Pyelonephritis is a bacterial infection of the kidney that can be life-threatening if not properly treated. Common symptoms include fever over 103°F, flank or back pain, nausea, and sometimes gross hematuria. Diagnosis involves urine tests to check for white blood cells, nitrites, and blood. Treatment requires antibiotic therapy tailored to the specific bacteria based on urine culture results, with hospitalization for intravenous antibiotics if the infection is severe or complicated by other factors.

1. Pyelonephritis
By O. A

2. Defn
• Acute pyelonephritis is a bacterial infection of the kidney parenchyma
that can be organ- and/or life-threatening and that often leads to
scarring of the kidney. The bacteria in these cases have usually
ascended from the lower urinary tract, but may also reach the kidney
via the bloodstream. Timely diagnosis and management of acute
pyelonephritis has a significant impact on patient outcomes.[1,

3. Signs and symptoms
• Fever - This is not always present, but when it is, the temperature
often exceeds 103°F (39.4°C)
• Costovertebral angle pain - Pain may be mild, moderate, or severe;
flank or costovertebral angle tenderness is most commonly unilateral
over the involved kidney, although bilateral discomfort may be
present
• Nausea and/or vomiting - These vary in frequency and intensity, from
absent to severe; anorexia is common in patients with acute
pyelonephritis

4. • Gross hematuria (hemorrhagic cystitis), unusual in males with
pyelonephritis, occurs in 30-40% of females, most often young
women, with the disorder.

5. Diagnosis
• Dipstick leukocyte esterase test (LET) - Helps to screen for pyuria
• Nitrite production test (NPT) - To screen for bacteriuria
• Examination for hematuria (gross and microscopic) and proteinuria

6. Management
• Antibiotic therapy is essential in the treatment of acute
pyelonephritis and prevents progression of the infection. Urine
culture and sensitivity testing should always be performed, and
empirical therapy should be tailored to the infecting uropathogen.[3]
• Patients presenting with complicated pyelonephritis should be
managed as inpatients and treated empirically with broad-spectrum
parenteral antibiotics.

7. • Outpatient treatment is appropriate for patients who have an
uncomplicated infection that does not warrant hospitalization.
Treatment can be with a single dose of a parenteral antibiotic
followed by oral therapy, provided that the patient is monitored
within the first 48 hours.

8. • Supportive care
• Monitoring of urine and blood culture resultsMonitoring of comorbid
conditions for deterioration
• Maintenance of hydration status with IV fluids until hydration can be
maintained with oral intake
• IV antibiotics until defervescence and significant symptomatic
improvement occur; convert to an oral regimen tailored to urine or
blood culture results

9. • In addition to antibiotics, surgery may be necessary