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Acute pyelonephritis is an upper urinary tract infection that typically occurs when bacteria, most commonly E. Coli, make their way from the lower urinary tract, such as the urethra and bladder, up the ureters and kidneys. Now, based on the patient’s clinical features, acute pyelonephritis can be classified as complicated or uncomplicated. Complicated pyelonephritis occurs when the patient has functional or structural abnormalities, like neurogenic bladder, or like urinary obstruction due to nephrolithiasis. Complicated pyelonephritis also occurs when the patient has specific host risk factors, such as immunosuppression, advanced age, or male sex. On the other hand, a patient has uncomplicated pyelonephritis when there are no urinary tract abnormalities and no host specific risk factors.
Now, if you suspect acute pyelonephritis, you should first perform an ABCDE assessment to determine if they are stable or unstable. Unstable individuals might present with signs of sepsis or shock, like tachycardia and hypotension, so don’t forget to stabilize their airway, breathing, and circulation. Additionally, obtain IV access, administer supplemental oxygen, and put your patient on continuous vital sign monitoring.
Ok, let’s return to the ABCDE assessment. If the patient is stable or once you stabilize them, obtain a focused history and physical examination. Your patient will likely report fever, chills, malaise, flank pain, nausea and vomiting, and sometimes dysuria. On the other hand, physical exam may reveal elevated body temperature, hypotension, tachycardia, costovertebral angle and flank tenderness, and abdominal tenderness to palpation.
At this point you should suspect pyelonephritis, so your next step is to order labs, including CBC and CMP, as well as urinalysis and urine cultures.
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