Pyelonephritis
Pyelonephritis
o Bacterial infection of the renal pelvis, tubules and interstitial tissue of one or both kidneys
o Infection usually ascends from the urethra
o Haematogenous spread is rare
o Frequently due to ureterovesical reflux
o Other causes are : urinary tract obstruction - bladder tumours strictures, benign prostatic hyperplasia and urinary stones
Pyelonephritis may be acute or chronic
Acute Pyelonephritis
Pathology
o Kidneys enlarge
o Interstitial infiltration of inflammatory cells
o Abscesses on the capsule and at corticomedullary junction
o Result in destruction of tubules and the glomeruli
o When chronic kidneys become scarred, contracted and nonfunctioning
Clinical Manifestations
o Fever
o Flank pain and
o Renal angle tenderness
o Leukocytosis Acutely ill
o Chills
o Pyuria
o Bacteriuria
In addition symptoms of lower tract involvement
o Dysuria
o Frequency
Investigations
o Usgm KUBU and abdomen
o CT scan
o Intravenous Pyelogram (IVP)
o Radionucleotide imaging with gallium citrate and indium-111-labeled WBCs
o Urine culture and sensitivity
to detect any causative factor like obstruction and the infective agent
Medical Management
o Treated as outpatients if there is no nausea, vomiting or dehydration and other signs and symptoms of sepsis
o Very ill patients and all pregnant women are hospitalized at least for 2 to 3 days for parenteral therapy
o 2 weeks course
o Bactrim with an urinary alkanizer
o Ciprofloxacin, Ofloxacin, Gatifloxacin
o Gentamicin with or without amoxicillin
Problem
o Chronic or recurring symptomless infection persisting for months or years
o Another 6 weeks course if relapse
o Follow up urine culture 2 weeks after completion of therapy
Chronic Pyelonephritis
o Repeated bouts of acute pyelonephritis may lead to chronic pyelonephritis
o Clinical manifestations
o No symptoms of infection unless an acute exacerbation occurs
o Fatigue
o Head ache
o Poor appetite
o Polyuria
o Excessive thirst
o Weight loss
Progressive scarring → renal failure
Assessment and diagnostic findings
o IVP
o Serum creatinine
o Blood urea
o Culture and sensitivity
Complications
End Stage Renal Disease (ESRD)
Hypertension
Kidney stones
Medical management
o Antibiotics : According to C&S result
o Drugs carefully titrated if renal function is impaired
Nursing management
o Fluid balance - I / O chart
o Fluids encouraged unless contraindicated
o 4th hourly temp
o Antibiotics
o Bed rest
o Teach how to prevent recurrent infections : adequate fluids, emptying the bladder regularly and performing recommended perineal hygiene taking antibiotics as prescribed
