Renal & urology · UKMLA & AKT
Acute pyelonephritis
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise acute pyelonephritis — the full SA Note notes add investigations, management, complications and 10 practice questions.
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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