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==Overview==
Pyelonephritis is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade [[fever]], [[dysuria]] and [[Flank pain|pain radiating to the flank]]. A sonopalpation test, which is an ultrasound guided palpation, is usually positive and helpful in detecting the exact anatomical structure and position as the cause of tenderness.
 
==Physical Examination==
The following features can be found during a physical examination of a patient with pyelonephritis. The patient must be in supine position to facilitate a proper examination.<ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614 }} </ref><ref name="pmid16716786">{{cite journal| author=Chang SL, Shortliffe LD| title=Pediatric urinary tract infections. | journal=Pediatr Clin North Am | year= 2006 | volume= 53 | issue= 3 | pages= 379-400, vi | pmid=16716786 | doi=10.1016/j.pcl.2006.02.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16716786  }} </ref><ref name="pmid18787367">{{cite journal| author=Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW et al.| title=Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. | journal=Korean J Intern Med | year= 2008 | volume= 23 | issue= 3 | pages= 140-8 | pmid=18787367 | doi=10.3904/kjim.2008.23.3.140 | pmc=2686968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18787367 }} </ref>
 
===Appearance of the Patient ===
*Patients with pyelonephritis are usually in distress.
*Patient may have hands on abdomen or back at the area of [[tenderness]].
 
===Vital Signs===
The following variations in vital signs can be seen in pyelonephritis:  
 
*[[Fever]] may be present
*[[High blood pressure|High Blood pressure]] as an early finding of kidney involvement
*[[Hypotension]]


{{CMG}}
=== Skin ===
* Skin examination of patients with pyelonephritis is usually normal.


==Overview==
=== HEENT ===
* HEENT examination of patients with pyelonephritis is usually normal.
 
=== Neck ===
* Neck examination of patients with pyelonephritis is usually normal.


==Physical Examination==
=== Lungs ===
* Pulmonary examination of patients with pyelonephritis is usually normal.


===Vitals===
=== Heart ===
====Temperature====
* [[Tachycardia]]
* A [[fever]] is often present


===Abdomen===
===Abdomen===
* Tenderness of the bladder area and the side of the involved kidney ("renal angle tenderness").
* [[Costovertebral angle]] tenderness
* Positive sonopalpation test of the kidney<ref name="pmid28050884">{{cite journal| author=Faust JS, Tsung JW| title=Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis. | journal=Crit Ultrasound J | year= 2017 | volume= 9 | issue= 1 | pages= 1 | pmid=28050884 | doi=10.1186/s13089-016-0056-6 | pmc=5215196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28050884  }} </ref>
* Suprapubic [[tenderness]]
 
===Digital rectal examination (DRE)===
A [[digital rectal exam]] is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum.
*If pyelonephritis is suspected in men, a [[Digital rectal examination|DRE]] helps to differentiate if the obstruction is due to a swollen [[prostate gland]].
 
=== Back ===
* [[Costovertebral angle]] tenderness
 
===Genitourinary===
The following findings may be found on genitourinary examination of a patient with pyelonephritis:<ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614  }} </ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref>
 
*[[Tenderness|Suprapubic tenderness]]
*[[Urethral discharge]] (if the cause is urethritis)
*[[Lymphadenopathy|Inguinal lymphadenopathy]]
*Examination of the scrotum and the pubic area must be done
 
===Neuromuscular===
* Patient is usually oriented to persons, place, and time.
* The following neurological signs can rarely be witnessed in elderly:
**[[Delirium]]
**[[Hallucinations]]
 
=== Extremities ===
* Extremities examination of patients with pyelonephritis is usually normal.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Nephrology]]
[[Category:Inflammations]]
[[Category:Disease]]


{{WH}}
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{{WS}}
{{WS}}
[[Category:Medicine]]
[[Category:Infectious disease]]
[[Category:Nephrology]]
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[[Category:Emergency medicine]]

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 is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade fever, dysuria and pain radiating to the flank. A sonopalpation test, which is an ultrasound guided palpation, is usually positive and helpful in detecting the exact anatomical structure and position as the cause of tenderness.

Physical Examination

The following features can be found during a physical examination of a patient with pyelonephritis. The patient must be in supine position to facilitate a proper examination.[1][2][3][4]

Appearance of the Patient

  • Patients with pyelonephritis are usually in distress.
  • Patient may have hands on abdomen or back at the area of tenderness.

Vital Signs

The following variations in vital signs can be seen in pyelonephritis:

Skin

  • Skin examination of patients with pyelonephritis is usually normal.

HEENT

  • HEENT examination of patients with pyelonephritis is usually normal.

Neck

  • Neck examination of patients with pyelonephritis is usually normal.

Lungs

  • Pulmonary examination of patients with pyelonephritis is usually normal.

Heart

Abdomen

Digital rectal examination (DRE)

A digital rectal exam is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum.

  • If pyelonephritis is suspected in men, a DRE helps to differentiate if the obstruction is due to a swollen prostate gland.

Back

Genitourinary

The following findings may be found on genitourinary examination of a patient with pyelonephritis:[2][6][7]

Neuromuscular

  • Patient is usually oriented to persons, place, and time.
  • The following neurological signs can rarely be witnessed in elderly:

Extremities

  • Extremities examination of patients with pyelonephritis is usually normal.

References

  1. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  2. ↑ 2.0 2.1 Colgan R, Williams M (2011). "Diagnosis and treatment of acute uncomplicated cystitis". Am Fam Physician. 84 (7): 771–6. PMID 22010614.
  3. ↑ Chang SL, Shortliffe LD (2006). "Pediatric urinary tract infections". Pediatr Clin North Am. 53 (3): 379–400, vi. doi:10.1016/j.pcl.2006.02.011. PMID 16716786.
  4. ↑ Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW; et al. (2008). "Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases". Korean J Intern Med. 23 (3): 140–8. doi:10.3904/kjim.2008.23.3.140. PMC 2686968. PMID 18787367.
  5. ↑ Faust JS, Tsung JW (2017). "Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis". Crit Ultrasound J. 9 (1): 1. doi:10.1186/s13089-016-0056-6. PMC 5215196. PMID 28050884.
  6. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  7. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.

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