Pyelonephritis

Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)

Aetiology

  • Generally caused by bacteria ascending from lower urinary tract or travelling in blood
  • E.coli most common cause, other causative organisms include Enterobacter, Proteus, Pseudomonas aeruginosa

Risk factors

  • Infection of the kidney is more common in females as the urethral orifice is closer to the anus and the route of spread for the bacteria is shorter
  • Other risk factors include urological abnormalities and diabetes

Clinical presentation

  • High fever and rigors
  • Loin to groin pain
  • Dysuria and urinary frequency
  • Haematuria
  • Other non-specific symptoms (e.g. vomiting)
  • Pain on bimanual palpation of the renal angle (over kidney)

Investigations

  • Urine dipstick - blood, protein, leukocyte esterase, nitrates
  • Imaging - CT can help confirm diagnosis
  • Blood and urinary cultures

Management

  • IV amoxicillin + gentamicin until culture and sensitivities are avaliable
  • Supportive management - rehydration, analgesia, antipyretics