Pyelonephritis Health Article

Signs and tests

A physical exam may show tenderness when the health care provider presses (palpates) the area of the kidney.

• Blood culture may show an infection.
• Urinalysis commonly reveals white or red blood cells in the urine.
• Other urine tests may show bacteria in the urine.

An intravenous pyelogram (IVP) or CT scan of the abdomen may show swollen kidneys. These tests can also help rule out underlying disorders.

Additional tests and procedures that may be done include:

• Kidney biopsy
• Kidney scan
• Kidney ultrasound
• Voiding cystourethrogram

Treatment

The goals of treatment are to:

• Control the infection
• Relieve symptoms

Due to the high death rate in the elderly population and the risk of complications, prompt treatment is recommended. Sudden (acute) symptoms usually go away within 48 to 72 hours after appropriate treatment.

Your doctor will select the appropriate antibiotics after a urine culture identifies the bacteria that is causing the infection. In acute cases, you may receive a 10- to 14-day course of antibiotics.

If you have a severe infection or cannot take antibiotics by mouth, you may be given antibiotics through a vein (intravenously) at first.

Chronic pyelonephritis may require long-term antibiotic therapy. It is very important that you finish all the medicine.

Commonly used antibiotics include the following:

• Amoxicillin
• Cephalosporin
• Levofloxacin and ciprofloxacin
• Sulfa drugs such as sulfisoxazole/trimethoprim

Expectations (prognosis)

With treatment, most kidney infections get better without complications. However, the treatment may need to be aggressive or prolonged.

Pregnant women and persons with diabetes or spinal paralysis should have a urine culture after finishing antibiotic therapy to make sure that the bacteria are no longer present in the urine.

In rare cases, permanent kidney damage can result when:

• Chronic kidney infections occur in a transplanted kidney
• Many kidney infections occur during infancy or childhood

Acute kidney injury (acute renal failure) may occur if a severe infection leads to significantly low blood pressure (shock). The elderly, infants, and persons with a weakened immune system have an increased risk for developing shock and a severe blood infection called sepsis. Often, such patients will be admitted to the hospital for frequent monitoring and IV antibiotics, IV fluids, and other medications as necessary.

Severe episodes of acute kidney injury may result in permanent kidney damage and lead to chronic kidney disease.