Pyelonephritis vs Cystitis – All You Need To Know

Jeannette | Posted on November 25, 2022 
pyelonephritis vs cystitis

Do you drink ample water every day and still experience UTI symptoms like urgency to urinate and a burning sensation during urination? If yes, then this article is just for you! Learn about pyelonephritis vs. cystitis, symptoms, and everything else you need to know before visiting your doctor.

Infections anywhere in the entire length of the urinary tract result in a urinary tract infection or UTI. Microbial agents that gain access to the urinary tract via the gut or external genitalia disturb the flora of the urinary system. UTIs are classified according to the anatomical positions of infections occurring: the upper urinary tract and lower urinary tract infections. Both of these infection types vary from one another in aspects of pathogenesis, etiology, and treatment.

What is Cystitis?

An infection of the bladder or urethra due to a bacterial invasion is known as cystitis. Owing to the shorter urethra in females, cystitis has a more common occurrence in women than in men. While the development of cystitis in men is rare, it is not impossible.

Escherichia coli is a bacteria strain already present in the body’s normal flora. In immunosuppressed or immunocompromised states, these bacteria may multiply in number and become virulent. As with every other substance in the body, it needs to exist in a specific range for normal body function.  An increased number of E. coli bacteria invade the bladder and urethral walls, attaching to the pili in their membranes. Here, the bacteria multiply rapidly and result in irritation and inflammation of the bladder wall.

Causes and Risk Factors

Most cases of cystitis occur due to ascending infections. This accounts for virulent bacteria that happen to enter the female genital tract through the external genitalia. The risk factors of cystitis in women include:


The continuous fluctuation in hormone levels disturbs the flora of the female genital tract and may leave the immune system vulnerable to bacteria that it would normally react against.


Pregnant women are mostly unable to empty their bladder. The inability to fully void yourself leads to the growth of bacteria in the bladder and urethra.

Using Certain Contraceptive Methods

According to a published case-control investigation, women using IUDs and diaphragms are relatively likely to develop cystitis.

Using Tampons

Leaving a tampon in for a long period or using different tampons for bleeding that lasts for over five days may cause inflammation in the cervix. This later ascends to the urethra and bladder.

Vigorous or Frequent Sexual Activity

Frequent sexual intercourse has been established as a major risk factor for cystitis among women. Thrusting may introduce bacteria that are supposed to protect the vaginal and cervical flora up the urethra and into the bladder. Sex that brings discomfort should be stopped immediately and you should refer to a gynecologist.

Other risk factors include urinary catheterization and urinary tract obstruction.

Signs and Symptoms

Early stages of cystitis usually present with fatigue, fever, exhaustion, nausea, and vomiting. As the inflammation increases and the disease progresses, the following symptoms are generally observed.

  • Burning sensation while passing urine
  • Cloudy or dark-colored urine, resembling the color of coca cola
  • Decreased appetite
  • Dysuria, difficulty in passing urine
  • Hematuria, blood in the urine
  • High fever, 100.4 F or higher
  • Irritability
  • Lower back pain
  • Pain above the pubic bone and/or in the abdomen
  • Smelly urine
  • Urinary frequency
  • Vomiting

UTI Specialist

What is Pyelonephritis?

Inflammation that initiates in the lower urinary tract and ascends to the ureters and kidneys is known as pyelonephritis. Severe cases of pyelonephritis may even cause the kidneys to swell and result in permanent damage.

Pyelonephritis, like cystitis and other urinary tract infections, is more common amongst women due to shorter urethras. This makes it easier for bacteria to enter the bodies.

Causes and Risk factors

Similar to cystitis, pyelonephritis is also commonly caused by the bacteria E. coli. Bacteria enter the body through the external genitalia, travel up the urethra, and begin to multiply rapidly, making their way to the bladder. Bacterial growth from the bladder extends to the ureters and then to the kidneys. Further bacterial multiplication causes extreme inflammation of the kidneys, spilling infection into the bloodstream.

