Browse categories and answer follow-up questions to refine your symptom profile.
Triage and immediate threats
High-risk presentation
Septic shock concern
SBP < 90 mmHg after fluids
MAP < 65 mmHg
Lactate >= 2 mmol/L
Obstructed infected system
Flank pain with anuria
Known stone with fever
Hydronephrosis on POCUS
Pregnancy with fever and flank pain
Preterm labor concern
Rapid progression risk
Immunocompromised host
Neutropenia
Transplant
Chronic high-dose steroids
Poor oral tolerance
Persistent vomiting
Inability to take oral antibiotics
Immediate stabilization
Airway and breathing
Hypoxemia management if present
Escalate if work of breathing increases
Circulation
IV access x2 if unstable
Crystalloid 20-30 mL/kg if hypotension or lactate >= 4 mmol/L (Class I, sepsis bundles)
If MAP < 65 mmHg after fluids, initiate norepinephrine infusion (Class I, sepsis bundles)
Monitoring
Continuous pulse oximetry
Cardiac monitoring if unstable
Urine output target >= 0.5 mL/kg/hr
Early antibiotics timing
Sepsis physiology
Broad-spectrum within 1 hour of recognition (Class I, sepsis bundles)
Source control planning in parallel
Non-severe pyelonephritis
Antibiotics after urine culture collected
Avoid delaying for imaging if clinically clear
Key decision points
Severity stratification
Uncomplicated pyelonephritis
Nonpregnant
No known structural or functional urinary tract abnormality
No significant immunocompromise
Complicated pyelonephritis
Obstruction
Urologic instrumentation
Indwelling catheter
Nephrolithiasis
CKD or solitary kidney
Diabetes mellitus with severe illness
Pregnancy
Male sex
Imaging threshold
Immediate imaging
Sepsis with urinary source and obstruction concern
Anuria or rising creatinine with flank pain
Persistent severe pain atypical for pyelonephritis
Delayed imaging at 48-72 hours
Persistent fever
Persistent leukocytosis
No clinical improvement on appropriate antibiotics
Consultation triggers
Urology involvement
Suspected infected obstruction requiring decompression (Class I concept for source control)
Renal or perinephric abscess concern
Emphysematous pyelonephritis concern
ICU involvement
Vasopressor requirement
Worsening mental status
Rising lactate or refractory hypotension
Obstetrics involvement
Pregnancy with pyelonephritis
Contractions or vaginal bleeding
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.