Repeated bouts of acute pyelonephritis may lead to chronic pyelonephritis. Complications of chronic pyelonephritis include chronic kidney disease (from progressive loss of nephrons secondary to chronic inflammation and scarring), hypertension, and formation of kidney stones (from chronic infection with urea-splitting organisms).

• Patient usually has no symptoms of infection unless an acute exacerbation occurs.
• Fatigue, headache, and poor appetite may occur.
• Polyuria, excessive thirst, and weight loss may result.
• Persistent and recurring infection may produce progressive scarring resulting in chronic kidney disease.

• Assess prior history of pyelonephritis.
• IV urography
• Measurement of blood urea nitrogen (BUN), creatinine levels, and creatinine clearance

Long-term use of prophylactic antimicrobial therapy to eradicate bacteria in the urine may help limit recurrence of infections and renal scarring. Impaired renal function alters the excretion of antimicrobial agents and necessitates careful monitoring of renal function, especially if the medications are potentially toxic to the kidneys.

• If patient is hospitalized, encourage fluids (3 to 4 L per day) unless contraindicated.
• Monitor and record intake and output.
• Assess body temperature every 4 hours and administer antipyretic and antibiotic agents as prescribed.
• Educate patient and family about preventive measures and early recognition of symptoms.
• Stress the importance of taking antimicrobial medications exactly as prescribed, along with the need for keeping follow-up appointments.

For more information, see Chapter 55 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.