The diagnosis and management of a patient with acute pyelonephritis

This case study explores the aetiology, epidemiology, pathophysiology, clinical assessment and diagnosis of acute pyelonephritis via a critical analysis of current evidence. Effective history taking, combined with refined physical examination skills, are the two most powerful tools to exclude differential diagnoses (Colgan et al, 2011). Utilisation of these skills by the practitioner, together with the recognised presenting symptom triad of flank pain, fever and nausea (Frassetto, 2018), enables the diagnosis of acute pyelonephritis to be given. To respect confidentiality and ensure anonymity a pseudonym (Jane White) will be used in this article (Nursing and Midwifery Council, 2018; Health and Care Professions Council, 2016).

Acute pyelonephritis, known in clinical practice as an upper urinary tract infection (UTI), is defined as a tubulointerstitial disorder characterised by inflammation of the renal parenchyma caused by bacteriuria ascending from the bladder up the ureters to the kidneys (Choong et al, 2015). Bethel (2012) estimated that, annually, 1 in every 830 people in England develops pyelonephritis. However, the exact epidemiology and economic cost remain unknown because of the overlap of treatment in primary and secondary care (Bethel, 2012). In comparison, a lower UTI has an annual incidence of 3 in every 100 people, which accounts for over 224 000 hospital admissions each year (National Institute for Health and Care Excellence (NICE), 2014) with an associated £316 million healthcare cost (McDonald et al, 2014). It is important to emphasise that nearly all of these admissions have the pathophysiological possibility to develop into pyelonephritis if treatment is delayed or inadequate.