Pyelonephritis: Kidney and Repeat Urine Cultures

Pyelonephritis is an inflammation of the kidney and upper urinary tract that usually results from noncontagious bacterial infection of the bladder, known as cystitis. Acute pyelonephritis is most common in adult females but can affect people of either sex and any age. Its onset is usually sudden, with symptoms that are often mistaken as the result of straining the lower back. Pyelonephritis often is complicated by systemic infection. Left untreated or unresolved, it can progress to a chronic condition that lasts for months or years, leading to scarring and possible loss of kidney function.
The most common cause of pyelonephritis is the backward flow (reflux) of infected urine from the bladder to the upper urinary tract. A blockage or abnormality of the urinary system, such as those caused by stones, tumors, congenital deformities, or loss of bladder function from nerve disease, increases a person’s risk of pyelonephritis. Other risk factors include diabetes mellitus, pregnancy, chronic bladder infections, a history of analgesic abuse, paralysis from spinal chord injury, or tumors. Symptoms of acute pyelonephritis typically include fever and chills, burning or frequent urination, aching pain on one or both sides of the lower back or abdomen, cloudy or bloody urine, and fatigue. Patient may also have nausea, vomiting, and diarrhea. The symptoms of chronic pyelonephritis include weakness, loss of appetite, hypertension, anemia, and protein and blood in the urine. Treatment of acute pyelonephritis may require hospitalization if the patient is severely ill or has complications. Therapy most often involves a two or three week course of antibiotics, with the first few days of treatment given intravenously. The early symptoms of pyelonephritis usually disappear in 48 to 72 hours of the start of antibacterial treatment. Repeat urine cultures are done in order to evaluate the effectiveness of the medication. Chronic pyelonephritis may require high doses of