COMPLICATED PYELONEPHRITIS Emphysematous pyelonephritis (EPN) is an uncommon but life-threatening necrotizing infection that causes gas formation in the collecting system and renal parenchyma. It is most common in diabetic patients…
PRESENTATION AND DIAGNOSIS In addition to the symptoms associated with cystitis (see Plate 5-2), which may or may not be present, acute pyelonephritis features high fever, anorexia, nausea/vomiting, costovertebral angle…
Some patients will require prophylactic treatment to prevent recurrent infection. Some young women, for example, experience frequent UTIs associated with sexual intercourse. These patients should be advised to void after…
In certain populations, such as the elderly, symptoms may be less specific and include depressed mental status and failure to thrive, or there may be no symptoms at all. Children…
When initiating treatment, rapid hydration of the patient can increase urine production and facilitate clearance of some bacteria through voiding. As discussed earlier, urinary pH plays an integral role in…
These protective mechanisms, however, may be overcome or impaired in certain circumstances. For example, when women engage in sexual intercourse, there is often substantial displacement of both fecal and vaginal…
In general, erythropoiesis-stimulating agents are used to maintain a hemoglobin level of 11 to 12 g/dL. The target should not exceed 13 g/dL. In patients receiving this treatment, iron stores…
If PTH levels remain elevated despite these measures, active vitamin D analogues (such as calcitriol) may be used in lieu of ergocalciferol; however, these agents may cause marked elevation of…
ADDITIONAL CONSIDERATIONS It is essential that renally cleared medications be dosed based on eGFR. Furthermore, drugs that may precipitate an acute decline in renal function, such as nonsteroidal antiinflammatory drugs…
Diuretics are often needed as well, especially as more advanced disease leads to greater retention of sodium and water. In general, at an eGFR <30 mL/min/1.73 m2, loop diuretics are…
