- Home
- Search
- Tools
- Saved
- 0Notifications
- CME
- Help & Feedback
- About epocrates
- Business Solutions
Highlights & Basics
- Chronic pyelonephritis is most commonly caused by chronic vesicoureteral reflux.
- Diagnosis is clinical and confirmed with imaging studies. Typically, a biopsy is not performed.
- There is no specific treatment, as damage is irreversible.
- May result in end-stage renal disease.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Chronic pyelonephritis: tubular damage, interstitial scarring, and fibrosis in chronic pyelonephritis
Medium-power microscopic view of dense polymorphonuclear infiltrates, showing chronic tubular atrophy, glomerulosclerosis, and surrounding areas of normal tubules and glomeruli
High-power view of polymorphonuclear cells in the renal tubules, showing damage to the tubules and red blood cell infiltration in the interstitial spaces
Xanthogranulomatous pyelonephritis: very low-power microscopic view showing extensive cellular infiltrate and granulomas. Note the marked destruction of the normal renal architecture
H&E stain: high-power view of granulomas found in xanthogranulomatous pyelonephritis
Very high-power view of xanthoma cells, which are lipid-filled macrophages
Citations
Vourganti S, Agarwal PK, Bodner DR, et al. Ultrasonographic evaluation of renal infections. Radiol Clin North Am. 2006 Nov;44(6):763-75.[Abstract]
European Association of Urology. Urological infections. 2023 [internet publication].[Full Text]
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 Mar 1;52(5):e103-20.[Abstract][Full Text]
American Urological Association. Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). 2021 [internet publication].[Full Text]
1. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27;160(6):797-805.[Abstract][Full Text]
2. Ataei N, Madani A, Esfahani ST, et al. Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol. 2004 Oct;19(10):1127-31.[Abstract]
3. Dias CS, Silva JM, Diniz JS, et al. Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux. Pediatr Infect Dis J. 2010 Feb;29(2):139-44.[Abstract]
4. Dick PT, Feldman W. Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr. 1996 Jan;128(1):15-22.[Abstract]
5. Macedo CS, Riyuzo MC, Bastos HD. Renal scars in children with primary vesicoureteral reflux [in Portuguese]. J Pediatr (Rio J). 2003 Jul-Aug;79(4):355-62.[Abstract]
6. Wadie GM, Moriarty KP. The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection. Pediatr Nephrol. 2012 Apr;27(4):529-38.[Abstract]
7. Marra G, Oppezzo C, Ardissino G, et al. Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the ItalKid Project. J Pediatr. 2004 May;144(5):677-81.[Abstract]
8. Quinn FM, Dick AC, Corbally MT, et al. Xanthogranulomatous pyelonephritis in childhood. Arch Dis Child. 1999 Dec;81(6):483-6.[Abstract][Full Text]
9. Stoica I, O'Kelly F, McDermott MB, et al. Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): outcomes from a large single-center series. J Pediatr Urol. 2018 Apr;14(2):169.e1-169.e7.[Abstract]
10. Sangüesa Nebot C, Picó Aliaga S, Serrano Durbá A, et al. Xantogranulomatous pyeloneprhritis in children. Insights Imaging. 2018 Oct;9(5):643-51.[Abstract][Full Text]
11. Riccabona M, Fotter R. Urinary tract infection in infants and children: an update with special regard to the changing role of reflux. Eur Radiol. 2004 Mar;14 Suppl 4:L78-88.[Abstract]
12. Vachvanichsanong P. Urinary tract infection: one lingering effect of childhood kidney diseases - review of the literature. J Nephrol. 2007 Jan-Feb;20(1):21-8.[Abstract]
13. Wennerstrom M, Hansson S, Jodal U, et al. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr. 2000 Jan;136(1):30-4.[Abstract]
14. Moreau JF, Grenier P, Grunfeld JP, et al. Renal clubbing and scarring in adults: a retrospective study of 110 cases. Urol Radiol. 1979-1980;1(3):129-36.[Abstract]
15. Guignard JP. Importance of vesico-ureteral reflux in the pathogenesis of chronic pyelonephritis [in French]. Schweiz Med Wochenschr. 1983 Feb 12;113(6):223-8.[Abstract]
16. Grainger RG, Longstaff AJ, Parsons MA. Xanthogranulomatous pyelonephritis: a reappraisal. Lancet. 1982 Jun 19;1(8286):1398-401.[Abstract]
17. Mokabberi R, Ravakhah K. Emphysematous urinary tract infections: diagnosis, treatment and survival (case review series). Am J Med Sci. 2007 Feb;333(2):111-6.[Abstract]
18. Rubenstein JN, Schaeffer AJ. Managing complicated urinary tract infections: the urologic view. Infect Dis Clin North Am. 2003 Jun;17(2):333-51.[Abstract]
19. Tseng CC, Wu JJ, Wang MC, et al. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis. 2005 Sep;46(3):432-9.[Abstract]
20. Ransley PG, Risdon RA. The pathogenesis of reflux nephropathy. Contrib Nephrol. 1979;16:90-7.[Abstract]
21. Shaikh N, Ewing AL, Bhatnagar S, et al. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010 Dec;126(6):1084-91.[Abstract]
22. Kincaid-Smith P, Becker G. Reflux nephropathy and chronic atrophic pyelonephritis: a review. J Infect Dis. 1978 Dec;138(6):774-80.[Abstract]
23. Hodson CJ, Maling TM, McManamon PJ, et al. The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol. 1975;suppl 13:1-26.[Abstract]
24. Skoog SJ, Peters CA, Arant BS, Jr., et al. Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010 Sep;184(3):1145-51.[Abstract]
