1. PYELONEPHRITIS Presented By: Jillymae Medina

2. Inflammation of the structures of the kidney: the renal pelvis renal tubules interstitial tissue Almost always caused by E.coli Etiology

3. Etiology • Usually seen in association with: • Pregnancy • diabetes mellitus • Polycystic • hypertensive kidney disease • insult to the urinary tract from catheterization, infection, obstruction or trauma

4. 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

5. 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

6. 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

7. Costovertebral Angle (CVA)

8. 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       Chronic Pyelonephritis

9. 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

10. 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

11. 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

12. 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

13. Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin) Cipro Septra Bactrim Floxin Medicines

14. 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

15. 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 Nursing Intervetion & Patient Teaching

16. 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