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Pyelonephritis: Information on Causes, Diagnosis & Treatments

Infection Bladder Ureter Kidneys Pyelonephritis is a urinary tract infection that usually starts in the bladder or urethra before traveling to the kidneys. The infection requires immediate medical attention. Without treatment, the infection in the kidney can cause permanent damage or can spread to the bloodstream and develop into a life-threatening infection. Doctors typically treat this and other kidney infections using antibiotics. However, a case of pyelonephritis usually requires hospitalization.

Acute pyelonephritis comes on suddenly where the kidneys begin to swell. If the kidneys are persistently and repeatedly attacked, doctors consider this a chronic form of the infection. Though rare, chronic pyelonephritis tends to occur more and children and individuals who suffer from a urinary obstruction. Receiving a diagnosis during its initial acute stage can greatly impact the patient's prognosis (outcome).

Who Is at Risk for Pyelonephritis?

The infection in the kidneys usually develops in the urinary tract in the urethra, before it enters the bladder. The infection can multiply quickly and travel to other areas in the body through the bloodstream. Kidney infections are extremely dangerous for individuals with an artificial heart or joint valve.

While anyone can develop pyelonephritis, there are known risk factors that increased the potential risk of developing kidney infections. This includes:

  • Gender – Women have an elevated risk of developing kidney infections compared to men due to their anatomy. The female urethra is significantly shorter than the male urethra, minimizing the distance bacteria can travel from the opening of the urethra into the bladder. Once the infection has reached the bladder and can easily spread the kidneys.

  • Pregnancy – Being pregnant can increase the risk of developing kidney disease.

  • Urinary Tract Obstruction – Any obstruction that restricts the flow of urine or does not allow the bladder to completely empty while urinating can cause a kidney infection. This could include a kidney stone or a urinary system structural abnormality. Men with enlarged prostate glands are also at risk of developing kidney infections.

  • Weakened Immune System – An immune system compromised by a medical condition like HIV or diabetes can increase the potential risk of the individual developing kidney infections. Specific medications including anti-rejection drugs taken by organ transplantation can also produce kidney infections.

  • Bladder Nerve Damage – Any damage the spinal cord or nervous system and block bladder sensations and lead to an infection that could travel to the kidneys.

  • Extended Urinary Catheter Use – Individuals with urinary catheter tubes that allow the bladder to drain urine continuously are at risk of kidney infections, especially when used continuously while bedridden.

  • Vesicoureteral Reflux – Individuals who suffer from vesicoureteral reflux experience tiny amounts of urine that back up from the bladder into the ureters and kidneys. Often, the individuals with vesicoureteral reflux who suffer kidney infections during childhood have a higher potential risk of developing kidney infections in their later years through adulthood.


If a case of pyelonephritis his left untreated, infection to the kidneys can cause potentially serious complications involving:

  • Septicemia (blood poisoning) – The function of the kidneys is to filter waste out of the bloodstream before returning the blood to flow through the rest of the body. If the kidneys are infected, the bacterial infection can easily spread as the blood circulates, leading to septicemia.

  • Permanent Kidney Damage – Individuals who suffer from creek chronic kidney disease can develop an infection that eventually causes permanent kidney damage.

  • Complications with Pregnancy – Any kidney infection occurring during pregnancy can increase the woman's potential of delivering a baby with a low birth weight.

Common Symptoms

Individuals with any of the signs and symptoms listed below should make an appointment to see the doctor to ensure they receive quick treatment if a urinary tract infection is present. This is because a severe kidney infection can often result in a life-threatening complication.

The most common symptoms associated with pyelonephritis include:

  • Frequent urination

  • Pain in the abdomen

  • Fever

  • Hematuria (blood or pus in the urine)

  • Groin pain

  • Flank (side) and back pain

  • Persistent urge to urinate

  • Pain or burning sensation during urination

  • Cloudy or smelly urine

It is essential to obtain immediate medical attention at the first sign of a kidney infection, especially when experiencing vomiting, nausea, or bloody urine.

Diagnosing Pyelonephritis

Diagnosing Pyelonephritis is relatively straightforward. The doctor will perform a comprehensive physical examination to identify common symptoms, tenderness in the abdominal region, or a fever. If in a faction is suspected, the doctor typically orders a urine test. The results of the test can provide information on the cause, blood, a bacterial concentration in the urine. Other tests might involve:

  • Laboratory Tests including urinalysis and urine cultures can help identify the presence of an infection. The sample of urine can be viewed under a microscope and identify white blood cells and bacteria. A urine culture can identify the type of bacteria and is effective at assisting the doctor in determining the best treatment for an ideal outcome.

  • Imaging – Using x-ray technology and ultrasound equipment, the doctor can quickly identify tumors, cysts or other obstructions that are blocking the patient's urinary tract. If the patient is given the treatment that is ineffective after 72 hours, the doctor may order a CT (computerized tomography) scan that might or might not require an injectable dye to identify urinary tract obstructions.

  • Radioactive Imaging – The doctors may order a DMSA (dimercaptosuccinic acid) test if they suspect a kidney infection (pyelonephritis) has caused scarring. The results of the imaging test are acquired by injecting radioactive material, usually through a vein in the arm. The radioactive material will make its way to the kidneys before being scanned to reveal scarred or infected areas in the organ.

Pyelonephritis Treatments

The first recommendation the doctor will provide a patient suffering from pyelonephritis is to take antibiotics to alleviate the symptoms and cure the acute condition. However, there are different types of antibiotics and not all are effective at treating the type of infection in the kidney and urinary tract. If the correct bacteria cannot be isolated, the doctor will likely prescribe a broad-spectrum antibiotic.

  • Antibiotics – The most common antibiotics that are prescribed for treating kidney infections include:
    • ampicillin

    • ciprofloxacin

    • levofloxacin

    • cotrimoxazole
  • Hospitalization – If a course of antibiotics proves to be ineffective, the patient will likely be admitted to the hospital before the condition becomes severe. The amount of time the patient will stay in a hospital will be based on the severity of the kidney infection and how while the patient responds to the appropriate treatment. However, antibiotics are usually given intravenously for up to two days while the doctor and medical team monitor urine and blood to see the response the infection as having from the antibiotics.

  • Surgical Options – Recurrent cases of pyelonephritis often develop because of an underlying medical issue. In these cases, the doctor will likely recommend a surgical procedure to correct a structural problem with the kidneys or remove an obstruction restricting urination. Other surgical procedures can drain an abscess in the kidney that is not responding to antibiotics.

The most severe cases of pyelonephritis, the doctor may recommend a nephrectomy where a portion of the kidney is removed to minimize a life-threatening condition caused by the rapid growth of bacterial infection.


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