Pyelonephritis Flashcards
What is pyelonephritis?
Inflammation of the kidney due to bacterial infection
Inflammation affects the renal pelvis
What are the risk factors of pyelonephritis?
Female
Structural urological abnormalities
Vesico-ureteric reflux
Diabetes
What is the most common cause of pyelonephritis?
Escherichia coli
Gram negative
Anaerobic
Bacilli
What are some less frequent causes of pyelonephritis?
Klebsiella pneumoniae (gram-negative anaerobic bacilli)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans
How do patients with pyelonephritis present?
LUTS + Triad of symptoms:
Fever
Loin or back pain
Nausea/vomiting
What symptoms may patients with pyelonephritis may also have asides from the regular triad?
Systemic illness
Loss of appetite
Haematuria
Renal angle tenderness (on examination)
What investigations should be used for pyelonephritis?
Urine dipstick
MSU for microscopy, culture and sensitivity
Blood tests
Imaging to exclude other pathology e.g. ultrasound or CT
How is pyelonephritis managed?
Referral to hospital if there are features of sepsis if not
7-10 days of
Cefalexin
Co-amoxiclav (if cultures are available)
Trimethoprim (if cultures are available)
Ciprofloxacin (tendon damage and lowered seizure threshold risk)
If patients do not respond well to treatment of pyelonephritis, what should be considered?
Renal abscess
Kidney stone- obstructing ureter causing pyelonephritis
What can recurrent kidney infections lead to?
Scarring of the renal parenchyma leading to CKD
May also progress to end-stage renal failure
What is used in recurrent pyelonephritis to assess for renal damage?
Dimercaptosuccinic acid (DMSA) scans
Inject radiolabelled DMSA which builds up in healthy kidney tissue, but not damaged tissue
When imaged, indicates scarring or damage
