What parents should know about paediatric pyelonephritis

Paediatric pyelonephritis (kidney infection)


Paediatric pyelonephritis is an infection of the kidney that is caused by bacteria or viruses. A range of medical journals suggest that most paediatric kidney infections begin as a bladder infection that travels “upstream” in the urinary tract to one or both of a child’s kidneys.

In paediatric patients it can be difficult for physicians to differentiate pyelonephritis (an upper urinary tract infection) from cystitis (a lower urinary tract infection). Both conditions have similar urination-related symptoms that can include fever.

If your physician believes your child has paediatric pyelonephritis, you will want to know if it has been caused by vesicoureteral reflux (VUR).

VUR is a condition in which urine from the bladder backs up to the ureters. The ureters are the tubes that carry urine from the kidneys down to the bladder. Sometimes when a child has VUR, urine can flow all the way back up into the kidney.

If your child does have VUR, this website will help you learn more about it.

Signs & symptoms

Symptoms that may suggest the presence of paediatric pyelonephritis tend to vary and are not always obvious. However, traditionally, paediatric pyelonephritis can be in infants and toddlers who have:

  • Fever
  • Vomiting
  • Flank pain
  • Pain when the area of the lower back over the kidneys is touched

These symptoms may also be paired with poor feeding, lethargy, and abdominal pain.

It should be noted again that instances of paediatric pyelonephritis do not always have clear-cut symptoms, and imaging studies are sometimes needed to confirm an accurate diagnosis.

Potential complications and treatment

A urinalysis (urine test) and urine culture are usually part of an evaluation to test for paediatric pyelonephritis. The most common complication that you’ll be able to notice is dehydration. In extreme dehydration cases, intravenous (IV) fluid replacement may be needed.

A potential immediate complication of paediatric pyelonephritis can be renal abscess formation.1 Long-term complications may include renal scarring,2 hypertension (high blood pressure), decreased renal function, and in highly severe cases, renal (kidney) failure.3

In addition, renal scarring that is paired with poor long-term kidney function is something to be concerned about in more advanced cases of paediatric pyelonephritis.

If your child shows signs and symptoms of a urinary tract infection, it is recommended that you see a paediatric urologist to minimise the chance of having complications associated with paediatric pyelonephritis.

A paediatric urologist will also be able to determine if there is an underlying cause such as VUR.

  1. Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol. 2016;31(8):1253-1265.
  2. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: A systematic review. Pediatrics. 2010;126(6):1084-1091.
  3. Hinfey PB, Steele RW. MedScape. Pediatric Pyelonephritis. Available at: https://emedicine.medscape.com/article/968028-overview#showall. Accessed November 1, 2019.