[55] Pyelonephritis Flashcards
What is pyelonephritis?
Inflammation of the kidney typically due to bacterial infection
Acute pyelonephritis is the underlying cause of the majority of what presentations?
Febrile urinary tract infections in infants and young children
What usually causes pyelonephritis?
Ascension of perineal contaminants via the urinary tract to colonise the kidneys
Where do the perineal contaminants usually come from?
Bowel flora
What is the assumed origin of pyelonephritis in neonates?
Haematogenous
What bacteria accounts for 90% of all pyelonephritis cases?
E. coli
What other bacteria can cause pyelonephritis?
- Klebsiella
- Proteus
- Enterococcus faecalis
- Gram +ve organisms e.g. staph and Group B Strep
What are the risk factors for developing pyelonephritis?
- High-grade VUR
- Congenital or acquired renal abnormalities
- Delayed or incomplete voiding
- Constipation
- Catheterisation
- Sexual activity
What are the potential causes of delayed or incomplete voiding?
- Neurogenic bladder
- Obstruction
- Dysfunctional voiding
What are the signs and symptoms of pyelonephritis in neonates?
- Jaundice
- Hypothermia or fever
- Poor feeding
- Vomiting
- Failure to thrive
What are the signs and symptoms of pyelonephritis in infants and young children?
- Fever (longer than 48 hours)
- Poor feeding
- Vomiting
- Diarrhoea
- Foul urine
- Haematuria
What are the signs and symptoms of pyelonephritis in pre-school and school-age children?
- Fever
- Abdominal pain or flank pain
- Vomiting, diarrhoea and anorexia
- Foul urine
- Haematuria
- Voiding related symptoms e.g. enuresis, dysuria, urgency and frequency
What are the signs and symptoms of pyelonephritis in adolescents?
- Fever, often with chills and rigors
- Flank pain
- Abdominal and suprapubic pain
- Voiding related symptoms
- Foul urine
- Haematuria
What investigations can be used in pyelonephritis?
- Urinalysis
- Urine culture
- U&E’s
- ESR
- Imaging
What are the signs of a UTI on urinalysis?
- Nitrites
- Leukocytes
- Blood
