Last reviewed: 6 Nov 2021
Last updated: 03 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

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

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

Risk factors

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

Diagnostic investigations

1st investigations to order

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

Investigations to consider

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

Treatment algorithm

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.

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