Acute Pyelonephritis

Question 1

What assessment findings or diagnostic test results indicate upper UTI/pyelonephritis vs lower UTI/uncomplicated UTI?

Answer 1

Assessment:
- CVA tenderness

U/A:
- WBC casts indicate pyelonephritis
- Blood: if + (or if patient very ill) => REFER
(note: get culture with sensitivity before Rx)

CBC:
- Leukocytosis

Sed Rate (ESR)/CRP:
- Positive indicates inflammation => Upper UTI

Question 2

Who is more likely to get acute pyelonephritis?

Answer 2

Women > Men

Question 3

What is the most likely organism to cause acute pyelonephritis?

Answer 3

> 90% from E. coli

Question 4

What are possible complications from acute pyelonephritis?

Answer 4

• Abscess
• Renal damage/scarring
• Renal failure
• Multi-organ failure
• Sepsis
• Death

Question 5

List adult risk factors for acute pyelonephritis.

Answer 5

• Untreated/undertreated UTI
• Urinary tract abnormalities
• DM
• Older age
• Fecal incontinence
• Pregnancy (risk of preterm labor)

Question 6

Describe signs and symptoms of acute pyelonephritis.

Answer 6

• ***Appear sudden and fast!
• Variable S/S
• Fever (alone or with other s/s)
• Triad: dysuria, frequency, frequency (not always)
• N/V
• Chills
• Orthostasis
• Flank pain/CVA tenderness (may be pyelonephritis or cystitis)

Question 7

How might acute pyelonephritis presentation differ in the elderly?

Answer 7

Fever may be the only presenting symptom

–OR–

Fever may be one of only a few presenting symptoms

Question 8

Describe treatment for acute pyelonephritis.

Answer 8

• Referral
• Most patient need hospitalization/IV antibiotics
• Blood culture and CT
• Urine culture before antibiotics started