The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis?
A. Myoglobinuria
B. Ketonuria
C. Pyuria
D. Low white blood cell (WBC) count
Correct Answer: C. Pyuria
Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. On urinalysis, one should look for pyuria as it is the most common finding in patients with acute pyelonephritis. Proteinuria and microscopic hematuria may be present as well on urinalysis. Blood work such as a complete blood cell count (CBC) is sent to look for an elevation in white blood cells.
Option A: The complete metabolic panel can be used to search for aberrations in creatinine and BUN to assess kidney function. All patients with suspected acute pyelonephritis should also have urine cultures sent for proper antibiotic management.
Option B: Ketonuria indicates a diabetic state. A good history and physical is the mainstay of evaluating acute pyelonephritis, but laboratory and imaging studies can be helpful. A urinary specimen should be obtained for a urinalysis.
Option D: The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low. Though the mechanism in which renal scarring occurs is still poorly understood, it has been hypothesized that the adhesion of bacteria to the renal cells disrupts the protective barriers, which lead to localized infection, hypoxia, ischemia, and clotting in an attempt to contain the infection.
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