Urinary Tract Disease: Upper: Pyelonephritis

Question 1

UTI definition

Answer 1

Presence of micro-organisms in the urinary tract which produces clinical features.

Question 2

Most common pathogens: KEEPS

Answer 2

Klebsiella
E. coli
Enterococci
Proteus/ Pseudomonas Aeruginosa
Staphylococcus Saprophyticus > 50% of cases

Question 3

Pyelonephritis Definition

Answer 3

Infection of renal parenchyma + upper ureter ascending transurethral spread. Usually uropathogenic E.coli , can be other KEEPS

Question 4

Epidemiology

Answer 4

Females
<35

Question 5

Risk factors (CUPID = lots of s*x)

Answer 5

Catheter (indwelling)
Urinary tract obstruction
Pregnancy
Immunocompromised
Diabetes
Frequent sexual intercourse
Vesico-ureteric reflux

Question 6

Signs and symptoms

Answer 6

CLASSIC TRIAD:
- Fever
- Loin pain
- Pyuria
N+V
Chills
Costovertebral joint pain + tenderness
Sepsis

Question 7

Diagnosis

Answer 7

FIRST LINE = Urine dipstick
+ leukocytes
+ nitrates
+/- haematuria
GOLD STANDARD = Midstream MC+S
- confirm UTI + ID pathogen

Question 8

Treatment

Answer 8

Analgesia = paracetamol
Abx = ciprofloxacin, or co-amoxiclav
Cefalexin if preggo
If hospitalised/ severe: IV GENTAMICIN