Pyelonephritis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]


Pyelonephritis patients usually present in the emergency department with sudden development of pain radiating to the flank in the presence of dysuria and fever. The differentiation of pyelonephritis from other causes of dysuria is based on severity of symptoms and the typical radiation of pain. A thorough history and examination is required to differentiate pyelonephritis from other causes of dysuria and flank pain.


Patients with pyelonephritis can present with the history of following important findings:[1]


Patients with pyelonephritis can report the following symptoms:[1][2][3][4]

Symptoms requiring urgent management

  • Fever- usually high grade
  • Dysuria (painful voiding of urine)
  • Abdominal pain (radiating to the back on the affected side)
  • Rib or back pain
  • Rigors (violent shivering while the temperature rises)

Other Common Symptoms

Symptoms in infants

Pyelonephritis in infants and children less than 2 years may present as:

Symptoms in Elderly

In elderly, pyelonephritis can present as:

Urinary symptoms

Urinary symptoms of pyelonephritis can include:




In elderly, pyelonephritis may present as:

Cardiovascular System


  1. 1.0 1.1 Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–10. PMID 12020306. Review in: Evid Based Nurs. 2002 Oct;5(4):119
  2. Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD (2008). "Xanthogranulomatous pyelonephritis: clinical experience with 41 cases". Urology. 71 (2): 178–80. doi:10.1016/j.urology.2007.09.026. PMID 18308077.
  3. Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). "Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs". BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
  4. Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F; et al. (2007). "Does this child have a urinary tract infection?". JAMA. 298 (24): 2895–904. doi:10.1001/jama.298.24.2895. PMID 18159059.

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