Solution Acute Pyelonephritis: A 32-year-old female is seen in the urologist’s office because of a fever, chills, and generalized fatigue.

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Case Study Scenario

A 32-year-old female is seen in the urologist’s office because of a fever, chills, and generalized fatigue. She also reported urgency, frequency, dysuria, and hematuria. In addition, she noticed that her urine was cloudy with a fishy odor. The physician ordered the following tests: a clean catch specimen for a U/A, a urine C&S, and a KUB. The U/A revealed pyuria, bacteriuria, and a slightly acidic pH. A common type of bacteria was grown in the culture. X-rays revealed acute pyelonephritis resulting from cystitis, which has spread up to the kidney from the bladder. The patient was placed on an antibiotic and encouraged to “push fluids” by drinking two liters of water a day.

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Acute Pyelonephritis Case Study Questions

This patient has two urinary system infections in different locations; name them. Which one caused the other and how? (3 points)

List and define each of the patient’s presenting symptoms (in bold) in your own words. (4 points)

What diagnostic tests did the urologist order? Describe them in your own words. (3 points)

  1. Explain the results of each diagnostic test in your own words. (3 points)
  2. What were the physician’s treatment instructions for this patient? Explain the purpose of each treatment. (3 points)
  3. Describe the normal appearance of urine.
  4. Textbook: Medical Terminology: A Living Language, 7e
  5. by Bonnie Fremgen and Suzanne Frucht
Acute Pyelonephritis

References

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  • Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007;45(3):273-280.
  • Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med. 2005;142(1):20-27.
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  • Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53-70.
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  • Shoff WH, Green-McKenzie J, Edwards C, Behrman AJ, Shepherd SM. Acute pyelonephritis: the differential diagnosis and workup. March 5, 2010. http://emedicine.medscape.com/article/245559. Accessed January 17, 2011.
  • Michaeli J, Mogle P, Perlberg S, Heiman S, Caine M. Emphysematous pyelonephritis. J Urol. 1984;131(2):203-208.
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  • Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120.
  • Bradbury SM. Collection of urine specimens in general practice: to clean or not to clean?. J R Coll Gen Pract. 1988;38(313):363-365.
  • Immergut MA, Gilbert EC, Frensilli FJ, Goble M. The myth of the clean catch urine specimen. Urology. 1981;17(4):339-340.
  • Bray PA, Corry MF. Mid-stream urine collection: is preparatory cleansing essential?. N Z Nurs J. 1979;72(3):13-14.
  • Johnson JR, Lyons MF, Pearce W, et al. Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days. J Infect Dis. 1991;163(2):325-330.
  • Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med. 2001;135(1):41-50.
  • American College of Radiology. ACR Appropriateness Criteria. Acute pyelonephritis. http://www.acr.org/secondarymainmenucategories/quality_safety/app_criteria/pdf/expertpanelonurologicimaging/acutepyelonephritisdoc3.aspx. Accessed December 17, 2010.
  • Mitterberger M, Pinggera GM, Colleselli D, et al. Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography. BJU Int. 2008;101(3):341-344.
  • Tanagho E. Radiography of urological infections. In: Tanagho EA, McAninch JW, eds. Smith’s General Urology. New York, NY: McGraw-Hill; 2008.
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  • Velasco M, Martínez JA, Moreno-Martínez A, et al. Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary?. Clin Infect Dis. 2003;37(8):1127-1130.
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  • Otto G, Sandberg T, Marklund BI, Ulleryd P, Svanborg C. Virulence factors and pap genotype in Escherichia coli isolates from women with acute pyelonephritis, with or without bacteremia. Clin Infect Dis. 1993;17(3):448-456.
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