Case of UTI with AKI but denies any symptoms of UTI

A 75 year old female under treatment from elsewhere for UTI and CAD Chief Complaints She is unable to walk, feeling discomfort in left flank and mild fever too History She was started levoflox 500mg OD along with other drugs like wysolone, lorazepam, nitroglycerin, olmesartan etc since 10 February, and at that time she had 25 to 30 pus cells in urine and her S.Cr was 2.41 She has had analgesics for a brief time too few months back Vitals 07.03.2021 BP 100/80 P - 133/min Hb - 12.5 TLC - 17000 USG W/A - Raised echogenecity in both kidneys Management I have started her on Piptaz 4.5 gm TDS, Levoflox 100ml OD Kindly guide me in taking this case further, regarding management, like does piptaz need dose titration etc

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In this case creatinine is 2.08 and BUN calculated is 52 Ratio of BUN to Serum creatinine is more than 20:1 , this indicates that rise in creatinine is prerenal type of renal failure Prerenal type of renal failure indicate that rise in creatinine is not because of renal pathology but it is because of decreased blood supply to kidney because of severe infection In prerenal type of renal failure dose of antibiotic is to be based on baseline creatinine If baseline creatinine is normal then there is no reduction in dose of antibiotic is required In this case it is likely that this patient is having acute pyelonephritis which is causing severe urinary tract infection and rise in creatinine. Left flank pain is because of acute pyelonephritis I would advise 1) Start on tablet urotone one tablet three times a day, tablet urotone will help in better drainage of urine and therefore crucial in treatment of acute pyelonephritis 2) per urethral Catheterization - this is also crucial as it will help in better drainage of urine which is very crucial in treatment of acute pyelonephritis 3) To be on safer side I would consider that her basal creatinine is normal and give her full dose of antibiotic In this case full dose of piperacillin tazobactum is 4.5 gm IV every 6 hourly. This is because giving her lesser dose would make her drug resistant and her infection would not resolve. Progression of infection in her can be dangerous. I would repeat creatinine after 24 hours and would adjust the dose of antibiotic based on repeat creatinine. 4) It is likely that she is diabetic and control of blood sugar with insulin is Vitally important to control infection 5) Finally CT scan plain KUB without contrast can be done to look for status of both kidneys 6) Urine culture and sensitivity, change antibiotic based on report

sir how much dose of urotone give??
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Need to titrate the dose of piptaz as per creatinine clearance. May be 2.25 gm is preferred TDs . Send urine culture sensitivity test.

AKI Leucocytosis Deranged KFTS Yes inj piperacillin+inj tazobactum 4.5 gm tds Inj lasix Keep monitoring and electrolytes balance

Thanx dr Sandeep Ghodekar
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Crf Do GFR usg kub Leucocytosis Uti Chances of pyelonephritis Urine culture and sensitivity

the symptoms of high creatinine can vary depending on the cause. In many cases, medications can help resolve high creatinine levels by treating the condition that's causing the increase. Some examples include antibiotics for a kidney infection or medications that help control high blood pressure

Prerenal azotemia. Meropenem may be a better option as empiric monotherapy along with fluids and electrolytes correction. Meanwhile, CT imaging of abdomen and pelvis may be required +/- CT renal angiogram, urine c/s, CRP.

Urinalysis Urinne forr C/S after results of reports start treatment Consult Nephrologist

This PT need low dose of pippercilline we can reduce 2.25 ,GM bds 5to7days ,Cteatineclearence is needed by avoiding Alcohol eggs smoking increase use of pinnapple

NEED'S.. URINE C AND S..EXAMINATION..AND .. TREATMENT ACCORDINGLY..

Seems to be steroid and analgesics induced AKI with UTI Dont go with Piptaz, Continue inj. Levoflox 750 mg OD, inj. Metro 500mg TDS Send Urine for C/S and as per that report alter the antibiotics Supportive treatment Fever management Avoid neurotoxic drugs Monitor intake and output Calculate creatinine clearance Take a nephrologist opinion Avoid NSAIDS, ARBs, ACE inhibitors, steroids. Can use diuretics as per creatinine clearance Monitor BP, pulse , spo2, temperature regularly hourly Can give antispasmodic for pain flank pain relief

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