Pyelonephritis Flashcards

1
Q

What is it?

What is caused by?

A

Infection of the renal pelvis

Ascending infection (E. coli) from lower UT

Or less commonly through bloodstream (sepsis)

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2
Q

What are the SX?

A

Rapid onset:

  • Fever
  • Rigors
  • Loin pain
  • N/V, malaise
  • Pyuria - white cell casts in urine
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3
Q

What IX do you do?

What bloods can you take?

What is the first line imaging method?

What is dx imaging method?

What is the preferred imaging in preg?

What scan is used to detect scarring in recurrent infections?

A

Urinalysis

  • offensive, cloudy urine
  • blood, leucocyte, protein, nitrate +ve dip
  • MCS MSU - clean catch

Bloods

  • CRP, ESR
  • FBC: high WCC + neurophilia
  • Procalcitonin
  • Cultures

Imaging:

  • US 1st line
  • Contrast-enhanced helical/spiral CT**
  • In preg - US or MRI

Dimercaptosuccinic acid (DMSA) scan - detects scarring in recurrent cases

Renal biopsy

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4
Q

Name 4 RF

A
Structural renal abnormalities
Calculi and urinary tract catheterisation 
Stents or drain procedures 
Pregnancy 
DM
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5
Q

How is it MX?

A

Supportive: rest, fluids, analgesia

Hospital admission may be necessary

1st line abx - ciprofloxacin** or co-amoxiclav 7d course

Surgery maybe - drain renal or perinephric abscesses or to relieve obstructions causing infection e.g. stones

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6
Q

What indicates the need for hospital admission?

A
Pregnancy 
Severe vomiting
Co-morbidity e.g. DM
Dehydration/ inability to intake fluids
Severe pain
Failure to respond to primary care RX within 24h
Urinary tract obstruction 
Oliguria/anuria
Relapse of SX as soon as abx stopped
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7
Q

Name 3 complications

A

Sepsis
Perinephric abscess/ renal abscess
Premature labour in pregnancy
Renal damage = AKI or CKD

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8
Q

What causes acute interstitial nephritis and how does it present?

A

Arises following abx therapy and other drugs

Presents with sterile pyuria and WC casts, rash and fever, HTN

IX - eosinophilia, urine

Def DX - renal biopsy (reserved for if unsure of dx)

MX - stop offending drug, if severe = steroids or dialysis

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