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Pyelonephritis - acute - Management
When should I arrange admission for a person with acute pyelonephritis?

  • Admit people who:
    • Are significantly dehydrated or who are unable to take oral fluids and medications.
    • Have signs of sepsis, including:
      • A temperature greater than 38°C or less than 36°C, and
      • Marked signs of illness (such as impaired level of consciousness, perfuse sweating, rigors, pallor, significantly reduced mobility), or
      • Significant tachycardia, hypotension, or breathlessness.
    • Are pregnant and pyrexial.
    • Are frail, elderly residents in care homes who have recently been hospitalized or who have had recurrent urinary tract infection.
    • Fail to improve significantly within 24 hours of starting antibiotics.
  • Consider admitting people who are able to take oral fluids and medications if they are pyrexial and have a risk factor for developing a complication. In the absence of any widely accepted admission criteria, clinical judgement on when to admit is required. A low threshold is required for people with:
    • Immunocompromise, due to immunosuppressant drug use, cancer, cancer therapies, or AIDS.
    • A foreign body within the renal tract, including renal stones and ureteric or nephrostomy catheters.
    • Abnormalities of renal tract anatomy or function, including vesico–ureteric reflux and polycystic kidney disease.
    • Diabetes.
    • Renal impairment.
    • Advanced age.
  • Manage in primary care those people with acute pyelonephritis who are:
    • Pyrexial but have no risk factors for developing a complication from acute pyelonephritis.
    • Apyrexial, with or without risk factors for developing a complication.

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