Thường có kèm theo các triệu chứng gợi ý nhiễm trùng đường tiết niệu thấp (tần số, khẩn cấp, đau suprapubic, niệu đạo rát hoặc đau trên voiding) dẫn đến sự lây nhiễm tăng dần, dẫn đến viêm bể thận cấp tính tiếp theo. | 32 J. REYNARD Figure . JJ stent post insertion. diagnosis of PUJO becomes likely and a renogram . MAG3 scan should be done to confirm the diagnosis Fig. . ACUTE PYELONEPHRITIS Clinical Definition This is a clinical diagnosis made on the basis of fever flank pain and tenderness often with an elevated white count. it may affect 3. NONTRAUMATIC RENAL EMERGENCIES 33 Figure . a Right pelviureteric junction PUJ obstruction on ultrasound. b PUJ obstruction on CT. Note the normal-calibre ureter with hydronephrosis above. c MAG3 renogram of PUJ obstruction demonstrating obstruction to excretion of radioisotope by the kidney. See this figure in full color in the insert. one or both kidneys. There are usually accompanying symptoms suggestive of a lower urinary tract infection frequency urgency suprapubic pain urethral burning or pain on voiding that led to the ascending infection which resulted in the subsequent acute pyelonephritis. The infecting organisms are commonly Escherichia coli enterococci Streptococcus faecalis Klebsiella Proteus and Pseudomonas. 34 J. REYNARD Figure . Continued Urine culture is positive for bacterial growth but the bacterial count may not always be above the 100 000 colony-forming units cfu mL of urine which is the strict definition for urinary infection. Thus if you suspect a diagnosis of acute pyelonephritis from the symptoms of fever and flank pain but there are only 1000 cfu mL manage the case as acute pyelonephritis. Investigation and Treatment For those patients who have a fever but are not systemically unwell outpatient management is reasonable. Culture the urine and start oral antibiotics according to your local antibiotic policy which will be based on the likely infecting organisms and their likely antibiotic sensitivity . We use oral ciprofloxacin 500 mg . for 10 days. if the patient is systemically unwell admit them to hospital culture urine and blood and start intravenous fluids and intravenous antibiotics again .
