Chapter 50: Pyelonephritis

Question 1

What is the most common cause of acute pyelonephritis?

A. Fungi
B. Protozoa
C. Bacterial infection
D. Viruses

Answer 1

C. Bacterial infection

Rationale: The most common cause of acute pyelonephritis is bacterial infection, often caused by bacteria normally found in the gastrointestinal tract, such as E. coli.

Question 2

Urosepsis is a systemic infection arising from a urologic source. Why is it critical to promptly diagnose and treat urosepsis?

A. It can lead to kidney failure
B. It can result in septic shock and death if untreated
C. It increases the risk of chronic kidney disease
D. It can cause irreversible damage to the urinary tract

Answer 2

B. It can result in septic shock and death if untreated

Rationale: Urosepsis can lead to septic shock and death if not diagnosed and treated promptly. Early intervention is crucial to prevent these severe outcomes.

Question 3

Which of the following is a preexisting factor that can increase the risk of developing acute pyelonephritis?

A. Chronic hypertension
B. Vesicoureteral reflux
C. Chronic alcoholism
D. Hyperthyroidism

Answer 3

A. Vesicoureteral reflux

Rationale: Vesicoureteral reflux, which is the retrograde movement of urine from the lower to upper urinary tract, is a significant predisposing factor for acute pyelonephritis.

Question 4

How does pregnancy-induced physiologic changes affect the risk of acute pyelonephritis?

A. It causes increased kidney perfusion, reducing the risk of infection
B. It leads to urinary stasis, increasing the risk of pyelonephritis
C. It enhances immune function, preventing kidney infections
D. It causes changes in the pH of the urine, reducing bacterial growth

Answer 4

B. It leads to urinary stasis, increasing the risk of pyelonephritis

Rationale: Pregnancy-induced physiologic changes, such as urinary stasis and dilation of the ureters, increase the risk of developing acute pyelonephritis during pregnancy.

Question 5

Which of the following bacteria is most commonly associated with causing acute pyelonephritis?

A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Staphylococcus aureus

Answer 5

C. Escherichia coli

Rationale: Escherichia coli (E. coli), a bacterium normally found in the gastrointestinal tract, is the most common pathogen associated with acute pyelonephritis.

Question 6

In the pathophysiology of acute pyelonephritis, which part of the kidney is typically affected first?

A. Renal cortex
B. Glomerulus
C. Ureter
D. Renal medulla

Answer 6

D. Renal medulla

Rationale: Acute pyelonephritis typically begins in the renal medulla and spreads to the adjacent cortex.

Question 7

What is a complication of recurring episodes of acute pyelonephritis, especially in the presence of obstructive abnormalities?

A. Chronic pyelonephritis
B. Renal failure
C. Renal abscess
D. Ureteral strictures

Answer 7

A. Chronic pyelonephritis

Rationale: Recurring episodes of acute pyelonephritis, especially in the presence of obstructive abnormalities, can lead to chronic pyelonephritis.

Question 8

What is a common mechanism by which bacteria reach the kidneys to cause acute pyelonephritis?

A. Hematogenous spread from other infections
B. Colonization and infection of the lower urinary tract via the ascending urethral route
C. Lymphatic spread from the abdomen
D. Direct spread from the skin through the urethra

Answer 8

B. Colonization and infection of the lower urinary tract via the ascending urethral route

Rationale: The most common mechanism for pyelonephritis is the ascending infection of the lower urinary tract via the urethra, where bacteria colonize and travel upward to the kidneys.

Question 9

Which of the following is a classic manifestation of acute pyelonephritis?

A. Abdominal pain and bloating
B. Flank pain and costovertebral angle tenderness
C. Chest pain and shortness of breath
D. Diarrhea and abdominal cramping

Answer 9

B. Flank pain and costovertebral angle tenderness

Rationale: Classic manifestations of acute pyelonephritis include flank pain and costovertebral angle (CVA) tenderness, along with fever, chills, nausea, and malaise.

Question 10

What does the presence of WBC casts in the urine suggest in the diagnosis of pyelonephritis?

A. It indicates glomerular involvement
B. It indicates a urinary tract obstruction
C. It suggests renal parenchyma involvement
D. It is a sign of renal calculi

Answer 10

C. It suggests renal parenchyma involvement

Rationale: WBC casts in the urine suggest renal parenchyma involvement, which is characteristic of pyelonephritis and indicates infection has reached the kidney tissue.

