Conversation 5

Acute pyelonephritis in adults

"An otherwise healthy 35-year-old woman presents with urinary urgency, dysuria, fever, malaise, nausea, and flank pain.

On examination, the temperature is 38.6°C, the pulse 110 beats per minute, and the blood pressure 105/50 mm Hg; she has suprapubic and flank tenderness, without abdominal tenderness. The white-cell count is 16,500 per cubic millimeter, and the serum creatinine concentration 124 μmol per liter (most recent measurement before presentation, 71 μmol per liter). Urinalysis is positive for leukocyte esterase and nitrites."

We will talk about……….

  1. When to suspect acute pyelonephritis and how useful the concept of systemic inflammation + bladder inflammation is for this purpose
  2. The febrile-urinary tract infection syndrome and how acute pyelonephritis is one component of this syndrome
  3. The differential diagnosis of flank pain in a febrile patient
  4. Why leukocyte esterase and nitrites are considered useful markers of urinary infection
  5. What a urinary pH of more than 7 can tell us about the urinary infection
  6. Why E.coli is the commonest urinary pathogen
  7. Empirical treatment choices for urinary infections
  8. What to suspect when renal function shows a recent deterioration in acute pyelonephritis
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