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What Causes Worsening Test Report Results Despite Receiving Treatment For Kidney Infection?
Question: Age 85 female no diabetes. recently admitted her in a hospital due to kidney infection (creatinine 4.5) & after 4 days creatinine became 2 but WBC count became >23.2 ( initially it was 14.7) leading to suspicision of a bigger problem. went for CT on doc's advice. attaching report. plz suggest further course of action based on the report.
Brief Answer:
Possible Pyelonephritis ( Acute kidney Infection)
Detailed Answer:
Hello,
As per your description and reports, the possibility of an acute kidney Infection is very high.
This is manifested as very high WBC count.
This should be considered as a medical emergency and should be treated in an ICU set up at the earliest with intravenous antibiotics.
Dialysis may also required.
It's advisable to get the required expert care under the supervision of a Nephrologist.
Post your further queries if any.
Thank you
Possible Pyelonephritis ( Acute kidney Infection)
Detailed Answer:
Hello,
As per your description and reports, the possibility of an acute kidney Infection is very high.
This is manifested as very high WBC count.
This should be considered as a medical emergency and should be treated in an ICU set up at the earliest with intravenous antibiotics.
Dialysis may also required.
It's advisable to get the required expert care under the supervision of a Nephrologist.
Post your further queries if any.
Thank you
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir,
Is it possible to have a CT contrast with serum creatinine value at 2?? because doc. suggested that only at 1.3 we can go for that. once CT contrast is done everything will be clear wrt correct diagnosis...the doc said. any suggestions plz coz we want to go for CT contrast for my grandmother.
Is it possible to have a CT contrast with serum creatinine value at 2?? because doc. suggested that only at 1.3 we can go for that. once CT contrast is done everything will be clear wrt correct diagnosis...the doc said. any suggestions plz coz we want to go for CT contrast for my grandmother.
Brief Answer:
Findings on non-contrast CT scan are sufficient to initiate empirical therapy
Detailed Answer:
Hello,
CT with contrast even though an imaging procedure of choice, cannot be done in presence of increased creatinine levels.
In my opinion, the findings on non-contrast CT scan are sufficient enough to offer the relevant treatment.
Post your further queries if any.
Thank you
Findings on non-contrast CT scan are sufficient to initiate empirical therapy
Detailed Answer:
Hello,
CT with contrast even though an imaging procedure of choice, cannot be done in presence of increased creatinine levels.
In my opinion, the findings on non-contrast CT scan are sufficient enough to offer the relevant treatment.
Post your further queries if any.
Thank you
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hello,
yesterday stent procedure done on kidneys & infection is removed. Doc saying that 2 more days of observation is needed. 3 days back infection in the intestines also removed through a pipe. Doc is now saying that question of tumours can be ruled out as most of the infection is removed. now wbc count reduced to 14.3 (it was 20.4 before the stent). serum creatinine at 1.9( it was 1.89 before the stent). i am still preferring a CT with contrast if creatinine comes down to 1.1 or 1.2 coz it gives an a accurate picture but Doc is saying it may not be required & suggesting an ultrasound to evaluate the condition with 3 more days in observation. kindly guide us regarding this one.
yesterday stent procedure done on kidneys & infection is removed. Doc saying that 2 more days of observation is needed. 3 days back infection in the intestines also removed through a pipe. Doc is now saying that question of tumours can be ruled out as most of the infection is removed. now wbc count reduced to 14.3 (it was 20.4 before the stent). serum creatinine at 1.9( it was 1.89 before the stent). i am still preferring a CT with contrast if creatinine comes down to 1.1 or 1.2 coz it gives an a accurate picture but Doc is saying it may not be required & suggesting an ultrasound to evaluate the condition with 3 more days in observation. kindly guide us regarding this one.
Brief Answer:
CT scan with contrast not required
Detailed Answer:
Hello,
Since there is significant improvement noted, no further investigative work up required except ultrasound abdomen.
CT with contrast at this point can be more harmful than useful.
Post your further queries if any
Thank you
CT scan with contrast not required
Detailed Answer:
Hello,
Since there is significant improvement noted, no further investigative work up required except ultrasound abdomen.
CT with contrast at this point can be more harmful than useful.
