Pyelonephritis Flashcards
Define pyelonephritis
inflammation of the kidney parenchyma (cortex, medulla, pyramids) and the renal pelvis, typically due to bacterial infection
The most common causative organism in pyelonephritis
E. coli
E.coli gram staining features
- gram -ve
- anaerobic
- rod shape
Pyelonephritis traid of Sx
- Pyrexia
- unilateral Loin / back pain
- N + V
acute - occurs over 24-48h
pyelonephritis initial Ix
- Urinalysis: Nitrites, Leuk, blood
- Urine MC&S (before Abx Tx)
- Urine beta-hCG (women)
- Bloods: FBC (WCC, CRP, UEs)
pyelonephritis pharmacological Mx
1st: Cefalexin 500mg TDS 7-10D
2nd: Co-amox 625mg TDS 7-10D
3rd: Trimethroprim 200mg BD 14D
4th: Ciprofloxacin 500 mg BD 7D
Ciprofloxacin SEs
- Tendon damage
- Lowers seizure threshold
when to admit pt with pyelonephritis to the hospital
patient w/ pyelonephritis Sx + features of sepsis
what should be consider if pt DO NOT respond to Tx / significant Sx
- development of a renal abscess
- Renal tract calculi obstructing the ureter
Acute pyelonephritis pathophysiology
bacterial infection of the renal pelvis and parenchyma. Bacteria can reach the kidney either by ascending from the lower urinary tract, directly from the blood stream, as in cases of septicaemia or infective endocarditis
Pyelonephritis urological risk factors
1.Factors reducing antegrade flow of urine
- BPH
- Renal calculi
2.Factors promoting retrograde ascent of bacteria
- Female: short urethra
- Indwelling catheter or ureteric stents / nephrostomy tubes in-situ
- Renal calculi
Pyelonephritis non-urological risk factors
Factors predisposing to infection or immunocompromise
Diabetes mellitus, corticosteroid use, HIV infection (untreated)
pyelonephritis examination findings
- costovertebral (renal) angle tenderness
- Pyrexial
- septic (hypotensive, tachycardic, tachypnoeic)
what is the single most important differential of loin/back pain + septic
potential ruptured AAA (abdominal aortic aneurysm)
pyelonephritis imaging Ix
1.USS KUB assess for obstruction (infected obstruction = emergency)
followed by
2.non-contrast CT KUB is obstruction is suspected
Pyelonephritis complications
- Chronic Pyelonephritis
- Sepsis
- Renal scarring –> CKD
- pyonephrosis (swelling caused by infection filled with pus)
Which of imaging investigations best can exclude a suspected pyonephrosis or perinephric abscess
CT KUB
other than the triad of Sx what Sx can pt w/ pyelonephritis co-exist
LUT infection Sx
- Dysuria
- Polyuria
- Urgency
- Haematuria
Pyelonephritis Mx in pregnancy w/ septic features
Intraveous cefuroxime
