1. PYELONEPHRITIS

2. Pathophysiology
Pyelonephritis, an upper urinary tract infection, is a bacterial infection of the renal pelvis, tubules, and interstitial tissue in one or both kidneys.
Bacteria reach the bladder through the urethra and ascend to the kidney.
It is frequently secondary to urine backup into the ureters usually at the time of voiding.
Urinary tract obstruction (e.g. Urinary stones, tumors, and prostatic hypertrophy) is another cause.
Pyelonephritis may be acute or chronic.

3. Etiology the renal pelvis renal tubules interstitial tissue
Inflammation of the structures of the kidney:
the renal pelvis
renal tubules
interstitial tissue
Almost always caused by E.coli

4. Etiology Pregnancy diabetes mellitus Polycystic
Usually seen in association with:
Pregnancy
diabetes mellitus
Polycystic
hypertensive kidney disease
insult to the urinary tract from catheterization, infection, obstruction or trauma

5. The kidney becomes edematous and inflamed and the blood vessel are congested
The urine may be cloudy and contain pus, mucus and blood
Small abscesses may form in the kidney

6. Clinical Manifestations
Acute Pyelonephritis may be unilateral or bilateral, causing :
chills
fever,
flank pain
leukocyosis
bacteriuria .

7. Studies has shown that chronic Pyelonephritis may develop in association with other renal disease unrelated to infection processes
Azotemia (the retention in the blood of excessive amounts of nitrogenous compounds) develops if enough nephrons are nonfunctional

8. Signs and Symptoms
Subjective Data in acute pyelonephritis:
pt will become acutely ill, weakness , malaise and pain in the costovertebral angle (CVA)
CVA tenderness to percussion is a common finding
In the chronic phase the pt may show unremarkable symptoms such as nausea and general malaise

9. Costovertebral Angle (CVA)

10. Diagnostic Tests
Diagnosis is confirmed by bacteria and pus in the urine and leukocytosis
A clean-catch or catheterized urinalysis with culture and sensitivity identifies the pathogen and determines appropriate antimicrobial therapy

11. Diagnostic Tests U/S or CT scan.
IV pyelogram will Identify the presence of obstruction or degenerative changes caused by the infection process
BUN and Creatine levels of the blood and urine may be used to monitor kidney function
U/S or CT scan.

12. Medical Management
Goal of treatment is to eradicate bacteria from the urine.
Pt will mild signs and symptoms may be treated on an outpatient basis with antibiotics for 14 to 21 days
Antibiotics are selected according to results of urinalysis culture and sensitivity and may include broad-spectrum medications

13. Medicines
Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin) “Antibiotic”
Cipro (ciprofloxacin
“Antibiotic”
(cotrimoxazole)
Septra Bactrim
“Trimethoprim”

14. Medical Management Adequate fluids at least eight glasses per day.
Urinary analgesics such as Phenazopyridine (Pyridium)
is helpful
Follow up urine culture is indicated

15. Nursing Intervention Pt is taught to identify the S &S of infection
Pt should also be taught: Indications, Dose, Length of course, Side effects
Importance of follow up care with the physician on a routine basis

16. Prognosis
Prognosis is dependent upon early detection and successful treatment
Baseline assessment for every pt must include urinary assessment because Pyelonephritis may occur as a primary or secondary disorder