Acute Pyelonephritis
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Acute pyelonephritis is a sudden and severe upper urinary tract infection involving one or both kidneys.
Risk Factors
- Bladder outlet obstruction
- Malformations of the urinary tract
- Pregnancy
- HIV and other immunocompromised states
- Old age
- Diabetes
- Intravenous drug abuse
Causes
- Bacteria such as E. coli (most frequent cause); Proteus, Klebsiella, Enterobacter, and Pseudomonas spp.
Signs and symptoms
- Fever (may be very high grade) with tachycardia
- Nausea and vomiting
- Severe pain in the affected loin
- Urine may be cloudy and offensive
- Dysuria and urgency
- Blood pressure maybe low
- Tenderness in the affected loin
Differential diagnosis
- Appendicitis
- Diverticulitis
- Endometriosis
- Pelvic inflammatory disease
- Kidney stones
Investigations
- Full blood count
- Blood cultures
- E/U/Cr
- Urine microscopy, culture, and sensitivity testing
- Ultrasound scan of the kidneys, ureters, and bladder
Treatment objectives
- Treat according to culture and sensitivity test results. Empirical treatment can be commenced while waiting for the results
Pharmacological treatment
Amoxicillin IV
500 mg every 8 hours for 14 days
OR
Amoxicillin/clavulanate
Adult:
1.2 g IV every 8 hours until the patient’s condition improves and fever subsides, then commence oral treatment.
500/125 mg -orally every 8 hours
Child:
30 mg/kg IV every 8 hours
250 mg orally every 8 hours
OR
Ciprofloxacin I.V
Adult: 200mg every 12 hours
THEN commence oral treatment
Oral 500mg every 12 hours
OR
Ceftriaxone IV
Adult:
1-2 g IV once daily
Child:
80-100 mg/kg IV once daily
When fever subsides, continue with oral antibiotics
Note
- Avoid Gentamicin until the renal status is established.
- Patients may require IV fluids if vomiting
Prevention
- Encourage liberal oral fluid intake
- Avoid postponing micturition
- Advise females to wipe from front to back
Referral
- Refer if the patient is not responding to treatment or if she is pregnant.