Pyelonephritis

Etiology

  • Typically GNRs (e coli in particular) from an ascending urinary tract infection
  • Can be other GNRs (including resistant organisms), enterococcus, other
  • Hematogenous spread (e.g. from Staph bacteremia) much less common

Risk Factors

  • Untreated lower urinary tract infection (ascends)
  • Impaired drainage of kidney from: obstructing stone, ureteral stricture/fibrosis, bladder outlet obstruction, other
  • Young women (15-30); Older adults (> 60)
  • Chronically infected stone or foreign body in urinary tract
  • Immuno-compromised

Symptoms

  • Fever
  • Chills
  • Dysuria
  • Acute low back/flank pain
  • Sometimes perceived as radiating towards LUQ or RUQ
  • Urinary frequency

Physical Exam Findings

  • F
  • +CVAT
  • Pain on flank palpation
  • Can be quite ill, w/sepsis physiology (i.e. tachycardia, hypotension, confusion, hypo-perfusion)