Pyelonephritis

Question 1

Pyelonephritis

Answer 1

Inflammation of the kidney parenchyma and the renal pelvis due to bacterial infection

Question 2

Common organisms

Answer 2

Escherichia coli - 80%

Klebsiella
Proteus

Catheters:
Enterococcus faecalis
Staphylococcus aureus
Pseudomonas

Question 3

Risk factors

Answer 3

Urinary obstruction e.g. BPH/stone

Neuropathic bladder - spinal injury

Female

Indwelling catheter

Vesico-ureteric reflux

Predisposition to infection:

• DM
• Corticosteroids
• HIV

Bacterial colonisation:

• Renal calculi
• Sex
• Menopause

Question 4

Classical triad

Answer 4

Fever
Unilateral loin pain
Nausea & vomiting

Question 5

Clinical Features

Answer 5

Triad
Typically over 1 - 2 days
Co-existing lower urinary tract infection
Haematuria

Examination:
- costovertebral angle tenderness

Question 6

Investigations

Answer 6

Urinalysis + MCS
Routine bloods
Pregnancy test
Renal USS

Obstruction suspected:
- CT KUB no contrast

Question 7

Management

Answer 7

A-E
Abx

Severe or non-responding cases - catheterisation and high-dependency unit monitoring

Question 8

Complications

Answer 8

Sepsis

Renal scarring - CKD

Question 9

Chronic Pyelonephritis

Answer 9

Repeated infections can lead to chronic pyelonephritis - leads to chronic pyelonephritis

Question 10

Emphysematous Pyelonephritis

Answer 10

Rare and severe form of acute pyelonephritis, caused by gas-forming bacteria

• fails to respond to empirical IV antibiotics
• CT imaging - gas within and around the kidney
• more common in DM patients

Question 11

Mx of Emphysematous Pyelonephritis

Answer 11

Mild cases - broad-spectrum anti-microbial

Severe cases:

• nephrostomy insertion
• percutaneous drainage
• nephrectomy