Introduction

Definition Infection of the upper urinary tract that involves the kidney and usually presents with systemic manifestations.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

Typical presentation

Fever.
Chills.
Flank pain.
Nausea/vomiting.
Positive costovertebral angle (fist percussion) tenderness.
May be associated with dysuria, frequency, or urgency.

Diagnosis

Order:

Urinalysis.
Urine culture with antibiogram.
Complete blood count and renal function depending on severity.
Blood cultures in selected patients with systemic disease/sepsis.

EAU recommendation

The EAU recommends performing urine culture and antimicrobial susceptibility testing in all cases of pyelonephritis.

Should imaging be ordered for everyone?

Not necessarily the same study for everyone. Imaging becomes especially important when we suspect:

Obstruction.
Stone disease.
Urinary tract abnormalities.
Sepsis.
Clinical deterioration.
Persistent fever despite treatment.

Evaluation of the urinary tract is recommended to exclude urgent urological pathology, and additional studies should be considered if there is deterioration or persistence of symptoms/fever after 48–72 hours.

🔴 Alert

Pyelonephritis + obstruction = urological emergency. Think: antibiotics + resuscitation if needed + urgent urinary drainage.

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PDF

⬇ Download module guide (PDF)

Urinary tract infections — Guide for Medicine: uncomplicated and complicated UTI, pyelonephritis, prostatitis, epididymitis/orchitis, urethritis and STIs, urine culture interpretation, and rational antibiotic use (all 8 topics of the module in a single document).

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Practical algorithm

Content pending upload The general algorithm for the whole module (patient with urinary symptoms → localized vs. systemic UTI → management) is developed in the lesson "Rational antibiotic use" (block 5).

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Clinical case

Integrative case

Fever and flank pain

Interactive case: patient with fever and flank pain in the emergency department. Test your clinical reasoning step by step.

Solve the case →

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

European Association of Urology (EAU) — Guidelines on Urological Infections.

Source cited in the PDF study guide (block 4).

Pyelonephritis