Emphysematous pyelonephritis: Difference between revisions
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==Management== | ==Management== | ||
*IVF | |||
*Antibiotics | |||
**IV ampicillin, gentamicin, metronidazole | |||
**Vancomycin in place of ampicillin for pcn allergy | |||
==Disposition== | ==Disposition== | ||
Revision as of 05:51, 16 February 2016
Background
- Rare gas-forming infection nearly always occurring in pts w/ DM and obstruction
- Pts appear toxic and septic; nephrectomy may be required
Clinical Features[1]
- Fever
- Abdominal pain or Flank pain
- crepitus over the flank may be present in severe cases
- Nausea/vomiting
- Dyspnea
- Renal dysfunction
- Altered mental status
- Shock
- Thrombocytopenia
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Diagnosis
Labs
- CBC with high WBC, low platelets
- UA with urine culture
- Creatinine
- Blood culture
Imaging
- CT is definitive
Management
- IVF
- Antibiotics
- IV ampicillin, gentamicin, metronidazole
- Vancomycin in place of ampicillin for pcn allergy
Disposition
- Urological c/s for surgical drainage
See Also
External Links
Sources
- ↑ Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30.