Pyelonephritis

Question 1

Cause

Answer 1

trans-urethral ascend of colonic commensals, most commonly E. coli

Question 2

What is it?

Answer 2

pyelonephritis is urinary tract infection affecting the kidneys/renal pelvis

Question 3

clinical features

Answer 3

fever/rigors, malaise, loin/flank pain, and vomiting.

Clinical examination reveals fever and loin/flank tenderness.

Question 4

differentials

Answer 4

the key differential is cystitis. In cystitis the patient will rarely be pyrexial or have loin/flank tenderness

Abnormal vital signs are more indicative of pyelonephritis

Question 5

investigations

Answer 5

bedside tests include a urine dipstick which will typically be positive for leucocytes and nitrites

After admitting the patient, bloods should be taken to include FBC (raised WCC), U&E (to check for renal impairment), and blood cultures.

Other investigations include a urine MSU for MC&S.

A renal ultrasound can be performed to look for hydronephrosis if severe infection occurs with acute kidney injury.

Question 6

management

Answer 6

patient should be admitted to hospital for intravenous antibiotics (broad-spectrum cephalosporin/a quinolone/gentamicin)