top of page

Understanding Pyelonephritis:
Causes, Symptoms, Diagnosis, Treatment and Support

  • What Is Pyelonephritis?


  • Causes and Risk Factors


  • Signs and Symptoms


  • Diagnosis and Medical Evaluation


  • Treatment Options


  • Lifestyle Changes and Coping Strategies



Pyelonephritis is a type of urinary tract infection (UTI) that affects one or both kidneys. It occurs when bacteria, usually from the bladder, travel up the ureters and infect the kidneys. This condition can be acute, with sudden onset and severe symptoms, or chronic, with persistent or recurring symptoms over a long period.

What Is Pyelonephritis?

What Is Pyelonephritis?

Causes and Risk Factors

The causes and risk factors of pyelonephritis primarily revolve around the introduction and proliferation of bacteria in the urinary tract, leading to infection in the kidneys. Here's a breakdown:
1. Bacterial Infection: The most common cause of pyelonephritis is bacterial infection, with Escherichia coli (E. coli) being the primary culprit. Bacteria typically enter the urinary tract through the urethra and ascend to the bladder. From there, they can migrate up the ureters and infect the kidneys, leading to pyelonephritis.
2. Urinary Tract Obstruction: Any condition that obstructs the flow of urine can increase the risk of pyelonephritis. This obstruction may be due to kidney stones, urinary tract abnormalities, enlarged prostate gland in men, or anatomical abnormalities that disrupt the normal flow of urine.
3. Compromised Immune System: Individuals with weakened immune systems, such as those with HIV/AIDS, diabetes, or undergoing chemotherapy, are more susceptible to infections, including pyelonephritis.
Risk Factors:
1. Gender: Women are at higher risk of developing pyelonephritis compared to men. This heightened risk is primarily due to anatomical differences, such as a shorter urethra, which allows bacteria to travel more easily into the bladder.
2. Sexual Activity: Sexual intercourse can introduce bacteria into the urinary tract, increasing the risk of developing a urinary tract infection (UTI) and subsequently pyelonephritis.
3. Urinary Catheterization: Individuals who require urinary catheterization, such as those with urinary retention or hospitalized patients, have an increased risk of developing urinary tract infections, including pyelonephritis.
4. Structural Abnormalities: Anatomical abnormalities in the urinary tract, such as vesicoureteral reflux (backward flow of urine from the bladder into the ureters) or kidney abnormalities present at birth, can predispose individuals to recurrent urinary tract infections and pyelonephritis.
5. Bladder Dysfunction: Conditions that affect bladder emptying, such as neurogenic bladder (damage to nerves controlling bladder function) or urinary retention, can increase the risk of urinary tract infections and subsequent pyelonephritis.
6. Age: Infants, elderly individuals, and those with weakened immune systems are at increased risk of pyelonephritis due to factors such as incomplete bladder emptying or impaired immune responses.
7. Pregnancy: Pregnancy can alter the urinary tract anatomy and increase the risk of urinary stasis (reduced urine flow), making pregnant individuals more susceptible to urinary tract infections and pyelonephritis.
Understanding these causes and risk factors can help in identifying individuals at higher risk of developing pyelonephritis and implementing preventive measures and appropriate treatment strategies.

