PATHOLOGY - Pyelonephritis Flashcards
What is pyelonephritis?
Pyelonephritis is the interstitial inflammation of the kidney(s) associated with bacterial infection
What are the two main causes of pyelonephritis?
Ascending bacterial infection
Haematogenous bacterial infection
Which factors increase the risk of pyelonephritis?
Immune suppression
Chronic kidney disease (CKD)
What are the clinical signs of acute pyelonephritis?
Mild renomegaly
Renal pain
Pyrexia
Anorexia
Dehydration
Weight loss
PUPD
Vomiting
What are the clinical signs of chronic pyelonephritis?
Normal to small kidneys on palpation (due to fibrosis)
Chronic pyelonephritis is very often missed
How do you approach diagnosis of pyelonephritis?
History and clinical signs
Clinical examination
Haematology and biochemistry
Urinalysis
Diagnostic imaging
What are some of the changes you would see on haematology and biochemistry in a patient with pyelonephritis?
Neutrophilia (not always)
Azotaemia (if progressed to renal failure)
What are some of the changes you would see on urinalysis in a patient with pyelonephritis?
Haematuria
Pyuria
Low urine specific gravity (USG)
White blood cell casts (not always)
Bacteria in the urine culture (not always)
What is a key signs on pyelonephritis on ultrasound?
Mild hydronephrosis with no dilatation of the ureters
What are some of the key indicators that a patient has pyelonephritis rather than bacterial cystitis or subclinical bacteruria?
Neutrophilia
Low urine specific gravity (USG)
Renal ultrasound changes
Recurrence of infection after short course of antibiotics
Why is the recurrence of infection after a short course of antibiotics indicative of pyelonephritis over bacterial cystitis?
Bacterial cystitis only requires a 3 -5 day course of antibiotics in order for the antibiotics to concentrate in the urine and treat the infection, whereas pyelonephritis requires a 10 - 14 days course of antibiotics in order for the antibiotics to concentrate in the renal tissue and treat the infection
How do you treat pyelonephritis?
10 - 14 day course of antibiotics (ideally based on culture and sensitivity)
Which antibiotic can you use to treat pyelonephritis if you don’t have culture and sensitivity results?
Fluoroquinolones
When should pyelonephritis patients begin to improve with treatment?
Pyelonephritis patients should begin to improve within 72 hours, if not, you should begin to consider other differential diagnoses
When should you recheck pyelonephritis patients?
You should recheck pyelonephritis patients 1 to 2 weeks post treatment and do a clinical exam, haematology and biochemistry, urinalysis and culture and sensitivity. It is important to do a recheck as pyelonephritis can progress to chronic renal failure
