Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)

Aetiology

• Generally caused by bacteria ascending from lower urinary tract or travelling in blood
• E.coli most common cause, other causative organisms include Enterobacter, Proteus, Pseudomonas aeruginosa

Risk factors

• Infection of the kidney is more common in females as the urethral orifice is closer to the anus and the route of spread for the bacteria is shorter
• Other risk factors include urological abnormalities and diabetes

Clinical features

• High fever and rigors
• Loin to groin pain
• Dysuria and urinary frequency
• Haematuria
• Other non-specific symptoms (e.g. vomiting)
• Pain on bimanual palpation of the renal angle (over kidney)

Investigations

• Bloods: cultures
• Urine:
  • Dipstick: blood, protein, leukocyte esterase, nitrates
  • Cultures
• Imaging: CT can help confirm diagnosis

Management

• IV amoxicillin + gentamicin until culture and sensitivities are available