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Pyelonephritis

Katelin M. Lisenby, PharmD, BCPS, Dana G. Carroll, PharmD, BCPS, CDE, BCGP and Catherine Scarbrough, MD, MSc, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A syndrome caused by infection of the renal parenchyma and/or renal pelvis, often producing localized flank/back pain combined with systemic symptoms, such as fever, chills, and naus...

DIAGNOSIS

HISTORY

  • In adults

    • Fever; flank pain

    • Nausea ± vomiting

    • Malaise, anorexia

    • Myalgia

    • Dysuria, urinary frequency, urgency

    • Suprapubic discomfort

    • Mental status changes (elderly)

  • In infants and children

    • Fever

    • I...

TREATMENT

  • ≤7 days of treatment is equivalent to longer regimens in adults (including those with bacteremia) without urogenital abnormalities (2),(3),(4)[A].

  • IV antibiotics for inpatients who are toxic ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Women: routine follow-up cultures not recommended unless symptoms recur after 2 weeks and then urologic evaluation is necessary

  • Men, children, adolescents, patient...

REFERENCES

1
Ninan S, Walton C, Barlow G. Investigation of suspected urinary tract infection in older people. BMJ.  2014;349:g4070. [View Abstract on OvidMedline]
2
Eliakim-Raz N, Yahav D, Paul M, e...

ADDITIONAL READING

  • Goel RH, Unnikrishnan R, Remer EM. Acute urinary tract disorders. Radiol Clin North Am.  2015;53(6):1273–1292. [View Abstract on OvidMedline]

  • Noelle L. Urinary tract infections ...

CODES

ICD10

  • N12 Tubulo-interstitial nephritis, not spcf as acute or chronic

  • N10 Acute tubulo-interstitial nephritis

  • N11.9 Chronic tubulo-interstitial nephritis, unspecified

  • N11.8 Other chronic tubulo-inte...

CLINICAL PEARLS

  • Pyelonephritis can present with isolated confusion or mental status changes (no fever) in the elderly.

  • The most common causes of poor response to treatment are antibiotic resistance and...

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