What is the treatment for calculi-related infections in patients with acute pyelonephritis (kidney infection)?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

A major challenge with calculi-related UTI is that the organisms can survive within the calculus. In the presence of acute infection, calculi must be removed immediately using cystoscopy or open surgical procedure. In a review of adult patients with obstructive pyelonephritis due to a ureteral stone or kidney stone with hydronephrosis (n=311,100), delayed decompression (2 or more days after admission) increased the odds of in-hospital death by 29% (odds ratio 1.29, 95% confidence interval 1.03-1.63, P=0.032). [41]

The preferred method of treatment is surgical. Options include extracorporeal shockwave lithotripsy (ESWL), endoscopic methods, percutaneous methods, and open surgery. For staghorn calculus, the treatment of choice is to remove the whole stone. Fragments left behind remain infected and will grow again. Antibiotic therapy should be used in conjunction.


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