Clinical Case Database / Category: Case Based Discussion

Acute pyelonephritis

Publication details

Benjamin Ayres BSC (Hons), MBChB (Hons), MRCS (Eng), Rajendra Persad ChM, FRCS (Urol), FEBU
Foundation Years Journal, volume 1, issue 4, p.167 (123Doc Education, London, July 2007)

Abstract

A sexually active 28-year-old woman presents to the surgical admissions unit with a 2 day history of left loin pain, fever, nausea and vomiting. Preceding this she describes urinary frequency, urgency and dysuria. She is otherwise fit and well.

On clinical examination she looks flshed and sweaty and her temperature is 38.5°C. She is tachycardic (105bpm) but normotensive (110/75 mmHg). She is tender in the left renal angle. Otherwise her abdomen is soft with no palpable organomegaly or masses.

Dipstick urinalysis shows blood, protein and nitrites. Urine pregnancy test (βHCG) is negative.

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Authors

Benjamin Ayres BSC (Hons), MBChB (Hons), MRCS (Eng)

Urology research clinical fellow
Department of Urology
Bristol Royal Infimary and Bristol Urological Institute
Bristol, UK

Rajendra Persad ChM, FRCS (Urol), FEBU

Consultant Urological Surgeon
Department of Urology
Bristol Royal Infimary and Bristol Urological Institute
Bristol, UK

References

1.  Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med 2005; 142: 20-7.

2.  Reynard J, Brewster S, Biers S. Oxford Handbook of Urology. Oxford: Oxford University Press, 2006.

3.  Piccoli GB, Consiglio V, Colla L, Mesiano P, Magnano A, Burdese M, Marcuccio C, Mezza E, Veglio V, Piccoli G. Antibiotic treatment for acute ‘uncomplicated’ or ‘primary’ pyelonephritis: a systematic, ‘semantic revision’. Int J Antimicrob Agents 2006; 28 Suppl 1: S49-63.

4.  Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA, Roehrborn CG, Kryger JV, Nakada SY. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 1998; 160: 1260-4.

5.  Lynch MF, Anson KM, Patel U. Current opinion amongst radiologists and urologists in the UK on percutaneous nephrostomy and ureteric stent insertion for acute renal unobstruction: results of a postal survey. BJU Int 2006; 98: 1143-4.

6.  Lynch MF, Anson KM, Patel U. The management of acute urinary obstruction. Presentation at The British Association of Urological Surgeons Section of Endourology and The British Society of Urogenital Radiology Joint Meeting, Edinburgh, 17-18th May 2007.

7.  Chen MT, Huang CN, Chou YH, Huang CH, Chiang CP, Liu GC. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. 1997; 157.

8.  Soo Park B, Lee SJ, Wha Kim Y, Sik Huh J, Il Kim J, Chang SG. Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis. Scand J Urol Nephrol. 2006; 40: 332-8.

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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