Acute Pyelonephritis Epidemiology and Management
Summary
Acute pyelonephritis is a common and potentially serious infection of the renal parenchyma and pelvis that affects patients worldwide, with a higher incidence in women and older adults. Typical clinical features include fever, flank pain and urinary symptoms, but presentations may vary. Risk factors for hospitalisation and poor outcomes include male sex, advanced age, comorbidities such as diabetes or immunosuppression, urinary tract abnormalities and prior antibiotic exposure. The rise of antimicrobial resistance, particularly among uropathogenic Escherichia coli, has complicated empirical therapy and driven increased use of broad-spectrum agents such as carbapenems. Diagnostic evaluation relies primarily on clinical assessment, urinalysis and cultures, supplemented by imaging—usually contrast-enhanced computed tomography—to identify complications such as abscesses or obstruction. Management strategies range from outpatient oral therapy for uncomplicated cases to inpatient intravenous antibiotics and supportive care for severe or complicated infections. Emerging evidence underscores the importance of host factors, including immune cell function, in disease severity, while evolving clinical prediction rules and imaging criteria aim to refine admission and treatment decisions. Overall, optimal outcomes depend on timely diagnosis, judicious antibiotic use and attention to individual risk profiles.
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Acute Pyelonephritis Epidemiology and Management publication trend
The graph below shows the total number of articles in acute pyelonephritis epidemiology and management across all publications each year (not limited to Nature Index journals).
Technical terms
Acute Pyelonephritis: Severe bacterial infection of the renal pelvis and parenchyma.
Uropathogenic Escherichia coli: Strains of E. coli adapted to colonise and infect the urinary tract.
Neutrophil maturation: Developmental process by which neutrophil precursors acquire full antimicrobial capacity.
Carbapenems: Class of broad-spectrum β-lactam antibiotics reserved for multidrug-resistant infections.
Contrast-enhanced computed tomography: Imaging technique employing intravenous contrast to visualise renal morphology and complications.
Clinical prediction rule: Algorithmic tool combining clinical variables to guide diagnostic or management decisions.
References
- Androgen exposure impairs neutrophil maturation and function within the infected kidney. mBio (2024).
- Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade. Antibiotics (2020).
- Hospitalization for community-acquired febrile urinary tract infection: validation and impact assessment of a clinical prediction rule. BMC Infectious Diseases (2017).
- Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection. Infectious Disease Reports (2024).
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