- An acute infection of cortex
- May progress to chronic pyelonephritis
- most commonly seen in
- girls with vesiculouteral reflux (reflux type)
- lower urinary tract obstructions (obstructive type)
- Other complications include
- perinpehric abcess, renal papillary necrosis, spesis
- flank pain
- urinary frequency
- Physical exam
- costovertebral angle (CVA) tenderness
- Urinary sediment analysis
- clumps pf neutrophils (pyuria)
- scattered RBC
- bacteria with the presence of WBC casts
- Microscopic urine analysis
- > 5 leukocytes/hpf
- a bacterial pathogen
- Gold standard is clean catch urine culture with >100,000 bacteria/ml
- IV antibiotics
- ciprofloxacin, ampicillin/gentamicin, piperacillin/tazobactam
- In pregnant women
- Ceftriaxone is first-line for mild-moderate disease
- Increased risk for pre-term labor
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Wing, D.A., Fassett, M.J. and Getahun, D., 2014. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. American journal of obstetrics and gynecology, 210(3), pp.219-e1.
PMID:24100227 (Link to Abstract)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005 Mar 1;71(5):933-42. Review. Erratum in: Am Fam Physician. 2005 Dec 1;72(11):2182.
PMID:15768623 (Link to Abstract)
Shields J, Maxwell AP. Acute pyelonephritis can have serious complications. Practitioner. 2010 Apr;254(1728):19, 21, 23-4, 2.
PMID:20486480 (Link to Abstract)
Delzell Jr, J.E. and Lefevre, M.L., 2000. Urinary tract infections during pregnancy. American family physician, 61(3), pp.713-721.
PMID:10695584 (Link to Abstract)
- First Aid for the USMLE STEP 2 CK. Le Tao. New York: McGraw-Hill Medical, 2012.
- Brochert's Crush Step 2. O'Connell, Theodore. Philadelphia: Elsevier Saunders, 2013.
- Master the Boards USMLE Step 2 CK. Fischer, Conrad. New York: Kaplan Publishing, 2012.
- Boards and Wards for USMLE Steps 2 and 3. Ayala, Carlos. New York: Lippincott Williams and Wilkins, 2012.