A patient with a ureteric stone, fever and signs of infection has an obstructed, infected kidney until shown otherwise. Antibiotics alone do not reach an obstructed collecting system well, and the patient can deteriorate quickly into urosepsis.
The priority is urgent decompression, by a ureteric stent or percutaneous nephrostomy, alongside antibiotics and resuscitation. Definitive stone treatment waits until the infection has settled. Check renal function and lactate, and take blood and urine cultures before antibiotics where it does not delay treatment.
- Treat fever with an obstructing ureteric stone as a urological emergency.
- Arrange urgent drainage by stent or nephrostomy, not antibiotics alone.
- Defer definitive stone treatment until infection has resolved.
- Take cultures and check renal function and lactate early.
Why it matters
Delayed decompression of an infected, obstructed kidney is a preventable cause of death from urosepsis.
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