PathophysiologyPyelonephritis, 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.

EtiologyInflammation of the

structures of the kidney:the renal pelvisrenal tubulesinterstitial tissue

Almost always caused by E.coli

EtiologyUsually seen in association with:

Pregnancydiabetes mellitusPolycystichypertensive kidney diseaseinsult to the urinary tract from

catheterization, infection, obstruction or trauma

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

Clinical ManifestationsAcute Pyelonephritis may be unilateral

or bilateral, causing : chillsfever, flank pain leukocyosis bacteriuria .

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

Signs and SymptomsSubjective 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

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

Diagnostic TestsIV 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.

Medical ManagementGoal 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

MedicinesAmpicillin or vancomycin

combined with an aminoglycoside (Nebcin, Garamycin) “Antibiotic”

Cipro (ciprofloxacin “Antibiotic”

(cotrimoxazole)

Septra Bactrim

“Trimethoprim”

Medical ManagementAdequate fluids at least eight glasses per day.Urinary analgesics such as Phenazopyridine

(Pyridium) is helpfulFollow up urine culture is indicated

Nursing InterventionPt is taught to identify the S &S of infectionPt should also be taught: Indications, Dose,

Length of course, Side effectsImportance of follow up care with the

physician on a routine basis

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