Acute Pyelonephritis II: Diagnostic Studies and Management

Diagnosing acute pyelonephritis involves diagnostic tests such as urinalysis to detect white blood cells, bacteria, and nitrites, along with urine culture and sensitivity testing to identify the bacterial strain and guide antibiotic selection.

A CBC with a WBC differential helps detect systemic infection, while blood cultures confirm bacteremia.

Imaging studies, such as ultrasound, visualize the kidneys and detect abnormalities, though CT scans are reserved for complex cases or suspected abscesses.

Cystoscopy may sometimes be performed to identify stones or anatomical issues.

Treatment depends on severity.

Mild cases are often managed on an outpatient basis, with recommendations for adequate fluid intake, NSAIDs, or antipyretics, and broad-spectrum antibiotics like fluoroquinolones or cephalosporins, which are later adjusted based on culture results.

Severe cases require hospitalization, where treatment includes IV fluids, NSAIDs, or antipyretics to reduce fever and broad-spectrum IV antibiotics—such as carbapenems or vancomycin—adjusted according to culture sensitivity results.