PYELONEPHRITIS

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PYELONEPHRITIS
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Etiology

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

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Etiology

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

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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

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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

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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

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Costovertebral Angle (CVA)
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     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 

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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

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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

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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

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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

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Medicines

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

• Septra
• Bactrim
• Floxin

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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

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Nursing Intervetion Patient Teaching

• 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

• Pt is taught to identify the SS of infection
• Elevated temp.
• Flank pain
• Chills
• Fever
• Nausea
• Vomiting
• Urgency

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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