Question 11

Which of the following urinalysis findings is most suggestive of pyelonephritis?

A. Proteinuria and oliguria
B. Pyuria and bacteriuria
C. Hematuria and elevated specific gravity
D. Glucosuria and ketonuria

Answer 11

B. Pyuria and bacteriuria

Rationale: Pyuria (presence of white blood cells) and bacteriuria (presence of bacteria) are common findings in pyelonephritis and suggest an ongoing infection in the urinary tract.

Question 12

In diagnosing severe cases of pyelonephritis, which diagnostic test would be most appropriate for identifying systemic infection?

A. Urine culture
B. Blood cultures
C. CT scan
D. Abdominal x-ray

Answer 12

B. Blood cultures

Rationale: Blood cultures are important for identifying urosepsis in hospitalized patients with severe pyelonephritis, as systemic infection may be present.

Question 13

Which imaging study is preferred for assessing complications of pyelonephritis such as renal scarring or abscesses?

A. Ultrasound
B. X-ray
C. CT scan
D. MRI

Answer 13

C. CT scan

Rationale: CT scans are the preferred imaging studies for assessing complications of pyelonephritis, including impaired renal function, renal scarring, and abscesses.

Question 14

What can costovertebral angle tenderness (CVA) indicate in a patient with suspected pyelonephritis?

A. It suggests liver involvement
B. It points to abdominal muscle strain
C. It is a sign of gallbladder disease
D. It indicates kidney involvement

Answer 14

D. It indicates kidney involvement

Rationale: CVA tenderness is a hallmark sign of kidney involvement, specifically suggesting pyelonephritis or other renal conditions.

Question 15

Which of the following potential complications of pyelonephritis is considered life-threatening?

A. Renal scarring
B. Chronic pyelonephritis
C. Hydronephrosis
D. Urosepsis

Answer 15

D. Urosepsis

Rationale: Urosepsis, a systemic infection arising from a urologic source, is potentially life-threatening and can lead to septic shock if not treated promptly.

Question 16

When treating acute pyelonephritis, which of the following is the initial treatment for hospitalized patients with severe infections?

A. Oral antibiotics for 5-14 days
B. IV antibiotics to rapidly establish high serum and urinary drug levels
C. NSAIDs for pain relief
D. Intravenous fluid administration alone

Answer 16

B. IV antibiotics to rapidly establish high serum and urinary drug levels

Rationale: IV antibiotics are typically administered initially in hospitalized patients with severe infections to quickly establish high serum and urinary drug levels, which are essential for effective treatment.

Question 17

For patients with mild symptoms of acute pyelonephritis, how is the condition typically managed?

A. Immediate hospitalization and IV antibiotics
B. Oral antibiotics for 5-14 days
C. Surgery to drain the kidney abscess
D. Bed rest and fluid restriction

Answer 17

B. Oral antibiotics for 5-14 days

Rationale: Patients with mild symptoms may be treated as outpatients with oral antibiotics for 5-14 days.

Question 18

How long does it typically take for symptoms of acute pyelonephritis to improve or resolve after starting antibiotic therapy?

A. 24-48 hours
B. 48-72 hours
C. 72-96 hours
D. 1-2 weeks

Answer 18

B. 48-72 hours

Rationale: Symptoms and signs typically improve or resolve within 48-72 hours after starting appropriate antibiotic therapy for acute pyelonephritis.

Question 19

What is a possible reason for a relapse of acute pyelonephritis?

A. Ineffective initial antibiotic therapy or bacterial resistance
B. Poor dietary habits
C. Inadequate hydration
D. High levels of exercise

Answer 19

A. Ineffective initial antibiotic therapy or bacterial resistance

Rationale: Relapses may occur if the initial course of antibiotics was ineffective or if there is bacterial resistance. Treatment with a different antibiotic may be necessary.

Question 20

Which of the following should be closely monitored in a patient with urosepsis?

A. Serum calcium levels
B. Blood glucose levels
C. Vital signs and signs of septic shock
D. Electrolyte levels

Answer 20

C. Vital signs and signs of septic shock

Rationale: Close monitoring of vital signs and signs of septic shock is critical in patients with urosepsis to recognize and treat complications promptly.

Question 21

Which of the following is true regarding antibiotic prophylaxis in acute pyelonephritis?

A. It is used for recurrent infections
B. It is only prescribed after a relapse
C. It is ineffective in preventing recurrent infections
D. It is only indicated for pregnant women

Answer 21

A. It is used for recurrent infections

Rationale: Antibiotic prophylaxis may be used to prevent recurrent infections in patients with a history of repeated pyelonephritis.

Question 22

What is the primary method of confirming effective therapy in treating acute pyelonephritis?

A. CT scan showing reduced kidney size
B. Improvement in clinical symptoms
C. Bacterial growth on urine culture
D. Decrease in WBC count

Answer 22

C. Bacterial growth on urine culture

Rationale: The effectiveness of antibiotic therapy is confirmed by bacterial growth on urine culture, indicating that the infection is being treated successfully.

Question 23

Which of the following interventions is critical for preventing irreversible damage or death in patients with urosepsis?

A. Immediate administration of antipyretics
B. Prompt recognition and treatment of septic shock
C. Bed rest and limiting fluid intake
D. Restriction of antibiotic use

Answer 23

B. Prompt recognition and treatment of septic shock

Rationale: Prompt recognition and treatment of septic shock in patients with urosepsis are essential for preventing irreversible damage or death.

Question 24

When assessing a patient for acute pyelonephritis, which diagnostic assessment is the first-line imaging study used to evaluate the condition?

A. CT scan
B. MRI
C. Ultrasound
D. Voiding cystourethrogram (VCUG)

Answer 24

C. Ultrasound

Rationale: Ultrasound is often the first imaging study used to evaluate acute pyelonephritis, especially to detect abnormalities such as hydronephrosis or abscesses.

Question 25

In patients with mild symptoms of acute pyelonephritis, which of the following management strategies is most appropriate?

A. Immediate hospitalization for IV antibiotics
B. Outpatient management with oral antibiotics and NSAIDs
C. Strict bed rest with no fluid intake
D. IV fluids only until discharge

Answer 25

B. Outpatient management with oral antibiotics and NSAIDs

Rationale: Patients with mild symptoms are typically treated with outpatient management, including oral antibiotics, NSAIDs, and adequate fluid intake.

Question 26

When administering broad-spectrum antibiotics for acute pyelonephritis, which of the following is a preferred drug class?

A. Fluoroquinolones
B. Macrolides
C. Tetracyclines
D. Penicillin

Answer 26

A. Fluoroquinolones

Rationale: Fluoroquinolones such as ciprofloxacin or levofloxacin are commonly used as empiric broad-spectrum antibiotics for treating acute pyelonephritis.

Question 27

After initial treatment of acute pyelonephritis, how should therapy be adjusted once urine and blood culture results are available?

A. Continue empiric antibiotics until discharge
B. Cease antibiotics if symptoms improve
C. Switch to broad-spectrum antifungal agents
D. Switch to sensitivity-guided antibiotic therapy

Answer 27

D. Switch to sensitivity-guided antibiotic therapy

Rationale: Once urine and blood culture results are available, antibiotic therapy should be adjusted to sensitivity-guided therapy to ensure the most effective treatment.

Question 28

Which of the following diagnostic assessments is essential to detect bacteremia in severe cases of acute pyelonephritis?

A. Urine culture
B. CBC with WBC differential
C. Blood culture
D. CT scan

Answer 28

C. Blood culture

Rationale: Blood cultures are crucial for detecting bacteremia in severe cases of acute pyelonephritis, especially if the infection has spread systemically.

Question 29

For a patient with severe symptoms of acute pyelonephritis, what is the initial route of fluid administration?

A. Oral fluids
B. Subcutaneous fluids
C. IV fluids
D. Enteral nutrition

Answer 29

C. IV fluids

Rationale: For patients with severe symptoms, IV fluids are given initially to restore hydration and correct electrolyte imbalances, especially if the patient is vomiting or has significant dehydration.

Question 30

A patient with acute pyelonephritis has been started on IV antibiotics. What is the next step in the management plan once the patient can tolerate oral intake?

A. Continue IV antibiotics for the full treatment course
B. Switch to oral antibiotics
C. Discontinue antibiotics and monitor for complications
D. Start antifungal therapy

Answer 30

B. Switch to oral antibiotics

Rationale: Once the patient tolerates oral intake, antibiotics should be switched from IV to oral form to complete the course of therapy.

Question 31

Which of the following broad-spectrum antibiotics is typically used for patients with severe symptoms of acute pyelonephritis requiring hospitalization?

A. Penicillin
B. Carbapenem
C. Macrolides
D. Tetracyclines

Answer 31

B. Carbapenem

Rationale: For severe symptoms, carbapenems such as imipenem or meropenem, along with other broad-spectrum agents like vancomycin or daptomycin, are often used to treat acute pyelonephritis.

Question 32

When treating acute pyelonephritis with NSAIDs or antipyretic drugs, what is the goal of these medications?

A. To lower fever and relieve discomfort
B. To reduce kidney inflammation
C. To prevent bacterial resistance
D. To control blood glucose levels

Answer 32

A. To lower fever and relieve discomfort

Rationale: NSAIDs and antipyretics are used to reduce fever and relieve discomfort, helping to manage symptoms in patients with acute pyelonephritis.

Question 33

A patient with acute pyelonephritis is receiving empiric broad-spectrum antibiotics. What is the primary reason for starting antibiotics before urine culture results are available?

A. To prevent bacterial resistance
B. To ensure complete resolution of symptoms
C. To reduce the risk of sepsis
D. To treat underlying comorbidities

Answer 33

C. To reduce the risk of sepsis

Rationale: Empiric antibiotics are started promptly in acute pyelonephritis to reduce the risk of sepsis and other complications, such as kidney damage, while waiting for culture results.

Question 34

Which of the following imaging studies is most commonly used to assess for renal abscesses in a patient with acute pyelonephritis?

A. MRI
B. CT scan
C. Voiding cystourethrogram (VCUG)
D. Cystoscopy

Answer 34

B. CT scan

Rationale: CT scans are the preferred imaging study for identifying renal abscesses and assessing complications in patients with acute pyelonephritis.

Question 35

Which urinalysis finding is typically associated with renal parenchymal involvement in acute pyelonephritis?

A. Pyuria
B. Hematuria
C. WBC casts
D. Proteinuria

Answer 35

C. WBC casts

Rationale: WBC casts in the urine are indicative of renal parenchymal involvement, which is characteristic of acute pyelonephritis.

Question 36

When managing a patient with acute pyelonephritis, why is follow-up urine culture necessary after treatment?

A. To assess for bacterial resistance
B. To evaluate kidney function
C. To identify the underlying cause of the infection
D. To monitor for recurrence or persistent infection

Answer 36

D. To monitor for recurrence or persistent infection

Rationale: A follow-up urine culture is important to monitor for recurrence or persistent infection, ensuring that the chosen antibiotics have effectively treated the condition.

Question 37

What is the primary goal of nursing management for a patient with acute pyelonephritis?

A. To maintain normal renal function and prevent complications
B. To provide pain relief and ensure hydration
C. To reduce fever and control nausea
D. To prevent progression to chronic pyelonephritis

Answer 37

A. To maintain normal renal function and prevent complications

Rationale: The main goals for managing acute pyelonephritis are to ensure normal renal function, prevent complications, relieve pain, and prevent recurrence of symptoms.

Question 38

Which of the following clinical problems is commonly seen in patients with acute pyelonephritis?

A. Pain
B. Hypertension
C. Hypoglycemia
D. Hyperkalemia

Answer 38

A. Pain

Rationale: Pain is a common clinical problem in patients with acute pyelonephritis, typically characterized by flank pain. Other common problems include fluid imbalance and impaired renal function.

Question 39

Which of the following interventions is most important to prevent ascending urinary tract infections in patients with pyelonephritis?

A. Encourage the patient to drink at least 8 glasses of fluid per day
B. Teach the patient to avoid antibiotics to reduce resistance
C. Recommend a high-protein diet to promote healing
D. Advise the patient to take antipyretics for fever control

Answer 39

A. Encourage the patient to drink at least 8 glasses of fluid per day

Rationale: Encouraging the patient to drink plenty of fluids helps flush the urinary tract, reducing the risk of recurrent infections and preventing ascending infections.

Question 40

A patient with acute pyelonephritis is prescribed long-term, low-dose antibiotics. What is the primary reason for this therapy?

A. To treat the infection and prevent recurrence or relapse
B. To reduce pain and inflammation
C. To improve renal function
D. To prevent the development of chronic pyelonephritis

Answer 40

A. To treat the infection and prevent recurrence or relapse

Rationale: Long-term, low-dose antibiotics are used to prevent recurrence or relapse of the infection, especially in patients with frequent relapses or reinfections.

Question 41

Which of the following actions should the nurse prioritize when evaluating the outcomes for a patient with acute pyelonephritis?

A. Ensure the patient is pain-free
B. Monitor for the development of renal failure
C. Assess for signs of recurrence or relapse
D. Confirm the patient’s adherence to a high-protein diet

Answer 41

C. Assess for signs of recurrence or relapse

Rationale: Evaluating the outcomes of treatment includes assessing for signs of recurrence or relapse, ensuring that the patient is free from further infections.

Question 42

When teaching a patient with acute pyelonephritis about the disease process, which of the following instructions is most important to ensure compliance with antibiotic therapy?

A. Emphasize the need to complete the entire course of antibiotics as prescribed
B. Advise the patient to stop taking antibiotics when symptoms resolve
C. Encourage the patient to take antibiotics only when experiencing pain
D. Instruct the patient to take antibiotics with food for best absorption

Answer 42

A. Emphasize the need to complete the entire course of antibiotics as prescribed

Rationale: It is essential to emphasize the importance of completing the full course of antibiotics to ensure the infection is fully treated and prevent the development of resistance.

Question 43

What should the nurse teach a patient with pyelonephritis regarding the use of follow-up urine cultures?

A. Follow-up cultures are necessary only if symptoms worsen
B. Urine cultures should only be done if the patient develops new symptoms
C. Follow-up urine cultures are not necessary if the patient feels better
D. Follow-up urine cultures help to confirm the infection is fully treated and prevent recurrence

Answer 43

D. Follow-up urine cultures help to confirm the infection is fully treated and prevent recurrence

Rationale: Follow-up urine cultures are important to ensure that the infection has been completely eradicated and to monitor for recurrence or relapse of symptoms.

Question 44

A patient with acute pyelonephritis is experiencing pain. Which of the following interventions should the nurse prioritize to help relieve the patient’s discomfort?

A. Apply cold packs to the affected area
B. Encourage frequent voiding of urine
C. Administer prescribed analgesics as ordered
D. Limit fluid intake to reduce bladder distention

Answer 44

C. Administer prescribed analgesics as ordered

Rationale: Administering prescribed analgesics as ordered is crucial for pain relief. Other interventions, like fluid intake, can help manage symptoms but are secondary to managing pain directly.

Question 45

Which of the following is a key characteristic of chronic pyelonephritis?

A. Complete resolution of kidney function
B. Progressive inflammation and fibrosis leading to renal atrophy
C. Acute onset of severe flank pain
D. Sudden improvement after antibiotic therapy

Answer 45

B. Progressive inflammation and fibrosis leading to renal atrophy

Rationale: Chronic pyelonephritis is characterized by persistent infection leading to inflammation, fibrosis, and renal atrophy, which can result in the loss of kidney function.

Question 46

hronic pyelonephritis is most commonly caused by which of the following?

A. Hyperkalemia
B. Sudden trauma to the kidneys
C. Significant anatomic abnormalities such as vesicoureteral reflux
D. Viral infections

Answer 46

C. Significant anatomic abnormalities such as vesicoureteral reflux

Rationale: Chronic pyelonephritis is usually the result of significant anatomical abnormalities, like vesicoureteral reflux, which cause recurring infections in the upper urinary tract.

Question 47

What radiologic imaging technique is most commonly used to confirm the diagnosis of chronic pyelonephritis?

A. Abdominal X-ray
B. Renal biopsy
C. CT scan
D. MRI

Answer 47

C. CT scan

Rationale: Radiologic imaging studies such as CT scans are typically used to confirm the diagnosis of chronic pyelonephritis and assess contributing factors.

