Which presentation is most consistent with pyelonephritis?

• A. Cough and shortness of breath
• B. N/V, fever, chills, flank pain, and costovertebral angle tenderness
• C. Rash and itching
• D. Weight gain and edema

Answer: (B)

Acute kidney infection presents with systemic signs of infection plus findings pointing to the kidney. The combo of nausea/vomiting, fever with chills, flank pain, and costovertebral angle tenderness fits this pattern, because the pain is located in the flank and tapping over the CVA elicits tenderness—a classic sign of kidney involvement. These systemic symptoms reflect a true infection of the upper urinary tract.

Choices describing cough and shortness of breath suggest a respiratory issue, not a kidney problem. Rash and itching point to a dermatologic or allergic process. Weight gain and edema imply fluid overload or kidney/heart disease but not an acute kidney infection.