Pyelonephritis

Question 1

What is pyelonephritis?

Answer 1

Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)

Question 2

What are some common bacteria in pyelonephritis?

Answer 2

E.coli most common cause, other causative organisms include Enterobacter, Proteus, Pseudomonas aeruginosa

Question 3

How does pyelonephritis usually present?

Answer 3

• High fever and rigors
• Loin to groin pain
• Dysuria and urinary frequency
• Haematuria
• Other non-specific symptoms (e.g. vomiting)
• Pain on bimanual palpation of the renal angle (over kidney)

Question 4

What investigations are required in pyelonephritis?

Answer 4

• Urine dipstick - blood, protein, leukocyte esterase, nitrates
• Imaging - CT can help confirm diagnosis
• Blood and urinary cultures

Question 5

How is pyelonephritis managed?

Answer 5

• IV amoxicillin + gentamicin until culture and sensitivities are avaliable
• Supportive management - rehydration, analgesia, antipyretics