Acute Pyelonephritis
Definition
Upper UTI; often starts in LUT as UTI → spread to kidney; or septicemia → kidney. Potentially organ/life threatening infection that causes scarring of kidney. An episode of pyelonephritis may lead to significant renal damage, renal failure, abscess formation, sepsis, septic shock, multi-organ system failure.
Epidemiology
- F>M
- 20-30% of pregnant women with untreated asymptomatic bacteriuria
- 25% of children with UTI & no signs/sx of pyelonephritis have upper UTI
Clinical features
Symptoms
- Acute onset (hours-day)
- Can be non-specific sx. Sx may be different in children & elderly.
Triad in adults (medscape)
- Abdo pain – costovertebral pain, usually unilateral (b/l possible)
- Nausea & vomiting
- Fever/rigors
Symptoms in non-elderly adults:
- Lower UTI sx (e.g. dysuria, frequency, urgency, gross haematuria, suprapubic pain)
- Upper UTI sx (e.g. flank pain, back pain)
- ± systemic sx (e.g. fevers/chills, abdo pain, nausea, costovertebral angle tenderness)
- ± Gross haematuria (haemorrhagic cystitis) - 30-40% females, unusual in males
In children (UTI): failure to thrive, feeding difficulty, fever, vomiting
In elderly (UTI): fever, mental status changes (common), decompensation in other organ systems
Signs
- ↑ temperature
- Renal angle tenderness ± suprapubic tenderness w/o rebound
- In women, absence of tenderness of cervix/uterus/adnexa
Investigations
- Dipstick urinalysis: +blood (gross/micro), +protein, +nitrates
- Urine MSU for M/C/S: bacteria, leucocytes and RBC on microscopy; and for culture
- FBC, UEC, CMP, LFT, blood cultures if shocked
Management
- If complication pyelonephritis – refer to nephrologist/urologist/ID
- If pyelonephritis – IV fluids + IV antibiotics until organism identified
- If sx mild and consistent with predominantly cystitis – PO antibiotics
- Drink more fluids (avoid dehydration) – light-coloured urine/almost like water
Source
On call (Marshall & Ruedy) 2013
Medscape (acute pyelonephritis) 2014
Upper UTI; often starts in LUT as UTI → spread to kidney; or septicemia → kidney. Potentially organ/life threatening infection that causes scarring of kidney. An episode of pyelonephritis may lead to significant renal damage, renal failure, abscess formation, sepsis, septic shock, multi-organ system failure.
Epidemiology
- F>M
- 20-30% of pregnant women with untreated asymptomatic bacteriuria
- 25% of children with UTI & no signs/sx of pyelonephritis have upper UTI
Clinical features
Symptoms
- Acute onset (hours-day)
- Can be non-specific sx. Sx may be different in children & elderly.
Triad in adults (medscape)
- Abdo pain – costovertebral pain, usually unilateral (b/l possible)
- Nausea & vomiting
- Fever/rigors
Symptoms in non-elderly adults:
- Lower UTI sx (e.g. dysuria, frequency, urgency, gross haematuria, suprapubic pain)
- Upper UTI sx (e.g. flank pain, back pain)
- ± systemic sx (e.g. fevers/chills, abdo pain, nausea, costovertebral angle tenderness)
- ± Gross haematuria (haemorrhagic cystitis) - 30-40% females, unusual in males
In children (UTI): failure to thrive, feeding difficulty, fever, vomiting
In elderly (UTI): fever, mental status changes (common), decompensation in other organ systems
Signs
- ↑ temperature
- Renal angle tenderness ± suprapubic tenderness w/o rebound
- In women, absence of tenderness of cervix/uterus/adnexa
Investigations
- Dipstick urinalysis: +blood (gross/micro), +protein, +nitrates
- Urine MSU for M/C/S: bacteria, leucocytes and RBC on microscopy; and for culture
- FBC, UEC, CMP, LFT, blood cultures if shocked
Management
- If complication pyelonephritis – refer to nephrologist/urologist/ID
- If pyelonephritis – IV fluids + IV antibiotics until organism identified
- If sx mild and consistent with predominantly cystitis – PO antibiotics
- Drink more fluids (avoid dehydration) – light-coloured urine/almost like water
Source
On call (Marshall & Ruedy) 2013
Medscape (acute pyelonephritis) 2014