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Pyelonephritis 849

Advanced or Confirmatory Testing can be made based on results of culture • Crusts secondary to excoriations are
• Skin biopsies for histopathologic evaluation and sensitivity testing, which is strongly frequently seen in atopic dermatitis, food
VetBooks.ir indicated when • Antifungal therapy: itraconazole 5 mg/kg PO • Treat for and rule out pyoderma before taking Diseases and Disorders
intolerance, and flea bite dermatitis.
recommended.
• Bacterial culture and sensitivity (C&S)
biopsies.
○ Bacilliform bacteria are noted on cytologic
q 24h for 3-6 weeks (pulse or continuous)
exam
dermatophytosis.
○ Poor response to previous appropriate is a good first-choice therapy for cats with Technician Tips
antibiotic therapy • Antiparasitics: choice depends on the parasite • Cytologic exam of pustular content is best
○ Antibiotic treatment in the past 6 months identified performed by rupturing the top of the
or another known risk factor for antimi- • Glucocorticoids for immune-mediated pustule with a needle or the sharp corner
crobial resistance (p. 653) disorders such as juvenile cellulitis, pem- of the glass microscopic slide. Smears are
• Endocrine tests if history and physical exam phigus complex, eosinophilic folliculitis/ then done by direct impression on the open
suggest underlying endocrinopathy furunculosis, eosinophilic pustulosis pustule.
• Serologic testing for FIV, feline leukemia ○ Prednisone/prednisolone is a common first • Bacterial culture samples should be made
virus (FeLV), and leishmaniasis based on choice for dogs, usually for 10-14 days at from pustular content whenever possible
history and environment high induction dosage (2-4 mg/kg PO q or by vigorously rubbing the swab under a
24h), then gradually tapered according to freshly lifted crust.
TREATMENT clinical response. Prednisolone is preferred
for cats. Client Education
Treatment Overview In lay terms, pustules are pimples, and crusts
Pyoderma is the most common cause of PROGNOSIS & OUTCOME are scabs.
pustules and crust formation in dogs. Most
pyodermas are successfully addressed with • Varies according to the disease SUGGESTED READING
antibiotic therapy. Because causes of crusting • Excellent for most parasitic and infectious Miller WH, et al: Diagnostic methods. In Miller
and pustular skin diseases are often infectious skin diseases WH, et al, editors: Muller and Kirk’s Small animal
or parasitic, glucocorticoids should not be used • Excellent for some immune-mediated skin dermatology, ed 7, St. Louis, 2013, Saunders, pp
until a final diagnosis has been reached. diseases such as juvenile cellulitis, eosino- 57-107.
philic folliculitis, and furunculosis
Acute General Treatment AUTHOR: Caroline de Jaham, DMV, MScV, DACVD
EDITOR: Manon Paradis, DMV, MVSc, DACVD
Depends on the cause of the disorder: PEARLS & CONSIDERATIONS
• Antibiotic therapy: common empirical
choices include cephalexin 25-30 mg/kg PO Comments
q 12h or amoxicillin-clavulanate 15-20 mg/ • Crusts alone are noted in certain diseases,
kg PO q 12h, usually for 1-2 weeks beyond such as in cornification disorders or zinc-
resolution of lesions. A more specific selection responsive dermatosis.

Pyelonephritis Client Education
Sheet

BASIC INFORMATION • Perineal urethrostomy ASSOCIATED DISORDERS
• Urolithiasis • Acute kidney injury
Definition • Vulvar conformational abnormalities • Chronic kidney disease (CKD)
Inflammation of the renal pelvis and inter- Functional abnormalities: • Hypokalemia (cats)
stitium is typically associated with bacterial • Urine retention (>0.25 mL/kg after complete • Bacterial cystitis
infection. Acute pyelonephritis is uncommon; voiding) • Urolithiasis
chronic pyelonephritis is more common but • Urine reflux due to increased intravesicular • Hydronephrosis
often clinically inapparent. pressure Clinical Presentation
• Urinary incontinence
Synonym • Isosthenuria, hyposthenuria (any cause) DISEASE FORMS/SUBTYPES
Pyelitis • Immunocompromise • Ascending pyelonephritis: most common
• Indwelling urinary catheter or repeated • Hematogenous pyelonephritis: rare; may be
Epidemiology catheterization sequela of septicemia
SPECIES, AGE, SEX Lower genitourinary tract infection: • Acute pyelonephritis: less common, often
• Dogs and cats are susceptible, with females • Dogs and cats: various bacteria; Escherichia causes systemic illness
predisposed. coli most common isolate in urinary tract • Chronic pyelonephritis: more common, often
• Most common in older animals or in younger infections (UTIs) insidious
animals with predisposing cause (e.g., • Fungal and yeast pyelonephritis possible,
congenital urinary malformations, uroliths). especially in immunocompromised animals HISTORY, CHIEF COMPLAINT
• Bacterial prostatitis: intact male dogs Clinical signs may be absent; chronic pyelone-
RISK FACTORS phritis can be a complicating factor in CKD.
Anatomic abnormalities: CONTAGION AND ZOONOSIS When present, clinical signs may include
• Ectopic ureter(s) Rarely, shared clones of bacteria involved in • Polyuria and polydipsia (PU/PD; acute or
• Urethral/ureteral obstruction UTIs have been found in people and their chronic pyelonephritis)
• Hydroureter/hydronephrosis dogs. • Malaise (usually acute pyelonephritis)

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