Pyelonephritis Flashcards
1
Q
ESSENCE
A
Refers to inflammation of kidney from bacterial infection
Affects renal pelvis (joint between kidney and ureter) and parenchyma (tissues)
2
Q
AETIOLOGY
Risk factors
A
- Female sex
- Strucural urological abnormalities
- Vesico-ureteric reflux
- Diabetes
3
Q
AETIOLOGY
Organisms
A
- E. Coli (most common)
- Klebsiella pneumonae
- Enterococcus
- Psudomonas auruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
4
Q
CLINICAL FEATURES
Presentation
A
- Triad of symptoms
- Fever
- Loin or back pain (unilateral or bilateral)
- Nausea/vomiting
- Systemic illness
- Loss of appetite
- Haematuria
- Renal angle tenderness on examination
5
Q
What is the classical triad of symptoms
A
- Fever
- Loin or back pain
- Nausea/vomiting
6
Q
INVESTIGATIONS
First choice
A
- Urine dipstick - infection
- Midstream urine (MSU) - organism cause
- Bloods - inflammatory markers and WCC
- Maybe US or CT - exclude other pathologies such as kidney stones or abscesses
7
Q
MANAGEMENT
General principles
A
- Referal to hospital if features of sepsis, if not manage in community
- Antibiotics for 7-10 days
- 1st - cefalexin
- Co-amoxiclav (if culture available)
- Trimethoprime (if culture available)
- Ciprofloxacin
8
Q
Patients admitted to hospital require what
A
- Sepsis 6
- 3 tests
- Blood lactate
- Blood cultures
- Urine output
- 3 treatments
- Oxygen to maintain 94-98% (88-92% in COPD)
- Empirical broad spectrum IV antibiotics
- IV fluids
9
Q
2 key differentials for patients with significant symptoms and dont respond to treatment
A
- Renal abscess
- Kidney stone (obstructing ureter causing pyelonephritis)
10
Q
How does chronic pyelonphritis present
A
- Recurrent episodes of infection in kidneys
- Can scar renal parenchyma, leading to chronic kidney disease which can progress to end stage renal failure
11
Q
What investigation is used in chronic pyelonephritis to assess scaring
A
Dimercaptosuccinic acid (DMSA)
