Pyelonephritis in pregnancy

Renal infection is the most common serious medical complication of pregnancy. 

1. Why pregnant women are more likely to have renal infection?
• Ureters are more dilated
• Uterus can compress the ureter, leading to stagnant urine
2. Presentation: fever, chills, CVA tenderness, UTI symptoms may be present 
3. W/U: urine analysis
4. Management
• Initially aggressive intravenous hydration is given to ensure adequate urinary output
• Antimicrobials are begun promptly after diagnosis (cephzolin)
5. Outcome:
• The majority of patients are afebrile by 72 hours. If there is no clinical improvement by 72 hours, further evaluation is warranted including sonography to look for urinary tract obstruction (abnormal ureteral or pyelocaliceal dilatation) or calculi. 
• Obstruction can be relieved by cystoscopic placement of a double-J ureteral stent unless long-term stenting is foreseen, then percutaneous nephrostomy is indicated. 

• Surgical exploration is required in up to 2% of women if other conservative therapies are not successful