Diagnosis: Acute Pyelonephritis (Kidney Infection)
Based on the 8-day history of flank pain, dysuria, urinary frequency, and orthostatic dizziness in this 26-year-old female, the diagnosis is acute pyelonephritis, despite normal CBC and UA results. 1, 2
Clinical Reasoning
The combination of flank pain with urinary symptoms is nearly universal in pyelonephritis and distinguishes it from simple bladder infection. 1, 2
Key Diagnostic Features Present:
- Flank pain (balakang) is the hallmark symptom - present in almost all pyelonephritis cases according to the American College of Radiology 1, 3
- Dysuria (mahapdi) with urinary frequency (paunti-unti ang ihi) - classic lower tract symptoms that accompany upper tract infection 1
- Orthostatic dizziness - suggests systemic involvement and possible dehydration from 8 days of illness 1
- Duration of 8 days - prolonged symptoms warrant treatment even with normal initial tests 1
Important Clinical Caveat:
Normal urinalysis does NOT rule out pyelonephritis. 1 The 2024 JAMA guidelines emphasize that diagnosis should be primarily based on clinical symptoms, not laboratory tests alone 1. Up to 20% of pyelonephritis patients may lack typical bladder symptoms, but flank pain remains predominant 1, 3
Recommended Tests
Urine culture with antimicrobial susceptibility testing is mandatory - this is the gold standard for confirming pyelonephritis and guiding targeted antibiotic therapy 1, 2
Why Culture is Essential:
- Confirms the diagnosis definitively 1
- Identifies the specific bacteria (E. coli causes >90% in young women) 1
- Determines antibiotic sensitivities for appropriate treatment 1, 2
- Required for all suspected pyelonephritis cases per Infectious Diseases Society of America 2
Treatment Plan
Antibiotic Therapy (PhilHealth Konsulta Formulary):
Ciprofloxacin 500mg tablet
- Dose: 1 tablet twice daily (every 12 hours)
- Duration: 7 days
- Dispense: 14 tablets
- Cost: Approximately ₱140-210 (within ₱300 budget)
Alternative if Ciprofloxacin unavailable: Cefalexin 500mg capsule
- Dose: 1 capsule four times daily (every 6 hours)
- Duration: 7 days
- Dispense: 28 capsules
- Cost: Approximately ₱280 (within ₱300 budget)
Symptomatic Relief:
Mefenamic Acid 500mg tablet
- Dose: 1 tablet three times daily as needed for pain
- Duration: 3-5 days
- Dispense: 10 tablets
- Cost: Approximately ₱20-30
Supportive Care Instructions:
- Increase fluid intake to at least 2-3 liters daily 4
- Complete full antibiotic course even if symptoms improve 4
- Return immediately if fever develops, pain worsens, or vomiting occurs 1
Medical Certificate
This certifies that patient has been seen and examined today with the diagnosis of: Acute Pyelonephritis (Kidney Infection)
Recommendation: Complete 7-day antibiotic course, increase fluid intake, follow-up in 3 days or sooner if symptoms worsen. Patient is advised to rest and is temporarily unfit for work/school for 3-5 days pending clinical improvement.
This medical certificate is issued upon the request of the patient for: sick leave from work/school due to kidney infection requiring rest and medical treatment.
Patient Education (Tagalog Explanation)
Ang inyong kondisyon ay impeksyon ng bato (acute pyelonephritis). Ang sakit sa balakang, mahapdi sa pag-ihi, at paunti-unting pag-ihi ay mga palatandaan na ang impeksyon ay umabot na sa bato, hindi lang sa pantog. Ang pagkahilo kapag tumayo ay dahil sa matagal nang may sakit at posibleng kulang sa tubig ang katawan.
Mahalagang malaman:
- Kahit normal ang unang laboratory tests, ang inyong mga sintomas ay malinaw na nagpapakita ng impeksyon ng bato 1
- Kailangan ng antibiotic na aabutin ng 7 araw para gumaling ng tuluyan 4
- Uminom ng maraming tubig (8-10 baso araw-araw) 4
- Huwag ihinto ang gamot kahit gumaan na ang pakiramdam - dapat ubusin ang lahat ng antibiotic 4
- Bumalik kaagad kung magkalagnat, lumala ang sakit, o nagsusuka 1
Ang impeksyon ng bato ay seryoso at kailangan ng tamang paggamot para maiwasan ang komplikasyon tulad ng permanent kidney damage 1. Sa tamang antibiotic at sapat na pahinga, gagaling kayo sa loob ng 3-5 araw 4.