PYELONEPHRITIS

Presented By: Jillymae Medina

Etiology Inflammation of the

structures of the kidney: the renal pelvis renal tubules interstitial tissue

Almost always caused by E.coli

Etiology Usually seen in association with:

Pregnancy diabetes mellitus Polycystic hypertensive kidney disease insult to the urinary tract from

catheterization, infection, obstruction or trauma

What happens to the kidney?

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 Manifestations

Acute pyelonephritis may be unilater or bilateral, causing chills, fever, prostration and flank pain.

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 Symptoms

Subjective Data in acute pyelonephritis: pt will become acutely ill, w/ 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

Costovertebral Angle (CVA)

     Chronic Pyelonephritis

The autopsy specimen

consists of a bisected

kidney which is

markedly shrunken

because of chronic

inflammation and

Scarring.

(B) multiple calculi in

the proximal ureter

(A) Calyceal system 

Signs and Symptoms

Objective data includes assessing the pt for: Elevated Temperature Chills Pus in the urine

Systemic signs occur as a result of the chronic disease: elevated BP Vomiting Diarrhea

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 Tests IVP 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

Medical Management

Pt w/ 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

Medicines

Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin)

Cipro

Septra

Bactrim

Floxin

Medical Management

Adequate fluids at least eight 8-oz. glasses per day

Urinary analgesics such as Phenazopyridine (Pyridium)

is helpful Follow up urine culture is indicated

Nursing Intervetion & Patient Teaching

Pt is taught to identify the S&S of infection:

Elevated temp. Flank pain Chills Fever Nausea Vomiting Urgency

Fatigue General malaise Pt should also be taught: Indications Dose Length of course Side effects Importance 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 disoder