What are the complications of acute pyelonephritis?

From the Guidelines

Acute pyelonephritis can lead to severe complications, including sepsis, shock, and death, if not promptly and effectively treated. The complications of acute pyelonephritis can be categorized into several key areas, including:

• Sepsis and shock: Acute pyelonephritis can progress to sepsis and shock, particularly in patients with underlying medical conditions or compromised immune systems 1.
• Renal damage: Untreated or severe acute pyelonephritis can cause permanent renal damage, including scarring and chronic kidney disease 1.
• Abscess formation: Acute pyelonephritis can lead to the formation of renal or perinephric abscesses, which require prompt drainage and antibiotic treatment 1.
• Obstruction: Acute pyelonephritis can cause obstruction of the urinary tract, particularly in patients with underlying anatomical abnormalities or kidney stones 1.
• Recurrence: Acute pyelonephritis can recur, particularly in patients with underlying medical conditions or compromised immune systems 1.

The management of acute pyelonephritis should prioritize prompt and effective treatment to prevent these complications. This includes:

• Prompt antibiotic therapy: Broad-spectrum antibiotics, such as fluoroquinolones or cephalosporins, should be initiated promptly to treat acute pyelonephritis 1.
• Imaging studies: Imaging studies, such as CT or ultrasound, should be performed to rule out obstruction or abscess formation 1.
• Fluid resuscitation and pain management: Adequate fluid resuscitation and pain management with acetaminophen or NSAIDs should be provided to support the patient's overall health 1.
• Monitoring: Close monitoring of the patient's renal function, blood cultures, and urine cultures should be performed to adjust antibiotics and manage potential complications 1.

From the Research

Complications of Acute Pyelonephritis

The complications of acute pyelonephritis can be severe and may include:

• Sepsis, which can occur in patients with severe illness or those who are immunocompromised 2, 3, 4
• Persistent vomiting, which can lead to dehydration and electrolyte imbalances 2
• Treatment failure, which can be caused by resistant organisms, underlying anatomic or functional abnormalities, or immunosuppressed states 2, 3, 5
• Urinary tract obstruction, which can lead to severe complications and requires urgent decompression 4
• Recurrence of symptoms, which can occur if the underlying cause of the infection is not addressed 3, 5, 6

Risk Factors for Complications

Certain patients are at higher risk for complications from acute pyelonephritis, including:

• Pregnant patients, who are at significantly elevated risk of severe complications and should be admitted and treated initially with parenteral therapy 4
• Patients with underlying medical conditions, such as diabetes or immunosuppression, who may be more susceptible to severe illness 2, 3, 5
• Patients with a history of urinary tract infections or other kidney problems, who may be more likely to experience recurrence or complications 3, 5, 6

Management of Complications

The management of complications from acute pyelonephritis may include:

• Hospitalization and intravenous antibiotic therapy for patients with severe illness or those who are at high risk for complications 2, 3, 5, 4
• Surgical intervention, such as renal drainage, for patients with urinary tract obstruction or other complicating factors 5, 6
• Imaging studies, such as CT scans, to evaluate the extent of the infection and guide treatment 3, 5, 6