pyelonephritis l.
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PYELONEPHRITIS - PowerPoint PPT Presentation

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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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Presented By: Jillymae Medina

Inflammation of the structures of the kidney:

the renal pelvis

renal tubules

interstitial tissue

Almost always caused by E.coli

  • Usually seen in association with:
    • Pregnancy
    • diabetes mellitus
    • Polycystic
    • hypertensive kidney disease
    • insult to the urinary tract from catheterization, infection, obstruction or trauma
what happens to the kidney
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
clinical manifestations
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
signs and symptoms
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
chronic pyelonephritis
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
signs and symptoms9
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
diagnostic tests
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
diagnostic tests11
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
medical management
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
Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin)





medical management14
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
nursing intervetion patient teaching
Pt is taught to identify the S&S of infection:

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
  • 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