25. Alan C, Atas S, Tunc B. Xanthogranulomatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol. 2004;36(4):489-93.[Abstract]
26. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77.[Abstract][Full Text]
27. Babich T, Eliakim-Raz N, Turjeman A, et al. Risk factors for hospital readmission following complicated urinary tract infection. Sci Rep. 2021 Mar 25;11(1):6926.[Abstract][Full Text]
28. Stevens LA, Coresh J, Feldman HI, et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol. 2007 Oct;18(10):2749-57.[Abstract][Full Text]
29. Ozeki S, Kawamura T, Nishino Y, et al. Clinical evaluation of nitrite test for the detection of bacteriuria [in Japanese]. Hinyokika Kiyo. 1997 Dec;43(12):861-5.[Abstract]
30. Yang WJ, Cho IR, Seong do H, et al. Clinical implication of serum C-reactive protein in patients with uncomplicated acute pyelonephritis as marker of prolonged hospitalization and recurrence. Urology. 2009 Jan;73(1):19-22.[Abstract]
31. Kljucevsek D, Kljucevsek T, Kersnik LT, et al. Catheter-free methods for vesicoureteric reflux detection: our experience and a critical appraisal of existing data. Pediatr Nephrol. 2010 Jul;25(7):1201-6.[Abstract]
32. Stoller ML, Kogan BA. Sensitivity of 99mtechnetium-dimercaptosuccinic acid for the diagnosis of chronic pyelonephritis: clinical and theoretical considerations. J Urol. 1986 Jul;25(7):977-80.[Abstract]
33. Loffroy R, Guiu B, Wafta J, et al. Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms. Clin Radiol. 2007 Sep;62(9):884-90.[Abstract]
34. Vourganti S, Agarwal PK, Bodner DR, et al. Ultrasonographic evaluation of renal infections. Radiol Clin North Am. 2006 Nov;44(6):763-75.[Abstract]
35. Dwivedi US, Goyal NK, Saxena V, et al. Xanthogranulomatous pyelonephritis: our experience with review of published reports. ANZ J Surg. 2006 Nov;76(11):1007-9.[Abstract]
36. Kondo T, Okuda H, Suzuki M, et al. A case of emphysematous pyelonephritis improved with conservative therapy - indication for conservative therapy [in Japanese]. Hinyokika Kiyo. 2000 May;46(5):335-8.[Abstract]
37. Evanoff GV, Thompson CS, Foley R, et al. Spectrum of gas within the kidney. Emphysematous pyelonephritis and emphysematous pyelitis. Am J Med. 1987 Jul;83(1):149-54.[Abstract]
38. Naseri M. Association of nocturnal enuresis with vesicoureteral reflux and renal cortical damage. Nephrourol Mon. 2012 Spring;4(2):448-53.[Abstract][Full Text]
39. Afgan F, Mumtaz S, Ather MH. Preoperative diagnosis of xanthogranulomatous pyelonephritis. Urol J. 2007 Summer;4(3):169-73.[Abstract][Full Text]
40. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil. 1995 Mar;76(3):272-80.[Abstract][Full Text]
41. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 5 Mar 2024 [Epub ahead of print].[Abstract][Full Text]
42. Kirsch AJ, Grattan-Smith JD, Molitierno JA Jr. The role of magnetic resonance imaging in pediatric urology. Curr Opin Urol. 2006 Jul;16(4):283-90.[Abstract]
43. Kass EJ, Kernen KM, Carey JM. Paediatric urinary tract infection and the necessity of complete urological imaging. BJU Int. 2000 Jul;86(1):94-6.[Abstract]
44. American College of Radiology; American College of Nuclear Medicine; Society for Pediatric Radiology. ACR-ACNM-SPR practice parameter for the performance of renal scintigraphy. 2022 [internet publication].[Full Text]
45. European Association of Urology. Urological infections. 2023 [internet publication].[Full Text]
46. Garin EH, Olavarria F, Garcia Nieto V, et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006 Mar;117(3):626-32.[Abstract]
47. Dhillon S. Meropenem/vaborbactam: a review in complicated urinary tract infections. Drugs. 2018 Aug;78(12):1259-70.[Abstract][Full Text]
48. Wagenlehner FME, Cloutier DJ, Komirenko AS, et al. Once-daily plazomicin for complicated urinary tract infections. N Engl J Med. 2019 Feb 21;380(8):729-40.[Abstract][Full Text]
49. Tamma PD, Heil EL, Justo JA, et al. Infectious Diseases Society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024 Aug 7:ciae403.[Abstract][Full Text]
50. Heuer JG, Sharma GR, Zhang T, et al. Effects of hyperglycemia and insulin therapy on outcome in a hyperglycemic septic model of critical illness. J Trauma. 2006 Apr;60(4):865-72.[Abstract]
51. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004 Aug;79(8):992-1000.[Abstract]
52. Somani BK, Nabi G, Thorpe P, et al; ABACUS Research Group. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008 May;179(5):1844-9.[Abstract]
53. 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 Mar 1;52(5):e103-20.[Abstract][Full Text]
54. Soo Park B, Lee SJ, Wha Kim Y, et al. Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis. Scand J Urol Nephrol. 2006;40(4):332-8.[Abstract]
55. Bailey RR. End-stage reflux nephropathy. Nephron. 1981;27(6):302-6.[Abstract]
56. National Kidney Foundation. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Jan 2013 [internet publication].[Full Text]
57. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Jul 2017 [internet publication].[Full Text]
58. Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008 Nov;122(5):1064-71.[Abstract]
59. Chishti AS, Maul EC, Nazario RJ, et al. A guideline for the inpatient care of children with pyelonephritis. Ann Saudi Med. 2010 Sep-Oct;30(5):341-9.[Abstract][Full Text]
60. American Urological Association. Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). 2021 [internet publication].[Full Text]
