Acute Pyelonephritis

Question 1

Define Acute pyelonephritis

Answer 1

Inflammation and infection of the kidney parenchyma and renal pelvis

Question 2

What are the most common and less common bacteria involved in Acute pyelonephritis

Answer 2

Gram Negative (Most Common): E. Coli, Klebsiella, Enterobacer, and pseudomonas
Gram Positive (Less Common): Enterococcus Faecalis and staph aureus

Question 3

What are s/s of acute pyelonephritis

Answer 3

Fever, Flank pain, Chills, voiding symptoms, N/V/D, Costovertebral tenderness

Question 4

What Lab results, UC, and UA results suggest acute pyelonephritis?

Answer 4

CBC: Leukocytosis with a left shift
UA: pyuria, bacteria, blood, and WBC casts
UC: positive

Question 5

What ultrasound and CT results suggest acute pyelonephritis?

Answer 5

US: potential hydronephrosis
CT Pelvis: decreased kidney perfusion, perinephric fat stranding

Question 6

What are some complications of untreated acute pyelonephritis?

Answer 6

Sepsis and Shock: especially with emphysematous pyelonephritis which is gas producing and life threatening
Can lead to chronic pyelonephritis and scarring
Abscess if therapy is inadequate

Question 7

What is the ABX regimen and length for tx for acute pyelonephritis

Answer 7

Ampicillin 1g q6 IV and Gentamicin 1mg/kg q 8hrs
If PCN allergy can use Ceftriaxone or ciprofloxacin
Treatment should continue 24hours after afebrile then po x14 days

Question 8

What are surgical options for acute pyelonephritis

Answer 8

Urinary catheter or nephrostomies