What are the symptoms and physical findings of pyelonephritis?

Updated: Jan 02, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Patients with pyelonephritis appear ill; have fever, chills, and flank pain; and may have hypotension. Although fever is very suggestive of pyelonephritis, it has also been demonstrated in some males with simple cystitis. Note that 30-50% of pyelonephritis cases may be silent, without clinical symptoms.

In the older male, prostate enlargement along with delayed presentation are the primary causes of pyelonephritis. Other historical risk factors include nephrolithiasis, neurogenic bladder, prostatitis, or symptom duration greater than 5 days.

Classic findings with pyelonephritis include fever, chills, and flank pain/costovertebral angle tenderness that follow the symptoms of UTI; these findings are combined with pyuria and bacteriuria. Occasionally, the urinalysis and urine culture findings are negative, such as when an obstruction of the upper urinary tract is present due to stone disease.

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