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Pyelonephritis
Elisabeth Fandrich
April 7, 2008
Pyelonephritis
Pyelonephritis 2
ascending infection, meaning that an infection of the lower urinary tract has reached the pelvis of
the kidney. It occurs most often when there is a backflow of urine from the bladder into the
ureters or the pelvis of the kidney. Although cystitis (bladder infection) is common, the
The common signs and symptoms of pyelonephritis are flank pain, dysuria, abdominal pain that
radiates around to the back on the affected side, fatigue, fever, nausea and vomiting, diaphoresis,
urinary frequency, urinary urgency, nocturia, blood in the urine, cloudy or discolored urine, mental
3511,L,B presented to the emergency department complaining of severe abdominal pain and
mental status changes. A CT scan was done and it was determined that there was abnormal
dilation of the left urinary collecting system with urine and air. It was also noted that there was
extensive abnormal perinephretic fat stranding, and fluid along the spleen. These observations are
indicative of pyelonephritis and also the possibility of a recently passed kidney stone.
A urinalysis and labs were done upon admission. The urinalysis showed cloudy urine, with high
glucose, ketones and protein as well as a positive clinitest. As the patient is diabetic, this indicates
poorly managed blood sugars. There was also a large amount of blood in the urine and bacteria
was cultured. The patient had a high WBC level (12.67 K/uL), high % Neuts (93.8%), high
absolute neuts (11.88 K/uL), low % Lymphs (2.5%) and low absolute lymphs (0.31 K/uL). This
indicates acute infection rather than a chronic infection. With subsequent labs, these values have
shown steady improvement. The most recent results show that the WBC count is within normal
limits, the % Neuts are only slightly high. The % Lymphs are still low at 14.9%, but this value has
improved quite a bit. The RBC, HGB and HCT have all fallen slightly below normal ranges in the
Pyelonephritis 3
last labs. This could be explained by the body’s response to the anti-infective agent given to kill
The treatment of pyelonephritis requires that a culture and sensitivity be done to determine the
causative organism. Appropriate anti-infectives are then administered to the patient. Recovery
References
http://www.nlm.nih.gov/medlineplus/ency/article/000522.htm