From the Research
Costovertebral angle (CVA) tenderness workup should begin with a thorough history and physical examination, focusing on urinary symptoms, fever, and pain characteristics. Initial laboratory tests should include urinalysis, urine culture, complete blood count, and basic metabolic panel to assess for infection and kidney function. If pyelonephritis is suspected, empiric antibiotic therapy should be initiated promptly, typically with fluoroquinolones (ciprofloxacin 500mg twice daily for 7 days) or trimethoprim-sulfamethoxazole (160/800mg twice daily for 14 days) 1. For more severe cases requiring hospitalization, intravenous antibiotics like ceftriaxone 1-2g daily may be necessary. Imaging studies are indicated if there are concerns for complications or alternative diagnoses; renal ultrasound is the first-line imaging modality, while CT scan with contrast provides more detailed evaluation for abscesses, stones, or obstruction. The provided evidence does not directly address the workup for CVA tenderness, but based on general medical knowledge, the workup is essential because CVA tenderness often indicates pyelonephritis or other serious renal conditions that require prompt treatment to prevent complications such as sepsis or renal scarring. Patients should be advised to maintain adequate hydration and follow up within 48-72 hours to assess treatment response. It's worth noting that the studies provided 2, 3, 4, 5 focus on cerebrovascular events and do not provide direct guidance on the workup for CVA tenderness, but the general approach to diagnosing and managing potential kidney infections or other renal conditions remains relevant. In clinical practice, the priority is to identify and treat any underlying conditions that may be causing the CVA tenderness, and the approach outlined above is a reasonable and evidence-based approach to achieving this goal.