Urology - pyelonephritis Flashcards
Risk factors for pyelonephritis
Female sex
Structural urological abnormalities
Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
Diabetes
Causes of pyelonephritis
E.Coli (most common)
Other causes: Klebsiella pneumoniae (gram-negative anaerobic rod) Enterococcus Pseudomonas aeruginosa Staphylococcus saprophyticus Candida albicans (fungal)
Presentation of pyelonephritis
LUTS plus triad of:
- Fever
- Loin or back pain
- Nausea and vomiting
Also may have: Systemic illness Loss of appetite Haematuria Renal angle tenderness on examination
Investigations in suspected pyelonephritis
Urine dipstick
MSU for MC+S
Bloods - FBC, CRP
Imaging to exclude other pathology may be needed e.g. kidney stones or abscesses. This could be an ultrasound or CT scan.
Management of pyelonephritis
7-10 days of antibiotics (one of these):
- Cefalexin
- Co-amoxiclav (if culture results are available)
- Trimethoprim (if culture results are available)
- Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
If patients with pyelonephritis aren’t responding well to treatment or there are significant symptoms think of…
Renal abscess
Kidney stone, obstructing ureter causing pyelonephritis
What is a potential risk in pyelonephritis?
Chronic pyelonephritis presents with recurrent episodes of infection in the kidneys.
Recurrent infections lead to scarring of the renal parenchyma, leading to chronic kidney disease (CKD).
It can progress to end-stage renal failure.
What scan can be done to assess for renal scarring as a result of recurrent pyelonephritis?
DMSA scan (Dimercaptosuccinic acid)
Involves injecting radiolabeled DMSA, which builds up in healthy kidney tissue.
When imaged using gamma cameras, it indicates scarring or damage in areas that do not take up the DMSA.
