ICU Decoded › Library › Ward Pathways › Infectious Disease › PyelonephritisPyelonephritisEmergency
Infectious Disease · Ward Pathways · Locked — free with a referral
By Dr Javed Akhtar · Last reviewed 2 October 2026
Presentation Diabetic woman, 2 days of fever with rigors, right flank pain, vomiting; renal angle tender; BP 96/60; urine nitrite + leucocytes
Red flags Septic shock Anuria Gas on imaging No improvement at 72 h Differential diagnosis Renal colic with stone Renal/perinephric abscess Appendicitis, cholecystitis PID, ectopic pregnancy Lower lobe pneumonia When to admit, call ICU or discharge Admit: Sepsis, vomiting/unable to take oral, obstruction, pregnancy, diabetes with poor control, elderly frailICU: Septic shock, obstructed infected system with instabilityVasopressors: Septic shock after fluidsKey points An obstructed infected kidney is a urological emergency — decompress within hours. India: E. coli and Klebsiella with high ESBL and fluoroquinolone resistance — use the local antibiogram and always culture. Diabetics: emphysematous pyelonephritis and papillary necrosis. Never Treat an obstructed infected kidney with antibiotics alone Use nitrofurantoin or fosfomycin for pyelonephritis (no renal tissue levels) Give an empirical fluoroquinolone where resistance is high (most of India) without culture Forget pregnancy in women of childbearing age Common mistakes No imaging in septic or diabetic patients Missing obstruction Inappropriate empirical agent Overlong courses Disposition and follow-up Ward; ICU for septic shock; urology for obstruction or stones.
Locked ABCDE first moves The step-by-step decision sequence Order set Monitoring timeline and escalation triggers Treatment doses and preparation Discharge package Open the full pathway in Ward Pathways
Free with a referral from any ICU Decoded member, or by applying with your medical registration. How access works .
← Endocarditis · Cellulitis →
More Infectious Disease pathways
Part of Infectious Disease in Ward Pathways — open the interactive version .