When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Chronic pyelonephritis

Last reviewed: 29 Nov 2025
Last updated: 04 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • history of vesicoureteral reflux (VUR)
  • history of acute pyelonephritis
  • history of renal obstruction
Full details

Other diagnostic factors

  • female sex
  • nausea
  • elevated blood pressure
  • children and infants (risk of VUR)
  • adults (risk of XGP and EPN)
  • weight loss
  • fatigue
  • malaise
  • cloudy urine
  • fever
  • back/flank pain and tenderness
Full details

Risk factors

  • neurogenic bladder
  • acute pyelonephritis
  • vesicoureteral reflux
  • obstruction
  • renal calculi
  • diabetes mellitus
Full details

Diagnostic tests

1st tests to order

  • urinalysis
  • renal function
  • urine culture
  • electrolyte panel
  • CBC
  • renal ultrasound
  • kidney-ureter-bladder (KUB) radiograph
  • CT abdomen
Full details

Tests to consider

  • MRI abdomen
  • voiding cystourethrography (VCUG)
  • renal biopsy
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Lynda A. Frassetto, MD

Professor of Medicine

Division of Nephrology

University of California

San Francisco

CA

Disclosures

LF declares that she has no competing interests.

Acknowledgements

Dr Frassetto would like to gratefully acknowledge the assistance of Donna M. Frassetto.

Disclosures

DMF declares that she has no competing interests.

Peer reviewers

Bernard G. Jaar, MD, MPH

Clinical Director

Johns Hopkins School of Medicine

Division of Nephrology

Baltimore

MD

Disclosures

BGJ declares that he has no competing interests.

Farah Abifaraj, MD

Clinical Associate

Johns Hopkins School of Medicine

Division of Nephrology

Baltimore

MD

Disclosures

FA declares that she has no competing interests.

James Marsh, MA FRCP

Consultant Nephrologist and Clinical Director

Renal Unit

St Helier Hospital

Carshalton

Surrey

UK

Declarações

JM declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

European Association of Urology. Urological infections. 2025 [internet publication].Texto completo

Vourganti S, Agarwal PK, Bodner DR, et al. Ultrasonographic evaluation of renal infections. Radiol Clin North Am. 2006 Nov;44(6):763-75. Resumo

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.Texto completo  Resumo

American Urological Association. Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). 2021 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Chronic pyelonephritis images
  • Diagnósticos diferenciais

    • Acute pyelonephritis
    • Renal calculi
    • Renal cancer
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Urological infections
    • IDSA 2024 guidance on the treatment of antimicrobial resistant gram-negative infections
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Kidney infection

    Kidney stones

    Mais Folhetos informativos para os pacientes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal