Kidney infection (pyelonephritis)

Alternative Names

Treatment

The goals of treatment are control of the infection and reduction of symptoms. Acute symptoms usually disappear within 48 to 72 hours after appropriate treatment.

Due to the high mortality rate in the elderly population and the risk of complications, prompt treatment is recommended.

After obtaining a urine culture to identify the bacteria, antibiotics are selected to treat the infection.

MEDICATIONS

Intravenous (IV) antibiotics may be used initially to control the bacterial infection if your infection is severe or you cannot take antibiotics by mouth. In acute cases of pyelonephritis, you may receive a 10- to 14-day course of antibiotics.

Chronic pyelonephritis may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include the following:

• Sulfa drugs such as sulfisoxazole/trimethoprim
• Amoxicillin
• Cephalosporins
• Levofloxacin and ciprofloxacin

Permanent kidney damage can rarely result from these infections when they are chronic, when they occur in a transplanted kidney, or when multiple infections occur during infancy or childhood. Acute kidney injury (acute renal failure) may occur when an infection is severe enough to result in shock (low blood pressure). Severe episodes of acute kidney injury may result in permanent kidney damage and lead to chronic kidney disease.

The elderly, infants, and people with a compromised immune system are at increased risk for developing sepsis (a severe blood infection) and shock. Often, these people will be admitted to the hospital to receive frequent monitoring for potential problems and to receive IV antibiotics, additional IV fluids, and other medications as necessary.

MONITORING

In diabetic patients and pregnant women, as well as in people with spinal paralysis, follow-up should include a urine culture at the completion of antibiotic therapy to ensure that bacteria are no longer present in the urine.

Outlook (Prognosis)

Most cases of pyelonephritis get better without complication after the treatment. However, the treatment may need to be aggressive or prolonged. If sepsis occurs, it can be fatal.

Possible Complications

• Recurrence of pyelonephritis
• Perinephric abscess (infection around the kidney)
• Sepsis
• Acute renal failure

When to Contact a Medical Professional

Call your health care provider if symptoms suggesting pyelonephritis occur.

If you have pyelonephritis, call your health care provider if new symptoms develop, especially decreased urine output, persistent high fever, or severe flank pain or back pain.