Differential Diagnosis Primary diagnosis:Pyelonephritis

Differential Diagnosis

Primary diagnosis:Pyelonephritis

Pyelonephritis refers to the upper urinary tract infection (UTI) The condition is associated with the inflammation of the renal pelvis and renal parenchyma of both of the kidney. Patients with this condition tend to develop the fever (38 degree Celsius) as well as other symptoms and signs such as lumbar tenderness, flank pain among others (Tabasi, Karam, Habibi, Mostfavi $ Bouzari, 2016). In the United States, in each year, more than a quarter million cases are diagnosed. More than 200, 000 patients are hospitalized as a result of complications associated with pyelonephritis (Sommers & Fannin, 2015). Pyelonephritis is caused by the invasion of pathogenic virus, fungi or bacteria. The infection affect medulla, calyces, and renal pelvis primarily progress to urinary tract as the pathogenic microorganism ascent from the bladder to the uterus (Sommers & Fannin, 2016). Patients with chronic illness such as hypertension, diabetes among others are more likely to develop the condition compared to other people. The long-term illness is more common in an elderly population. It means therefore that Leroy is likely to develop the condition considering he is 70 years of age.

The most common symptoms linked with the condition include vomiting, nausea, costovertebral angle pain, and fever. It is paramount to evaluate the color of the urine for the patients with pyelonephritis. This includes assessing for the presence of blood in the urine, cloudiness and four smell in urine. It is of important also to assess and carry out deep palpation or perform percussion over the costovertebral elicit in areas with tenderness.

The diagnostic testing for this condition involves a series of analysis. Some of the tests include contrast-enhanced spiral/helical computed tomography, renal ultrasound, creatinine, blood urea nitrogen, complete blood count, blood culture and urinalysis (Sommers & Fannin, 2015). The objective of the therapy is to eliminate the pathogenic microorganism responsible for infection as well as relieving of the presence of the obstruction. The necessity of obstruction permits the use of urinary catheterization. If the underlying defect is responsible for calculi, reflux or obstruction, surgery is carried out (Majdoub, Khallouk, &Farih, 2016)

Urinary Tract Infection (UTI)

It is one of the most often occurring bacterial infection is elderly population Bing-Jonsson, & Tonnessen, 2017). The National Health Survey of 2007, in the United States, on a yearly basis, nearly two million patients visits the ED as a result of (UTI) (Lee, Lee, Jeong, Kim, &Ahn, 2014). The most common pathogenic bacteria that is extracted from most patients include gram negative pathogenic strains of E. coli or Enterobacteriaceae. Gram-positive pathogenic strains of Proteus mirabilis and staphylococcus and streptococcus are also common (Reis et al., 2016). The most common symptoms associated with UTI include pain during urination, frequent urination, fever. Febrile UTI is easily treated without much complication (Lee et al., 2014). In elderly patients, symptoms such as falling tendency, dizziness, confusion, vaguer symptoms are often common (Bing-Jonsson & Tonnessen, 2017). Diagnostic include urine culture to determine the pathogenic microorganism responsible for infection and dipstick. The negative predictive value associated with the use of dipstick analysis for nitrate and leucocyte is approximate 100 percent. This method, as opposed to urine culture or urinalysis, can effectively rule out the urinary tract infection (Ajayi & Radhakrishnan, 2016). The condition has treated the use of antibiotics that are composed of synthetic, semi-natural or natural compounds. They are often bactericidal (Reis et al., 2016). The most common and effective antibiotics used for the treatment of UTI include broad-spectrum levofloxacin. The antibiotics with greater activity wide range of gram-negative bacteria and community acquired UTI are often used. They include the combination of sulfamethoxazole and trimethoprim, aminoglycosides, fluoroquinolones, b-lactam among others.

Kidney stones

Renal calculosis is the condition caused by many factors (multifactorial problem) and initiates with the formation of microcrystal present in urine. The condition terminates with the production of mature calculus in the kidney (Kakkar, Kakkar, Lal, &Singla, 2014). Out of many extrinsic and intrinsic factors that play a bigger role in renal calculosis etiology, the leading causes of the conditions are mineralization inhibitors present in the body fluid such as serum and urine. The best imaging study employed in the confirmation of kidney stones during diagnosis include Computed tomography (CT). Approximate 12% of the patients with are diagnosed with CT scan are found to have kidney stones. The most common sign and symptom of the kidney stone include flank pain (Kakkar et al., 2014). The most common treatment for the patients of the condition include Extracorporeal Shock Wave Lithotripsy (ESWL) and has proved to be more successful compared to other methods (Prakash et al., 2017).

Additional test to confirm diagnosis

I would recommend for the patient to undertake CT scan. I would also recommend the patients to undertake urinary culture to determine specific pathogenic bacteria responsible for the infection. The urinary culture would be important in determining the best antibiotic to employ in the treatment of the condition (Sommers & Fannin, 2015). Other important tests that can be carried out include blood count, blood culture among others.

The chosen pharmacological treatment and doses and the chosen prescription mechanism of action

The severity of the illness determines the antibiotic choice for treatment of pyelonephritis. The considered choice for treatment of illness according to research is carbapenems (Park et al., 2014).  The drug should be used judiciously as a result of the prevalence of resistance of carbapenem-resistant (Park et al., 2014). Other non-carbapenem antibiotics employed in the treatment of the condition include fluoroquinolones, aminoglycosides among others.

In this case, I would start Leroy with Ciprofloxacin. The fluoroquinolones belong synthetic groups of antibiotics and are broad spectrum (Fu et al., 2014).  Ciprofloxacin inhibits the DNA synthesis of bacteria through the inhibition of type two DNA topoisomerase. The enzyme plays a crucial role replication, recombination, and transcription of the bacterial DNA. The antibiotic exhibits cytotoxicity effects against some of the tumor activity.

In this case, I would assess if Leroy renal function is within the normal limit. The first dose I would recommend the first dose of intravenous administration of 400 mg.  I would also recommend 50 mg/kg as well as 100mg/kg PO (Shivashankar, Purushotham, & Mangala, 2016). I would recommend the change of antibiotic therapy if Leroy isn’t improving after a period of seven days.





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