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Urinary tract infection (UTI), including both cystitis and pyelonephritis, may present with back pain. Cystitis typically causes a low lumbar or sacral aching pain, whereas the pain of pyelonephritis typically localizes to the costovertebral angle on the side of the infected kidney. Patients with cystitis usually have dysuria and the other classic symptoms of UTI.

Pyelonephritis can present without urinary symptoms, and back pain is occasionally the chief complaint. Although many risk factors for pyelonephritis are the same as those for cystitis (urinary retention, instrumentation or indwelling catheter, pregnancy, immunosuppression), additional risk factors for pyelonephritis include anatomic abnormalities of the kidney (bifid ureter, ureteral valves, renal scarring from prior infections, and renal calculi). Pyelonephritis is more common in women than men, although men are more likely to have predisposing anatomic abnormalities. Chronic prostatitis also predisposes men to UTI.


  • Pyelonephritis may be cause by the the following infections includes infections in the bladder, use of a catheter to drain urine from the bladder, use of a cystoscope to examine the bladder and urethra, surgery on the urinary tract, conditions such as prostate enlargement and kidney stones that prevent the efficient flow of urine from the bladder
  • Several bacteria that may cause Pyelonephritis such as Escherichia coli, Klebsiella. Enterobacter, Proteus, or Pseudomonas are other common causes of infection. Once these organisms enter the urinary tract, they cling to the tissues that line the tract and multiply in them.
  • Chronic pyelonephritis is renal injury that may be caused by recurrent or persistent renal infesction.


  • Fever and chills, occasionally rigors
  • Nausea or vomiting
  • Flank pain
  • Dysuria, frequency, and urgency may be present whenever cystitis coexists with pyelonephritis.


  • Unilateral costovertebral angle tenderness usually present
  • Fever
  • Malaise
  • Unlike musculoskeletal back pain, the back pain of pyelonephritis does not radiate, nor is it exacerbated by movement
  • Flank tenderness to percussion should be elicited.


  • For the treatment of Chronic pyelonephritis, then it may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include the following Sulfa drugs such as sulfisoxazole, Amoxicillin, Cephalosporins, Levofloxacin and ciprofloxacin.
  • You can treat Progressive renal injury by restricting dietary protein intake.
  • Another treatment for Pyelonephritis is Supportive care, it includes rest, antipyretics as needed, oral or parenteral pain medications as needed, oral or parenteral antiemetics as needed, urinary tract analgesics to relieve dysuria, intravenous or oral fluids to maintain hydration status.

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