How is acute pyelonephritis treated?

Written by Zhou Qi
Nephrology
Updated on April 27, 2025
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Acute pyelonephritis is a problem caused by an infection, also known as an upper urinary tract infection. Therefore, the treatment plan for this disease should be based on the pathogen. The vast majority of acute pyelonephritis is caused by bacterial inflammation, so antibiotics are often required. It is generally recommended that patients should receive intravenous antibiotic treatment to kill the bacteria, choosing the antibiotics sensitive to the results of urine culture. After 10 to 14 days of treatment, the condition of acute pyelonephritis can usually be controlled in most cases. The patient's body temperature will gradually decrease, symptoms of back pain will ease, and the white blood cells in the urine will also disappear. Only a very few cases of acute pyelonephritis are difficult to treat because such patients may have predisposing factors to urinary tract infection such as diabetes and urinary system stones. (Specific medication use should be conducted under the guidance of a doctor.)

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Written by Pan Wu Shan
Nephrology
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Does pyelonephritis cause a fever?

Pyelonephritis is actually a part of urinary tract infections, which are divided into cystitis and acute pyelonephritis. The main symptoms of cystitis are frequent urination, urgency, and painful urination, among other urinary irritative symptoms, and these do not involve fever. However, if cystitis is not treated in time, it can worsen into acute pyelonephritis, which then presents with symptoms such as fever and back pain. The fever with acute pyelonephritis can be quite high, often exceeding 38 or 39 degrees Celsius, and might last for two to three days. At this point, treatment requires anti-infective medications, which should be continued for two weeks without any interruption. If the treatment duration is insufficient, pyelonephritis may recur. It is important to drink plenty of water, urinate frequently, and avoid holding in urine. Drinking lots of water can help flush out bacteria from the urine early on, promoting a quicker recovery from the illness.

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Written by Zhou Qi
Nephrology
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How to check for pyelonephritis?

Pyelonephritis, also known as upper urinary tract infection, is mostly caused by bacterial infection and the inflammatory response of the urinary system. The screening for this disease involves routine urine tests. Presence of white blood cells in the urine, coupled with symptoms like fever and back pain, can lead to a preliminary diagnosis. However, to confirm the diagnosis and identify the specific infecting pathogen, a culture of midstream urine is needed. Generally, to exclude certain causes of pyelonephritis, it is also necessary for the patient to have blood sugar levels checked and an ultrasound of the urinary system conducted. These tests can confirm whether the patient has diabetes, urinary system stones, or obstructions in the urinary system. Male patients can also undergo a prostate ultrasound to rule out urinary obstruction caused by prostate enlargement. These examinations can also help determine why the patient might have developed pyelonephritis.

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Written by Zhou Qi
Nephrology
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Can pyelonephritis be cured?

Whether pyelonephritis can be cured mainly depends on whether the patient has predisposing factors for urinary tract infections. These factors primarily include: Firstly, abnormalities in the anatomical structure of the urinary tract that may lead to obstruction of urine excretion, such as urological system stones, tumors, prolonged indwelling catheters, congenital abnormalities of the urinary system, and others. Additionally, there are some conditions that may lead to a decreased immune response, such as elderly individuals who are bedridden, those with diabetes, or patients using immunosuppressants. If the aforementioned factors are present, treatment of such cases of pyelonephritis might be challenging, with patients possibly experiencing recurrent episodes and potentially progressing to chronic pyelonephritis, eventually becoming difficult to cure completely. However, if none of these factors exist, the majority of cases with simple acute pyelonephritis can be cured and controlled by medication.

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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 Niu Yan Lin
Nephrology
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The difference between pyelonephritis and nephritis

Pyelonephritis and nephritis are two completely different diseases. Pyelonephritis is an infectious disease caused by bacteria, viruses, mycoplasma, chlamydia, etc. Treatment generally requires the use of antibiotics. The vast majority of patients can fully recover within two weeks under the treatment of sensitive antibiotics, without any sequelae. On the other hand, nephritis is mostly an autoimmune disease, not an infectious disease caused by pathogens. Therefore, its treatment does not require the use of antibiotics. Treatment usually involves ACE inhibitors or ARB type RUSH blockers, glucocorticoids, immunosuppressants, cytotoxic drugs, etc., and the course of nephritis is relatively long, with some patients having relatively poor prognosis. (Please use medication under the guidance of a doctor.)