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Pyelonephritis is a topic covered in the 5-Minute Emergency Consult.

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  • Complication of a lower UTI by bacterial ascension into the upper urinary tract
  • Primarily a clinical diagnosis
  • Incidence lower in males in every age group
  • Male/female ratio:
    • 1:10 in 1st years of life
    • 1:5 in children
    • 1:50 in reproductive years
    • 1:1 in 5th decade and later
  • Bilateral infection in up to 25% of cases, hence no lateralizing signs (in some studies)


  • Bacteriology:
    • Escherichia coli 80–95% predominates
    • Uropathogens:
      • Klebsiella species
      • Citrobacter species
      • Enterobacter species
    • Others:
      • Staphylococcus saprophyticus 5–15%
      • Proteus mirabilis
      • Serratia species
      • Pseudomonas species
      • Staphylococcus aureus (increasing)
  • Predisposing factors (consider complicated infections):
    • Recent instrumentation:
      • Catheterization
      • Cystoscopy
    • Urinary retention:
      • Mechanical (see Obstruction below)
      • Medications (e.g., anticholinergics)
      • Other infections (e.g., herpes simplex)
    • Urinary obstruction:
      • Stricture
      • Renal calculi
      • Prostatic hypertrophy
    • Anatomic abnormalities:
      • Hypospadias
      • Ureteral ectopia
      • Bifid ureter
      • Renal scarring
      • Ureterovesicular reflux (UVR)
      • Posterior urethral valves
    • Neurologic conditions:
      • Neurogenic bladder
      • Spinal cord injury
    • Abnormal urodynamics
    • Previous UTIs (in childhood, >3 in last year)
    • Recent pyelonephritis (within 1 yr)
    • Diabetes mellitus
    • Immunosuppression
    • Pregnancy

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Rosen, Peter, et al., editors. "Pyelonephritis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis.
Pyelonephritis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis. Accessed April 24, 2019.
Pyelonephritis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis
Pyelonephritis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pyelonephritis ID - 307386 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307386/all/Pyelonephritis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -