P0277PATIENTS WITH PYELONEPHRITIS PRESENTING ONLY WITH LOWER URINARY TRACT SYMPTOMS

Abstract Background and Aims The rate of acute pyelonephritis (APN) is assessed at almost 9– 11 cases for every 10,000 tenants. Its prevalence is more in developing countries and among those having low socioeconomic status. The demographics of the population in our region is different from the western population with multiple factors such as delayed presentation to hospital, varying socioeconomic status, malnutrition and lack of knowledge about basic treatment leads to increased morbidity and mortality as compared to western population. To the best our knowledge this will be the first study of its kind to describe the frequency of pyelonephritis without upper urinary tract symptoms in hospital setting. AIM To determine the frequency of pyelonephritis in patients presenting only with low urinary tract symptoms, at a tertiary care hospital, Karachi. Method Study is conducted at a tertiary care hospital charts and files were reviewed from 01-11-2018 to 28-02-2019 for all the patients having diagnosis of APN from medical record files. Results In our study total five hundred and twenty-one (n=521) patients were included (n=492 (94%) of the participants were suffering from pyelonephritis. Approximately, 22.8% of the patients showed absence of both flank pain and costo-vertebral tenderness but were diagnosed with pyelonephritis on the basis of CT/MRI as presented. While 27% of the patients reported both upper urinary tract symptoms and were also positive on CT-MRI. It is also witnessed that 24% and 16% of the patients either reported flank pain or costo-vertebral tenderness respectively. Insignificant association between gender, age, comorbid with pyelonephritis. While, the total leucocytes count was significantly related with CT/MRI. Conclusion Our study showed significant number of patients having pyelonephritis in the absence of any upper tract symptoms. Ignoring the diagnosis as serious can lead to under treatment, possibility of higher rate of re-admissions or poor selection of initial antibiotics. Whereas, other side of the spectrum haunts with higher investigation cost of imaging and broad spectrum use of antibiotic for every patient presenting with just urinary tract infection in Emergency department. A balance should be devised to equilibrate the balance between two extremes.