Ascending

A 33-year old woman presents with fever and right-sided flank pain for one day. There is no history of frequency, urgency, dysuria, or hematuria, and no bowel symptoms are present.

Her medical history is unremarkable. A routine screening for diabetes, hypertension, and dyslipidemia performed last month was negative on all counts.

Her surgical and gynecological histories are also unremarkable. Her last menstrual period was two weeks ago, and she is currently in a monogamous relationship. There is no history of sexually transmitted infections.

She drinks socially and has never smoked.

Select Relevant Investigations
Urinalysis and urine cultures

Performed

Urinalysis:
Pus cells: Field full
RBC: 10-15/hpf
WBC casts: Positive
Leukocyte esterase test: Positive

Urine Cultures:
Results will be available in 48 to 72 hours
Ultrasound KUB

Performed

The ultrasound scan appears normal, with no imaging findings suggestive of calculi, ureteral obstruction, hydronephrosis, or abscesses.
Renal profile

Performed

BUN: 12 mg/dL (6 - 23)
Creatinine: 0.79 mg/dL (0.6 - 1.0)
Noncontrast CT Abdomen

Performed

The CT scan shows no abnormalities of the kidneys, liver, gallbladder or pancreas.

Select Relevant Management
Admit patient
Oral antibiotics
Urology Referral
ACE inhibitors