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Pyelonephritis - acute - Management
Basis for recommendation
Dipstick tests for nitrite and leucocyte esterase
- Experts recommend urinary dipstick tests to detect nitrite and leucocyte esterase to help distinguish people with acute pyelonephritis from those with similar symptoms and signs who do not have a UTI [SIGN, 2006; COMPASS, 2007].
- Although dipstick tests are not highly sensitive and specific, they help support decisions to start immediate treatment for pyelonephritis or investigate for other causes of symptoms and signs.
Microbiological examination of urine for all people with suspected pyelonephritis
- Experts recommend sending a midstream or catheter specimen of urine for all people with suspected acute pyelonephritis to [SIGN, 2006; HPA and Association of Medical Microbiologists, 2008] to:
- Confirm the diagnosis.
- Guide an appropriate change of treatment if the infection is not sensitive to empirical antibiotics.
Clinical features suggestive of infection localized to the upper urinary tract
- In the absence of more sensitive clinical features or practical clinical tests, experts recommend diagnosing acute pyelonephritis based on evidence of a UTI in a person with loin pain or a temperature over 38°C [Tomson, 2003].
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