II. Epidemiology

  1. Incidence: 2% of pregnancy
  2. Peak Incidence in the second and third trimesters

III. 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

IV. Symptoms

  1. Fever
  2. Chills
  3. Nausea
  4. Contractions
  5. Preterm Labor
  6. Acute Cystitis Symptoms

V. Signs

  1. Fever
  2. Maternal Tachycardia
  3. Fetal Tachycardia
  4. Costovertebral angle tenderness to palpation
  5. Pelvic exam

VI. 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

VII. Imaging

VIII. 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

IX. 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

X. Complications

  1. Acute Respiratory Distress Syndrome (in up to 8% of cases of Pyelonephritis in Pregnancy)
  2. Acute Kidney Injury
  3. Anemia

XI. References

  1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: 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