The evaluation of pyelonephritis begins with a history and physical exam.

Physical findings in someone with pyelonephritis may include:

• Abdominal tenderness
• Tenderness over the back or flank
• Fever
• Signs of dehydration

Signs of dehydration include:

• Pale, dry skin
• Dry eyes and mouth
• Sunken eyes
• Sunken fontanelle in infants
• Rapid pulse
• Low blood pressure when standing
• Confusion
• Lethargy:
• Excessive sleepiness
• Decreased urination
• Urinating less than 3 times over 24 hours

Tests are necessary to make the diagnosis of pyelonephritis.

Tests that may be used to evaluate pyelonephritis may include:

• Urinalysis
• Urine culture
• Complete blood count
• Kidney profile
• Abdominal ultrasound
• Determines the amount of urine in the bladder before and after urinating

Less commonly performed tests that may be used to evaluate pyelonephritis include:

• Cystoscopy
• A scope is used to examine the inside of the bladder
• Cystourethrogram
• An x-ray study of the bladder and ureters
• Intravenous pyelogram (IVP)
• An x-ray study of the entire urinary tract
• CT scan of the abdomen and pelvis:
• Prostate ultrasound in males
• Renal arteriogram