Renal & Urology /Pyelonephritis

Question 1

What is pyelonephritis?

Answer 1

Inflammation of the kidney and renal pelvis

Question 2

What percentage of women with dysuria in the outpatient setting will have pyelonephritis?

Answer 2

5%

Question 3

What signs and symptoms are suggestive of pyelonephritis?

Answer 3

• fever (symptoms of pyelonephritis without fever should prompt an evaluation for an alternative diagnosis)
• nausea
• vomiting
• abdominal/pelvic pain
• lower UTI signs and symptoms
  
  • dysuria, frequency, urgency
• chills
• costovertebral angle tenderness

Question 4

What is the most common etiology of UTI and pyelonephritis?

Answer 4

Ascending infection

Question 5

How is the diagnosis of pyelonephritis made?

Answer 5

• clinical diagnosis supported by lab findings, such as pyuria or WBC casts

Question 6

What is the only laboratory test that can immediately and specifically support the diagnosis of pyelonephritis?

Answer 6

White cell casts (sign of infection in the renal medulla)

Question 7

Pain in the flank on deep percussion of the kidneys over the costovertebral angle is also known as what sign?

Answer 7

Lloyd sign

Question 8

Are imaging studies, such as CT or ultrasound helpful in establishing the diagnosis of pyelonephritis?

Answer 8

No

Question 9

What are the indications for hospitalization in pyelonephritis?

Answer 9

• inability to tolerate oral hydration and medications
• noncompliance with medical treatment
• pregnancy
• intractable pain
• area of high resistance to antibiotics

Question 10

What classes of antibiotics are used to treat pyelonephritis?

Answer 10

Fluoroquinolones and third-generation cephalosporins