التهاب الحويضة والكلية

Definition

Acute pyelonephritis is bacterial infection of the kidney, most often by E. coli.

Risk factors

Female sex, pregnancy, diabetes, obstruction (stone or prostate), catheters and reflux in children.

Symptoms

• Fever and rigors
• Flank pain and costovertebral angle tenderness
• Nausea and vomiting
• Sometimes dysuria and frequency

Diagnosis

Urinalysis and culture before antibiotics, bloods, and imaging if not improving or obstruction is suspected.

Treatment

• Oral antibiotics for mild cases; IV for severe, pregnant or vomiting clients
• Fluids, analgesia and antipyretics
• Urgent drainage if the kidney is obstructed and infected

Complications

Renal abscess, sepsis and scarring, especially in children.

Exam point

An obstructed kidney with fever and hypotension is an emergency needing drainage, not antibiotics alone.