Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.

In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.

Infection in the kidneys may spread to the bloodstream—a serious condition called sepsis—though this is also uncommon.



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You perform joint aspiration on a patient with a painful, swollen knee. Microscopic examination of the fluid shows rhomboid-shaped, positively birefringent crystals. Which one of the following is the most likely to alleviate the patient's acute symptoms?

The correct answer is D.

 This patient likely has pseudogout—calcium pyrophosphate deposition disease. Remember, gout crystals are sharp (and hurt more—a good way to remember this) and negatively birefringent; pseudogout crystals are rhomboid and positively birefringent. Treatment of pseudogout consists of oral NSAIDs or oral or intra-articular steroids. One can have coexistent septic and crystalline joint disease (not uncommon), but it sounds like our patient just has pseudogout. Allopurinol or topical creams will not work either acutely or long term. Colchicine can be useful in long term treatment of pseudogout (though it is not as effective as in gout). Acetaminophen is less effective than NSAIDs or steroids because it is not an anti-inflammatory. 



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