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Pathophysiology
 Pyelonephritis, an upper urinary tract infection, is a bacterial
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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.
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
 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 unilateral or
bilateral, causing :
 chills
 fever,
 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 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
Costovertebral Angle (CVA)
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
 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.
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
Medicines
 Ampicillin or vancomycin
combined with an
aminoglycoside (Nebcin,
Garamycin) “Antibiotic”
 (cotrimoxazole)
Septra Bactrim
“Trimethoprim”
 Cipro (ciprofloxacin
“Antibiotic”
Medical Management
 Adequate fluids at least eight glasses per day.
 Urinary analgesics such as Phenazopyridine
(Pyridium)
is helpful
 Follow up urine culture is indicated
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
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