Acute pyelonephritis in adults - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute pyelonephritis in adults commonly presents as acute-onset fever, chills, severe back or flank pain, nausea and vomiting, and costovertebral angle tenderness.
Urinalysis and urine culture confirm the diagnosis of pyelonephritis. Urine cultures, obtained prior to treatment, demonstrate bacteria, most often Escherichia coli.
The route and choice of empiric antibiotics depend on the severity of illness and the presumed bacterial sensitivities pending culture results.
Complications most often result from inappropriate (wrong drug or wrong dose) antibiotic use or antibiotic resistance, leading to recurrent or progressive infection.
Other common causes of complications are inadequate treatment of anatomic abnormalities (e.g., kidney stones or obstruction), preventing bacterial clearance.

Cross-section of a kidney with acute suppurative pyelonephritis. The white streaks are purulent exudates throughout the kidney, in both the tubules and the interstitium

McLay RN, Harrison JH, Fermin CD, et al. Tulane gross pathology tutorial. Tulane University School of Medicine; 1997

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Cross-section of a kidney with acute suppurative pyelonephritis. The white streaks are purulent exudates throughout the kidney, in both the tubules and the interstitium
External surface of the kidney with multifocal irregular, whitish, raised lesions consisting of purulent exudates
Interstitial infiltrates and edema in acute pyelonephritis. Some glomeruli also show evidence of a second kidney disease, focal glomerulosclerosis
Higher magnification: polymorphonuclear cell infiltrates in and around the renal tubules
Psoas muscle shadow enhanced by retroperitoneal air in emphysematous pyelonephritis

Citations

Key Articles

Scholes D, Hooton TM, Roberts PL, et al. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med. 2005 Jan 4;142(1):20-7.[Abstract]
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103-120.[Abstract][Full Text]
European Association of Urology. Guidelines on urological infections. 2024 [internet publication].[Full Text]
Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015 Nov;42(4):547-60.[Abstract][Full Text]

Referenced Articles

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