Pyelonephritis: Difference between revisions
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*UTI = significant bacteriuria in presence of symptoms | *UTI = significant bacteriuria in presence of symptoms | ||
**Described by location: urethritis, cystitis, or pyelonephritis | **Described by location: urethritis, cystitis, or pyelonephritis | ||
{{UTI types}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 13:10, 22 February 2015
Background
Definitions
- UTI = significant bacteriuria in presence of symptoms
- Described by location: urethritis, cystitis, or pyelonephritis
Genitourinary infection
"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.
- Renal/perirenal
- Ureteral
- Infected urolithiasis
- Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
- Urethra/periurethra
Diagnosis
Clinical Features
- Pyelo = Cystitis sx AND fever/chills/nausea/vomiting
- CVAT alone may be referred pain from cystitis
- CVAT is only physical examination finding that increases likelihood of a UTI
Labs
- UA with clumps and/or high WBCs
- Nitrite
- Very high specificity (>90%) in confirming diagnosis of UTI
- Low sensitivity (enterococcus, pseudomonas, acinetobacter are not detected)
- Nitrite
- Urine culture
- Blood cultures are NOT indicated (organisms in blood culture matched those in urine culture 97% of time)
Imaging
- Consider if any of the following:
- History of Renal Stone
- Poor response to antibiotics
- Male
- Elderly
- Diabetic
- Severely ill
Differential Diagnosis
Major
- Acute cystitis
- Infected kidney stone
Flank Pain
- Vascular
- Abdominal aortic aneurysm
- Renal artery embolism
- Renal vein thrombosis
- Aortic dissection
- Mesenteric ischemia
- Renal
- Pyelonephritis
- Perinephric abscess
- Perinephric hematoma
- Papillary necrosis
- Renal cell carcinoma
- Obstructive uropathy
- May or may not be due to nephrolithiasis
- Renal infarction
- Renal hemorrhage
- Ureter
- Nephrolithiasis
- Blood clot
- Stricture
- Tumor (primary or metastatic)
- Bladder
- Tumor
- Varicose vein
- Cystitis
- GI
- Biliary colic
- Pancreatitis
- Perforated peptic ulcer
- Appendicitis (appendix may be pushed to RUQ in pregnancy)
- Inguinal Hernia
- Diverticulitis
- Cancer
- Bowel obstruction
- Gynecologic
- Ectopic Pregnancy
- PID/TOA
- Ovarian cyst
- Ovarian torsion
- Endometriosis
- Mittelschmerz or benign ovulatory pain
- GU
- Other
- Shingles
- Lower lobe pneumonia
- Retroperitoneal hematoma, abscess, or tumor
- Epidural abscess
- Epidural hematoma
- Rib contusion/fracture
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Management
Disposition
- Discharge
- Consider if young, otherwise healthy, tolerating PO
- Admission
- Consider if elderly, Renal Calculi, obstruction, recent hospitalization/instrumentation, DM
Disposition
Complications
- Acute bacterial nephritis
- CT shows ill-defined focal areas of decreased density
- Renal/Perinephric Abscesses
- Sign/symptoms similar to pyelo (fever, CVAT, dysuria)
- Occurs in setting of ascending infection w/ obstructed pyelo
- Associated w/ DM and Renal Stones
- Also occurs due to bacteremia w/ hematogenous seeding (Staph)
- Emphysematous pyelonephritis