Cystitis v pyelonephritits

[bowlofmushypeas]

So I've had 2 patients present on a Family rotation like this and after scouring uptodate, etc I still don't really know the answer (and the attending was less than helpful). So I've had 1 Adult male and female present with findings that I consider to be Amex of cystitis vs pyelonephritis, but I wondr if theres a better to discriminate these two. Obviously, classic pyelonephritits sx included fever, chills, and flank pain whereas my understanding of cystitis is that it typically does not have systemic symptoms, mostl just dysuria, some blood maybe, and suprapubic pain. Both patients had 2/3 (chills and possible flank vs side/back pain, which seems hard to discriminate also, nausea, hadaches...) They also had suprapubic pain and a positives for bacteria.. So my deduction was cystitis and ascending pyelonephritits despite being afebrile. I think in 1 of the 2, he was normotensive but rrs in the 20s and slight tachycardia also.

In both, my attending felt like it was just cystitis with systemic findings and ended up prescribing meds that primarily target the bladder. I don't what happened to these folks, but was wondering what you guys thought. I know you can be afebrile with pyelonephritits at the extremes of age (babies and old folks), but what about your typical adult who seems otherwise healthy without know immunosuppressive, etc? Has anyone else seen this picture before cause it seems pretty common.

Oh wise peers, help me out!

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[ijn]

Do they not actually look at WBC casts in the real world to make a differential between the two or is that another useless STEP 1 factoid?

 

[bowlofmushypeas]

I think it's helpful if they're there, but it's not a very sensitive test since WBC casts are often absent

 

[turkeyjerky]

UTI with any systemic findings or CVA tenderness I would call pyelonephritis. Keep in mind, though, that not all pyelonephritis needs admission + I've abx, just don't treat it with macrobid or fosfomycin.

 

[haujun]

So I've had 2 patients present on a Family rotation like this and after scouring uptodate, etc I still don't really know the answer (and the attending was less than helpful). So I've had 1 Adult male and female present with findings that I consider to be Amex of cystitis vs pyelonephritis, but I wondr if theres a better to discriminate these two. Obviously, classic pyelonephritits sx included fever, chills, and flank pain whereas my understanding of cystitis is that it typically does not have systemic symptoms, mostl just dysuria, some blood maybe, and suprapubic pain. Both patients had 2/3 (chills and possible flank vs side/back pain, which seems hard to discriminate also, nausea, hadaches...) They also had suprapubic pain and a positives for bacteria.. So my deduction was cystitis and ascending pyelonephritits despite being afebrile. I think in 1 of the 2, he was normotensive but rrs in the 20s and slight tachycardia also.

In both, my attending felt like it was just cystitis with systemic findings and ended up prescribing meds that primarily target the bladder. I don't what happened to these folks, but was wondering what you guys thought. I know you can be afebrile with pyelonephritits at the extremes of age (babies and old folks), but what about your typical adult who seems otherwise healthy without know immunosuppressive, etc? Has anyone else seen this picture before cause it seems pretty common.

Oh wise peers, help me out!

It is mainly clinical dx and can be little confusing. It may be wise to treat males with 14 days of abx so outpatient treatment for both pyelo and complicated cystitis is identical unless pyelo develop abscess.

As for female if the uncomplicated cystitis you can treat her for 3 days as opposed to 14 days abx for pyelo.

If you exam shows CVA tenderness OR fever I like to treat for 14 days of abx. If pt had uncontrolled n/v with or without fever pt is admitted for IV abx.

In medicine it is not black or white. But make sure you learn to take good hx, exam and defend your clinical decision with your clinical reasoning.

 

[VA Hopeful Dr]

UTI with any systemic findings or CVA tenderness I would call pyelonephritis. Keep in mind, though, that not all pyelonephritis needs admission + I've abx, just don't treat it with macrobid or fosfomycin.

Agreed

 

[OveractiveBrain]

So I've had 2 patients present on a Family rotation like this and after scouring uptodate, etc I still don't really know the answer (and the attending was less than helpful). So I've had 1 Adult male and female present with findings that I consider to be Amex of cystitis vs pyelonephritis, but I wondr if theres a better to discriminate these two. Obviously, classic pyelonephritits sx included fever, chills, and flank pain whereas my understanding of cystitis is that it typically does not have systemic symptoms, mostl just dysuria, some blood maybe, and suprapubic pain. Both patients had 2/3 (chills and possible flank vs side/back pain, which seems hard to discriminate also, nausea, hadaches...) They also had suprapubic pain and a positives for bacteria.. So my deduction was cystitis and ascending pyelonephritits despite being afebrile. I think in 1 of the 2, he was normotensive but rrs in the 20s and slight tachycardia also.

In both, my attending felt like it was just cystitis with systemic findings and ended up prescribing meds that primarily target the bladder. I don't what happened to these folks, but was wondering what you guys thought. I know you can be afebrile with pyelonephritits at the extremes of age (babies and old folks), but what about your typical adult who seems otherwise healthy without know immunosuppressive, etc? Has anyone else seen this picture before cause it seems pretty common.

Oh wise peers, help me out!

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[VenusinFurs]

Do they not actually look at WBC casts in the real world to make a differential between the two or is that another useless STEP 1 factoid?

This is outpatient world, so we're probably just talking about a UA in the office without microscopy.