10.4: Acute Pyelonephritis
- Page ID
- 15629
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Acute pyelonephritis is an acute bacterial infection of the renal parenchyma and is the commonest disease of kidney.
Complications of Acute Pyelonephritis
- Septicaemia and septic shock
- Abscess
- intra-renal
- perinephric
- Chronic pyelonephritis
- healing with scarring
- Renal failure
- if bilateral chronic pyelonephritis
Clinical Presentation
- History
- fever and rigors
- loin or back pain
- nausea and vomiting in some patients
- LUT symptoms (frequency, dysuria) often absent
- Examination
- ill and pyrexial
- loin tenderness
- Urine
- Dipstick: WBCs ++ Nitrite test positive
- Microscopy: pus cells ++ organism +
- Culture: send specimen before starting antibiotics
- Blood Culture
- NO imaging (i.e. U/S) is needed in the acute phase UNLESS:
- diabetic
- immunocompromised
- history of stone disease
- no response to antibiotics within 72 hours
- NO imaging (i.e. U/S) is needed in the acute phase UNLESS:
Treatment
- General Measures
- admission to hospital if toxic, vomiting
- intravenous fluids if inadequate hydration
- blood culture if high temperature
- Antibiotics
- Goals of treatment
- eradicate infection
- prevent complications
- Ideal antibiotic
- bactericidal
- broad spectrum
- high penetration and concentration in urine and renal tissue
- Antibiotics most frequently used:
- Aminoglycosides
- Fluoroquinolones
- Cephalosporins
- Co-amoxiclav (Augmentin)
- Amoxycillin and CoTrimoxazole are not useful agents for empirical therapy because of high incidence of resistance to E coli
- antibiotics should be given for 7-14 days and whichever agent is used, cure rate = 90%
- Goals of treatment
- Urological Investigation (once acute infection has resolved)
- All women with recurrent UTIs
- Associated haematuria
- patients with recurrent acute pyelonephritis in the absence of urinary tract abnormality should have long-term continuous low dose antimicrobial prophylaxis (see below)
- patients with recurrent acute pyelonephritis in the absence of urinary tract abnormality should have long-term continuous low dose antimicrobial prophylaxis (see below)