RENAL INFECTIONS

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Clinical Features:

  • Rapid onset (hours to days)
  • fever, chills, nausea, vomiting, myalgia, malaise
  • costovertabral angle CVA tenderness or exquisite flank pain
  • LUTS (Urgency, frequency, dysuria)
  • may have symptoms of GN sepsis
  • atypical presentation in the elderly: confusion may be the only symptom
Investigations:
  • Urine dipsticks: +ve leucocytes and nitrates, possible hematuria
  • U-MCS:
    • Microscopy: >5WCC per HPF in unspun urine or > 10 WCC/HPF in spun urine
    • Gram stain: GN bacilli, GP cocci
    • u-CS - Culture and sensitivity:  >10^6 colony forming units (CFU)/ml in clean catch MSU or >10^2 CFU/ml in suprapubic aspirate or catheterised specimen
  • Bloods: 
    • CBC + differential: Increase WCC (leucocytosis), Increase neutrophils, left-shift
    • Blood cultures only positive in 20% of cases
  •  Consider investigation for pyelonephritis if:
    • fever, pain, leucocytosis not resoving with treatment in 72 hours
    • male patient
    • history of urinary tract abnormalities
    • CT for renal abcess, spiral CT for stones and cystoscopy
Treatment:
  • 14 day course of TMP/SMX or a third generation cephalosporin - 7 day course of ciprofloxacillin  if uncomplicated
  • can treat as an outpatient 

Acute Pyelonephritis

Water, Ion, and Urea Exchange in Production of Hypotonic Urine (ADH Absent)

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