Treatment Pathway
Treatment of Kidney Infection (Pyelonephritis)
Pyelonephritis is bacterial infection of one or both kidneys, usually ascending from a bladder infection. It requires prompt antibiotics to prevent kidney damage and sepsis.
KDIGO (Kidney Disease Improving Global Outcomes)ERA (European Renal Association)AUA (American Urological Association)NICEEAU (Urological)
Pyelonephritis is bacterial infection of one or both kidneys, usually ascending from a bladder infection. It requires prompt antibiotics to prevent kidney damage and sepsis.
First-Line Treatment Principles
- ✓BP control: target <130/80 mmHg; ACE inhibitor or ARB for proteinuric CKD
- ✓SGLT2 inhibitors for CKD with proteinuria (regardless of diabetes): reduce CKD progression by 30–40%
- ✓Treat underlying cause: immunosuppression for glomerulonephritis, antiviral for viral-associated nephropathy
- ✓Fluid management: adequate hydration in AKI; fluid restriction in oliguric/ESRD patients
- ✓Treat complications: anaemia (EPO/iron), bone disease (phosphate binders, vitamin D), hyperkalaemia
Non-Pharmacological Management
- •Dietary protein restriction (0.6–0.8 g/kg/day) in advanced CKD to slow progression
- •Sodium restriction (<2g/day) for BP and fluid management
- •Potassium restriction in hyperkalaemia; phosphate restriction in ESRD
- •Fluid management: adequate intake in early CKD; restrict to 1.0–1.5L/day in oliguric ESRD
- •Smoking cessation: accelerates CKD progression
- •Weight management: obesity drives glomerular hyperfiltration and proteinuria
- •Regular aerobic exercise where tolerated; renal rehabilitation programmes
Treatment Goals
🎯Slow CKD progression: halve rate of GFR decline; delay dialysis/transplant
🎯UACR <30 mg/mmol (or >50% reduction from baseline)
🎯BP <130/80 mmHg; haemoglobin 100–120 g/L
🎯Preserve quality of life; minimise uraemic symptoms
🎯Renal replacement therapy (dialysis or transplant) when eGFR <10–15 and uraemic symptoms present
Monitoring Parameters
- ◆eGFR and creatinine: 3–6 monthly in CKD stages 3–4; monthly in CKD stage 5 or rapid progressors
- ◆Urine albumin-creatinine ratio (UACR): every 3–6 months
- ◆Electrolytes: potassium (ACE inhibitor/ARB risk), sodium, bicarbonate, phosphate — 3–6 monthly
- ◆FBC: haemoglobin target 100–120 g/L with EPO therapy
- ◆Parathyroid hormone (PTH), calcium, phosphate: for renal bone disease monitoring
- ◆BP: target at every visit
Escalation Criteria
- →AKI: urgent assessment for reversible causes; IV fluids if pre-renal; emergency dialysis if urea >35, K+>6.5, acidosis, or fluid overload
- →Rapidly progressive GFR decline → renal biopsy and specialist nephrology review
- →Hyperkalaemia >6.5 mmol/L: immediate cardiac monitoring, calcium gluconate IV, insulin-dextrose, dialysis if refractory
- →Prepare for renal replacement therapy (RRT) education when eGFR <20: home dialysis or transplant listing
Special Populations
Elderly: reduced renal reserve; drug dosing adjustment essential; less aggressive BP targets to avoid AKI
Diabetes: combination of ACE inhibitor + SGLT2i provides maximal nephroprotection
Pregnancy: pre-existing CKD significantly increases maternal and fetal risks; specialist obstetric nephrology essential
Transplant recipients: immunosuppression (calcineurin inhibitors, steroids, MMF); vigilance for opportunistic infections
Clinical Insights
Compare With Similar Conditions
Not sure about your symptoms?
Our AI Symptom Checker analyses your symptoms and suggests the most likely diagnoses — including relevant treatment pathways.
Use AI Symptom Checker →