Pyelonephritis Flashcards
(17 cards)
Why are pregnant women at increased risk of pyelonephritis?
Progesterone slows ureteral peristalsis
This slowing can lead to urinary stasis, increasing the risk of infection.
What is the effect of the uterus on the ureters during the third trimester of pregnancy?
- 1) Progesterone slows ureteral peristalsis, thereby risk of urinary stasis and backup to kidney.
- 2) Compression of ureter(s) by uterus, notably in 3rd trimester, risk of stasis.
How is asymptomatic bacteriuria managed in pregnant women?
It is always treated
In non-pregnant women, asymptomatic bacteriuria may not require treatment.
What is a classic drug used to treat asymptomatic bacteriuria and UTIs in pregnancy?
Nitrofurantoin
Nitrofurantoin is considered safe for use in pregnant women.
Initial management of acute pyelo in pregnancy
IV Ceftriaxone
Following symptomatic improvement, management of acute pyelo in pregnancy
Oral penicillins or cephalosporins (cephalexin)
Nitrofurantoin is a classic drug used in pregnancy to treat
asymptomatic bacteriuria, standard UTIs, and cystitis in pregnancy
What are the common symptoms associated with pyelonephritis?
Fever and costovertebral angle (CVA) tenderness
Costovertebral angle tenderness is pain with percussion of the flank.
What type of casts can be seen in pyelonephritis?
Granular casts
Granular casts can also be seen in dehydration and ATN (don’t confuse with ATN)
What are the major risk factors for pyelonephritis?
Vesicoureteral reflux (especially in pregnancy) and posterior urethral valves
What is the most common organism causing pyelonephritis?
E. coli
Other organisms include Klebsiella, Serratia, and Proteus, which can cause struvite stones.
What histological finding is associated with pyelonephritis?
neutrophilic infiltration = Lots of blue/purple (basophilic) cells infiltrating kidney
This indicates acute inflammation, which is a key concept in the USMLE.
True or False: Bacteria are usually abundant in the urine during acute pyelonephritis.
False
Bacteria can be few in the urine during acute pyelonephritis; they are more copious in infections further down the urinary tract.
What is the first-line treatment for pyelonephritis?
Ciprofloxacin or ceftriaxone
2CK form has ceftriaxone as an answer in pyelo Q where cipro isn’t listed. But cipro is classic Tx. It’s to my observation that ceftriaxone is HY drug on 2CK for community-acquired “general sepsis” or “general complicated/severe infections” i.e., it is hard-hitting and covers wide array of community organisms.
What should be done if there is persistent fever despite antibiotic treatment for pyelonephritis?
Perform an ultrasound to look for perinephric abscess
Persistent fever can indicate complications that need further investigation.
What complication can occur in an older male patient treated with ciprofloxacin for pyelonephritis?
Tendonopathy
This can occur due to the use of ciprofloxacin, particularly in older patients.
The blue cells are neutrophils infiltrating the kidney in acute pyelo. The USMLE will show images basically identical to this for a variety of infections, e.g., prostatitis, where the bigger picture concept is, “Oh that’s acute inflammation. Those purple cells are neutrophils.” That’s what USMLE wants you to know. For instance, a nearly
identical image of prostate histo in old dude with prostate pain and fever then you’d know immediately it’s prostatitis.
