - complicated; Infection - kidney; Complicated urinary tract infection; Pyelonephritis
DefinitionPyelonephritis is an infection of the kidney and the ducts that carry urine away from the kidney (ureters).
Causes, incidence, and risk factors
Pyelonephritis most often occurs as a result of urinary tract infection , particularly in the presence of occasional or persistent backflow of urine from the bladder into the ureters or kidney pelvis ( vesicoureteric reflux ).
Pyelonephritis can be further classified as follows:
Although cystitis ( bladder infection ) is common, pyelonephritis occurs much less often. The risk is increased if there is a history of cystitis, renal papillary necrosis , kidney stones , vesicoureteric reflux, or obstructive uropathy .
The risk is also increased when there is a history of chronic or recurrent urinary tract infection and when the infection is caused by a particularly aggressive type of bacteria.
Signs and testsAn examination may show tenderness on palpation (pressing) over the kidney.
The goals of treatment are control of the infection and reduction of symptoms. Acute symptoms usually resolve within 48 to 72 hours after appropriate treatment.
Due to the high mortality rate in the elderly population and the risk of permanent kidney damage , prompt treatment is recommended.
Chronic pyelonephritis may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include the following:
In diabetic patients and pregnant women, as well as in people with spinal paralysis, follow-up should include a urine culture at the completion of antibiotic therapy to ensure that bacteria are no longer present in the urine.
Expectations (prognosis)Most cases of pyelonephritis resolve without complication after the treatment. However, the treatment may need to be aggressive or prolonged. If sepsis (widespread blood infection) occurs, it can be fatal.
Calling your health care providerCall your health care provider if symptoms suggesting pyelonephritis occur.
If you have pyelonephritis, call your health care provider if new symptoms develop, especially decreased urine output , persistent high fever , or severe flank pain or back pain .
Prompt and complete treatment of cystitis ( bladder infection ) may prevent development of many cases of pyelonephritis. Chronic or recurrent urinary tract infection should be treated thoroughly because of the chance of infection of the kidneys.
Update Date: 7/30/2002Christopher Parsons, M.D., Department of Internal Medicine, Division of Infectious Diseases, University of Virginia, Charlottesville, VA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT