Nephrology- Infection & Diagnostic testing

Question 1

Diagnosis: Acute fever, dysuria, flank pain, costrovertebral angle tenderness, leukocytosis, pyuria, perinephric fat stranding

Answer 1

Acute pyelonephritis

Question 2

Common pathogens of pyelonephritis

Answer 2

E.coli (~80%)
Proteus Mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus

Question 3

Urinary alkalization (ph> 8)

Answer 3

Urease splits urea into ammonia and CO2; ammonia then coverings to ammonium and alkalinity’s the urine.

Suspicion for urease-producing bacteria: Proteus & Klebsiella

Question 4

Struvite Stones

Answer 4

Magnesium ammonium phosphate crystals.

High pH reduces the solubility of phosphate —> struvite stone (staghorn calculus)

Question 5

S&S renal abscess

Answer 5

Systemic symptoms 
Unilateral flank pain/ tenderness 
Palpable mass
UTI symptoms absent 
Leukocytosis 
Elevated inflammatory markers

Question 6

Diagnosis renal abscess

Answer 6

CT or u/s

Question 7

Management renal abscess

Answer 7

Abx

percutaneous drainage

Question 8

Risk factors renal abscess

Answer 8

Anatomic abnormalities
Nephrolithiasis
Uncontrolled DM
Tobacco use

Question 9

Differential: Hx Urologic infection, Flank pain, Fever, acute kidney labs

Answer 9

Renal abscess: palpable mass, weight loss

Papillary Necrosis : hematuria

Question 10

management: Hematuria, dysuria, WBC+

Answer 10

Empiric Abx

Urine culture