GROUP MEMBERS
POKHREL,BHARAT
PYELONEPHRITIS
l Bacterial infection of the kidney (RENAL PELVIS)
l Difference from:l UTI→ Involves Urethral Cystitis →Involves Bladderl Female>Malel Attributed to ascending bacteria along the path of the URETER, E.coli (80%)
Predisposing Factors
l Mnemonics: SCARRIN' UPl S- SEX (Female <40, Male >40)l C- CATHETHERIZATIONl A- AGE (Infant and Elderly)l R- RENAL LESIONSl R- REFILUX (VESICOUTERAL)l I- IMMUNODEFICIENTl N- NIDDM, IDDMl U- URINARY OBSTRUCTIONl P- PREGNANCY
Signs and Symptoms
l Fever and flank painl In very young and elderly patientsl Irritability, poor appetite, or altered mental status.l Dysurial Nausea and vomiting (Non-specific)l CVA(Costovertebral angle) Tenderness
CVA TENDERNESS
PATHOPHYSIOLOGY
TYPES
ACUTE PYELONEPHRITIS CHRONIC PYELONEPHRITIS
l Characterized by fever, flank pain,dysuria.
l Potential organ and life threatening infection that often leads to RENAL SCARRING.
l DIAGNOSIS:l Outpatient setting→ History
and PE with urinalysis.
l Characterized by Renal Inflammation and fibrosis or persistent renal infection, vesicoureteral reflux or other causes of urinary tract obstruction.
l Associated with renal scarring that may lead to ESRD
l DIAGNOSISl Imaging studies like
ultrasound and CT scans
Can results to
l Renal scarring that is accelerated in the setting of urinary obstruction
l Abscess that can be located within renal parenchyma (RENAL ABSCESS) or between the capsule and Gerota's fascia (PERINEPHRITIC ABSCESS)
l Emphysematous pyelonephritis which can be a life threatening condition.
DIAGNOSIS
l Urinalysis → Examines the appearance, concentration and content of urine.
l Urine culture → To isolate the bacteria in the urine
l Any patient not responding to Antibiotic therapy after 72 hours should
l Undergo CT imaging to rule out an ABSCESS OR OBSTRUCTION
TREATMENT
l INPATIENT with fever, sepsis, high WBC count on urine → Give IV Antibiotics
l OUTPATIENT → Without too many risk factorsl Oral Antibiotics l Most commonly Fluroquiniolones eg. Ciprofloxacin, Levufloxacin
l Aminoglycosides (Gentamycin)l Bactrim (Trimethoprim-sulfamethaxazole)
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