Which presentation is typical of pyelonephritis?

• A. Dysuria and frequency
• B. Suprapubic pain
• C. Hematuria without systemic symptoms
• D. Fever with flank pain and CVA tenderness

Answer: (D)

Pyelonephritis is an infection that involves the kidneys and typically triggers a systemic inflammatory response. The most telling sign is fever along with flank pain, specifically with tenderness over the costovertebral angle after percussion or palpation. This combination localizes the infection to the kidney and shows the body's systemic reaction to it.

Lower urinary tract symptoms like dysuria and frequency point more to cystitis (bladder infection) rather than kidney involvement. Suprapubic pain similarly suggests bladder irritation. Hematuria can occur with UTIs in general but, without the systemic signs of fever and the characteristic CVA tenderness, it doesn’t point as strongly to pyelonephritis. Therefore, fever with flank pain and CVA tenderness best fits the classic presentation of a kidney infection.