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Pyelonephritis

Katelin M. Lisenby, BCPS, PharmD, Connie Leeper, MPH, MD and Dana G. Carroll, BCGP, CDCES, BCPS, PharmD Reviewed 06/2022
 


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, nausea a...

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

    • Fe...

TREATMENT

  • ≤7 days of treatment is equivalent to longer regimens in adults (including those with bacteremia) without urogenital abnormalities (1,2)[A].

  • IV antibiotics for inpatients who are toxic appea...

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
Eliakim-Raz  N, Yahav  D, Paul  M, et al. Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection—7 days or less versus longer ...

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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