Pyelonephritis differential diagnosis: Difference between revisions

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Since the pain of pyelonephritis radiates to the flank, it must be differentiated from various other causes of [[flank pain]].
Since the pain of pyelonephritis radiates to the flank, it must be differentiated from various other causes of [[flank pain]].


*[[Right flank pain]] can have the following life threatening causes
*[[Right flank pain]] can have the following life threatening causes:
**[[Ischemic colitis]]
**[[Ischemic colitis]]
**[[Ovarian torsion]]
**[[Ovarian torsion]]
Line 152: Line 152:
**[[Renal vein thrombosis]]
**[[Renal vein thrombosis]]


*[[Left flank pain]] can have the following life threatening causes
*[[Left flank pain]] can have the following life threatening causes:
**[[Blunt trauma|Abdominal compartment syndrome]]
**[[Blunt trauma|Abdominal compartment syndrome]]
**[[Acute kidney injury]]
**[[Acute kidney injury]]

Revision as of 19:32, 5 October 2017

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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 must be differentiated from other causes of dysuria such as cystitis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia, STDs and neoplasms such as renal cell carcinoma and from causes of abdominal pain such as ectopic pregnancy, renal stone, peritoneal or iliopsoas abscess and rib fracture.[1][2][3]

Differential Diagnosis

The differential diagnoses of pyelonephritis include:[2][3][4][5]

Differential Diagnosis on the basis of Urinary Symptoms

Pyelonephritis can be differentiated from other diseases that cause lower urinary tract irritation symptoms, such as: dysuria, urgency, and frequency, in addition to urethral discharge. The differential list includes: urethritis, cystitis, cervicitis, vulvovaginitis, epididimitis, prostatitis, and syphilis.[3][6][7][8]

Disease Findings
Cystitis Bladder inflammation, Features with increased frequency and urgency, dysuria, and suprapubic pain. Is more common among women. E.coli is the most common pathogen[9][10][11][12].
Urethritis Infection of the urethra,causes dysuria and urethral discharge[7][13][14]
Bacterial vulvovaginitis Presents with dysuria and pruritus, vaginal discharge and odor are almost always present, caused by Gardnerella species[15].
Cervicitis Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)[16]
Prostatitis Bacterial infection of the prostate, causes discomfort during ejaculation[17]
Epididymitis Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms(dysuria and frequency)[18].
Syphilis Presents with generalized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic. It is classically described as 1) non-pruritic bilateral symmetrical mucocutaneous rash; 2) non-tender regional lymphadenopathy; 3) condylomata lata and 4) patchy alopecia.[6]

Differential Diagnosis of flank pain

Since the pain of pyelonephritis radiates to the flank, it must be differentiated from various other causes of flank pain.

For a detailed review of the causes of right flank pain and left flank pain please visit the page on flank pain.

References

  1. ↑ Workowski, KA.; Berman, S.; Workowski, KA.; Bauer, H.; Bachman, L.; Burstein, G.; Eckert, L.; Geisler, WM.; Ghanem, K. (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
  3. ↑ 3.0 3.1 3.2 Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
  4. ↑ IMMERGUT S, COTTLER ZR (1950). "Mucin producing adenocarcinoma of the bladder associated with cystitis follicularis and glandularis". Urol Cutaneous Rev. 54 (9): 531–4. PMID 15443228.
  5. ↑ Choudhary A, Majee P, Gupta R, Basu S, Das RK (2016). "Adult Idiopathic Renal Vein Thrombosis Mimicking Acute Pyelonephritis". J Clin Diagn Res. 10 (9): PD18–PD19. doi:10.7860/JCDR/2016/20139.8568. PMC 5072018. PMID 27790518.
  6. ↑ 6.0 6.1 Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  7. ↑ 7.0 7.1 Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  8. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  9. ↑ Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn & Sanjay Saint (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–2710. PMID 12020306. Unknown parameter |month= ignored (help)
  10. ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  11. ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)
  12. ↑ 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.
  13. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  14. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  15. ↑ Daniel V. Landers, Harold C. Wiesenfeld, R. Phillip Heine, Marijane A. Krohn & Sharon L. Hillier (2004). "Predictive value of the clinical diagnosis of lower genital tract infection in women". American journal of obstetrics and gynecology. 190 (4): 1004–1010. doi:10.1016/j.ajog.2004.02.015. PMID 15118630. Unknown parameter |month= ignored (help)
  16. ↑ Kimberly A. Workowski & Gail A. Bolan (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. PMID 26042815. Unknown parameter |month= ignored (help)
  17. ↑ Felix Millan-Rodriguez, J. Palou, Anna Bujons-Tur, Mireia Musquera-Felip, Carlota Sevilla-Cecilia, Marc Serrallach-Orejas, Carlos Baez-Angles & Humberto Villavicencio-Mavrich (2006). "Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract". World journal of urology. 24 (1): 45–50. doi:10.1007/s00345-005-0040-4. PMID 16437219. Unknown parameter |month= ignored (help)
  18. ↑ A. Stewart, S. S. Ubee & H. Davies (2011). "Epididymo-orchitis". BMJ (Clinical research ed.). 342: d1543. PMID 21490048.


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