strength in numbers: Pyelonephritis

3 Feb

some interesting stats, via a recent emdocs overview of pyelonephritis:


  • fever – present in up to 77% of patients
  • flank pain or CVA tenderness – 86%
  • elderly patients with NO fever – up to 33% (just to make our jobs difficult)



  • needs 10,000 colony forming units (CFU) per mm3 to confirm diagnosis
  • leukocyte esterase (LE):
    • sensitivity: 72% to 97%
    • specificity: 41% to 86%
  • nitrites:
    • sensitivity: 19% to 48%
    • specificity: 92% to 100%
  • Urine cultures positive in 90%


Patient with symptoms, but negative dipstick: what now?

“urine dipstick showed sensitivities as low as 75%, which is not acceptable if the patient has symptoms.”

also beware of pyelo mimics (e.g. pneumonia, PE, AAA, chronic pyelonephritis, PID, pelvic pain syndrome, prostatitis, diverticulitis, appendicitis, ovarian/testicular torsion, HZV, epidural abscess, and ectopic pregnancy)


Food for thought.


References: emdocs article; picture


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