Pyelonephritis

Question 1

What is pyelonephritis?

Answer 1

Inflammation of the renal pelvis and parenchyma as a result of bacterial infection

Question 2

What is the most common cause of pyelonephritis?

Answer 2

E. coli

Question 3

What are the other causes of pyelonephritis?

Answer 3

Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans

Question 4

What are the risk factors for pyelonephritis?

Answer 4

Female sex
Structural urological abnormalities
Vesico-ureteric reflux
Diabetes

Question 5

What are the indicators of complicated pyelonephritis?

Answer 5

Pregnancy
Uncontrolled diabetes
Kidney transplants
Urinary anatomical abnormalities
Acute or chronic kidney failure
Immunocompromised patients
Hospital-acquired bacterial infections

Question 6

What are the clinical features of pyelonephritis?

Answer 6

Flank pain
Myalgia
Rigors
Dysuria
Haematuria
Confusion

Question 7

What signs are found on examination in pyelonephritis?

Answer 7

Renal angle tenderness
Suprapubic tenderness
Fever
Tachycardia
Hypotension
Altered mental status

Question 8

What are the first line investigations for pyelonephritis?

Answer 8

Urinalysis
Urine MC&S
FBC
CRP
U&Es

Question 9

What other investigations may be considered in pyelonephritis?

Answer 9

US KUB - assess structural abnormalities
CT KUB - if renal colic is suspected

Question 10

What is the management of pyelonephritis?

Answer 10

First line
- Oral Cefalexin for 7-10 days
- Oral Ciprofloxacin for 7 days

Second line - for severe disease
- IV gentamicin
- IV ciprofloxacin