Pyelonephritis

Question 1

Pyelonephritis definition

Answer 1

Upper tract urinary infection involving kidney’s renal parenchyma

Question 2

Pyelonephritis sxs

Answer 2

Fevers, chills, flank pain, abdominal pain, nausea, vomiting

Question 3

Pyelonephritis sxs if ascended along urinary tract from bladder

Answer 3

urinary sx likely present: dysuria, urinary frequency and urgency, hematuria

Question 4

Pyelonephritis sxs if hematogenous spread from IVDA or cutaneous infections

Answer 4

no urinary sxs

Question 5

what should you include in your PE?

Answer 5

temp - Febrile

Costovertebral angle tenderness

Question 6

Labs for pyelonephritis

Answer 6

UA: WBCs, WBC casts
Urine culture
CBC: Leukocytosis, left shift
Blood culture may be neg

Question 7

when should you order imaging for Pyelonephritis

Answer 7

If very ill, unstable, septic, DM, immunocompromised, structural abnormality of urinary tract, urinary obstruction, urinary stones, unresponsive to abx

Question 8

What imaging should you order and what can they show?

Answer 8

CT Urogram (CTU): Perinephric stranding, kidney enlargement
decr'd nephrogram, renal collecting system dilated but not obstructed

Renal U/S: Kidney enlargement,
abn kidney echogenicity

Question 9

Tx if mildly ill w/Pyelonephritis

Answer 9

Outpatient

FQ po x 7d or other x 14d and initial LA IV abx (ceftriaxone)

If febrile >72 hr, or if not sufficient clinical improvement, consider admission and add’l w/u

Question 10

Tx if mod/severely ill w/Pyelonephritis

Answer 10

High fever, high WBC, vomiting, dehydration, sepsis

Admit for: Urine/blood cultures, iv abx, imaging, PO when afeb x24-48hr, d/c home w/2wk po abx, adjust and f/u after C&S complete

Question 11

If pt is not improving after tx what dx should you consider?

Answer 11

ABN or renal abscess

Question 12

Acute Bacterial Nephritis??

Answer 12

Aka Acute lobar nephronia

Bacterial interstitial nephritis of the renal cortex, causing a renal mass, but no liquifaction

Question 13

Renal Abscess?

Answer 13

Purulent fluid collection of kidney

perinephric abscess is adjacent to kidney

Question 14

which pt’s are susceptible to renal abscess?

Answer 14

Often DM, immunocompromised

Question 15

what are the MC pathogens for pyelo

Answer 15

Gram negative

if hematogenous route, Gram positives (ie. Staph aureus)

Question 16

Tx for renal abscess

Answer 16

IV antibiotics
Percutaneous drainage
Surgical drainage
Follow pt’s clinical course and follow w/ imaging to ensure resolution

Question 17

chronic pyelonephritis?

Answer 17

Result of prior infections

Scarred, atrophic, poorly functioning kidney

Low flow, high renin

Question 18

clinical presentation for chronic pyelo

Answer 18

Hypertension
Anemia of chronic disease
Proteinuria
Renal insufficiency
Recurrent UTIs

Question 19

Radiographic findings for chronic pyelo

Answer 19

Caliceal blunting

Question 20

Tx for chronic pyelo

Answer 20

Manage UTI risk factors
Control HTN
Nephrectomy