A 37-year-old woman arrives as ESI 2 with fever and severe right flank pain. CT shows emphysematous pyelonephritis with gas in the renal parenchyma.

Question

A 37-year-old woman arrives as ESI 2 with fever and severe right flank pain. CT shows emphysematous pyelonephritis with gas in the renal parenchyma. BP is 88/50 despite fluids, glucose is 420 mg/dL. Which of the following is the most appropriate next step in management?

Accepted Answer

Start broad-spectrum IV antibiotics and obtain urgent urology/interventional radiology consultation

Answer

Discharge on oral antibiotics

Answer

Give analgesia and repeat CT in 1 month

Answer

Treat as uncomplicated cystitis

Answer

Delay antibiotics until urine culture finalizes

Emphysematous pyelonephritis — ABEM Board MCQ

A 37-year-old woman arrives as ESI 2 with fever and severe right flank pain. CT shows emphysematous pyelonephritis with gas in the renal parenchyma. BP is 88/50 despite fluids, glucose is 420 mg/dL. Which of the following is the most appropriate next step in management?