Pyelonephritis Flashcards
Pyelonephritis definition
Upper tract urinary infection involving kidney’s renal parenchyma
Pyelonephritis sxs
Fevers, chills, flank pain, abdominal pain, nausea, vomiting
Pyelonephritis sxs if ascended along urinary tract from bladder
urinary sx likely present: dysuria, urinary frequency and urgency, hematuria
Pyelonephritis sxs if hematogenous spread from IVDA or cutaneous infections
no urinary sxs
what should you include in your PE?
temp - Febrile
Costovertebral angle tenderness
Labs for pyelonephritis
UA: WBCs, WBC casts
Urine culture
CBC: Leukocytosis, left shift
Blood culture may be neg
when should you order imaging for Pyelonephritis
If very ill, unstable, septic, DM, immunocompromised, structural abnormality of urinary tract, urinary obstruction, urinary stones, unresponsive to abx
What imaging should you order and what can they show?
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
Tx if mildly ill w/Pyelonephritis
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
Tx if mod/severely ill w/Pyelonephritis
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
If pt is not improving after tx what dx should you consider?
ABN or renal abscess
Acute Bacterial Nephritis??
Aka Acute lobar nephronia
Bacterial interstitial nephritis of the renal cortex, causing a renal mass, but no liquifaction
Renal Abscess?
Purulent fluid collection of kidney
perinephric abscess is adjacent to kidney
which pt’s are susceptible to renal abscess?
Often DM, immunocompromised
what are the MC pathogens for pyelo
Gram negative
if hematogenous route, Gram positives (ie. Staph aureus)
Tx for renal abscess
IV antibiotics
Percutaneous drainage
Surgical drainage
Follow pt’s clinical course and follow w/ imaging to ensure resolution
chronic pyelonephritis?
Result of prior infections
Scarred, atrophic, poorly functioning kidney
Low flow, high renin
clinical presentation for chronic pyelo
Hypertension Anemia of chronic disease Proteinuria Renal insufficiency Recurrent UTIs
Radiographic findings for chronic pyelo
Caliceal blunting
Tx for chronic pyelo
Manage UTI risk factors
Control HTN
Nephrectomy