One of the risk factors of acute pyelonephritis is Nerve or spinal cord damage. Other factors are:

  • Certain Medications

Medications strictly forbidden for patients suffering from acute pyelonephritis include nitrofurantoin.

  • Cystoscopic Examination

Inserting a thin camera, called a cystoscope, inside the bladder increases the risk of allowing bacteria to enter the genital and urinary tract

  • Enlarged Prostate

In people with chronic illnesses that cause hyperplasia of the prostate

  • Obstruction of Normal Urinary Flow

An unusual shape or size of the urinary tract that hinders normal urine flow

  • Older Adults

Weakening of muscles in old age causes the bladder to not empty

  • Chronic Kidney Disease

Persisting chronic kidney stones or other kidney and/or bladder conditions

  • Suppressed Immune System

People with chronic illnesses, such as diabetes, cancer, or HIV/AIDS are at a higher risk of developing acute pyelonephritis

  • Urinary Catheterization

Insertion of a catheter through the urethra into the urinary tract

  • Vesicoureteral Reflex

This reflex causes a reverse track to be followed by a small amount of urine, as it backs up from the bladder into the ureters and kidney

Some of the risk factors of chronic pyelonephritis overlap with those of acute pyelonephritis. Other risk factors generally include urinary obstruction, which is more commonly seen in people with a former history of UTIs, vesicoureteral reflux, or anatomical anomalies.

Signs and Symptoms

Pyelonephritis symptoms start occurring about two days after the infection has set in. It generally presents with general symptoms in the beginning, such as:

  • Chills or shaking
  • General body ache
  • Lethargy
  • Mental confusion
  • Moist or damp skin
  • Nausea
  • Vomiting

Other symptoms that are more specific to pyelonephritis include:

  • Abdominal pain that may extend backward, sideways, or in the groin
  • Burning sensation during urination
  • Cloudy urine
  • Dysuria, difficulty or pain when passing urine
  • Frequent urination
  • Hematuria, blood in the urine
  • High fever, greater than 102 F
  • Pus in urine
  • Urgency to urinate
  • Urine with a fishy odor

Cystitis vs Pyelonephritis

The main difference between cystitis and pyelonephritis is that cystitis occurs due to inflammation of the lower urinary tract, such as the bladder and urethra, and pyelonephritis occurs due to inflammation of the upper urinary tract, including the ureters in the renal pelvis and kidney. Due to the wider spread of inflammation in pyelonephritis, it is a relatively severe infection compared to cystitis.

While both cystitis and pyelonephritis require a UDR (Urine Detailed Report) to confirm their diagnosis, there are other tests run for both that are different from one another. The tests run to identify the predisposing factors of a pyelonephritis infection include a blood culture, blood urea test, CBC (complete blood count), FBS (fasting blood sugar), and serum electrolyte.

Identifying the predisposing factors allows your general physician or nephrologist to treat your condition accordingly in a way to prevent recurrent urinary tract infections. On the other hand, the extra tests required to confirm the diagnosis of cystitis include a simple urine Culture, to identify the colony of bacteria involved in causing the disease.

Another difference between cystitis and pyelonephritis is the method of treatment. Since cystitis is a less severe inflammatory infection, oral antibiotics are prescribed as the first line of treatment. More commonly used antibiotics include Quinolones (norfloxacin and ciprofloxacin) and Co-amoxiclavs.

Patients with pyelonephritis are more commonly prescribed intravenous methods of the same antibiotics as those required to treat cystitis infection. The IV antibiotics include the IV version of Ciprofloxacin, Ceftazimide or Ceftriaxone, and a combination of Ampicillin and Clavulinic acid.

See Also: Chronic Pyelonephritis – What Is It And How To Treat It?


Are you confused about whether you have cystitis or pyelonephritis? You don’t need to worry! At Family Medicine Austin, we offer comprehensive preventative and diagnostic management care for you and your family. Reach out to us today and avail of our full spectrum of healthcare services!

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