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Pyelonephritis

Dana G. Carroll, BCGP, CDCES, BCPS, PharmD, Randi Cheree Melton, DO and Jacquelynn Parks Luker, MD Reviewed 04/2024
 


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 (older adults)

  • In infants...

TREATMENT

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

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

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Adults & Children: Patients treated in the outpatient setting should have follow-up at 48-72 hours to evaluate for improvement and consideration of further ev...

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 treatment: systematic revi...

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

  • Urine culture is helpful for targeting antibiotic therapy and should be obtained when possible.

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

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