UTI's and Pyelonephritis

Question 1

What is pyelonephritis?

Answer 1

Infection of the renal pelvis or upper urinary tract infection.

Question 2

Describe the classical symptoms of a patient presenting with pyelonephritis?

Answer 2

Systemically unwell, tacycardic, pyrexia, malaise.
Rigors.
Loin/flank, suprapubic or back pain.

Patients are often septic.

Question 3

Describe the acute and chronic complications of pyelonephritis?

Answer 3

Acute:
Septicaemia
Perinephric abcess (abcess in the retroperitoneal space behind the kidneys)
Hydronephrosis causing renal necrosis (if caused by an obstruction aka renal caliculi)

Chronic:
Progressive renal scarring with reflux nephropathy and renal failure
Secondary hypertension
Pyonephrosis (pus in the kidney)
Focal glomerulosclerosis

Question 4

List the factors that predispose to Pyelonephritis?

Answer 4

Renal abnormalities
Renal/Ureteric caliculi
Catheterisation

Preganacy
Diabetes
Immunocompromised
Primary Billary Cirrhosis

Question 5

What factors predispose to UTI’s?

Answer 5

Female
Increasing age
Sexual activity

Catheterisation
Structural abnormality
Bladder outflow obstruction
Colovesical fistulae

Question 6

What are the symptoms of a simple UTI and what are the common causative organisms?

Answer 6

• Dysuria
• Polyuria
• Confusion (in elderly)

Organisms:
E.coli (most common)
Proteus
Enterococci

Question 7

What are the investigations you would do with someone with suspected pyelonephritis? What would cause suspicion of renal Tb?

Answer 7

Bedside:
Urine dip
MSU

Bloods:
FBC
U/E's
LFTs
Blood Cultures

Imaging:
XR kub
CT kub

Sterile pyuria aka infective symptoms and white cells in urine with no causative organism

Question 8

What is the general treatment of UTI’s?

Answer 8

For simple cystitis:
3 day course of Trimethoprim/Nitrofurantoin
(7 day course in men)

Question 9

What is the general treatment of pyelonephritis?

Answer 9

First-line therapy in mild cases of uncomplicated pyelonephritis is oral ciprofloxacin for 7-10 days.

If septic follow Septic 6
IN: 
-O2
-IV fluids 
-IV abx (follow local guidelines) longer 2 week course switching to oral when possible

OUT:

• Blood cultures
• Lactate
• Catheter (monitor UO)