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Pyelonephritis (Risk factors (history of urinary tract infection, diabetes…
Pyelonephritis
Risk factors
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foreign body in urinary tract (e.g renal calculi, catheter)
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investigations
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CT abdomen. will show altered parenchymal perfusion, altered excretion of contrast dye, perinephric fluid, non-renal disease
MRI. Looking for structural anomalies, renal inflammation or masses.
Symptoms
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dysuria, frequency or urgency
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Management
Antibiotics: cephalexin, co-amoxiclav, trimethoprim, ciprofloxacin
If catheter in situ, ensure it is positioned correctly. Consider removing
Reassess. if no improvement in 48 hours of starting antibiotics then consider sepsis or antibiotic resistance. Consider referral to urology.
Aetology
Mostly caused by gram negative bacteria. Escherichia coli causes approximately 60% to 80% of uncomplicated infections.Other gram-negative pathogens include Proteus mirabilis (responsible for about 15% of infections) as well as Klebsiella (approximately 20%), Enterobacter , and Pseudomonas species. Less commonly, gram-positive bacteria such as Enterococcus faecalis , Staphylococcus saprophyticus , and S aureus may be seen
Complicated pyelonephritis occurs in older patients, diabetic patient, immuno-compromised patients and patients with complex urological problems or renal calculi
Definition
Pyelonephritis is derived from the Greek "pyelo" (pelvis), "nephros" (kidney), and "-itis" (inflammation). It is severe infectious inflammatory disease within the kidney. it can be acute recurrent or chronic.
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