Pyelonephritis
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Synopsis
Pyelonephritis is an infection of the kidney. Most cases of pyelonephritis are caused by ascent of bacterial pathogens (usually gram-negative bacilli but occasionally gram-positive organisms such as Enterococcus species) from the bladder to the kidney.
Patients with abnormalities of the urinary tract (including children with vesicoureteral reflux) are at increased risk for this infection. Pregnancy and renal transplant also increase the risk of pyelonephritis.
Patients with bloodstream infection with certain pathogens including Staphylococcus aureus or Candida species are at risk for hematogenous seeding of the kidneys.
Patients present with flank pain and fever. There are often associated urinary symptoms including dysuria, urgency, or frequency. Gross hematuria may occasionally be seen. Patients with spinal cord injury or dementia may present atypically, but fever is expected to be present in cases of pyelonephritis. Examination will reveal costovertebral angle tenderness.
Rare complications of pyelonephritis include papillary necrosis, renal abscess, and perinephric abscess.
Related topic: urinary tract infection
Patients with abnormalities of the urinary tract (including children with vesicoureteral reflux) are at increased risk for this infection. Pregnancy and renal transplant also increase the risk of pyelonephritis.
Patients with bloodstream infection with certain pathogens including Staphylococcus aureus or Candida species are at risk for hematogenous seeding of the kidneys.
Patients present with flank pain and fever. There are often associated urinary symptoms including dysuria, urgency, or frequency. Gross hematuria may occasionally be seen. Patients with spinal cord injury or dementia may present atypically, but fever is expected to be present in cases of pyelonephritis. Examination will reveal costovertebral angle tenderness.
Rare complications of pyelonephritis include papillary necrosis, renal abscess, and perinephric abscess.
Related topic: urinary tract infection
Codes
ICD10CM:
N12 – Tubulo-interstitial nephritis, not specified as acute or chronic
SNOMEDCT:
45816000 – Pyelonephritis
N12 – Tubulo-interstitial nephritis, not specified as acute or chronic
SNOMEDCT:
45816000 – Pyelonephritis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Renal infarction – imaging may be helpful
- Renal calculus – imaging may be helpful
- Cystitis – fever and flank pain are absent
- Urethritis – fever and flank pain are absent
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:04/06/2020