Causes and Risk Factors

Signs And Symptoms

The signs and symptoms of pyelonephritis can vary in severity and may overlap with those of other urinary tract infections (UTIs). Here's a list of common signs and symptoms associated with pyelonephritis:
1. Fever: A high fever, often above 100.4°F (38°C), is a hallmark symptom of pyelonephritis. The fever may come on suddenly and be accompanied by chills and sweating.
2. Flank Pain: Pain or discomfort in one or both sides of the lower back, just below the rib cage, is a common symptom of pyelonephritis. The pain may be dull, aching, or sharp and may worsen with movement or deep breathing.
3. Abdominal Pain: Some individuals with pyelonephritis may experience generalized abdominal pain, often on the side of the affected kidney.
4. Urinary Symptoms: Symptoms affecting the urinary tract may include:
   - Pain or burning sensation during urination (dysuria)
   - Increased frequency of urination
   - Urgency to urinate
   - Difficulty urinating
5. Hematuria: Blood in the urine (hematuria) may occur in some cases of pyelonephritis, causing the urine to appear pink, red, or cola-colored.
6. Cloudy or Foul-Smelling Urine: Urine may appear cloudy or have a strong, unpleasant odor due to the presence of bacteria and white blood cells.
7. Nausea and Vomiting: Some individuals with pyelonephritis may experience nausea, vomiting, or a general feeling of illness.
8. Fatigue and Weakness: Pyelonephritis can cause fatigue, weakness, and a general sense of malaise, particularly if the infection is severe or accompanied by fever.
9. Mental Confusion: In severe cases of pyelonephritis, especially in older adults or individuals with compromised immune systems, mental confusion or altered mental status may occur.
It's important to note that not everyone with pyelonephritis will experience all of these symptoms, and the severity of symptoms can vary from person to person. Prompt medical evaluation and treatment are essential if you suspect you have pyelonephritis or are experiencing symptoms suggestive of a kidney infection. Left untreated, pyelonephritis can lead to serious complications, including kidney damage and systemic infection (sepsis).

Signs and Symptoms

Diagnosing pyelonephritis typically involves a combination of medical history review, physical examination, and diagnostic tests to confirm the presence of a kidney infection and identify the underlying cause. Here's an overview of the diagnostic process:
1. Medical History Review: Your healthcare provider will ask about your symptoms, including any urinary tract symptoms, fever, flank pain, or other related complaints. They will also inquire about your medical history, including any past urinary tract infections or kidney problems.
2. Physical Examination: Your healthcare provider may perform a physical examination to assess for signs of pyelonephritis, such as tenderness in the flank area (the sides of the lower back), abdominal tenderness, or signs of systemic illness such as fever or dehydration.
3. Urinalysis: A urinalysis is often the initial test performed to detect the presence of bacteria, white blood cells, and other signs of infection in the urine. A urine sample is collected and analyzed in a laboratory to assess for signs of pyuria (white blood cells in the urine) and bacteriuria (bacteria in the urine).
4. Urine Culture: If pyelonephritis is suspected based on symptoms and initial urinalysis findings, a urine culture may be performed to identify the specific bacteria causing the infection and determine which antibiotics are most effective for treatment.
5. Blood Tests: Blood tests, including a complete blood count (CBC) and blood cultures, may be done to assess for signs of infection (elevated white blood cell count) and to identify bacteria in the bloodstream, which can occur in severe cases of pyelonephritis or if the infection has spread (septicemia).
6. Imaging Studies: Imaging tests such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be performed to visualize the kidneys and urinary tract and identify any structural abnormalities, obstructions, or signs of kidney inflammation or abscess formation.
7. Additional Tests: In some cases, additional tests such as a kidney biopsy or voiding cystourethrogram (VCUG) may be recommended, especially if there are concerns about underlying kidney disease or structural abnormalities contributing to recurrent infections.
Once a diagnosis of pyelonephritis is confirmed, appropriate treatment, including antibiotics and supportive care, can be initiated to manage the infection and prevent complications. It's essential to follow up with your healthcare provider for monitoring and further evaluation as needed, especially if symptoms persist or if there are concerns about recurrent infections or complications.

