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Pyelonephritis – Causes, Symptoms and Treatment

Pyelonephritis is a bacterial infection of the renal pelvis and kidney tissue. It requires prompt medical treatment to prevent serious complications.

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Things worth knowing about "Kidney Pelvis Inflammation"

Pyelonephritis is a bacterial infection of the renal pelvis and kidney tissue. It requires prompt medical treatment to prevent serious complications.

What Is Pyelonephritis?

Pyelonephritis, commonly known as a kidney pelvis inflammation or kidney infection, is a bacterial infection affecting the renal pelvis and kidney tissue. It is one of the most common upper urinary tract infections and can occur in both acute and chronic forms. Women are significantly more affected than men, largely due to the shorter urethra, which allows bacteria to reach the bladder and kidneys more easily.

Causes

Pyelonephritis is most commonly caused by bacteria that ascend from the lower urinary tract. In rare cases, bacteria may reach the kidneys through the bloodstream.

Most common pathogen: Escherichia coli (E. coli), responsible for approximately 80% of cases
Other pathogens: Klebsiella, Proteus, Enterococcus, and Staphylococci
Contributing risk factors: bladder infection (cystitis), urinary obstruction, kidney stones, urinary catheters, weakened immune system, pregnancy, and diabetes mellitus

Symptoms

The symptoms of acute pyelonephritis often develop rapidly and can be pronounced:

High fever (often above 38.5 °C / 101.3 °F) with chills
Flank pain, usually one-sided, which may radiate to the back or abdomen
Tenderness when tapping the kidney area (costovertebral angle tenderness)
Frequent and painful urge to urinate
Cloudy or foul-smelling urine
Nausea, vomiting, and general malaise

In chronic pyelonephritis, symptoms may be milder or develop gradually, making early diagnosis more challenging.

Diagnosis

Diagnosis is based on a combination of clinical examination and laboratory or imaging tests:

Urinalysis and urine culture: Detection of bacteria, white blood cells, and nitrites in the urine
Blood tests: Elevated inflammatory markers such as CRP, white blood cell count, and ESR
Kidney ultrasound: To rule out urinary obstruction or kidney stones
CT or MRI scan: In complicated cases or when an abscess is suspected

Treatment

Treatment depends on the severity of the infection and the results of urine culture testing.

Mild to Moderate Cases

Uncomplicated pyelonephritis is typically treated on an outpatient basis with oral antibiotics. Commonly used agents include ciprofloxacin, trimethoprim/sulfamethoxazole, or cephalosporins. The treatment duration is usually 7 to 14 days.

Severe Cases

When patients present with high fever, vomiting, or signs of sepsis (blood poisoning), hospitalization and intravenous antibiotics are required. Antipyretics and adequate fluid intake are also essential components of treatment.

Chronic Pyelonephritis

In chronic or recurrent cases, underlying causes such as kidney stones or structural abnormalities of the urinary tract must be addressed. Long-term antibiotic prophylaxis may be considered in selected patients.

Prevention

Drink sufficient fluids (at least 1.5 to 2 liters per day)
Wipe from front to back after using the toilet (especially important for women)
Treat bladder infections promptly before they can ascend to the kidneys
Have kidney stones and urinary tract abnormalities evaluated and managed

References

European Association of Urology (EAU): Guidelines on Urological Infections, 2023. Available at: https://uroweb.org
Hooton, T. M.: Uncomplicated Urinary Tract Infection. New England Journal of Medicine, 366(11):1028-1037, 2012.
World Health Organization (WHO): Antimicrobial Resistance Global Action Plan, 2015. Available at: https://www.who.int

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