American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition is an indication for hospitalization of a patient with acute pyelonephritis?

1. Recent urinary tract infection

2. Stable vitals

3. Presence of kidney stones

4. History of diabetes

The correct answer is: Presence of kidney stones

The indication for hospitalization of a patient with acute pyelonephritis is significantly influenced by the presence of kidney stones. When kidney stones are present in conjunction with acute pyelonephritis, there is a risk of obstructive uropathy, which can lead to complications such as renal abscess or sepsis. The obstruction caused by the stones can impede the flow of urine, resulting in further infection and potentially worsening the patient's condition. In contrast, a recent urinary tract infection without other complications or any significant mproving or stable vital signs typically does not necessitate hospitalization. Stable vitals indicate that the patient is not experiencing any severe systemic effects from the infection. Likewise, while a history of diabetes can complicate infections and may increase the risk of severe disease, it alone does not serve as a definitive indication for hospitalization without other concerning factors or clinical instability. Thus, the presence of kidney stones specifically raises the severity of the situation and underscores the need for inpatient management to monitor and intervene as necessary.