Diagnosis And Medical Evaluation

Diagnosis and Medical Evaluation

Treatment for pyelonephritis typically involves antibiotics to eliminate the bacterial infection and supportive care to manage symptoms and prevent complications. The choice of antibiotics depends on factors such as the severity of the infection, the suspected or identified bacteria causing the infection, and any underlying health conditions. Here's an overview of treatment options for pyelonephritis:
1. Antibiotics: 
   - Empirical Treatment: In cases where the specific bacteria causing the infection are not known, empirical antibiotic therapy is initiated based on the most likely pathogens and local resistance patterns. Commonly used antibiotics for empirical treatment of pyelonephritis include fluoroquinolones (such as ciprofloxacin or levofloxacin), cephalosporins (such as ceftriaxone or cefuroxime), or trimethoprim-sulfamethoxazole (TMP-SMX).
   - Targeted Treatment: Once urine culture results are available, antibiotic therapy may be adjusted to target the specific bacteria causing the infection and to ensure appropriate antibiotic coverage. The choice of antibiotics may be guided by the results of urine culture and susceptibility testing.
2. Supportive Care:
   - Fluid Replacement: Adequate hydration is essential to help flush out bacteria from the urinary tract and maintain kidney function. Drinking plenty of water is recommended, and in severe cases, intravenous fluids may be administered.
   - Pain Management: Over-the-counter or prescription pain relievers, such as acetaminophen (paracetamol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, may be used to alleviate fever, flank pain, and other symptoms of discomfort.
   - Fever Reduction: Fever-reducing medications such as acetaminophen or ibuprofen may be used to lower fever and alleviate associated symptoms such as chills and sweating.
3. Hospitalization:
   - Severe cases of pyelonephritis, especially those associated with high fever, dehydration, signs of systemic infection (sepsis), or complications such as kidney abscess, may require hospitalization for intravenous antibiotic therapy and close monitoring.
   - Hospitalization allows for more aggressive management of the infection and supportive care, including intravenous fluids and pain management.
4. Follow-up Care:
   - It's essential to complete the full course of antibiotics as prescribed by your healthcare provider, even if symptoms improve before the antibiotics are finished, to ensure that the infection is completely eradicated and to prevent recurrence or antibiotic resistance.
   - Follow-up appointments with your healthcare provider may be recommended to monitor your response to treatment, assess for any complications or recurrence of symptoms, and address any concerns or questions you may have.
It's crucial to seek prompt medical attention if you suspect you have pyelonephritis or are experiencing symptoms suggestive of a kidney infection. Untreated or inadequately treated pyelonephritis can lead to serious complications, including kidney damage, sepsis, or the spread of infection to other parts of the body.

Treatment Options

Treatment Options for Pyelonephritis

Lifestyle changes and coping strategies can play a significant role in managing pyelonephritis and reducing the risk of recurrence. Here are some recommendations:
1. Hydration: Drink plenty of water to help flush out bacteria from the urinary tract and maintain kidney function. Aim to drink at least 6-8 glasses of water per day, or more if you're experiencing symptoms of dehydration or fever.
2. Good Hygiene Practices:
   - Practice good hygiene habits, including wiping from front to back after using the toilet to prevent the spread of bacteria from the anus to the urethra.
   - Urinate after sexual intercourse to help flush out bacteria that may have entered the urinary tract.
   - Avoid using harsh soaps, douches, or feminine hygiene products in the genital area, as they can disrupt the natural balance of bacteria and increase the risk of infection.
3. Urinary Habits:
   - Avoid holding in urine for long periods, as this can increase the risk of bacterial growth in the bladder and urinary tract. Urinate as soon as you feel the need to go.
   - Empty your bladder completely each time you urinate to minimize the risk of residual urine pooling in the bladder, which can promote bacterial growth.
4. Dietary Modifications:
   - Avoid or limit consumption of foods and beverages that may irritate the bladder and urinary tract, such as caffeine, alcohol, spicy foods, and acidic foods like citrus fruits.
   - Consider incorporating foods that have natural antibacterial properties, such as cranberries, blueberries, and probiotic-rich foods like yogurt, into your diet.
5. Clothing Choices:
   - Wear loose-fitting, breathable clothing and cotton underwear to allow for better airflow and reduce moisture buildup, which can promote bacterial growth.
6. Pelvic Floor Exercises:
   - Pelvic floor exercises, such as Kegels, can help strengthen the muscles that support the bladder and urinary tract, potentially reducing the risk of urinary incontinence and improving bladder control.
7. Stress Management:
   - Practice stress-reduction techniques such as deep breathing, meditation, yoga, or mindfulness to help manage stress levels. Stress can weaken the immune system and potentially exacerbate symptoms of pyelonephritis.
8. Regular Medical Follow-up:
   - Attend regular follow-up appointments with your healthcare provider to monitor your kidney function, assess for any signs of recurrence or complications, and discuss any concerns or questions you may have about managing pyelonephritis.
By incorporating these lifestyle changes and coping strategies into your routine, you can help manage pyelonephritis symptoms, reduce the risk of recurrence, and improve your overall urinary tract health. However, it's essential to consult with your healthcare provider for personalized advice and treatment recommendations based on your individual needs and medical history.

Lifestyle Changes and Coping Strategies

Lifestyle Changes and Coping Strategies for Pyelonephritis

bottom of page