Pyelonephritis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Pyelonephritis is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade fever, dysuria and pain radiating to the flank. A sonopalpation test, which is an ultrasound guided palpation, is usually positive and helpful in detecting the exact anatomical structure and position as the cause of tenderness.
Physical Examination
The following features can be found during a physical examination of a patient with pyelonephritis. The patient must be in supine position to facilitate a proper examination.[1][2][3][4]
Appearance of the Patient
- Patients with pyelonephritis are usually in distress.
- Patient may have hands on abdomen or back at the area of tenderness.
Vital Signs
The following variations in vital signs can be seen in pyelonephritis:
- Fever may be present
- High Blood pressure as an early finding of kidney involvement
- Hypotension
Skin
- Skin examination of patients with pyelonephritis is usually normal.
HEENT
- HEENT examination of patients with pyelonephritis is usually normal.
Neck
- Neck examination of patients with pyelonephritis is usually normal.
Lungs
- Pulmonary examination of patients with pyelonephritis is usually normal.
Heart
Abdomen
- Costovertebral angle tenderness
- Positive sonopalpation test of the kidney[5]
- Suprapubic tenderness
Digital rectal examination (DRE)
A digital rectal exam is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum.
- If pyelonephritis is suspected in men, a DRE helps to differentiate if the obstruction is due to a swollen prostate gland.
Back
- Costovertebral angle tenderness
Genitourinary
The following findings may be found on genitourinary examination of a patient with pyelonephritis:[2][6][7]
- Suprapubic tenderness
- Urethral discharge (if the cause is urethritis)
- Inguinal lymphadenopathy
- Examination of the scrotum and the pubic area must be done
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- The following neurological signs can rarely be witnessed in elderly:
Extremities
- Extremities examination of patients with pyelonephritis is usually normal.
References
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
- ↑ 2.0 2.1 Colgan R, Williams M (2011). "Diagnosis and treatment of acute uncomplicated cystitis". Am Fam Physician. 84 (7): 771–6. PMID 22010614.
- ↑ Chang SL, Shortliffe LD (2006). "Pediatric urinary tract infections". Pediatr Clin North Am. 53 (3): 379–400, vi. doi:10.1016/j.pcl.2006.02.011. PMID 16716786.
- ↑ Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW; et al. (2008). "Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases". Korean J Intern Med. 23 (3): 140–8. doi:10.3904/kjim.2008.23.3.140. PMC 2686968. PMID 18787367.
- ↑ Faust JS, Tsung JW (2017). "Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis". Crit Ultrasound J. 9 (1): 1. doi:10.1186/s13089-016-0056-6. PMC 5215196. PMID 28050884.
- ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.