Urinary Disorders Q 1

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Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis?

  

    A. Jaundice and flank pain

    B. Costovertebral angle tenderness and chills

    C. Burning sensation on urination

    D. Polyuria and nocturia

    

    

Correct Answer: B. Costovertebral angle tenderness and chills

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Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys. Pyelonephritis occurs as a complication of an ascending urinary tract infection which spreads from the bladder to the kidneys. Symptoms usually include fever, flank pain, nausea, vomiting, burning with urination, increased frequency, and urgency.

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Option A: Jaundice indicates gallbladder or liver obstruction. Dysfunction in prehepatic phase results in elevated serum levels of unconjugated bilirubin while insult in post hepatic phase marks elevated conjugated bilirubin. Hepatic phase impairment can elevate both unconjugated and conjugated bilirubin.

Option C: A burning sensation on urination is a sign of lower urinary tract infection. Symptoms of uncomplicated UTI are pain on urination (dysuria), frequent urination (frequency), inability to start the urine stream (hesitation), sudden onset of the need to urinate (urgency), and blood in the urine (hematuria). Usually, patients with uncomplicated UTI do not have fever, chills, nausea, vomiting, or back pain, which are signs of kidney involvement or upper tract disease/pyelonephritis.

Option D: Nocturnal polyuria as a cause of nocturia is more prevalent in older patients, while in younger patients, a decreased nocturnal bladder capacity is the more common etiology. Caffeine and excessive oral fluid intake in the evenings, as well as alcoholism, can contribute significantly to this disorder. It is also associated with congestive heart failure, obstructive sleep apnea, evening use of diuretics, peripheral edema, high dietary salt intake, and chronic venous insufficiency of the lower extremities.

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