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Chronic pyelonephritis

Last reviewed: 30 Sep 2024
Last updated: 22 May 2024

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 BP
  • 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

Priyanka Sharma, MD

Associate Staff

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

PS 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.

  • Chronic pyelonephritis images
  • Differentials

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

    • Urological infections
    • IDSA 2023 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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