Pyelonephritis

Question 1

ESSENCE

Answer 1

Refers to inflammation of kidney from bacterial infection

Affects renal pelvis (joint between kidney and ureter) and parenchyma (tissues)

Question 2

AETIOLOGY

Risk factors

Answer 2

• Female sex
• Strucural urological abnormalities
• Vesico-ureteric reflux
• Diabetes

Question 3

AETIOLOGY

Organisms

Answer 3

• E. Coli (most common)
• Klebsiella pneumonae
• Enterococcus
• Psudomonas auruginosa
• Staphylococcus saprophyticus
• Candida albicans (fungal)

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Triad of symptoms
  
  • Fever
  • Loin or back pain (unilateral or bilateral)
  • Nausea/vomiting
• Systemic illness
• Loss of appetite
• Haematuria
• Renal angle tenderness on examination

Question 5

What is the classical triad of symptoms

Answer 5

• Fever
• Loin or back pain
• Nausea/vomiting

Question 6

INVESTIGATIONS

First choice

Answer 6

• Urine dipstick - infection
• Midstream urine (MSU) - organism cause
• Bloods - inflammatory markers and WCC
• Maybe US or CT - exclude other pathologies such as kidney stones or abscesses

Question 7

MANAGEMENT

General principles

Answer 7

• Referal to hospital if features of sepsis, if not manage in community
• Antibiotics for 7-10 days
  
  • 1st - cefalexin
  • Co-amoxiclav (if culture available)
  • Trimethoprime (if culture available)
  • Ciprofloxacin

Question 8

Patients admitted to hospital require what

Answer 8

• Sepsis 6
• 3 tests
  
  • Blood lactate
  • Blood cultures
  • Urine output
• 3 treatments
  
  • Oxygen to maintain 94-98% (88-92% in COPD)
  • Empirical broad spectrum IV antibiotics
  • IV fluids

Question 9

2 key differentials for patients with significant symptoms and dont respond to treatment

Answer 9

• Renal abscess
• Kidney stone (obstructing ureter causing pyelonephritis)

Question 10

How does chronic pyelonphritis present

Answer 10

• Recurrent episodes of infection in kidneys
• Can scar renal parenchyma, leading to chronic kidney disease which can progress to end stage renal failure

Question 11

What investigation is used in chronic pyelonephritis to assess scaring

Answer 11

Dimercaptosuccinic acid (DMSA)