Pyelonephritis Flashcards
How to distinguish pyelonephritis from lower UTI?
Pyelonephritis will have renal angle tenderness where the ribs meet the spine AKA flank pain. There will be general features like nausea and vomiting.
What is pyelonephritis?
Pyelonephritis refers to an infection of the renal pelvis and parenchyma which is typically caused by gram negative bacteria like E.Coli from ascending lower UTI or blood or lymphatic system
What are the causes of pyelonephritis in immunocompromised patients?
pyelonephritis secondary to fungi (e.g. Candida albicans, aspergillosis)
What are signs of pyelonephritis?
Renal angle tenderness
Haematuria
Suprapubic tenderness (without guarding)
Rigors
Sweating
Signs of dehydration (e.g. dry mucous membranes, tachycardia, cool peripheries)
What are the bedside tests for pyelonephritis?
Urine dipstick may be positive for blood, leukocytes and nitrites (less reliable in patients with a catheter or aged over 65)
Urine culture prior to starting antibiotics to identify the responsible bacteria and target treatment
Pregnancy test for all women of child-bearing age
Blood gas in acutely unwell patients assessed in hospital to check lactate and acid-base status
What imaging can be done for pyelonephritis?
Renal ltrasund
Non contrast CT KUB
What is the conservative antibiotic a management?
Oral cephalexin for mild cases
What IV medication is used for pyelonephritis?
IV options include ceftriaxone, ciprofloxacin or co-amoxiclav
Fluid for dehydrated patients
What is urogenital tuberculosis?
Extrapulmonary Tuberculosis through haematogenous spread which commonly affects people in their 40s it presents with weight loss, dysuria and suprapubic tenderness.
Is CT KUB or ultrasound best for assessing kidney stones?
CT KUB with non contract has a higher sensitivity/specificity