Post your further queries if any
Thank you
Above answer was peer-reviewed by :
Dr. Remy Koshy
dear sir this is what happened to my grandmother:
age 85 female no BP & diabetes. admitted to hospital with symptoms of less urine no apetite & vomitings. docs told us kidney infection. treated for 10days with antibiotics, stent in the kidney. on 11th day tests revealed WBC at 11k & creatinine at 1.8(they were 14.3k & 4.5 respectively before admission). also went for plain CT in the process based on which stent was performed. it's been 8days since discharge & we are continuing medicines still & there is no recovery at all. no apetite except very little liquid diet & nit abke to walk & getting confused of surroundings.& yestrday went for CBP. creatinine at 0.8 & WBC at 15.8k. docs told swelling of intestines was also there(suspected kidney infection spread to intestines). even after 15days of treatment with powerful antibiotics still WBC at 15.8k(at the time of discharge it was 11k). at the time of treatment docs. even suspected of tumors but couldn't go for CT with contrast as creatinine was high at that time.
urine output normal no vomitings & no fevers of which docs told us to be careful of st the time of discharge.
we are not financially sound to take her to hospital agn & also we dont trust the doctors 100%. she's experiencing pain above the ribs (right side) for the past 1week. it's getting severe day by day & we are using Odin killers. she sleeps only after getting the pain killer. we are not sure whether she's suffering from tumors or infection or both. plz guide us in diagnosis. i already uploaded the plain CT report. plz check.
age 85 female no BP & diabetes. admitted to hospital with symptoms of less urine no apetite & vomitings. docs told us kidney infection. treated for 10days with antibiotics, stent in the kidney. on 11th day tests revealed WBC at 11k & creatinine at 1.8(they were 14.3k & 4.5 respectively before admission). also went for plain CT in the process based on which stent was performed. it's been 8days since discharge & we are continuing medicines still & there is no recovery at all. no apetite except very little liquid diet & nit abke to walk & getting confused of surroundings.& yestrday went for CBP. creatinine at 0.8 & WBC at 15.8k. docs told swelling of intestines was also there(suspected kidney infection spread to intestines). even after 15days of treatment with powerful antibiotics still WBC at 15.8k(at the time of discharge it was 11k). at the time of treatment docs. even suspected of tumors but couldn't go for CT with contrast as creatinine was high at that time.
urine output normal no vomitings & no fevers of which docs told us to be careful of st the time of discharge.
we are not financially sound to take her to hospital agn & also we dont trust the doctors 100%. she's experiencing pain above the ribs (right side) for the past 1week. it's getting severe day by day & we are using Odin killers. she sleeps only after getting the pain killer. we are not sure whether she's suffering from tumors or infection or both. plz guide us in diagnosis. i already uploaded the plain CT report. plz check.
Brief Answer:
Age is an independent risk factor for recovery
Detailed Answer:
Hello,
Basically you need to understand that her recovery and functional reserve will be extremely low owing her age alone. Age here is the single most important risk factor determining the prognosis.
Recovery takes 2 to 3 weeks approximately.
CT scan shows no evidence of any tumor or malignancy.
It's important to understand that even plain CT scan does not miss the detection of any tumors as such. Hence you need not to falsely believe that CT with contrast could not be done and thus any tumor detection was missed.
Analgesics and antibiotics should be continued for 1 to 2 weeks as such.
To conclude this is a case of renal infection with minor spread to the nearby tissues of the abdomen.
No tumor is evident what so ever.
Post your further queries if any.
Thank you
Age is an independent risk factor for recovery
Detailed Answer:
Hello,
Basically you need to understand that her recovery and functional reserve will be extremely low owing her age alone. Age here is the single most important risk factor determining the prognosis.
Recovery takes 2 to 3 weeks approximately.
CT scan shows no evidence of any tumor or malignancy.
It's important to understand that even plain CT scan does not miss the detection of any tumors as such. Hence you need not to falsely believe that CT with contrast could not be done and thus any tumor detection was missed.
Analgesics and antibiotics should be continued for 1 to 2 weeks as such.
To conclude this is a case of renal infection with minor spread to the nearby tissues of the abdomen.
No tumor is evident what so ever.
Post your further queries if any.
