ACUTE PYELONEPHRITIS

Mrs.Linta ,Lecturer,KCN
ACUTE PYELONEPHRITIS
• Pyelonephritis is an inflammation of the renal
parenchyma and collecting system (including
the renal pelvis).
• The most common cause is bacterial infection,
but fungi, protozoa, or viruses can also infect the
kidney.
Causes
• Pyelonephritis usually begins with colonization
and infection of the lower urinary tract via the
ascending urethral route.
• Bacteria normally found in the intestinal tract,
such as E. coli or Proteus, Klebsiella, or
Enterobacter species, frequently causes
pyelonephritis.
Causes
• vesicoureteral reflux (retrograde, or backward,
movement of urine from lower to upper urinary
tract)
• dysfunction of the lower urinary tract (e.g.,
obstruction from benign prostatic hyperplasia
[BPH], a stricture, a urinary stone).
Clinical Manifestations
• Mild fatigue to the sudden onset of chills; fever;
vomiting;
• Malaise; flank pain; characteristic of cystitis,
including dysuria, urgency, and frequency.
Diagnostic Studies
• History and physical examination
• Urinalysis
• Urine for culture and sensitivity
• Imaging studies: ultrasound (initially), CT scan, IVP,
CT/IVP, VCUG,
• radionuclide imaging
• CBC count with WBC differential
• Blood culture (if bacteremia is suspected)
• Percussion for flank (costovertebral angle [CVA])
pain
Collaborative Therapy
• Mild Symptoms (Uncomplicated Infection)
• Outpatient management or short
hospitalization
• Empirically selected broad-spectrum antibiotics:
ampicillin,vancomycin combined with an
aminoglycoside (e.g., tobramycin, gentamicin
[Garamycin])
• ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin.
• Adequate fluid intake
• Non steroidal antiinflammatory drugs (NSAIDs) or
antipyretic drugs
• Follow-up urine culture and imaging studies
Severe Symptoms

• Severe Symptoms
• Hospitalization
• Parenteral antibiotics
• Empirically selected broad-spectrum antibiotics:
ampicillin, vancomycin combined with an
aminoglycoside (e.g., tobramycin,gentamicin)
Severe Symptoms

• Switch to sensitivity-guided antibiotic therapy when

results of urine and blood culture are available
• Oral antibiotics when patient tolerates oral intake
• Adequate fluid intake (parenteral initially; switch to
oral fluids as nausea, vomiting, and dehydration
subside).
• NSAIDs or antipyretic drugs to reverse fever and
relieve discomfort.
• Urinary analgesics (as above).
• Follow-up urine culture and imaging studies.
CHRONIC PYELONEPHRITIS
• In chronic pyelonephritis the kidneys become
small, atrophic, and shrunken and lose function
due to fibrosis (scarring).
• Chronic pyelonephritis is usually the result of
recurring infections involving the upper urinary
tract.
BIBLIOGRAPHY:
• 1)Black M. Joyce ; Medical surgical nursing ; 5th edition ; W.B
Saunders Company ; Singapore 2000 ; pg no. 1238.
• 2)Spring house ; handbook of medical surgical nursing ; 3rd
edition ; Judith A. Schilling McCann; Pennsylvania 1998 ; pg.
No. 617-618.
• 3)Suddarth’s and brunner; Textbook of medical surgical
nursing; 11th edition; Lippincott Williams and Wilkins ;
United states of America 2009; pg. No.

• 4)Lewis Mantik shoron; Medical surgical nursing; 11th edition;

Mosby Elsevier; United states of America 2013; pg. No.1238-
1240

• 5)Sorensen and luckmann; medical surgical nursing 4th

edition; W.B sauders company; pg no.-1150-1164