Pyelonephritis Flashcards
What is it?
What is caused by?
Infection of the renal pelvis
Ascending infection (E. coli) from lower UT
Or less commonly through bloodstream (sepsis)
What are the SX?
Rapid onset:
- Fever
- Rigors
- Loin pain
- N/V, malaise
- Pyuria - white cell casts in urine
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?
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
Name 4 RF
Structural renal abnormalities Calculi and urinary tract catheterisation Stents or drain procedures Pregnancy DM
How is it MX?
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
What indicates the need for hospital admission?
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
Name 3 complications
Sepsis
Perinephric abscess/ renal abscess
Premature labour in pregnancy
Renal damage = AKI or CKD
What causes acute interstitial nephritis and how does it present?
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