Modern principles of diagnosis and non-surgical treatment of acute pyelonephritis: a review
Abstract
Urinary tract infections (UTIs) represent a significant public health concern worldwide, accounting for approximately 40% of all antibiotic prescriptions. Acute pyelonephritis is an infectious-inflammatory renal disease primarily affecting the pelvicalyceal system and the tubulointerstitial tissue. In Russia, this condition is diagnosed in over a million individuals annually, predominantly among young and middle-aged women. Notably, the incidence shows a seasonal pattern, with peaks during the summer months. In 2025, the European Association of Urology revised its classification of UTIs. The revised framework eliminates the distinction between "uncomplicated" and "complicated" UTIs and instead delineates between localized and systemic UTIs based on clinical signs and symptoms. Importantly, the updated classification no longer identifies males as a risk factor for these infections. The principal pathogens responsible for acute pyelonephritis include Escherichia coli (identified in 70–95% of cases), Klebsiella spp., Proteus mirabilis, Enterobacter spp., Pseudomonas aeruginosa. Microbial entry into the kidneys may occur through an ascending route or via hematogenous spread. This article examines the predisposing factors, etiology, pathogenesis, and clinical manifestations associated with the disease. Detailed discussions are provided regarding diagnostic stages, from the assessment of complaints to the application of instrumental methods. Additionally, pertinent questions for…
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