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Pyelonephritis


Patients with concomitant uteral stones make poor candidates to be discharged home



Inclusion Criteria

  • Acceptable vital signs and normal mentation
  • Clinical evidence of pyelonephritis (flank pain, urgency, frequency, dysuria)
  • UA evidence of pyelonephritis (significant pyuria, nitrates, and/or leukocyte esterase)
  • Not suitable for discharge from the ED
  • Urine cultures obtained

Exclusion Criteria

  • Male patients
  • Pregnant females
  • Abnormal VS after ED treatment (SBP <90, HR >120, T<35 or >40 C)
  • Mental status changes
  • Significant comorbidities – diabetes, renal failure, sickle cell disease
  • Immunosuppressed patients - HIV, transplant patients, chronic high dose steroids, asplenic
  • Urinary tract anatomic abnormality (solitary kidney, reflux, or indwelling device)
  • Urethral or ureteral obstruction (ie. kidney stones, urinary retention)
  • Poor candidate for outpatient treatment of pyelonephritis (ie poor home support)

Potential Interventions

  • IV hydration, antiemetics, antipyretic
  • IV antibiotics based on contemporary guidelines for pyelonephritis
  • Advance to oral antibiotics, antiemetics, and analgesics – as tolerated
  • Imaging as needed (CT or ultrasound)

Discharge Criteria

Home

    • Resolution or improvement of systemic symptoms
    • Ability to take po medications
    • Stable vital signs
    • Require followup , when and where.

Admit

    • Clinical deterioration or lack of adequate improvement
    • Inability to tolerate oral meds or hydration
    • Unstable vital signs or evidence of septic shock
    • Abnormal imaging (ureteral obstruction or emphysematous pyelonephritis, solitary kidney)



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