Urology
Pyelonephritis
신우신염
Bacterial infection of renal parenchyma and pelvis (upper UTI)
- How common
- Women ~1/2,000 per year
- Typical age
- Young women, both sexes elderly
What is it?
Lower UTI pathogens ascend the ureter to invade renal parenchyma.
Commonly affected: Renal parenchyma, pelvis, calyces
How it develops
- Preceding lower UTIDevelops 24–48 hr after cystitis
- Ureteral ascentBacteria ascend ureter to renal pelvis
- Parenchymal invasionInvades collecting ducts, interstitium, tubules
- Systemic responseFever, bacteremia, sepsis risk
Symptoms
- High fever/rigorsFever >38.5°C with shaking chills
- Flank painDull CVA pain
- Nausea/vomitingMay preclude oral intake
- MalaiseMarked fatigue
- LUTSFrequency/dysuria may be present
How it is examined
- CVA tendernessCostovertebral angle percussion pain
- UA + cultureWBC casts, bacteriuria
- Blood culturesDetect bacteremia (20–30% positive)
Imaging
CT urography is standard; assess abscess/obstruction.
- Renal enlargement
- Wedge-shaped hypoperfusion
- Possible abscess
Renal US to quickly assess obstruction/hydronephrosis.
- Hydronephrosis = emergency
- Renal enlargement
Non-surgical care
- PO ciprofloxacin500 mg bid x 7 days (if outpatient)
- IV ceftriaxone1–2 g qd (inpatient standard)
- Fluids/antipyreticsManage dehydration/fever
- Hospitalization criteriaVomiting, sepsis, pregnancy, immunocompromise
- 14-day course14 days for complicated or male
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Obstructive pyelonephritis, perinephric abscess, emphysematous pyelonephritis
Procedures that may be discussed
- Percutaneous nephrostomy
- Ureteral DJ stent
- Emergency nephrectomy (emphysematous)
Outlook
Good with prompt therapy; obstruction risks septic shock.