Renal & urology · UKMLA & AKT
Acute pyelonephritis
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Classic triad (distinguishes from cystitis): fever >38°C ± rigors, loin/flank pain, nausea and vomiting
- Lower urinary tract symptoms - dysuria, frequency, urgency, haematuria (may be absent, especially in elderly)
- Renal angle tenderness - elicited by fist percussion over costovertebral angle; hallmark examination finding
- Severe disease - tachycardia, hypotension, tachypnoea, reduced consciousness (signs of sepsis)
In older or frail patients, confusion may be the only presenting feature - always include MSU in the workup of new acute confusion and actively look for systemic features suggesting pyelonephritis rather than cystitis.
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