Management of acute pyelonephritis in pregnancy in emergency settings: A comparative study of conservative therapy and renal drainage

Kongyrov Yerlan, Shalekenov Bulat, Shalekenov Sanjar, Apenova Ayagoz, Duisenbayev Nurbol, Kemelbekov Kanatzhan

2026

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DOI 10.4103/jehp.jehp_648_26
Data confidence 70 medium
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Abstract

BACKGROUND: Acute pyelonephritis in pregnancy is a serious clinical condition requiring timely decision-making between conservative therapy and renal drainage. However, the absence of standardized objective criteria may result in delayed intervention and increased maternal morbidity. This study introduces and evaluates the clinical utility of a novel 10-parameter risk stratification scale designed to standardize treatment decisions in acute gestational pyelonephritis (AGP). MATERIALS AND METHODS: A single-center retrospective–prospective comparative observational study was conducted on 451 pregnant women with AGP between 2023 and 2025. Patients treated before (2023) and after (2024–2025) implementation of a 10-parameter risk stratification scale were compared. Statistical analysis included the Chi-square test, Mann–Whitney U test, and Spearman correlation, with significance set at P < 0.05. Where applicable, 95% confidence intervals (CIs) were calculated. RESULTS: Implementation of the risk scale was associated with improved clinical outcomes. The success rate of conservative therapy increased by 2.7% ( P < 0.05). The rate of ureteral stenting decreased from 13.8% to 9.7% (difference −4.1%; 95% CI: −7.8% to −0.4%). The mean decision-making time decreased from 24.3 ± 6.1 hours to 12.8 ± 4.2 hours (mean difference −11.8 hours; 95% CI: −13.5 to −10.1; P < 0.01). CONCLUSION: The 10-parameter risk assessment scale shows potential as a structured and objective framework, pending external validation for clinical decision-making in AGP. Its implementation is associated with reduced invasive interventions, improved efficiency in clinical decision-making, and better risk-based stratification of patients. However, findings should be interpreted with caution due to the single-center design, lack of multivariable adjustment, and absence of fetal outcomes.