Pyelonephritis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Pyelonephritis patients usually present in the emergency department with sudden development of pain radiating to the flank in the presence of dysuria and fever. The differentiation of pyelonephritis from other causes of dysuria is based on severity of symptoms and the typical radiation of pain. A thorough history and examination is required to differentiate pyelonephritis from other causes of dysuria and flank pain.

History

Patients with pyelonephritis can present with the history of following important findings:^[1]

Sudden symptom onset
Fever
Recent urinary tract infection
Diabetes
Immunosuppression
Known structural defect of the urinary tract
Renal stones
History of pyelonephritis
Tumor
Cyst or abscess in the urinary tract

Symptoms

Patients with pyelonephritis can report the following symptoms:^[1]^[2]^[3]^[4]

Symptoms requiring urgent management

Fever– usually high grade
Dysuria (painful voiding of urine)
Abdominal pain (radiating to the back on the affected side)
Rib or back pain
Rigors (violent shivering while the temperature rises)

Other Common Symptoms

Frequency
Urgency
Hematuria
Constitutional symptoms (fatigue, decreased appetite)
Nausea and vomiting
Delirium
Headache

Symptoms in infants

Pyelonephritis in infants and children less than 2 years may present as:

Fever
Fussiness
Decreased appetite
Signs of urinary tract infection may be missing

Symptoms in Elderly

In elderly, pyelonephritis can present as:

Confusion
Disoriented speech
Hallucinations

Urinary symptoms

Urinary symptoms of pyelonephritis can include:

Frequency (frequent urination)
Urgency (urgent need to urinate)
Nocturia (need to urinate at night)
Dysuria (painful urination)
Low volume voids
Hematuria (blood in the urine)
Foul or strong urine odor
Abnormal urine color (cloudy)

Gastrointestinal

Abdominal pain or pain radiating to the flank
Nausea and vomiting

Musculoskeletal

Pressure in the lower pelvis or back
Flank pain or back pain

Neurological

In elderly, pyelonephritis may present as:

Cardiovascular System

Tachycardia

References

↑ ^1.0 ^1.1 Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). “Does this woman have an acute uncomplicated urinary tract infection?”. JAMA. 287 (20): 2701–10. PMID 12020306. Review in: Evid Based Nurs. 2002 Oct;5(4):119
↑ Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD (2008). “Xanthogranulomatous pyelonephritis: clinical experience with 41 cases”. Urology. 71 (2): 178–80. doi:10.1016/j.urology.2007.09.026. PMID 18308077.
↑ Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). “Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs”. BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
↑ Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D’Amico F; et al. (2007). “Does this child have a urinary tract infection?”. JAMA. 298 (24): 2895–904. doi:10.1001/jama.298.24.2895. PMID 18159059.

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[pmid12020306-1] 1.0 ^1.1 Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). “Does this woman have an acute uncomplicated urinary tract infection?”. JAMA. 287 (20): 2701–10. PMID 12020306. Review in: Evid Based Nurs. 2002 Oct;5(4):119

[pmid18308077-2] Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD (2008). “Xanthogranulomatous pyelonephritis: clinical experience with 41 cases”. Urology. 71 (2): 178–80. doi:10.1016/j.urology.2007.09.026. PMID 18308077.

[3] Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). “Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs”. BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.

[pmid18159059-4] Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D’Amico F; et al. (2007). “Does this child have a urinary tract infection?”. JAMA. 298 (24): 2895–904. doi:10.1001/jama.298.24.2895. PMID 18159059.

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