Pyelonephritis

In approximately 1 out of every 30 UTIs, infection ascends to the kidneys – we call this pyelonephritis ("pyelo" refers to the renal pelvis, from the Greek word for trough or basin). Frequent, urgent urination with burning sensation. Fever with chills, flank and abdominal pain, nausea and vomiting, and tenderness in the costovertebral angle – this is the area between the 12th rib and the spine, posteriorly, where the kidney sits. Hospitalization indicated when patients cannot maintain oral hydration, have persistently high fever (101 degrees F or higher), signs of toxicity, sepsis, or immune compromise. May have history of recent urinary tract infection. E.coli, Proteus, Klebsiella, Enterobacter, Pseudomonas, E. faecalis, S. aureus. Read more about bacterial causes of urinary tract infections. Complete blood cell count: Leukocytosis Urinary analysis: pyuria, bacteriuria, hematuria. Possible white cell casts. Urine culture: causative pathogen. Hospitalized - IV for 14 days:

• Ampicillin, Ceftriaxone, Ciprofloxacin

Non-Hospitalized IV x 1

• Ceftriaxone, Ciprofloxacin, Gentamicin

Followed by one of these oral options:

• Ciprofloxacin (2x day/7 days)
• Levofloxacin (1x day/5 days)
• Trimethoprim-sulfamethoxazole (2xday/14 days)

Chronic pyelonephritis can occur when kidney infections are persistent or recurrent; this can lead to inflammation and fibrosis. Chronic pyelonephritis is more likely to occur in patients with anatomic anomalies, for example, in children with ureterovesical reflux (urine moves "backwards" from the bladder to the ureters, usually due to a valve defect).