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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