questions 2

Pyelonephritis

Topic updated on 04/21/16 7:12pm

Introduction
  • pyeloAn acute infection of cortex
  • May progress to chronic pyelonephritis
    • most commonly seen in 
      • girls with vesiculouteral reflux (reflux type)
      • lower urinary tract obstructions (obstructive type)
  • Other complications include
    • perinpehric abcess, renal papillary necrosis, spesis
Presentation
  • Symptoms
    • nausea
    • vomiting
    • fever
    • flank pain
    • urinary frequency
    • dysuria
    • urgency
  • Physical exam
    • costovertebral angle (CVA) tenderness
Evaluation
  • Urinary sediment analysis 
    • clumps pf neutrophils (pyuria)
    • scattered RBC
    • bacteria with the presence of WBC casts 
  • Microscopic urine analysis 
    • > 5 leukocytes/hpf
    • a bacterial pathogen
  • Gold standard is clean catch urine culture with >100,000 bacteria/ml
  • CT
Treatment
  • Hospitilization
  • Pharmacologic
    • IV antibiotics
      • ciprofloxacin, ampicillin/gentamicin, piperacillin/tazobactam
  • In pregnant women
    • Ceftriaxone is first-line for mild-moderate disease
    • Increased risk for pre-term labor 


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