Pyelonephritis: The Daily PANCE Blueprint

Pyelonephritis: The Daily PANCE Blueprint

A 22-year-old G1P0 female at 28 weeks gestation with a history of diabetes presents to the clinic with fever, chills, and dysuria. Vitals show tachycardia (115 bpm), tachypnea (22 bpm), and hypotension (90/58 mmHg). Physical exam reveals suprapubic tenderness. Labs reveal leukocytosis, hyponatremia, and hyperglycemia. Urine dipstick is positive for nitrites, blood, glucose, and ketones. Which of the following is the next best step?

A. Send home with oral antibiotics and analgesics
B. Reassurance and oral rehydration solution
C. Admit to hospital for antibiotics, fluids, & insulin
D. Order outpatient CT scan of the abdomen
E. Refer to an outpatient nephrologist for workup

Answer and topic summary

The answer is C. Admit to hospital for antibiotics, fluids, & insulin

The patient most likely has pyelonephritis, which is an infection of the upper urinary tract and kidneys. It is one of the most common causes of sepsis in pregnancy. The pyelonephritis is also precipitating diabetic ketoacidosis in this diabetic patient.

Clinical features of pyelonephritis include fever, flank pain, N/V, and possible CVA tenderness. Pregnant patients are at high risk for obstetric and medical complications from the infection. It is recommended that pregnant women with acute pyelonephritis should be admitted for IV antibiotics (typically at least until the woman is febrile for 1-2 days and symptomatically improved). Antibiotic options include cefepime, piperacillin-tazobactam, and meropenem. This patient will also need insulin and fluids.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GenitourinaryInfectious DisordersPyelonephritis

Also covered as part of the Family Medicine EOR, Internal Medicine EOR, Emergency Medicine EOR topic list

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