Pyelonephritis Flashcards
What is pyelonephritis?
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis.
What is the most common cause?
E.Coli
Proteus
Klebsiella
Enterobacter
Pseudomonas
Gram negative most common
Gram positive are less common
Enterococcus faecalis
Staphylococcus aureus
Where does the infection usually ascend from?
Lower urinary tract, except for staph aureus which is normally spread by blood stream.
What are the signs and symptoms of pyelonephritis?
Fever
Flank pain
Irritative voiding
Shaking chills
Associated nausea and vomiting
Tachycardia
Diarrhea
Costovertebral angle tenderness
What lab findings will you have?
Leukocytosis
Pyuria
Bacteiruria
Varying hematuria
White cell casts
Heavy growth of offending organism
Blood may also be positive
What imaging should you gain?
Renal ultrasound may show hydronephrosis from a stone or other obstruction
What is the inpatient treatment for sever pyelonephritis?
Ampicillin 1g every 6 hrs
Gentamicin 1mg/kg every 8 hrs
IV for 24 hrs, 14 days of oral antibiotics following fever resolution
What is the outpatient treatment antibiotic?
Ciprofloxacin 750mg every 12 hrs by mouth for 7-14 days
Levofloxacin 750 mg by mouth for 7-14 days
How long may fevers persist?
72 hrs even with appropriate therapy
Can you give pyridium for pyelonephritis?
Yes
100-200mg by mouth every 8 hrs for max of 3 days
Does acute pyelonephritis carry a good prognosis?
Yes
Should you get follow up urine cultures?
Yes
Why should you medevac?
Need urology referral or severe infections
