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{{Pyelonephritis}}
{{Pyelonephritis}}
{{CMG}}; {{AE}} {{USAMA}}


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==Overview==
Pyelonephritis patients usually present in the emergency department with sudden development of [[pain]] radiating to the [[Flanks|flank]] in the presence of [[dysuria]] and [[fever]]. The differentiation of pyelonephritis from other causes of [[dysuria]] is based on severity of symptoms and the typical radiation of [[pain]]. A thorough history and examination is required to differentiate pyelonephritis from other causes of [[dysuria]] and [[flank pain]].


{{CMG}}
==History==
Patients with pyelonephritis can present with the history of following important findings:<ref name="pmid12020306">{{cite journal| author=Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S| title=Does this woman have an acute uncomplicated urinary tract infection? | journal=JAMA | year= 2002 | volume= 287 | issue= 20 | pages= 2701-10 | pmid=12020306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12020306  }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12402822 Review in: Evid Based Nurs. 2002 Oct;5(4):119] </ref>
*Sudden symptom onset
*[[Fever]]
*Recent [[urinary tract infection]]
*[[Diabetes mellitus|Diabetes]]
*[[Immunosuppression]]
*Known structural defect of the [[urinary tract]]
*[[Renal stones]]
*History of pyelonephritis
*[[Tumor]]
*[[Cyst]] or [[abscess]] in the [[urinary tract]]


==Overview==
==History==
==Symptoms==
==Symptoms==
Patients with pyelonephritis can report the following symptoms:<ref name="pmid12020306">{{cite journal| author=Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S| title=Does this woman have an acute uncomplicated urinary tract infection? | journal=JAMA | year= 2002 | volume= 287 | issue= 20 | pages= 2701-10 | pmid=12020306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12020306  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12402822 Review in: Evid Based Nurs. 2002 Oct;5(4):119] </ref><ref name="pmid18308077">{{cite journal| author=Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD| title=Xanthogranulomatous pyelonephritis: clinical experience with 41 cases. | journal=Urology | year= 2008 | volume= 71 | issue= 2 | pages= 178-80 | pmid=18308077 | doi=10.1016/j.urology.2007.09.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18308077  }} </ref><ref>{{Cite journal
| author = [[Leonie G. M. Giesen]], [[Grainne Cousins]], [[Borislav D. Dimitrov]], [[Floris A. van de Laar]] & [[Tom Fahey]]
| title = Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs
| journal = [[BMC family practice]]
| volume = 11
| pages = 78
| year = 2010
| month =
| doi = 10.1186/1471-2296-11-78
| pmid = 20969801
}}</ref><ref name="pmid18159059">{{cite journal| author=Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F et al.| title=Does this child have a urinary tract infection? | journal=JAMA | year= 2007 | volume= 298 | issue= 24 | pages= 2895-904 | pmid=18159059 | doi=10.1001/jama.298.24.2895 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159059  }} </ref>
===Symptoms requiring urgent management===
* [[Fever]]- usually high grade
* [[Dysuria]] (painful voiding of urine)
* [[Dysuria]] (painful voiding of urine)
* [[Abdominal pain]] (radiating to the back on the affected side)  
* [[Abdominal pain]] (radiating to the back on the affected side)
* [[Fever]]
* Rib or back pain
* [[Rigor (medicine)|Rigors]] (violent shivering while the temperature rises)
* [[Rigor (medicine)|Rigors]] (violent shivering while the temperature rises)
===Other Common Symptoms===
* [[Frequency]]
* [[Urgency]]
* [[Hematuria]]
* Constitutional symptoms ([[fatigue]], [[decreased appetite]])
* [[Nausea and vomiting]]
* [[Delirium]]
* [[Headache]]
* [[Headache]]
* [[Vomiting]]
 
* [[Delirium]]
===Symptoms in infants===
* Children younger than 2 years old may only have a high fever without symptoms related to the urinary tract. Older people may not have any symptoms related to the urinary tract either; instead, they may exhibit confusion, disordered speech, or hallucinations
Pyelonephritis in infants and children less than 2 years may present as:
*[[Fever]]
*Fussiness
*Decreased [[appetite]]
*Signs of [[urinary tract infection]] may be missing
 
===Symptoms in Elderly===
In elderly, pyelonephritis can present as:
*[[Confusion]]
*Disoriented speech
*[[Hallucinations]]
 
===Urinary symptoms===
Urinary symptoms of pyelonephritis can include:
*[[Frequency]] (frequent [[urination]])
*[[Urgency]] (urgent need to [[Urination|urinate]]) 
*[[Nocturia]] (need to [[Urination|urinate]] at night)
*[[Dysuria]] (painful [[urination]])
*Low volume voids
*[[Hematuria]] (blood in the urine)
*Foul or strong [[urine]] odor
*Abnormal [[urine]] color (cloudy)
 
===Gastrointestinal===
*[[Abdominal pain]] or pain radiating to the flank
*[[Nausea]] and [[vomiting]]
===Musculoskeletal===
*Pressure in the lower pelvis or back
*[[Flank pain]] or [[back pain]]
 
===Neurological===
In elderly, pyelonephritis may present as:
*[[Disorientation]]
*[[Delirium]]
 
===Cardiovascular System===
*[[Tachycardia]]
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Needs content]]
[[Category:Medicine]]
[[Category:Infectious disease]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Inflammations]]
[[Category:Urology]]
[[Category:Disease]]
[[Category:Up-To-Date]]
 
[[Category:Emergency medicine]]
{{WH}}
{{WS}}

Latest revision as of 23:54, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Pyelonephritis patients usually present in the emergency department with sudden development of pain radiating to the flank in the presence of dysuria and fever. The differentiation of pyelonephritis from other causes of dysuria is based on severity of symptoms and the typical radiation of pain. A thorough history and examination is required to differentiate pyelonephritis from other causes of dysuria and flank pain.

History

Patients with pyelonephritis can present with the history of following important findings:[1]

Symptoms

Patients with pyelonephritis can report the following symptoms:[1][2][3][4]

Symptoms requiring urgent management

  • Fever- usually high grade
  • Dysuria (painful voiding of urine)
  • Abdominal pain (radiating to the back on the affected side)
  • Rib or back pain
  • Rigors (violent shivering while the temperature rises)

Other Common Symptoms

Symptoms in infants

Pyelonephritis in infants and children less than 2 years may present as:

Symptoms in Elderly

In elderly, pyelonephritis can present as:

Urinary symptoms

Urinary symptoms of pyelonephritis can include:

Gastrointestinal

Musculoskeletal

Neurological

In elderly, pyelonephritis may present as:

Cardiovascular System

References

  1. ↑ 1.0 1.1 Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–10. PMID 12020306. Review in: Evid Based Nurs. 2002 Oct;5(4):119
  2. ↑ Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD (2008). "Xanthogranulomatous pyelonephritis: clinical experience with 41 cases". Urology. 71 (2): 178–80. doi:10.1016/j.urology.2007.09.026. PMID 18308077.
  3. ↑ Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). "Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs". BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
  4. ↑ Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F; et al. (2007). "Does this child have a urinary tract infection?". JAMA. 298 (24): 2895–904. doi:10.1001/jama.298.24.2895. PMID 18159059.

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