Pyelonephritis

Question 1

What is pyelonephritis?

Answer 1

Inflammation of the kidney due to bacterial infection

Affects the renal pelvis + parenchyma

Question 2

What are the risk factors for pyelonephritis?

Answer 2

Female
Structural urological abnormalities
Vesico-ureteric reflux (usually occurs in children)
Diabetes

Question 3

What are the most common bacteria associated with pyelonephritis?

Answer 3

E coli
Klebsiella pneumonia
Enterococcus
Pseudomonas aeruginosa

Question 4

How would someone with pyelonephritis present?

How could you differentite from LUTI?

Answer 4

LUTI signs
-dysuria/suprapubic discomfort/frequency

TRIAD:

• fever
• loin or back pain ( uni or bi)
• nausea + vomiting

Additional:

• systemic illness
• loss of appetite
• haematuria
• renal angle tenderness when examined

Question 5

What investigations are down when pyelonephritis is suspected?

Answer 5

Urine dip
-nitrites/leukocytes/RBC

MSU
-microscopy for causative organism

Bloos rests

• raised WCC
• raised CRP

US or CT
-exclude kidney stones or abscess

Question 6

How is pyelonephritis managed in the community?

Answer 6

Refer to hospital if signs of sepsis

7-10 days antiobiotics
-cefalexin
When cultures back: 
-co-amoxiclav 
-trimethoprim

Question 7

What is the main management of patients with pyelonephritis in hospital?

Answer 7

Sepsis 6 managment

3 test:

• blood lactate
• blood cultures
• urine output

3 tx:

• oxygen to maintain sats
• empirical broad spec IV antibiotics
• IV fluids

Question 8

What is chronic pyelonephritis?

What can occur as complication?

What imaging is used to asses for chronic pyelonephritis?

Answer 8

Recurrent episodes of infection in kidneys

Leads to scarring of parenchyma- can progress to CKD and end stage renal failure

Dimercaptosuccinic acod (DMSA) scan
-inject radiolabel DMSA= builds up in healthy tissue 
I.e. will show damaged areas as those not taken up DMSA