Chronic pyelonephritis

Mainstays of preventive therapy include treatment of acute infections and possibly surgical correction of anatomic abnormalities. See Urinary tract infections in children, Urinary tract infections in men, and Urinary tract infections in women.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon disease with no clear primary prevention strategies; treatment of renal stones, obstruction, and infection is recommended. Emphysematous pyelonephritis is extremely rare and, as with XGP, no clear primary prevention strategies exist; treatment of renal stones, obstruction, and infection is recommended.

For patients with recurrent infections, a high index of suspicion for infection and rapid treatment is important.[57]Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008 Nov;122(5):1064-71. http://www.ncbi.nlm.nih.gov/pubmed/18977988?tool=bestpractice.com Data suggest that children with pyelonephritis should undergo dimercaptosuccinic acid (DMSA) scans within 2 days of developing pyelonephritis, as those children with normal DMSA scans have a very low incidence of vesicoureteral reflux (VUR).[58]Chishti AS, Maul EC, Nazario RJ, et al. A guideline for the inpatient care of children with pyelonephritis. Ann Saudi Med. 2010 Sep-Oct;30(5):341-9. https://www.annsaudimed.net/doi/10.4103/0256-4947.68549 http://www.ncbi.nlm.nih.gov/pubmed/20716830?tool=bestpractice.com

There are conflicting results from studies on the use of prophylactic continuous antibiotic therapies, with borderline statistical significance even in larger studies of patients with significant VUR. Previously, it was recommended not to prescribe antibiotics to children with VUR. However, the recommendations have now changed to continuous antibiotic treatment for children <1 year old with VUR and febrile urinary tract infections (UTIs), children <1 year old with VUR stages III-V without a history of febrile UTIs, and in children with bladder and bowel dysfunction and VUR before and while therapies are being initiated.[59]American Urological Association. Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). 2021 [internet publication]. https://www.auanet.org/guidelines/guidelines/vesicoureteral-reflux-guideline#x3333 Patients who are not on continuous prophylactic antibiotic therapy who have breakthrough febrile UTIs should be considered for initiation of continuous therapy. If these children have anatomically abnormal urinary tracts and have not undergone surgical treatment, surgical treatment should be considered. Medical and surgical treatments for VUR may be combined, depending on the degree of anatomic abnormalities found. In patients already on continuous prophylactic antibiotic therapy who develop febrile UTIs, a change in prophylactic antibiotic is recommended after treatment of the acute infection.[59]American Urological Association. Management and screening of primary vesicoureteral reflux in children (2010, amended 2017). 2021 [internet publication]. https://www.auanet.org/guidelines/guidelines/vesicoureteral-reflux-guideline#x3333

Diet and glucose control is recommended in patients with diabetes mellitus.