Thank you
Above answer was peer-reviewed by :
Dr. Kampana
Fine sir now we are relieved a but. right now our concern is the pain she is getting above the ribs on the right side of the abdomen. She is not able to sleep due to this. If we give pain killer she is getting relief but only for sometime. Remaining all the symptoms associated with the renal infection are under control except the lack of appetite. Can you suggest analgesics & antibiotics for continuation for infection which we can get over the counter & also the pain killer for her pain plz..
Brief Answer:
Oral norfloxaxin may help
Detailed Answer:
Hello,
I generally prescribe a short course of oral antibiotics like Norfloxacin and analgesics like diclofenac sodium to my patients with such symptoms.
Please check with your physician if he shares my view and if can prescribe these medication to her.
Post your further questions if any.
Thank you
Oral norfloxaxin may help
Detailed Answer:
Hello,
I generally prescribe a short course of oral antibiotics like Norfloxacin and analgesics like diclofenac sodium to my patients with such symptoms.
Please check with your physician if he shares my view and if can prescribe these medication to her.
Post your further questions if any.
Thank you
Above answer was peer-reviewed by :
Dr. Prasad
Thank you sir. one final question: as u said because of her age factor it will be difficult to tell the prognosis at this stage. What may be the symptoms she will be associated with in future if she continues like this & is it advisable to take her to hospital again in due course? In the worst case scenario how long may take to face the inevitability?? Kindly guide us sir.
Brief Answer:
Monitor closely for toxic signs
Detailed Answer:
Hello,
It's important that you look for the following signs
1. New onset of high grade fever
2. Altered or fluctuating levels of consciousness
3. Sudden decrease or absence of urinary output
4. New or sudden onset of breathlessness
If she develops the above symptoms its advisable to take her to the hospital immediately.
The prognosis is difficult to predict in her case.
Hence it's important to follow her recovery closely and watch/identify for any toxic signs at the earliest.
Post your further queries if any
Thank you
Monitor closely for toxic signs
Detailed Answer:
Hello,
It's important that you look for the following signs
1. New onset of high grade fever
2. Altered or fluctuating levels of consciousness
3. Sudden decrease or absence of urinary output
4. New or sudden onset of breathlessness
If she develops the above symptoms its advisable to take her to the hospital immediately.
The prognosis is difficult to predict in her case.
Hence it's important to follow her recovery closely and watch/identify for any toxic signs at the earliest.
Post your further queries if any
Thank you
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
sir yesterday we started Norfloxacin 400 but after the first dose only she developed mild skin rash & suffered for all night. Now she is okay. Any other alternatives for this one sir?? As for the condition of the patient she is in the process of recovery with almost no symptoms. Her appetite is slowly getting back. Shall we continue with Norfloxacin?? or suggest some other else plz..
Brief Answer:
Antibiotic can be continued. But careful watch is required
Detailed Answer:
Hello,
Norfloxacin is generally well tolerated.
As the skin rash is minor and has resolved, nothing to worry much, and antibiotic can be continued.
Premedication with oral antihistamine like Levocetrizine can be given to minimise skin rash. Please check with your physician if he/she agrees with my opinion.
Post your further queries if any
Thank you
Antibiotic can be continued. But careful watch is required
Detailed Answer:
Hello,
Norfloxacin is generally well tolerated.
As the skin rash is minor and has resolved, nothing to worry much, and antibiotic can be continued.
Premedication with oral antihistamine like Levocetrizine can be given to minimise skin rash. Please check with your physician if he/she agrees with my opinion.
Post your further queries if any
Thank you
Above answer was peer-reviewed by :
Dr. Kampana
Hello sir she is recovering..that's good. everything is normal now. can you suggest if there is any chance of recurrence of this disease in future considering her age??? Actually she suffered from right obstructive uropathy, right papillary necrosis, urosepsis & acute kidney injury. will any of these bother her again??.plz clarify. what further precautions we should take regarding her kidney functioning?? and plz suggest something to get strength in her body.
Brief Answer:
Coexisting medical disorders should be well controlled.
Detailed Answer:
Hello,
The risk of recurrence of these disorders is usually low.
It's important to maintain adequate hydration, nutrition and control of blood pressure and sugar levels within the normal range to prevent such episodes again.
Periodic health checks should be carried out to identify such disturbances in the early stages.
