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Infected Obstructed Kidney Emergency — ESENeph MCQ

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EasyAcute Kidney InjuryInfected Obstructed Kidney EmergencyESENeph

A 42-year-old woman with type 2 diabetes develops a unilateral swollen kidney (14 cm) with perinephric stranding on CT. She has fever 39.5°C, loin pain, and rising creatinine. Blood cultures grow E.coli. Urine shows pyuria. An obstructing ureteric stone is seen on the symptomatic side. What are the two urgent priorities?

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Correct answer: D — IV antibiotics AND urgent decompression of the obstructed infected system (nephrostomy or ureteric stent)

An infected obstructed kidney is a urological emergency. The two urgent priorities are: (1) IV broad-spectrum antibiotics; and (2) urgent drainage of the obstructed system (percutaneous nephrostomy or retrograde ureteric stent). Without drainage, antibiotics alone cannot adequately treat the infection as the infected urine is trapped. Delaying drainage risks septic shock, renal abscess, and permanent kidney damage. Definitive stone treatment is performed once the infection is controlled.

Reference: NICE NG118 2019 – Renal Stones; EAU 2024 – Urological Emergencies