Pyelonephritis Flashcards
What is pyelonephritis?
Inflammation of the kidney typically due to bacterial infection
Acute pyelonephritis is the underlying cause of the majority of what presentations?
Febrile urinary tract infections in infants and young children
What usually causes pyelonephritis?
Ascension of perineal contaminants via the urinary tract to colonise the kidneys
Where do the perineal contaminants usually come from?
Bowel flora
What is the assumed origin of pyelonephritis in neonates?
Haematogenous
What bacteria accounts for 90% of all pyelonephritis cases?
E. coli
What other bacteria can cause pyelonephritis?
- Klebsiella
- Proteus
- Enterococcus faecalis
- Gram +ve organisms e.g. staph and Group B Strep
What are the risk factors for developing pyelonephritis?
- High-grade VUR
- Congenital or acquired renal abnormalities
- Delayed or incomplete voiding
- Constipation
- Catheterisation
- Sexual activity
What are the potential causes of delayed or incomplete voiding?
- Neurogenic bladder
- Obstruction
- Dysfunctional voiding
What are the signs and symptoms of pyelonephritis in neonates?
- Jaundice
- Hypothermia or fever
- Poor feeding
- Vomiting
- Failure to thrive
What are the signs and symptoms of pyelonephritis in infants and young children?
- Fever (longer than 48 hours)
- Poor feeding
- Vomiting
- Diarrhoea
- Foul urine
- Haematuria
What are the signs and symptoms of pyelonephritis in pre-school and school-age children?
- Fever
- Abdominal pain or flank pain
- Vomiting, diarrhoea and anorexia
- Foul urine
- Haematuria
- Voiding related symptoms e.g. enuresis, dysuria, urgency and frequency
What are the signs and symptoms of pyelonephritis in adolescents?
- Fever, often with chills and rigors
- Flank pain
- Abdominal and suprapubic pain
- Voiding related symptoms
- Foul urine
- Haematuria
What investigations can be used in pyelonephritis?
- Urinalysis
- Urine culture
- U&E’s
- ESR
- Imaging
What are the signs of a UTI on urinalysis?
- Nitrites
- Leukocytes
- Blood
Does a normal urinalysis result exclude pyelonephritis?
No
What urine culture result is diagnostic of a UTI?
Clean catch sample with more than 100,000 CFU’s of a single organism
Why might U&E’s be abnormal in pyelonephritis?
Due to diarrhoea and vomiting
What ESR result is indicative of pyelonephritis in the picture of a febrile UTI?
30mm/h
What imaging can be useful in assessing pyelonephritis?
- USS
- Voiding cystourethrography
What are the differentials for pyelonephritis?
- Bacteraemia
- Kawasaki disease
- UTI
- Appendicits
- Urolithiasis
How is the antibiotic of choice determined in pyelonephritis?
Based on urine cultures
How should pyelonephritis be treated prior to culture results?
Empirically based on local E. coli sensitivity
How long should IV antibiotics be given for?
3-4 days
How long should oral antibiotics be given post IV antibiotics?
10-14 days
When is hospitalisation for pyelonephritis necessary?
- Toxicity or sepsis
- Signs of obstruction or underlying disease
- Inability to tolerate oral fluids or medication
- Infants younger than 2
What should happen to patients managed as outpatients after 48 hours?
Re-assessment of hydration and response to therapy
What are the potential complications of pyelonephritis?
- Dehydration
- Renal parenchymal scarring
- Hypertension
- Decreased renal function
- Renal failure
