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Urology YR3 > Pyelonephritis > Flashcards

Pyelonephritis Flashcards

1
Q

What is pyelonephritis?

A
  • Inflammation of kidney parenchyma and renal pelvis
  • Typically due to bacterial infection
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2
Q

Typical age for pyelonephritis

A

Female 15-29

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3
Q

Complicated vs uncomplicated pyelonephritis

A

Uncomplicated when:
* Structurally or functionally normal urinary tract
* Non-immunocompromised

Complicated is opposite, UTI in males complicated by definition as will be associated with abnormal tracts

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4
Q

Pathophys of pyelonephritis

A
  • Bacterial infection of renal pelvis and parenchyma
  • Either by ascending from lower urinary tract or directly from blood stream (septicaemia or infective endocarditis)
  • Rare - spread from lymphatics in retroperitoneal abscess scenario
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5
Q

What happens when infection occurs at renal pelvis?

A
  • Neutrophils infiltrate tubules and interstitium and cause suppurative inflammation
  • Small renal cortical abscess and streaks of pus in medulla
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6
Q

Most common organism pyelonephritis

A
  • Escherichia coli
  • Others - Klebsiella, proteus
  • Catheter - enterococcus faecalis, staphylococcus aureus, pseudomonas
  • Staphylococcus saprophyticus is commensal and can cause
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7
Q

RF of pyelonephritis

A

Reduced antegrade flow of urine:
* obstructed tract eg BPH
* spinal cord injury –> neuropathic bladder

Factors promoting retrograde ascent of bacteria:
* female (short urethra)
* indwelling catheter
* Structural renal abnormalities eg vesico-ureteric reflux

Factors predisposing to infection:
* Diabetes
* Corticosteroid use
* HIV

Factors promiting bacterial colonisation:
* Renal calculi
* Sexual intercourse
* Oestrogen depletion (menopause)

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8
Q

Triad of pyelonephritis

A
  • Fever
  • Unilateral loin pain (or rarely bilateral)
  • Nausea + vomitting

Typically develops over 24-48hrs

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9
Q

Other symptoms of pyelonephritis

A

Co-existing lower urinary tract infection:
* Frequency
* Urgency
* Dysuria
* Visible/non-visible haematuria

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10
Q

Examination findings pyelonephritis

A
  • Pyrexial
  • Features of sepsis
  • Bilateral costovertebral angle tenderness +/- suprapubic tenderness
  • Assess fluid status and measure post void residual volumes
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11
Q

Differentials for back pain and tachycardia

A
  • AAA rupture
  • Renal calculi
  • Ectopic pregnancy etc
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12
Q

Investigations for pyelonephritis - bedside and bloods

A
  • Urinalysis - nitrites and leukocytes
  • Urinary beta-hCG if fertile age
  • Urine MC&S
  • Bloods - FBC, CRP, U&E - infection and renal function
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13
Q

Imaging for pyelonephritis

A
  • Renal US scan - look for obstruction evidence - emergency if infected, obstructed system
  • If obstruction suspected - non-contrast CT KUB
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14
Q

Management of pyelonephritis

A
  • A-E approach
  • Antibiotics based on guidelines (after urine culture specimen)
  • IV fluids
  • Analgesia
  • Antiemetics
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15
Q

When to consider hospital admission for pyelonephritis?

A

Not all patients need to be hospitalised, most can be managed in community except:
* Clinically unstable
* Significant dehydration
* Co-morbids eg diabetes mellitus, renal transplant graft
* Immunocompromised

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16
Q

How to manage severe or non-responding cases to initial management?

A
  • Cathterisation
  • High dependency unit input
  • Consider early CT imaging to check for complications eg obstruction, perinephric abscess, pyonephrosis
17
Q

Males without a clear underlying cause or RF for pyelonephritis?

A
  • Investigate and consider further imaging either US or CT KUB and flexible cystoscopy to rule out underlying causes
18
Q

Complications pyelonephritis

A
  • Severe sepsis
  • Multi organ failure
  • Renal scarring –> CKD
  • Pyonephrosis
19
Q

What is chronic pyelonephritis?

A
  • Repeated infection can lead to this
  • Repetitive inflammatory events than leads to fibrosis and destruction of kidney
  • More common in obstructed systems –> urinary reflux
  • Diagnosis made when small, scarred, shrunken kidney is seen on imaging
20
Q

Chronic pyelonephritis in children and management of all cases

A
  • More common in children
  • Can present asymptomatic or with first presentation as CKD
  • Management of all is to reverse underlying cause, optimise renal function and consider prophylactic abx
21
Q

What is emphysematous pyelonephritis?

A
  • Rare and severe form of acute pyelonephritis
  • Caused by gas forming bacteria
  • High mortality rate
22
Q

How does emphysematous pyelonephritis differ from usual in presentation?

A
  • Fail to respond to emperical IV abx
  • CT imaging show evidence of gas within and around kidney
  • Most common in diabetic patients as high glucose allows CO2 production from fermentation by enterobacteria
23
Q

Treatment emphysematous pyelonephritis?

A
  • Broad spectrum abx
  • Severe cases –> nephrostomy insertion or percutaneous drainage of any collections
  • Some cases nephrectomy may be required
24
Q
A

Urology YR3 (27 decks)

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