Pathophysiology UTI t/c Pyelonephritis Theoretical

Predisposing Factors Immunosuppression* Instrumentation of urinary tract* Kidney stones Urinary retention*

Precipitating Factors Diabetes mellitus* Pregnancy* Age Gender

the

Attachment of bacteria to the urethra

Proliferation of bacteria in the urethra

Urethritis

Urethrovesical reflux

Introduction of bacteria into the bladder

Proliferation of bacteria in the bladder

Inflammation of the bladder

Cystitis

Ureterovesical reflux

Introduction of bacteria to the ureter

Inflammation of the ureter

Ureteritis

Infection ascends to the kidneys

Pyelonephritis

Activation of the immune response Release of pyrogens from bacteria Release of prostaglandin E2 Elevation of the body thermostat by the hypothalamus Vasoconstriction Shivering

General feeling of being unwell Malaise

Nausea/Vomiting*

Dysuria

Flank pain*

Decreased erythropoietin production Reduced heat loss through the skin Chills Decrease stimulation of the bone marrows Decreased erythropoiesis Decreased RBC production Anemia

Fever