Pyelonephritis

Pyelonephritis

  • Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)
  • Female, structural urological abnormalities and diabetes are risk factors

 

Common organisms

  • Escherichia coliĀ is the most common cause
  • Klebsiella
  • Enterococcus
  • Pseudomonas

 

Presentation

  • 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)

 

Urine dipstick

  • Blood
  • Protein
  • Leukocyte esterase (produced by neutrophils)
  • Nitrite (gram negative organisms metabolise nitrates in the urine, which is normal to nitrites, which are not normally present)

 

Imaging

  • CT scan can help confirm the diagnosis
  • Ultrasound scans are useful in children to confirm diagnosis and investigate long term damage after recovery
  • Dimercaptosuccinic acid (DMSA) scans involves injecting radiolabelled DMSA, which builds up in the kidneys and when imaged using gamma cameras gives an indication of renal scarring. This is used in recurrent pyelonephritis to assess the damage.

 

Management

  • Blood and urinary cultures
  • Broad spectrum antibiotics (e.g. co-amoxiclav) until culture and sensitivities are avaliable
  • Admission if systemically unwell or complicated
  • IV rehydration
  • Analgesia
  • Antipyretics

 

Chronic pyelonephritis

  • Recurrent kidney infections
  • Leads to scarring of the renal parenchyma
  • Can result in chronic kidney disease
  • Can result in abscess and/or pus in or around the kidney
  • May be a role for prophylactic antibiotics
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