Urology Book

Infectious Disease


Pyelonephritis in Pregnancy

Aka: Pyelonephritis in Pregnancy
  1. See Also
    1. Pyelonephritis
    2. Acute Cystitis in Pregnancy
    3. Urinary Tract Infection
  2. Epidemiology
    1. Incidence: 2% of pregnancy
    2. Peak Incidence in the second and third trimesters
  3. Pathophysiology
    1. Pregnancy factors that increase Pyelonephritis risk
      1. Increased GFR (results in Glycosuria, alkaluria)
      2. Increased Serum Progesterone (results in dilation of renal calyces, ureteral peristalsis stagnation)
      3. Bladder compression
  4. Symptoms
    1. Fever
    2. Chills
    3. Nausea
    4. Contractions
    5. Preterm Labor
    6. Acute Cystitis Symptoms
  5. Signs
    1. Fever
    2. Maternal Tachycardia
    3. Fetal Tachycardia
    4. Costovertebral Angle Tenderness to palpation
    5. Pelvic exam
  6. Labs
    1. Urinalysis
    2. Urine Culture with Sensitivity
      1. Consider Urinary Catheter sample
    3. Complete Blood Count
      1. Leukocytosis
    4. Chemistry Panel (basic metabolic panel)
    5. Consider straining urine for calculi
  7. Imaging
    1. Renal Ultrasound
      1. Hydronephrosis
  8. Management: Inpatient
    1. Most pregnant patients with Pyelonephritis start with inpatient care
    2. Antibiotics
      1. Ceftriaxone (Rocephin) 1-2 grams IV or IM every 24 hours
        1. Avoid in the peripartum period due to risk of newborn Kernicterus
      2. Unasyn 1.5-3g IV q6h
      3. Combination Protocol for 14 days
        1. Ampicillin 2 g IV every 6 hours
        2. Gentamycin 1.5 mg/kg (Maximum 80-100 mg) q8 hours
          1. Adjust dosing per kinetics for >1-2 days use
    3. Other Inpatient Therapy
      1. Bedrest in semi-Fowler's position
        1. Place on side opposite affected Kidney
      2. Use cooling measures as needed for Temp > 102
      3. Intravenous hydration
      4. Maintain intravenous antibiotics
        1. Oral when affebrile without CVA pain for 48 hours
        2. Complete a total of 7-14 days
        3. Consider Urinary Tract Infection prophylaxis
  9. Management: Outpatient antibiotics
    1. Augmentin 875 mg PO bid for 14 days
    2. Macrodantin (avoid in third trimester, risk of newborn Hemolysis)
      1. Initial: 100 mg PO qid for 14 days
      2. Prophylaxis: 100 mg PO qhs until 6 weeks postpartum
    3. Keflex 250 mg PO qid for 14 days
  10. Complications
    1. Acute Respiratory Distress Syndrome (in up to 8% of cases of Pyelonephritis in Pregnancy)
    2. Acute Kidney Injury
    3. Anemia
  11. References
    1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4

pregnancy and pyelonephritis (C0747827)

Concepts Finding (T033)
ICD10 O23.0
English Pyelonephritis in pregnancy, pregnancy pyelonephritis, pregnancy and pyelonephritis, pyelonephritis pregnancy, pregnancy; pyelonephritis
Dutch zwangerschap; pyelonefritis
Derived from the NIH UMLS (Unified Medical Language System)

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