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)