From the Guidelines
Pyelocystitis, or inflammation of the renal pelvis, is a condition that typically presents with fever, chills, flank pain, nausea, vomiting, or tenderness at the costovertebral angle, and is diagnosed through urinalysis, urine culture, and imaging studies such as ultrasound or contrast-enhanced computed tomography scan. The diagnosis of pyelocystitis is crucial to prevent complications such as urosepsis, especially in patients with underlying urological abnormalities or comorbidities 1.
Key Symptoms and Diagnosis
- Fever (>38 °C)
- Chills
- Flank pain
- Nausea
- Vomiting
- Tenderness at the costovertebral angle
- Symptoms of cystitis Urinalysis, including assessment of white and red blood cells and nitrite, is recommended for routine diagnosis, along with a urine culture and antimicrobial susceptibility testing 1.
Importance of Prompt Diagnosis and Treatment
Prompt differentiation between uncomplicated and potentially obstructive pyelonephritis is crucial, as the latter can swiftly progress to urosepsis, and this delineation should be established promptly using appropriate imaging techniques 1.
Treatment Options
Treatment options for pyelocystitis include fluoroquinolones and cephalosporins for oral empiric treatment of uncomplicated pyelonephritis, while patients with uncomplicated pyelonephritis requiring hospitalisation should be treated initially with an intravenous antimicrobial regimen, such as a fluoroquinolone, an aminoglycoside, or an extended-spectrum cephalosporin or penicillin 1.
Considerations for Special Populations
For diagnosis of complicating factors in pregnant women, ultrasound or magnetic resonance imaging (MRI) should be used preferentially to avoid radiation risk to the foetus 1.
Overall Approach to Management
The management of pyelocystitis requires a comprehensive approach, including prompt diagnosis, appropriate treatment, and consideration of underlying conditions and special populations, to prevent complications and improve patient outcomes 1.
From the Research
Definition of Pyelocystitis
Pyelocystitis refers to the inflammation of the renal pelvis, which is the funnel-like space in the kidney that collects urine and passes it to the ureter. This condition is often associated with pyelonephritis, a bacterial infection of the kidney and renal pelvis 2, 3, 4.
Causes and Risk Factors
The most common cause of pyelocystitis is a bacterial infection, typically by Escherichia coli (E. coli) 3, 4, 5. Other risk factors include urinary tract obstruction, pregnancy, and compromised immune systems.
Symptoms and Diagnosis
Symptoms of pyelocystitis may include flank pain, fever, and laboratory evidence of urinary tract infection 2, 3. Diagnosis is typically confirmed by urinalysis and urine culture, with imaging studies used in more complex cases 2, 3, 6.
Treatment Options
Treatment for pyelocystitis usually involves antibiotic therapy, with the choice of antibiotic depending on the severity of the infection, the presence of any underlying conditions, and the results of antimicrobial susceptibility testing 2, 3, 4, 5. Oral fluoroquinolones and injectable third-generation cephalosporins are common empirical treatments, although resistance rates and potential side effects must be considered 5.
Key Considerations
- Urine culture with antimicrobial susceptibility testing should be performed in all patients to guide therapy 2, 3.
- Imaging studies are not necessary in uncomplicated cases, but may be useful in cases with no improvement or symptom recurrence 2, 3, 6.
- Outpatient management is often appropriate for patients with uncomplicated disease, while inpatient therapy may be necessary for those with severe illness or suspected complications 2, 3.