URINARY TRACT INFECTION IN PREGNANCY

Pathophysiology and Symptomatology of Acute Pyelonephritis

Uropathogenic Microorganisms entry
in the urethra (E. Coli, Klebsiella,
Proteus, Staphylococcus spp.)

Pregnancy (14th weeks midpregnancy)

CHILL

Bacterial attachment to
epithelial cells by mannoseresistant adhesins on the pfimbriae(pili)

Uterus rise out of the

pelvis

Progesterone

Compressing
ureters

Relaxation of the
muscular layer of
the urinary tract

Bacterial colonization of the

distal urethra and introitus

Urine Stasis
Dilatation of
ureters and renal
calyces

Shorter urethra
(female)

FEVE
Rapid
muscle
contraction
and
relaxation
to generate

Heat conservation and

increased heat
production

HEADACH
Resetting of the
hypothalamic
temperature to higher
than normal

Vasodilatio
n

Bacterial entry into the

urinary bladder
Resistance to the
cleansing action of
urine flow and bladder
emptying by
mannose-resistant

Prostaglandin
formation

Vesicoureteral
rreflux

Bacterial entry &

multiplication in the
kidneys

Bacterial multiplication in
the bladder
Release of lipopolysaccharide
toxins from bacterial cell
membrane
Activation of inflammatory
response

Tissue
injury
INCREASED
FREQUENC
Y OF
URINATION

Decreased bladder capacity

to hold urine

Release of inflammatory
products (histamine,
bradykinin, serotonin,
prostaglandins)

Bladder Filling

Stimulation of
sensory stretch
receptors

WEAKNES
S /

Micturition
contractions

PUS
CELLS:

CLOUDY
URINE

Release of IL-1 into

the body fluids
Pus
formation
Activation of the
macrophage
System and Neutrophils

Chemical excitation of
the pain receptors in
tissues

ANOREXI

NAUSEA
&

DYSURIA

Bacterial
phagocytosis by
macrophages and
neutrophils
ABDOMINAL PAIN/
FLANK PAIN

Intrinsic contractions
of the digestive tract