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Chronic pyelonephritis

最后审阅: 26 Sep 2026
最后更新: 04 Jul 2025

小结

定义

病史和体格检查

关键诊断因素

  • history of vesicoureteral reflux (VUR)
  • history of acute pyelonephritis
  • history of renal obstruction
完整详情

其他诊断因素

  • 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
完整详情

危险因素

  • neurogenic bladder
  • acute pyelonephritis
  • vesicoureteral reflux
  • obstruction
  • renal calculi
  • diabetes mellitus
完整详情

诊断性检查

首要检查

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

需考虑的检查

  • MRI abdomen
  • voiding cystourethrography (VCUG)
  • renal biopsy
完整详情

治疗流程

持续性治疗

all patients

撰稿人

作者

Lynda A. Frassetto, MD

Professor of Medicine

Division of Nephrology

University of California

San Francisco

CA

利益声明

LF declares that she has no competing interests.

鸣谢

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

利益声明

DMF declares that she has no competing interests.

同行评议者

Bernard G. Jaar, MD, MPH

Clinical Director

Johns Hopkins School of Medicine

Division of Nephrology

Baltimore

MD

Divulgaciones

BGJ declares that he has no competing interests.

Farah Abifaraj, MD

Clinical Associate

Johns Hopkins School of Medicine

Division of Nephrology

Baltimore

MD

Divulgaciones

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

Disclosures

JM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

European Association of Urology. Urological infections. 2025 [internet publication].Full text

Vourganti S, Agarwal PK, Bodner DR, et al. Ultrasonographic evaluation of renal infections. Radiol Clin North Am. 2006 Nov;44(6):763-75. 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 Mar 1;52(5):e103-20.Full text  Abstract

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

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Chronic pyelonephritis images
  • Differentials

    • Acute pyelonephritis
    • Renal calculi
    • Renal cancer
    More Differentials
  • Guidelines

    • Urological infections
    • IDSA 2024 guidance on the treatment of antimicrobial resistant gram-negative infections
    More Guidelines
  • Patient information

    Kidney infection

    Kidney stones

    More Patient information
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