Acute Pyelonephritis


Step 1: View clinicals

A 33-year old woman presents with fever and right-sided flank pain for one day. There is no history of frequency, urgency, dysuria, or hematuria, and no bowel symptoms are present. Her medical history is unremarkable. A routine screening for diabetes, hypertension, and dyslipidemia performed last month was negative on all counts. Her surgical and gynecological histories are also unremarkable. Her last menstrual period was two weeks ago, and she is currently in a monogamous relationship. There is no history of sexually transmitted infections. She drinks socially and has never smoked.

Step 2: Order all relevant investigations

Urinalysis and urine cultures

Urinalysis: Pus cells: Field full RBC: 10-15/hpf WBC casts: Positive Leukocyte esterase test: Positive Urine Cultures: Results will be available in 48 to 72 hours

Ultrasound KUB

The ultrasound scan appears normal, with no imaging findings suggestive of calculi, ureteral obstruction, hydronephrosis, or abscesses.

Renal profile

BUN: 12 mg/dL (6 - 23) Creatinine: 0.79 mg/dL (0.6 - 1.0)

Noncontrast CT Abdomen

The CT scan shows no abnormalities of the kidneys, liver, gallbladder or pancreas.

Step 3: Select appropriate management

Admit patient
Oral antibiotics
Urology Referral
ACE inhibitors

Score: ★★☆