Pyelonephritis Flashcards Preview

Y3M - Urology > Pyelonephritis > Flashcards

Flashcards in Pyelonephritis Deck (26)
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1

Definition

Inflammation of the kidney parenchyma and the renal pelvis

This is usually due to bacterial infection

2

Epidemiology

Highest incidence in women aged 15-29

3

Classifications of pyelonephritis

Uncomplicated = structurally or functionally normal in a non-immunocompromised host

Complicated = opposite

4

Pathophysiology

Neutrophils infiltrate the tubules and the interstitium

This leads to suppurative inflammation.

You can often see small renal cortical abscesses and streaks of pus in the renal medulla.

5

How does bacteria get to the kidneys?

Bacteria can reach the kidney either by ascending from the lower urinary tract, or directly by blood stream like septicaemia or infective endocarditis.

It can also rarely be via lymphatics like in retroperitoneal abscess

6

Common organisms

E. coli (80%)

Klebsiella

Proteus

Enterococcus faecalis

S. aureus

S. saprophyticus

Pseudomonas

7

Risk factors

Obstructed urinary tract and BPH

Spinal cord injury leading to neuropathic bladder

Female gender

Indwelling catheter or ureteric stents and nephrostomy tubes in-situ

Structural renal abnormalities like vesicoureteric reflux.

DM, corticosteroid use, HIV infection

Renal calculi, sexual intercourse and menopause

8

Clinical features

Classic triad = fever, unilateral loin pain and N+V

This typically develops over the course of 24-48h

Patients may also have symptoms of co-existing lower UTI with freq, urgency and dysuria

There may also be visible or non-visible haematuria

9

Examination findings

Often look unwell

Pyrexia

Features of sepsis

Unilateral or bilateral costovertbral angle tenderness and or suprapubic tenderness

Also assess the patient's fluid status and measure any post-void residual volumes.

10

Dx

Ruptured AAA

Renal calculi

Acute cholecystitis

Ectopic pregnancy

PID

Lower lobe pneumonia

Diverticulitis

11

Investigations

Urinalysis for nitrites and leucocytes

Urinary beta-hCG for all women of child-bearing age.

Urine culture

Routine bloods with FBC and CRP

12

Imaging

All cases should have renal USS to see if there is any obstruction.

If there is obstruction suspected (such as dilation) -> non-contrast CT imaging (CT-KUB) should be done.

13

Management

A-E assessment and appropriate resus.

Start empirical abx based on local protocols (in leicester co-amoxiclav orally for 14 days or ciprofloxacin if pen allergic)
If there is N+V give IV instead.
This should be started as culture are sent off.

Consider admission

14

Management of severe or non-responding cases

Catheterisation and high-dependency unit monitoring.

Consider early CT imaging in such cases to check for any obstruction and complication of pyelonephritis like pyonephrosis or perinephric abscess.

15

Complications

Severe sepsis

Multiorgan failure

Renal scarring -> CKD

Pyonephrosis

Preterm labour

16

What is chronic pyelonephritis?

Repeated infections can lead to chronic Py.

This in its turn leads to fibrosis and will ultimately destroy the kidney.

17

When is it more common to get chronic Py?

In obstructed systems like strictures in UTI, VUR or other anatomical abnormalities which leads to urinary reflux.

18

Diagnosis of chronic Py.

Usually radiologically where you can see a small scarred and shrunken kidney.

19

In what group of people is chronic Py more common?

Structural abnormalities of kidneys

More common in children and they often present asymptomatically or with first presentation being CKD.

20

Management of chronic Py.

Reverse any underlying cause

Optimise renal function

Consider prophylactic abx

21

Explain Emphysematous Pyelonephritis

A rare and severe form of acute pyelonephritis.

It is caused by gas-forming bacteria and is associated with a high mortality rate.

22

Clinical presentation of Emphysematous Pyelonephritis

Similar to acute pyelonephritis

Fail to respond to empirical IV abx

CT imaging will show evidence of gas within and around the kidney.

23

When is Emphysematous Pyelonephritis more common?

Diabetic patients

High glucose allows CO2 production from fermentation by enterobacteria

24

Management of mild Emphysematous Pyelonephritis

Broad-spectrum abx

25

Management of severe Emphysematous Pyelonephritis

Nephrostomy insertion or percutaneous drainage of any collections present

Sometimes nephrectomy will be required.

26