pyelonephritis Flashcards
risk factors
women
pregnancy
urinary tract obstruction
foreign bodies eg. catheters, other urological instramentation
anatomical abnormlaities
cystitis
recent administration of antibiotics
immunosuppresion
renal transplant
clinical features
fever, chills
flank pain
costovertebral angle tenderness:pain on percussion of the back
dysuria
weakness, nausea, vomiting
abdominal or pelvic pain
differential in men
consider prostatitis, particularly those with high fever, obstructive urinary symptoms, or prostate tenderness on gentle digital rectal examination
findings of pylonephritis on urinalysis
non specific findings of UTI eg. pyuria, leukocyturia, bacteriuria, positiv nitrites, heamaturia
other findings eg. WBC casts, urine pH >7.5-8, epithelial cells
collect urine sample for culture and sensitivity before starting antibiotics
positive nitrites indicates
bacteria that convert nitrates to nitrites
investigations for acute pylonephritis in adults
obtain a urine sample for culture and sensitivity before starting antibiotics
collect blood sample for culture and sensitivity testing in hospitalised patients
when is imaging indicated
not indicated in uncomplicated cases
without sepsis, nephrolithisis, new decline in GFR, recurrent or no response to therapy
consider imaging to exclude urinary obstruction, kidney stone disease or kidney abscess, partcularly if the patient remains febrile after 72 hours of ABx
what is the imaging modality of choice
CT abdo pelvic without and then with contrast
imging findings supportive of pylonephritis
may appear normal if early or oedematous
infected parenchyma my show streaky contrast enhaancement
imaging findings supportive of urinary tract obstruction
hyroureter, hydronephrosis
nephrolothisis, urolithiasis
empirical therapy of non-severe pylonephritis in adults awaiting investigations
amoxicillin + clavulanate
(augmentin)
