Pyelonephritis Flashcards
What is it?
Infection of the renal pelvis, usually with infected renal parenchyma
What causes it?
Often is caused by ascending infection from the bladder but can also be caused by haematogenous spread
What organisms cause the infection? (3)
E.coli, Klebsiella, Enterococci
What happens in repeat infection?
It can become chronic Pyelonephritis which leads to destruction and scarring of the renal tissue
Is it common?
Kind of, occurs in 1% of boys and 3% of girls by aged 7
Who is mostly affected?
Incidence is greatest in women aged 15-29
Risk Factors (8)
Structural abnormalities e.g Vesicoureteric reflux, calculi, urinary tract catheter, stents/drainage procedures, pregnancy, diabetes, Primary biliary cirrhosis, neuropathic bladder
Signs and Symptoms (16)
Rapid onset, unilateral loin pain, suprapubic pain, back pain, fever, rigors, malaise, nausea, vomiting, anorexia, diarrhoea, frequency, dysuria, haematuria, hesitancy, pain on kidney palpation
Differentials (5)
Abdominal abscess, appendicitis, ectopic pregnancy, renal abscess, Nephrolithiasis
What bloods would you do? (5)
FBC, U&E, CRP, ESR, Blood cultures (positive in 30%)
Other investigations
Urinalysis, Midstream Urine MC&S, ultrasound, CT, Renal biopsy
Treatment (7)
Rest, fluids and analgesia, hospital admission if olig/anuria or baby under 3 months, Empirical Antibiotic therapy with Ciprofloxacin/Co-Amoxiclav but switch to specific when confirmed e.G Trimethoprim, Surgery sometimes needed to drain abscess
Complications (5)
Sepsis, renal/perinephric abscess, Acute Papillary Necrosis (esp in elderly), AKI or CKD, Chronic Pyelonephritis
Is there a good prognosis?
Usually there is an uncomplicated recovery provided there are no co-morbidities
