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Pyelonephritis
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Pyelonephritis

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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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

Codes

ICD10CM:
N12 – Tubulo-interstitial nephritis, not specified as acute or chronic

SNOMEDCT:
45816000 – Pyelonephritis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

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
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Pyelonephritis
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Imaging Studies image of Pyelonephritis - imageId=8360960. Click to open in gallery. caption: '<span>Axial image from contrast enhanced CT scan demonstrating a peripheral, wedge-shaped, low attenuation region in the left kidney, consistent with pyelonephritis with possible abscess.</span>'
Axial image from contrast enhanced CT scan demonstrating a peripheral, wedge-shaped, low attenuation region in the left kidney, consistent with pyelonephritis with possible abscess.

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