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PYELONEPHRITIS. Presented By: Jillymae Medina. Inflammation of the structures of the kidney: the renal pelvis renal tubules interstitial tissue Almost always caused by E.coli. Etiology. Etiology. Usually seen in association with: Pregnancy diabetes mellitus Polycystic

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Pyelonephritis l.jpg


Presented By: Jillymae Medina

Etiology l.jpg

Inflammation of the structures of the kidney:

the renal pelvis

renal tubules

interstitial tissue

Almost always caused by E.coli


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  • Usually seen in association with:

    • Pregnancy

    • diabetes mellitus

    • Polycystic

    • hypertensive kidney disease

    • insult to the urinary tract from catheterization, infection, obstruction or trauma

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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

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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

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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

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The autopsy specimen

consists of a bisected

kidney which is

markedly shrunken

because of chronic

inflammation and


(B) multiple calculi in

the proximal ureter

(A) Calyceal system 

     Chronic Pyelonephritis

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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

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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

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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

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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

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Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin)






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Medical Management (Nebcin, Garamycin)

  • Adequate fluids at least eight 8-oz. glasses per day

  • Urinary analgesics such as Phenazopyridine (Pyridium)

    is helpful

  • Follow up urine culture is indicated

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Pt is taught to identify the S&S of infection: (Nebcin, Garamycin)

Elevated temp.

Flank pain







General malaise

Pt should also be taught:



Length of course

Side effects

Importance of follow up care with the physician on a routine basis

Nursing Intervetion & Patient Teaching

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Prognosis (Nebcin, Garamycin)

  • 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