The presence of fever suggests upper urinary tract infection. 5 RBC per hpf in a centrifuged urine sediment from a catheterized specimen. Confirm a positive dipstick by microscopic exam. BUN,creatinine, urine culture, cystoscopy, renal ultrasound . If proteinuria is present obtain 24h urine for protein and creatinine.
Most stones pass with conservative management i.e. hydration, analgesics.
Undiagnosed patients should have repeat urinalysis with or without cytology every 6 months, and cystoscope with IVP every other year. Bed rest with BRP Regular diet as tolerated LABS Urine and blood cultures X 2 during febrile episode,CBC with diff, SMA7. If recurrent pyelonephritis, or no response after 48 hours of IV antibiotics evaluate for stone. Macrodantin po qhs until 6 weeks postpartum,8-12 glasses of water per day. S. faecalis doesn't do it.