In plain words
Pyelonephritis is an infection of the kidney. Most often it starts as a bladder infection that climbs up the ureters, the tubes that carry urine from the kidneys to the bladder. Pregnancy makes it more likely, because hormone changes relax the ureters and the growing uterus presses on them. Pyelonephritis is a leading cause of sepsis in pregnancy, so clinicians move quickly. Signs include fever or chills, pain in the side or back below the ribs, nausea, and urinary symptoms such as burning or frequent urination. A fever with side pain is a call to your provider right away. A fever with confusion, , or trouble breathing is a call to 911. A urine test helps tell it apart from a simple bladder infection.
The deeper version
Pyelonephritis is ascending infection of the renal pelvis and parenchyma, most often by Escherichia coli. Pregnancy raises the risk through progesterone-related ureteral , mechanical compression of the ureters by the enlarging uterus (more often on the right), and urinary stasis. Asymptomatic bacteriuria is reported in roughly 2 to 10 percent of pregnancies (Schnarr and Smaill 2008), and untreated bacteriuria is the main precursor. Diagnosis combines costovertebral angle tenderness, fever, pyuria, and a urine culture, with blood cultures and a complete blood count used when systemic illness is suspected. Guidelines call for a urine culture before treatment and a repeat culture afterward to confirm clearance. The evidence base is largely observational, and open questions include the optimal duration of therapy and the long-term renal effects of repeated episodes in pregnancy.
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Sources
- Schnarr J, Smaill F — Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. European Journal of Clinical Investigation (2008)
- Cunningham FG, Leveno KJ, et al. — Williams Obstetrics, 26th edition (2022)