How to treat acute pyelonephritis?

Written by Hu Lin
Nephrology
Updated on May 09, 2025
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During the acute phase, it is important to rest, drink plenty of water, urinate frequently, and provide a diet that is easy to digest, high in calories, and rich in vitamins for patients with fever. For patients with evident bladder irritation symptoms and significant hematuria, oral sodium bicarbonate can be taken to alkalize the urine and relieve symptoms. The primary treatment for acute pyelonephritis, of course, is anti-infection therapy. The pathogen in 80% of acute pyelonephritis cases is Escherichia coli. After collecting urine samples for bacterial examination, treatment should be initiated. For patients with milder conditions, outpatient oral medication can suffice, with a treatment duration of 10 to 14 days. Common medications include ofloxacin, amoxicillin, and cephalosporins, among others. Secondly, for severe infections accompanied by obvious systemic toxic symptoms, hospitalization for intravenous medication is required. Commonly chosen drugs include ampicillin, cefotaxime sodium, ceftriaxone sodium, and levofloxacin, etc. If the patient improves following the above treatments, they can switch to oral therapy after fever cessation and continue with a drip for three more days to complete a two-week course of treatment. (Please use medications under the guidance of a doctor; do not self-medicate.)

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Written by Li Liu Sheng
Nephrology
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What causes acute pyelonephritis?

Acute pyelonephritis refers to an acute inflammatory disease caused by bacteria invading the renal pelvis. It is commonly seen in women of childbearing age, the elderly, individuals with weakened immune systems, and patients with urinary tract obstructions. The main clinical manifestations of acute pyelonephritis typically include frequent urination, increased urination frequency, painful urination, back pain, fever, cold stomach, and it can even present symptoms such as headache, whole body muscle soreness, nausea, and vomiting. The most common pathogen causing acute pyelonephritis is Escherichia coli, while other bacteria such as Klebsiella pneumoniae, Proteus, and Pseudomonas aeruginosa can also cause infections of acute pyelonephritis. Therefore, it is crucial to actively choose sensitive antibiotics for the treatment of acute pyelonephritis.

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Written by Zhou Qi
Nephrology
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Principles of treatment for pyelonephritis

Pyelonephritis, also known as an upper urinary tract infection, is a bacterial inflammation, with over 95% being caused by bacterial infections, among which 70% are caused by Escherichia coli. Therefore, as a bacterial infection-induced inflammation, antibiotic treatment is of course necessary. Clinically, third-generation cephalosporins or fluoroquinolone antibiotics are often chosen for bactericidal treatment. For acute pyelonephritis, it is generally recommended that medication be administered for 14 days, alongside measures such as increased water intake and frequent urination. In cases of chronic pyelonephritis, a low-dose, long-course antibacterial treatment, such as using nitrofurantoin, may also be employed, with continuous medication for two months. (Please consult a clinical doctor for specific medication use; do not self-medicate.)

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Written by Zhou Qi
Nephrology
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How is pyelonephritis diagnosed?

Pyelonephritis is an upper urinary tract infection, with over 95% caused by bacterial infections in areas such as the renal pelvis and calyces, leading to inflammation. As a type of bacterial infection, if a patient's urine routine shows leukocytes and there is percussion pain in the renal area, along with fever, these symptoms combined with the urine examination can essentially lead to a diagnosis. However, a definitive diagnosis requires a culture of clean-catch midstream urine. If the bacteria in two consecutive urine cultures exceed 100,000 per milliliter and are the same type, the patient can be clearly diagnosed with pyelonephritis.

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Written by Zhou Qi
Nephrology
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Is pyelonephritis more serious or nephritis more serious?

Pyelonephritis is an upper urinary tract infection caused by a bacterial infection, leading to an inflammatory response in the urinary system. The severity of this condition can vary. Nephritis, on the other hand, refers to the sterile inflammation within the glomeruli of the kidney, which also varies in severity. Therefore, it is challenging to compare these two diseases in terms of their severity. In the case of pyelonephritis, most conditions are relatively more treatable, and using antibiotics can control acute pyelonephritis. However, a small number of patients may develop severe complications such as perinephric abscess, acute renal failure, renal papillary necrosis, and even death from septic shock. The severity of nephritis also varies, with symptoms ranging from significant proteinuria to mild hematuria. Therefore, a comparison should be based on the specific conditions of the patients. (The use of medications should be under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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How to diagnose pyelonephritis?

For the diagnosis of pyelonephritis, it is first necessary to confirm the diagnosis. Generally, patients should first undergo routine urine tests. In these tests, the presence of white blood cells and positive nitrites, along with clinical symptoms such as back pain, blood in urine, and fever are common. A routine blood test often shows elevated white blood cells and C-reactive protein. These indicators together suggest the presence of pyelonephritis. Furthermore, a culture of a clean-catch midstream urine sample can be done. If the bacteria grow to a certain quantity, it can also help in confirming the diagnosis of pyelonephritis. Additionally, to assess complications associated with pyelonephritis, it is necessary to perform blood tests for kidney function and an ultrasound of the urinary system to rule out conditions such as acute renal failure, renal papillary necrosis, and perinephric abscess, among others.