Chronic pyelonephritis is most commonly caused by chronic vesicoureteral reflux.
Diagnosis is clinical and confirmed with imaging studies. Typically, a biopsy is not performed.
There is no specific treatment, as damage is irreversible.
May result in end-stage renal disease.
Pyelonephritis - from the Greek "pyelo" (pelvis), "nephros" (kidney), and "itis" (inflammation) - refers to an inflammation of the kidney that can be acute, recurrent, or chronic. Chronic pyelonephritis is a complex renal disorder characterized by chronic tubulointerstitial inflammation and deep segmental cortical renal scarring and clubbing of the pelvic calyces as the papillae retract into the scars. It is an important cause of end-stage renal disease (ESRD). The term chronic pyelonephritis is sometimes used synonymously with interstitial nephritis, reflux nephropathy, and chronic atrophic pyelonephritis, and encompasses relatively rare but severe variants such as xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN).
History and exam
Key diagnostic factors
- history of vesicoureteral reflux (VUR)
- history of acute pyelonephritis
- history of renal obstruction
Other diagnostic factors
- female sex
- elevated BP
- children and infants (risk of VUR)
- adults (risk of XGP and EPN)
- weight loss
- cloudy urine
- back/flank pain and tenderness
- neurogenic bladder
- acute pyelonephritis
- vesicoureteral reflux
- renal calculi
- diabetes mellitus
1st investigations to order
- renal function
- urine culture
- electrolyte panel
- renal ultrasound
- kidney-ureter-bladder (KUB) radiograph
- CT abdomen
Investigations to consider
- MRI abdomen
- voiding cystourethrography (VCUG)
- renal biopsy
Lynda A. Frassetto, MD
Professor of Medicine
Division of Nephrology
University of California
LF declares that she has no competing interests.
Dr Frassetto would like to gratefully acknowledge the assistance of Donna M. Frassetto.
DMF declares that she has no competing interests.
Priyanka Sharma, MD
Cleveland Clinic Foundation
PS declares that she has no competing interests.
James Marsh, MA FRCP
Consultant Nephrologist and Clinical Director
St Helier Hospital
JM declares that he has no competing interests.
- Acute pyelonephritis
- Renal calculi
- Renal cancer
- Urological infections
- ACR-SPR practice parameter for the performance of renal scintigraphy
Kidney stonesMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer