Pyelonephritis vs cystitis (UTI)???

[Poppy123]

Anyone know besides CVA tenderness?

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[SOUNDMAN]

Anyone know besides CVA tenderness?

Pyelo they will be usually sicker people, in addition you'll see WBC casts in the Urine as well. Cystitis will usually have suprapubic pain.

 

[J1515]

Anyone know besides CVA tenderness?

Systemic symptoms in pyelo (febrile).

Remember, uptodate is your friend.

 

[gudog]

Cystitis - irritative voiding symptoms, no fever

Pyelo - no voiding symptoms, fever, CVA tenderness, often + blood culture

U/A by itself will not discriminate between upper and lower tract infections.

Cystitis can be cured with short course antibiotics.

I usually recommend 2 weeks of therapy for pyelo.

 

[mrantarctica]

I agree with some of the distinguishing features listed above. Renal USS may be useful for pyelo is some centers.

And for management differences, as a general rule :

uncomplicated cystitis can be managed as an outpatient with oral antibiotics
pyelonephritis needs admission to hospital with IV antibiotics, then switched to orals later.

 

[had2piknowEM]

I agree with some of the distinguishing features listed above. Renal USS may be useful for pyelo is some centers.

And for management differences, as a general rule :

uncomplicated cystitis can be managed as an outpatient with oral antibiotics
pyelonephritis needs admission to hospital with IV antibiotics, then switched to orals later.

Not to be picky, as you said a "general rule," but pyelo does not mean necessary admission. Many people can be managed as an outpt. However, there are certain criteria that necessitate admission i.e. pregnancy, cannot tolerate po abx, single kidney or other anatomic abnormalities, extremems of age, or "toxic appearing."

 

[Rocket3004]

I think the above posters are correct, but IIRC the only thing diagnositc (i.e. specific but not 100% sensitive) are the WBC casts for pyelo... Systemic symptoms are only supportive, but not diagnostic for it.

And you can treat pyelo as an outpatient, but pretty much only if it's uncomplicated, but because of the nature of the disease, you want to make sure that your treatment for it is spot on for the infectious agent.

 

[DaveinDallas]

And watch the hell out for SIRS....Systemic Inflammatory Response Syndrome....usually a precursor to DIC....should be a quick trip to ICU....pyelo can turn to SIRS to DIC in a hurry like w/in 5 hours.....

 

[Tired]

And watch the hell out for SIRS....Systemic Inflammatory Response Syndrome....usually a precursor to DIC....should be a quick trip to ICU....pyelo can turn to SIRS to DIC in a hurry like w/in 5 hours.....

SIRS is not "usually" a precursor to DIC.

SIRS is clinical signs of sepsis in the absence of proven infection.

A patient who meets SIRS criteria in the presence of a known pyelonephritis is more accurately termed "septic" unless some other inciting event is suspected.

DIC is a known complication of SIRS/sepsis (as is ARF, ARDS, CNS dysfunction, among others), but only occurs in about 10-20% cases, though the rate is substantially higher in septic shock.

But yes, the complications of SIRS/sepsis do develop very quickly.

 

[DaveinDallas]

SIRS is not "usually" a precursor to DIC.

SIRS is clinical signs of sepsis in the absence of proven infection.

A patient who meets SIRS criteria in the presence of a known pyelonephritis is more accurately termed "septic" unless some other inciting event is suspected.

DIC is a known complication of SIRS/sepsis (as is ARF, ARDS, CNS dysfunction, among others), but only occurs in about 10-20% cases, though the rate is substantially higher in septic shock.

But yes, the complications of SIRS/sepsis do develop very quickly.

Thank you...I stand corrected....I had never heard of SIRS but one of the patients on my first clerkship met the criteria and things began happening quickly....I haven't yet had time to read up on it but just knew it was bad juju and had learned some of the criteria........seriously, thank you for providing the info....

 

[Tired]

I had never heard of SIRS but one of the patients on my first clerkship met the criteria and things began happening quickly....

I agree, very scary. Moreso when they're pregnant.

Freaky thing to see on your first clerkship; I got to #4 before I ran into one. Mine died. Hopefully yours made it through.

 

[roja]

Keep in mind there are no absolutes in medicine.

Cystitis *tends* to have hematuria, significant urinary sx and no CVAT.

Pyelo *tends* to have CVA tenderness, +/- urinary sx and may or may not be sick. U/S really has no role in diagnosing pyelo. Pyelo may or may not have hydronephrosis. Most go home with 10 days of abx.

UTI's, URI's, PNA, sepsis can all manifest SIRS. SIRS is a wide net cast to try and catch early infection. you will probably meet SIRS criteria the next time you have rotavirrus or strep throat. When pts are septic,they turn fast!

 

[DaveinDallas]

I agree, very scary. Moreso when they're pregnant.

Freaky thing to see on your first clerkship; I got to #4 before I ran into one. Mine died. Hopefully yours made it through.

Thankfully, they did make it.

 

[mrantarctica]

USS is not specific for pyelonephritis. having said that - most of the time you see pyelo, it will not be clear-cut, and you will want to rule out some other problems (e.g. calculi), in which case USS is probably your best bet. While many people say an XRAY will spot stones, it's not considered sensitive enough to rule out calculus.

wouldn't stress too much about SIRS. its a pretty loose term - not a diagnosis. On its own, it will NOT mean ICU admission.

considering that half of my colleagues who go for a brisk run after a days work will meet SIRS criteria if they measure their vitals once they return.... and you don't see them all lining up to enter ICU

Every patient i have seen with pyelo met SIRS criteria

treat the patient, not the numbers. there's no replacement for adequate history and examination.

and not everyone with sepsis dies. I suspect that most of the patients you have seen with sepsis had severe sepsis with end organ dysfunction -which has a mortality rate of 50% or higher... and usually progresses very quickly.

 

[Tired]

. . . and you will want to rule out some other problems (e.g. calculi), in which case USS is probably your best bet. While many people say an XRAY will spot stones, it's not considered sensitive enough to rule out calculus.

If you're using ultrasound to rule out calculi, you're likely not practicing in the U.S.

 

[mrantarctica]

correct. as i mentioned in my first post - the value of USS really differs from center to center depending on the local level of experience/resources etc. have seen it used quite a bit, and i suspect it'll probably take more hold as the years go on. the disadvantage of CT being that it doesnt say anything about the kidney function, or just how much obstruction there is.

where i work, KUB plain xrays and CT scan are the preferred option for stones here.

 

[mrantarctica]

Not to be picky, as you said a "general rule," but pyelo does not mean necessary admission. Many people can be managed as an outpt. However, there are certain criteria that necessitate admission i.e. pregnancy, cannot tolerate po abx, single kidney or other anatomic abnormalities, extremems of age, or "toxic appearing."

like I said ... as a general rule.

while most sources would suggest that the majority of cases of pyelo are uncomplicated, and mild illness - personal experience suggests completely otherwise. perhaps i've just been unlucky though. hence the specifier "general rule"

 

[roja]

If you're using ultrasound to rule out calculi, you're likely not practicing in the U.S.

ditto.

U/s is neither sensitive nor specific for calculi. (one exception is stones in the UVJ, which it is better at but still not great).

and more importantly, clinically insignificant.