Editing Pyelonephritis (section)

{{Short description|Inflammation of the kidney}}
{{Use dmy dates|date=July 2024}}
{{cs1 config |name-list-style=vanc |display-authors=6}}
{{Infobox medical condition (new)
| name = Pyelonephritis
| synonyms = Kidney infection<ref name=NIH2017/>
| image = Xanthogranulomatous_pyelonephritis_cd68.jpg
| alt = A color photomicrograph, demonstrating macrophages and giant cells in a case of xanthogranulomatous pyelonephritis.
| caption = [[CD68]] [[immunostaining]] on this [[Micrograph|photomicrograph]] shows [[macrophage]]s and [[giant cell]]s in a case of xanthogranulomatous pyelonephritis.
| field = [[Infectious disease (medical specialty)|Infectious disease]], [[urology]], [[nephrology]]
| pronounce = {{IPAc-en|p|aɪ|ə|l|oʊ|n|ə|ˈ|f|r|aɪ|t|ɪ|s}}
| symptoms = [[Fever]], [[costovertebral angle tenderness|flank tenderness]], [[nausea]], [[dysuria|burning with urination]], [[frequent urination]]<ref name=AFP2011/>
| complications = 
| onset = 
| duration = 
| types = 
| causes = [[Bacterial infection]]<ref name=AFP2011/>
| risks = [[Sexual intercourse]], prior [[urinary tract infections]], [[diabetes]], structural problems of the [[urinary tract]], [[spermicide]] use<ref name=AFP2011/><ref name=Lip2011/>
| diagnosis = Based on symptoms and supported by [[urinalysis]]<ref name=AFP2011/>
| differential = [[Endometriosis]], [[pelvic inflammatory disease]], [[kidney stones]]<ref name=AFP2011/>
| prevention = Urination after sex, drinking sufficient fluids<ref name=NIH2017/>
| treatment = 
| medication = Antibiotics ([[ciprofloxacin]], [[ceftriaxone]])<ref name=Pre2014/>
| prognosis = 
| frequency = Common<ref name=Fer2018/>
| deaths = 
}}
<!-- Definition and symptoms -->
'''Pyelonephritis'''  is inflammation of the [[kidney]], typically due to a [[bacterial infection]].<ref name=Lip2011>{{cite book|title=Lippincott's Guide to Infectious Diseases|date=2011|publisher=Lippincott Williams & Wilkins|isbn=9781605479750|page=258|url=https://books.google.com/books?id=ZF-eoG18XXAC&pg=PA258|language=en|url-status=live|archive-url=https://web.archive.org/web/20171105194328/https://books.google.ca/books?id=ZF-eoG18XXAC&pg=PA258|archive-date=5 November 2017}}</ref> Symptoms most often include [[fever]] and [[costovertebral angle tenderness|flank tenderness]].<ref name=AFP2011/> Other symptoms may include [[nausea]], [[dysuria|burning with urination]], and [[polyuria|frequent urination]].<ref name=AFP2011/> Complications may include [[pyonephrosis|pus around the kidney]], [[sepsis]], or [[acute kidney injury|kidney failure]].<ref name=Lip2011/>

<!-- Cause and diagnosis -->
It is typically due to a bacterial infection, most commonly ''[[Escherichia coli]]''.<ref name=AFP2011/> Risk factors include [[sexual intercourse]], prior [[urinary tract infections]], [[diabetes]], structural problems of the [[urinary tract]], and [[spermicide]] use.<ref name=AFP2011/><ref name=Lip2011/> The mechanism of infection is usually spread up the [[Urinary system|urinary tract]].<ref name=AFP2011/> Less often infection occurs through the bloodstream.<ref name=NIH2017>{{cite web|title=Kidney Infection (Pyelonephritis)|url=https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis/all-content|website=NIDDK|access-date=30 October 2017|date=April 2017|url-status=live|archive-url=https://web.archive.org/web/20171004230310/https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis/all-content|archive-date=4 October 2017}}</ref> Diagnosis is typically based on symptoms and supported by [[urinalysis]].<ref name=AFP2011/> If there is no improvement with treatment, [[medical imaging]] may be recommended.<ref name=AFP2011/>

<!-- Prevention and treatment -->
Pyelonephritis may be preventable by urination after sex and drinking sufficient fluids.<ref name=NIH2017/> Once present it is generally treated with [[Antibacterial|antibiotics]], such as [[ciprofloxacin]] or [[ceftriaxone]].<ref name=Pre2014>{{cite journal | vauthors =  | title = Antibiotic therapy for acute uncomplicated pyelonephritis in women. Take resistance into account | journal = Prescrire International | volume = 23 | issue = 155 | pages = 296–300 | date = December 2014 | pmid = 25629148 }}</ref><ref>{{cite journal | vauthors = Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE | title = 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 | journal = Clinical Infectious Diseases | volume = 52 | issue = 5 | pages = e103–e120 | date = March 2011 | pmid = 21292654 | doi = 10.1093/cid/ciq257 | doi-access = free | title-link = doi }}</ref> Those with severe disease may require treatment in hospital.<ref name=AFP2011/> In those with certain structural problems of the urinary tract or [[kidney stones]], surgery may be required.<ref name=NIH2017/><ref name=Lip2011/>

<!-- Epidemiology -->
Pyelonephritis affects about 1 to 2 per 1,000 women each year and just under 0.5 per 1,000 males.<ref name=Fer2018>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=9780323529570|page=1097|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA1097|language=en|url-status=live|archive-url=https://web.archive.org/web/20171105194328/https://books.google.ca/books?id=wGclDwAAQBAJ&pg=PA1097|archive-date=5 November 2017}}</ref><ref>{{cite book| vauthors = Lager DJ, Abrahams N |title=Practical Renal Pathology, A Diagnostic Approach E-Book: A Volume in the Pattern Recognition Series|date=2012|publisher=Elsevier Health Sciences|isbn=978-1455737864|page=139|url=https://books.google.com/books?id=Ir5JIOjBCuQC&pg=PA139|language=en|url-status=live|archive-url=https://web.archive.org/web/20171105194328/https://books.google.ca/books?id=Ir5JIOjBCuQC&pg=PA139|archive-date=5 November 2017}}</ref> Young adult females are most often affected, followed by the very young and old.<ref name=AFP2011>{{cite journal | vauthors = Colgan R, Williams M, Johnson JR | title = Diagnosis and treatment of acute pyelonephritis in women | journal = American Family Physician | volume = 84 | issue = 5 | pages = 519–526 | date = September 2011 | pmid = 21888302 }}</ref> With treatment, outcomes are generally good in young adults.<ref name=Lip2011/><ref name=Fer2018/> Among people over the age of 65 the risk of death is about 40%, though this depends on the health of the elderly person, the precise organism involved, and how quickly they can get care through a provider or in hospital.<ref name=Fer2018/>
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