Renal: Acute Pyelonephritis: Free MSRA Podcast

🧪 FREE MSRA PODCAST – Acute Pyelonephritis🎧 In this Deep Dive episode, we cut through the dense notes and break down one of the most important renal conditions for your MSRA revision: Acute Pyelonephritis – a serious kidney infection that needs quick action.🧠 Key Learning Points📌 Definition• Acute Pyelonephritis is a bacterial infection of the kidney, involving the renal parenchyma and renal pelvis.• Most commonly caused by ascending urinary tract infections, especially from the bladder.📌 Pathophysiology• Bacteria (usually E. coli) adhere to the urothelium, invade the kidney tissue, trigger inflammation, and may cause pus formation, abscesses, or long-term renal scarring.• Chronic pyelonephritis can result from repeated episodes.📌 Causes• E. coli is the most common cause.• Other organisms: Klebsiella, Proteus, Enterococcus.• Less common: fungi, yeasts (especially in immunocompromised patients).🧫 Mnemonic: "KEEPS" — Klebsiella, E. coli, Enterococcus, Proteus, Staph saprophyticus📌 Risk Factors• Structural abnormalities: VUR, kidney stones, enlarged prostate• Immunosuppression, diabetes, pregnancy• Medical devices: catheters, stents• Recurrent UTIs or neurogenic bladder• Men are always classified as “complicated”📌 Symptoms• Rapid onset of:– Fever (rigors)– Loin pain– Nausea & vomiting– Urinary symptoms: dysuria, frequency, urgency🧠 Mnemonic: “FLN” – Fever, Loin pain, Nausea📌 Paediatrics• Often presents non-specifically: irritability, poor feeding, fever• Always think of pyelo in infants with fever and no focus📌 Differential Diagnosis• Urological: cystitis, kidney stones• Gynaecological: ectopic, PID, endometritis• Gastrointestinal: appendicitis, diverticulitis• Vascular: AAA, papillary necrosis📌 Investigations• Urine culture before starting antibiotics – essential• Urine dip: leukocytes, nitrites, haematuria• Bloods: FBC, U&Es, CRP, blood cultures (if septic)• Imaging:– Ultrasound (especially in children)– CT KUB if not improving after 48–72h or if abscess suspected– DMSA scan (in children to assess for scarring)📌 Management• Empirical antibiotics:– Adults: Ciprofloxacin, Co-amoxiclav– Children: Co-amoxiclav, Cefixime• Adjust once culture results return• Supportive care: fluids, analgesia, antiemetics• Hospital admission if:– Sepsis– Vomiting or dehydration– Pregnancy or infant <3 months– Significant comorbidities or obstruction📌 Complications• Sepsis, renal abscess, perinephric abscess• Emphysematous pyelonephritis (gas in kidney – surgical emergency)• Papillary necrosis• Chronic kidney damage• Preterm labour in pregnancy📌 Prognosis• Good if treated promptly – symptoms improve in 48–72h• Poor outcomes in delayed or untreated cases – especially in high-risk patients📌 Prevention• Low-dose prophylactic antibiotics for recurrent UTIs• Paediatric prophylaxis if: VUR, recurrent UTIs, or scarring on imaging• Early investigation and treatment prevent long-term damage📚 More MSRA Resources for Acute Pyelonephritis📝 Revision Notes:https://www.passthemsra.com/topic/acute-pyelonephritis-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/acute-pyelonephritis-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/acute-pyelonephritis-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/acute-pyelonephritis-rapid-quiz/🧪 Topic Quiz:https://www.passthemsra.com/quizzes/acute-pyelonephritis/🎓 Full Course:https://www.passthemsra.com/courses/renal-for-the-msra/💡 Explore the full Renal for the MSRA course athttps://www.passthemsra.com – your all-in-one resource for high-yield revision, quizzes, flashcards and more.🔖 Hashtags#MSRA #MSRARevisionNotes #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #Renal #AcutePyelonephritis