A good nutrition will improve her general well being and strength. But it takes its own time. You need to be patient.
Post your further questions if any.
Thank you
Coexisting medical disorders should be well controlled.
Detailed Answer:
Hello,
The risk of recurrence of these disorders is usually low.
It's important to maintain adequate hydration, nutrition and control of blood pressure and sugar levels within the normal range to prevent such episodes again.
Periodic health checks should be carried out to identify such disturbances in the early stages.
A good nutrition will improve her general well being and strength. But it takes its own time. You need to be patient.
Post your further questions if any.
Thank you
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello sir this is regarding my uncle's problem: 1) Age 64 No BP No Diabetes not used to exercises & no real work. 2) Chain smoker for the past 30yrs & a long term constipation problem 3) Suffering from 6months:Dermato Phitotis 4) Got relief temporarily after using medication & again it came back 15daysago 5) Lot of itching is there 6) Also some blackishness on both forearms but no itching 7) Plz go through the medication prescribed & reports attached. Also attached the images of infection in the genital parts. Plz guide us sir regarding mdication & duration of it or any further tests needed.
Brief Answer:
Possible fungal infection of groin
Detailed Answer:
Hello,
As per your description the possibility of a fungal infection of groin is very high.
A short course of oral pills of antifungal medications may be useful.
I generally prescribe oral medications of Terbinafine to my patients with such symptoms for 2 weeks along with topical Candid B ointment.
Please check with your physician if he shares my view and if can prescribe these medications to improve his symptoms.
At the moment tests are required.
Post your further questions if any
Thank you
Possible fungal infection of groin
Detailed Answer:
Hello,
As per your description the possibility of a fungal infection of groin is very high.
A short course of oral pills of antifungal medications may be useful.
I generally prescribe oral medications of Terbinafine to my patients with such symptoms for 2 weeks along with topical Candid B ointment.
Please check with your physician if he shares my view and if can prescribe these medications to improve his symptoms.
At the moment tests are required.
Post your further questions if any
Thank you
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir recently, for almost 10days, he's been feeling loss of appetite. Went for LFT & attaching the report sir. Plz suggest medication based on the report if any problem is there wrt liver functioning.
Brief Answer:
Enzyme supplements will help
Detailed Answer:
Hello,
Liver function tests looks okay
Likewise, lossof appetite can be treated initially with enzyme supplements.
I generally prescribe oral syrup formulation of Aristozyme to my patients with such symptoms.
Please check with your physician if he shares my view and if can prescribe these medications to improve his symptoms.
In case if symptoms don't improve, it's advisable to get an ultrasound abdomen test.
Post your further questions if any
Thank you
Enzyme supplements will help
Detailed Answer:
Hello,
Liver function tests looks okay
Likewise, lossof appetite can be treated initially with enzyme supplements.
I generally prescribe oral syrup formulation of Aristozyme to my patients with such symptoms.
Please check with your physician if he shares my view and if can prescribe these medications to improve his symptoms.
In case if symptoms don't improve, it's advisable to get an ultrasound abdomen test.
Post your further questions if any
Thank you
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir yesterday & today she vomitted while taking food. i am fearing whether she developed the infection again. other than vomitings no symptoms. no temperature. urine output is good. she is conscious also. norfloxacin is being given along with the antihistamine tablets for rahes as u suggested days back. any possible sideeffects of the medicines ??can you suggest any change in medication?? plz guide us
Brief Answer:
Could be antibiotic induced Gastritis
Detailed Answer:
Hello,
Norfloxacin can cause mild nausea or vomiting due to antibiotic induced Gastritis. This can be controlled with oral antigastritis pills like Pantoprazole plus Domperidone combination.
Maintain adequate hydration.
Please check with your physician if he shares my view and if can prescribe these medications to her.
Post your further questions if any
Thank you
Could be antibiotic induced Gastritis
Detailed Answer:
Hello,
Norfloxacin can cause mild nausea or vomiting due to antibiotic induced Gastritis. This can be controlled with oral antigastritis pills like Pantoprazole plus Domperidone combination.
Maintain adequate hydration.
Please check with your physician if he shares my view and if can prescribe these medications to her.
Post your further questions if any
Thank you
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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