Acute uncomplicated pyelonephritis

• 2-week course of appropriate oral antibiotics (trimethoprim-sulfamethoxasole or fluoroquinolones).
• For patients who are vomiting and dehydrated, septic, or with complicated pyelonephritis
  • Intravenous hydration and antibiotic therapy (a penicillin and an aminoglycoside, substituting vancomycin in penicillinallergic patients).
  • Cephalosporins (recommended for pregnant patients).
  • Convert to appropriate oral antibiotics (once clinically stable).
  • Duration of antibiotic treatment for complicated pyelonephritis is 3 weeks.
• Narcotic analgesics, nonsteroidal antiinflammatory drugs, and antiemetics (for pain and nausea)
• Patients promptly responding to therapy should undergo subsequent evaluation for urinary obstruction, calculi, or other factors, with intravenous urography and/or ultrasonography.

Chronic pyelonephritis

• Surgical treatment, occasionally in conjunction with;
• Appropriate urinary antiseptics (penicillin, nitrofurantoin, or trimethoprim-sulfamethoxisole).
• Urease inhibitors (acetohydroxaminic acid).
• Nephrectomy

Special Case: XANTHOGRANULOMATOUS PYELONEPHRITIS (XGP)

Treatment

• XGP is usually treated with nephrectomy.

Complications

Renal Abscess
May follow insufficient treatment of focal bacterial nephritis (lobar nephronia).

Treatment

• Percutaneous aspiration and prolonged antimicrobial therapy or definitive surgical drainage

Perinephric Abscess

Treatment

• Similar to treatment for renal abscess

Emphysematous Pyelonephritis

Treatment

• Immediate nephrectomy in combination with appropriate antibiotics
• Aggressive percutaneous renal and perirenal drainage

References

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