Curriculum · Gynecology / Women's Health / Infertility / Perinatal Care / Birth Spacing
Pyelonephritis in pregnancy
What it is
Acute pyelonephritis is the urinary tract infection that is set against cystitis and carries everything cystitis carries and more, and unlike cystitis it is treated with admission. In pregnancy it is the thing that untreated bacteriuria runs into, and the two accounts do not agree on how often. In one reading asymptomatic bacteriuria occurs in 2-10% of pregnant women, and up to 30-40% progress to pyelonephritis if untreated; in another it affects up to 7% of pregnant women, of whom 25% will go on to develop pyelonephritis. Pyelonephritis heads the maternal complications of bacteriuria in pregnancy with sepsis and anemia. Pregnancy makes that step easier because the calyces and ureters dilate.
How it presents
Cystitis gives dysuria, increased frequency, urgency and retropubic or suprapubic abdominal pain. Acute pyelonephritis gives all of those and adds spiking fever with chills, anorexia, nausea and vomiting, and loin pain or tenderness. Costovertebral angle tenderness is the sign to elicit on examination. A neutrophilic leukocytosis with a mildly increased creatinine is the blood picture described in a worsening flank pain with fever, chills and rigors.