From the Research
The next step in managing a patient with paranephric stranding and right flank pain is to initiate empiric antibiotic therapy for presumed acute pyelonephritis while obtaining urine and blood cultures. A reasonable antibiotic regimen would include intravenous ceftriaxone 1-2g daily or oral fluoroquinolones such as ciprofloxacin 500mg twice daily for 7-14 days, depending on clinical response 1. Pain management with acetaminophen or NSAIDs should be provided. The patient requires adequate hydration either orally or intravenously if unable to tolerate oral intake. Close monitoring of vital signs, renal function, and inflammatory markers is essential. Paranephric stranding on imaging represents inflammation in the perinephric fat, which combined with flank pain strongly suggests pyelonephritis. If the patient has severe symptoms (high fever, vomiting, inability to maintain hydration) or complicating factors (diabetes, immunosuppression, pregnancy), hospitalization may be necessary. If symptoms do not improve within 48-72 hours of appropriate antibiotic therapy, further imaging such as a contrast-enhanced CT scan should be considered to evaluate for complications like abscess formation or obstruction that might require drainage or surgical intervention 2. It's also important to consider other potential causes of flank pain, such as ureterolithiasis or Page kidney, and to use imaging modalities like ultrasonography or helical CT to aid in diagnosis 3, 4, 5. However, given the presence of paranephric stranding, acute pyelonephritis is the most likely diagnosis and should be treated empirically while further evaluation is ongoing.