Pyelonephritis

Question 1

What causes it?

Answer 1

Its associated with neutrophil infiltration of the renal parenchyma; small cortical abscesses and streaks of pus in the renal medulla are often present.

There may be acute deterioration in renal function but significant permanent kidney damage in adults with normal renal tracts is rare.

Tends to be cause by bacteria ascending from the lower UT.
Causative organisms are: E. coli, Klebsiella pneumoniae, Proteus species, Pseudomonas species, Enterococcus species.

Question 2

What risk factors are there?

Answer 2

Same as for UTI

Question 3

How does it present?

Answer 3

Classic triad of fever, costovertebral angle pain, and nausea and/or vomiting.

Symptoms of UTI.

Question 4

Signs on examination?

Answer 4

There are no clinical features or routine investigations that conclusively distinguish acute pyelonephritis from cystitis.

Question 5

Investigations

Answer 5

Send a midstream specimen of urine for culture and sensitivity. Do the same dipstick test as for UTI, same results mean the same thing.

Question 6

Treatment

Answer 6

A high fluid intake. Iv antibiotics, Kumar and Clarke seems to recommend amoxicillin until sensitivity testing has been performed but I would be tempted to go for nitrofurantoin or trimethoprim.

Question 7

Conditions that would present similarly

Answer 7

Other causes of loin pain/fever: pelvic inflammatory disease, appendicitis, renal calculi