A nurse is admitting a client who has pyelonephritis. Which of the following manifestations should the nurse expect to be present during the assessment (Select All that Apply.)

A. Hypertension is not a typical early sign of pyelonephritis; it is more associated with chronic kidney disease. B. Frothy urine usually indicates proteinuria, which is not a common feature of pyelonephritis. C. Fish-type urine odor can occur due to bacterial infection in the urinary tract. D. Lower abdominal pain is common with urinary tract infections, including pyelonephritis. E. Mental confusion can occur especially in older adults or severe infections as a systemic response.