What is the treatment for infectious supportive hydronephritis (infection of the kidney and renal pelvis with resulting swelling)

From the Guidelines

For infection supportive hidrwntits, also known as pyelonephritis, the most effective treatment approach involves a combination of antimicrobial therapy and supportive care, with the goal of reducing morbidity, mortality, and improving quality of life.

Diagnosis and Treatment

The diagnosis of pyelonephritis typically involves urinalysis, urine culture, and antimicrobial susceptibility testing, as well as imaging studies such as ultrasound to rule out urinary tract obstruction or renal stone disease 1.

• The treatment of pyelonephritis depends on the severity of the infection and the presence of complicating factors, such as urinary tract obstruction or sepsis.
• For uncomplicated pyelonephritis, oral fluoroquinolones or cephalosporins are recommended as first-line therapy, with a treatment duration of 5-7 days 1.
• For complicated pyelonephritis, intravenous antimicrobial therapy with a fluoroquinolone, an aminoglycoside, or an extended-spectrum cephalosporin or penicillin is recommended, with a treatment duration of 10-14 days 1.

Antimicrobial Therapy

The choice of antimicrobial therapy for pyelonephritis should be based on local resistance patterns and the results of antimicrobial susceptibility testing.

• Fluoroquinolones, such as ciprofloxacin, are effective against a wide range of uropathogens, including Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa 1.
• Cephalosporins, such as ceftriaxone, are also effective against a wide range of uropathogens, including E. coli, K. pneumoniae, and P. aeruginosa 1.

Supportive Care

Supportive care for pyelonephritis includes hydration, pain management, and monitoring for complications such as sepsis or acute kidney injury.

• Patients with pyelonephritis should be encouraged to drink plenty of fluids to help flush out the infection and prevent dehydration.
• Pain management may include the use of analgesics such as acetaminophen or ibuprofen, as well as antimicrobial therapy to reduce inflammation and pain. The most recent and highest quality study, published in 2024, recommends a short-course antibiotic treatment for acute pyelonephritis, with a treatment duration of 5-7 days, which is equivalent to longer therapy durations in terms of clinical and microbiological success 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Infection Supportive Hydronephrosis

• The term "infection supportive hydronephrosis" is not directly addressed in the provided studies, but we can gather information related to infections and hydronephrosis from the available evidence.
• Hydronephrosis is a condition characterized by the dilation of the renal collecting system, which can be caused by various factors, including infections 2.
• Infected hydronephrosis is a serious condition that requires prompt treatment to avoid complications and reduce costs 3.
• The treatment of infected hydronephrosis often involves the use of antibiotics, and the choice of antibiotic and duration of treatment depend on various factors, including the causative organism and the severity of the infection 4, 5, 3, 6.

Antibiotic Treatment

• The use of antibiotics is crucial in the treatment of infected hydronephrosis, but it is essential to use them wisely to avoid the development of antimicrobial resistance 4, 6.
• Various antibiotics have been studied for the treatment of urinary tract infections, including those caused by multidrug-resistant organisms 4.
• Shorter courses of antibiotic therapy have been shown to be effective for many common infections, including community-acquired pneumonia, intraabdominal sepsis, and gram-negative bacteremia 6.
• The choice of antibiotic and duration of treatment should be based on the specific needs of the patient and the causative organism, rather than relying on expert opinion or traditional treatment protocols 6.

Hydronephrosis Diagnosis and Treatment

• Hydronephrosis can be diagnosed using various imaging modalities, including sonography, radiography, and magnetic resonance imaging 2.
• The grading scale for hydronephrosis is an essential tool in determining the severity of the condition and guiding treatment decisions 2.
• Treatment options for hydronephrosis depend on the underlying cause and may include surgical intervention, antibiotic therapy, or other supportive measures 2, 3.