Pielonefrite aguda - diagnóstico clínico e manejo inicial!

Patient with fever, chills, lower back pain, and lower urinary tract symptoms: when to suspect pyelonephritis, who needs hospitalization, and which antibiotic to start with? In this video, I present an objective step-by-step guide to clinical diagnosis, severity stratification, and antimicrobial regimen selection—even in resource-limited settings. What you will learn: ✔ Differentiation between lower UTI and pyelonephritis: systemic signs, lower back pain, and Giordano's sign. ✔ Essentially clinical diagnosis and when to order tests (complete blood count, urea/creatinine, electrolytes, urinalysis, urine culture). ✔ Ultrasound of the kidneys and urinary tract: when to request it and what to look for (hydronephrosis, collection/abscess, obstruction). ✔ Severity factors: advanced age, immunosuppression, single kidney, kidney stones, previous antibiotic use, recurrent UTIs. ✔ Criteria for hospitalization/observation 24–48h and when to activate sepsis (urosepsis) protocol ✔ Initial antibiotic in the ER: IV ceftriaxone (1 g every 12 hours) or ciprofloxacin (PO/IV); alternatives and precautions (gentamicin/nephrotoxicity). ✔ Outpatient treatment: PO ciprofloxacin (5–7 days), levofloxacin or amoxicillin/clavulanate in selected cases. ✔ Obstruction due to calculi: urological emergency (double J stent/obstruction removal). ✔ Analgesia and support: antipyretics, avoid NSAIDs; hydration and clear instructions to return in 48–72 hours. ✔ How to document instructions and monitor for therapeutic failure/resistance (importance of urine culture before antibiotic administration when possible). ➡️If this content improves your practice, subscribe to the channel, activate the bell, and share it with colleagues. Comment on your approach to pyelonephritis with lithiasis and what topics you would like to see in future videos. ⚠️Content intended for physicians and medical students. Do not use for self-diagnosis or self-medication; each case requires individualized evaluation. #Pyelonephritis #Urology #InfectiousDiseases #MedicalEmergency #InternalMedicine #AntibioticTherapy #Urosepsis #PhysicianInPractice #MedicalEducation