Pyelonephritis most commonly occurs as a result of urinary tract infection (cystitis), particularly in the presence of transient (occasional) or persistent backflow of urine from the bladder into the ureters or kidney pelvis (vesicoureteric reflux).

Pyelonephritis can be further classified according to the clinical setting. Types include:

• Acute uncomplicated pyelonephritis (sudden development of kidney inflammation)
• Chronic pyelonephritis (i.e., a long standing infection that does not clear)
• Reflux nephropathy (i.e., an infection inthe presence of an obstruction)

Although cystitis (bladder infection) is common, pyelonephritis occurs much less often. The risk is increased if there is a history of cystitis, renal papillary necrosis, kidney stones, vesicoureteric reflux, or obstructive uropathy.

The risk is also increased when there is a history of chronic or recurrent urinary tract infection, and when the infection is caused by a particularly virulent bacteria.

Acute pyelonephritis can be severe in the elderly, and in people who are immunosuppressed (for example, those with cancer or AIDS).

Prompt and complete treatment of cystitis (bladder infection) may prevent development of many cases of pyelonephritis. Chronic or recurrent urinary tract infection should be treated thoroughly because of the chance of infection of the kidneys.

LIFESTYLE CHANGES:
Preventive measures may reduce symptoms and prevent recurrence of infection. Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of dragging bacteria from the rectal area to the urethra.

Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long period of time may allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections.

DIET:
Increasing the intake of fluids (2000 to 4000 cc per day) encourages frequent urination that flushes bacteria from the bladder.

• Flank pain or back pain
• Severe abdominal pain (occurs occasionally)
• Fever
  • Higher than 102 degrees Fahrenheit
  • Persists for more than 2 days
• Chills with shaking
• Warm skin
• Flushed or reddened skin
• Moist skin (diaphoresis)
• Vomiting, nausea
• Fatigue
• General ill feeling
• Urination, painful
• Urinary frequency/urgency, increased
• Need to urinate at night (nocturia)
• Cloudy or abnormal urine color
• Blood in the urine
• Foul or strong urine odor
• Mental changes or confusion *

• A urinalysis commonly reveals white blood cells (WBC) and/or red blood cells (RBC).
• A urine culture (clean catch) or urine culture (catheterized specimen) may reveal bacteria in the urine.
• A blood culture may show an infection.
• An IVP or CT scan of the abdomen may show enlarged kidney(s) with decreased excretion of contrast. (IVP and CT scan of the abdomen can also indicate underlying disorders.)

• Voiding cystourethrogram
• Renal ultrasound
• Renal scan
• Renal biopsy

The goals of treatment are control (cure) of the infection and reduction of symptoms. Acute symptoms may persist longer than 48 hours after treatment is begun, although usually symptoms get better rapidly.
Also, due to the high mortality rate in the elderly population, and the risk of permanent kidney damage, prompt treatment is recommended.

Initial therapy usually consists of obtaining a urine culture to identify the causative organism, and selecting appropriate antibiotics to treat that infection. However, it may take 3 to 5 days to receive urine culture results. In the interim, you will usually be given a broad spectrum antibiotic that should cover most urinary infections.

MEDICATIONS:
Intravenous (IV) antibiotics may be used initially to control the bacterial infection if your infection is severe or you cannot take antibiotics by mouth. In acute cases of pyelonephritis, you may receive a ten to fourteen day course of antibiotics. Chronic pyelonephritis may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include:

• Sulfa drugs such as sulfisoxazole/trimethoprim
• Amoxicillin
• Cephalosporins
• Levofloxacin and ciprofloxacin