Question 48

In chronic pyelonephritis, which of the following is most commonly observed in renal biopsy results?

A. Infiltration of the renal parenchyma with inflammatory cells and fibrosis
B. Increased glomerular filtration rate
C. Enlarged nephrons with improved function
D. Absence of inflammation or scarring

Answer 48

A. Infiltration of the renal parenchyma with inflammatory cells and fibrosis

Rationale: A renal biopsy in chronic pyelonephritis shows loss of functioning nephrons, infiltration of inflammatory cells, and fibrosis in the renal tissue.

Question 49

Which of the following is a potential long-term complication of chronic pyelonephritis?

A. End-stage renal disease (ESRD)
B. Sudden urinary retention
C. Acute glomerulonephritis
D. Decreased bladder compliance

Answer 49

A. End-stage renal disease (ESRD)

Rationale: Chronic pyelonephritis can progress to end-stage renal disease (ESRD) due to ongoing damage to the kidneys and loss of renal function.

Question 50

A patient with chronic pyelonephritis is experiencing a decline in kidney function. Which factor will most significantly affect the rate of progression to end-stage renal disease (ESRD)?

A. The number of urinary tract infections
B. The extent of scarring and number of affected kidneys
C. The presence of coexisting diabetes
D. The patient’s age and sex

Answer 50

B. The extent of scarring and number of affected kidneys

Rationale: The progression to ESRD in chronic pyelonephritis depends largely on the extent of scarring and the number of affected kidneys.

Question 51

Chronic pyelonephritis is most commonly associated with which of the following?

A. Renal calculi (kidney stones)
B. Urinary tract obstruction
C. Vesicoureteral reflux
D. Autoimmune disorders

Answer 51

C. Vesicoureteral reflux

Rationale: Chronic pyelonephritis is most commonly associated with vesicoureteral reflux, which allows urine to flow backward into the kidneys, leading to repeated infections and kidney damage.

Question 52

A nurse is educating a patient with chronic pyelonephritis about disease management. Which statement by the patient indicates a need for further teaching?

A. “I need to take antibiotics as prescribed, even if I feel better.”
B. “I should have regular follow-up appointments to monitor my kidney function.”
C. “I must notify my healthcare provider if I experience symptoms of a urinary tract infection.”
D. “I should avoid drinking fluids to prevent kidney strain.”

Answer 52

D. “I should avoid drinking fluids to prevent kidney strain.”

Rationale: Patients with chronic pyelonephritis should be encouraged to maintain adequate fluid intake to help prevent further urinary tract infections, rather than restricting fluid intake.

Question 53

In a patient with chronic pyelonephritis, which of the following would be an early sign of worsening kidney function?

A. Elevated blood pressure
B. Increased urine output
C. Decreased glomerular filtration rate
D. Increased red blood cell count

Answer 53

C. Decreased glomerular filtration rate

Rationale: A decrease in glomerular filtration rate (GFR) is an early sign of worsening kidney function, indicating progression toward renal insufficiency or failure.

Question 54

Which of the following interventions is most critical for managing chronic pyelonephritis and preventing further kidney damage?

A. Treating underlying infections and correcting contributing factors
B. Administering antipyretics for fever control
C. Encouraging a high-protein diet to enhance healing
D. Restricting fluid intake to prevent kidney overload

Answer 54

A. Treating underlying infections and correcting contributing factors

Rationale: The most important management approach for chronic pyelonephritis is treating ongoing infections and correcting contributing factors such as anatomical abnormalities to prevent further kidney damage.

Question 55

A patient who has nephrotic syndrome develops flank pain. Which treatment will the nurse plan to explain to this patient?

a. Antifungals

b. Antibacterials

c. Anticoagulants

d. Antihypertensives

Answer 55

c. Anticoagulants

Rationale: Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals. Antihypertensives are used if the patient has high blood pressure.

Question 56

Which finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?

a. Flank tenderness to palpation

b. Blood pressure 90/48 mm Hg

c. Cloudy and foul-smelling urine

d. Temperature 100.1F (57.8C)

Answer 56

b. Blood pressure 90/48 mm Hg

Rationale: The low blood pressure indicates that urosepsis and septic shock may be occurring and would be immediately reported. The other findings are typical of pyelonephritis.