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aka Kidney Infection (pyelonephritis), glomerulonephritis, Definition: Pyelonephritis = a specific type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels up into your kidneys. Glomerulonephritis = a type of kidney disease that damages your kidney’s ability to remove waste and excess fluids Etiology and Pathophysiology Affects the renal pelvis and parenchyma Infection develops in scattered areas and spreads from renal pelvis to cortex Kidney becomes edematous Abscesses may develop Tissue destruction primarily affects the tubules Scar tissue replaces normal tissue and affected tubules atrophy E-coli is the most common cause Proteus and Klebsiella bacteria are less common Acute form: usually caused by bacterial infection Chronic form: associated with nonbacterial infections such as metabolic, chemical, or immunologic disorders. Vesicoureteral reflux Symptoms of Kidney Infection Fever Back, flank, or groin pain Abdominal pain Frequency in urination Strong urge to urinate Burning or pain on urination Pus or blood in the urine Causes of Kidney Infection Typically occurs when bacteria enters the urinary tract through the urethra Bacteria from infection elsewhere in the body can spread through the bloodstream and infect the kidneys. Rarely, after kidney surgery Risk Factors Female anatomy Poor hygiene Obstruction in the urinary tract Weakened immune system Damage to nerves around the bladder Prolonged use of a urinary catheter Urine flowing the wrong way Congenital malformations Diabetes mellitus Complications of Kidney Infection Permanent kidney damage Septicemia Pregnancy complications Tests and Treaments Urine studies: urinalysis and urine culture; 24-hour urine collection, clean catch urine specimen or urinary catheterization (creatinine clearance, or protein) Ultrasonography: size, shape and position Blood studies: BUN, Serum creatinine clearance Treatment MEDICATIONS Antimicrobials – Sulfonamides (Bactrim; Septra) Antispasmodics – Phenazopyridine (Pyridium) Urine color is reddish-orange Stains clothing Analgesics – Acetaminophen, Ibuprofen **lots of choices, these are examples of each Non-Pharmacologic therapies Apply heat If a heating pad is used, it should only be set on low and used for 30-45 minutes and then removed for 1 hour. (the rebound phenomenon kicks in if used for a longer period of time). Hydration – helps flush bacteria from the body (no caffeine, citrus or alcohol until the infection has cleared (these products promote urgency and frequency) Prevention Drink plenty of fluids, especially water Urinate frequently Empty the bladder after intercourse Avoid feminine products in the genital area Use proper hygiene Glomerulonephritis A type of kidney disease that damages the kidneys’ ability to remove waste and excess fluids Primary Secondary Signs and Symptoms Cola-colored or ice-tea-colored urine Foamy urine High blood pressure Fluid retention (edema) Fatigue Less frequent urination than usual Causes Frequently unknown Infections: Post-streptococcal glomerulonephritis Bacterial endocarditis Viral infections Immune Diseases Lupus Goodpasture’s syndrome IgA nephropathy Vasculitis Polyarteritis Wegener’s granulomatosis Conditions that cause scarring of the glomeruli HTN Diabetic kidney disease Focal segmental glomerulosclerosis Complications Acute Kidney Failure Chronic Kidney Failure High Blood Pressure Nephrotic Syndrome Tests and Diagnosis Blood tests = creatinine, BUN Urinalysis Kidney Biopsy Imaging tests IVP (kidney x-ray) CT Scan(computerized tomography scan) Treatment and Drugs Treatment is dependent on: Whether you have an acute or chronic form of the disease. The underlying cause The type and severity of your signs and symptoms To control HTN and slow the decline of kidney function: Diuretics Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor agonists Treatment of Underlying Causes R/T bacterial infections = appropriate antibiotic R/T Lupus or Vasculitis = corticosteroids and immune- suppressing drugs R/T IgA nephropathy = fish oil supplements are under study Goodpasture’s syndrome = Plasmapheresis Patient Education Seek prompt treatment of a strep infection causing a sore throat or impetigo To prevent infections such as HIV and hepatitis, use safe sex practices and avoid IV drug use Control blood sugar to help prevent diabetic nephropathy Control your blood pressure