Summary
Definition
History and exam
Key diagnostic factors
- história de refluxo vesicoureteral (RVU)
- história de pielonefrite aguda
- história de obstrução renal
Other diagnostic factors
- sexo feminino
- náuseas
- pressão arterial elevada
- crianças e lactentes (risco de RVU)
- adultos (risco de pielonefrite xantogranulomatosa [PNX] e pielonefrite enfisematosa [PNE])
- perda de peso
- fadiga
- mal-estar
- urina turva
- febre
- dor e sensibilidade nas costas/flanco
Risk factors
- bexiga neurogênica
- pielonefrite aguda
- refluxo vesicoureteral
- obstrução
- litíase renal
- diabetes mellitus
Diagnostic investigations
1st investigations to order
- urinálise
- função renal
- urocultura
- painel de eletrólitos
- Hemograma completo
- ultrassonografia renal
- ultrassonografia de rins, ureteres e bexiga (RUB)
- tomografia computadorizada (TC) abdominal
Investigations to consider
- ressonância nuclear magnética (RNM) do abdome
- cistouretrografia miccional
- biópsia renal
Treatment algorithm
todos os pacientes
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
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
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.
Differentials
- Pielonefrite aguda
- Litíase renal
- Câncer renal
More DifferentialsGuidelines
- Urological infections
- IDSA 2024 guidance on the treatment of antimicrobial resistant gram-negative infections
More GuidelinesPatient information
Nefrolitíase
Infecção renal
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer