PYELONEPHRITIS (UPPER URINARY TRACT INFECTION)
Pyelonephritis is a bacterial infection of the renal pelvis, tubules and interstitial tissues of 1 or both kidneys.
Causes
The following are the sources of bacterial invasion or urinary obstruction.
a. Enteric bacteria (E-coli - most common)
b. Secondary to vesicoureteral reflux (incompetence of ureterovesical valve, which allows urine to regurgitate into ureters, usually at time of voiding)
c. Urinary obstruction. Infection.
d. Trauma
e. Blood borne infection
f. Renal disease
g. Pregnancy
h. Metabolic disorders
Pathophysiology
Areas of influencing in the kidney with interstitial infiltration of inflammatory cells.
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Tubular distraction and abscess formation.
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[Low-grade interstitial inflammation leads to atrophy and destruction of tubules and glomeruli]
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Chronic Pyelonephritis
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Scarred, contracted and non-functioning kidneys
Clinical manifestations
1. Fever, Chills,
2. Costovertebral angle tenderness, flank pain [(with or without radiation to groin)]
3. Nausea, vomiting |
4. Leukocytosis, bacteria and pus in the urine.
5. Symptoms of LUTI - dysuria and frequency.
6. Upper urinary tract infection is associated with Ab coating of the bacteria in the urine. [(Abs coat the bacteria in the renal medulla, when the bacteria are excreted in the urine, the immunofluorescent test can detect the Ab coating)]
Diagnostic Evaluation
1. Urinalysis (dipstick of microscopic) to identify leukocytes bacteria or pus in urine; gross or microscopic haematuria.
2. Urine culture to identify Ab- coated bacteria in urine; [bacteria invading kidney induce an Ab response that coats the bacteria differentiates renal infection from bladder infection.] c/s- determines causative organism.
3. JVP to evaluate for urinary tract abstraction [other radiologic / urinary tests as necessary.]
Medical Management
1. [Monitoring and supportive therapy for complications bacteraemia and gram ve sepsis; papillary necroses leading to renal failure; renal abscess /perinephric abscess.]
2. Organism specific antimicrobial therapy- adjusted according to culture results. Parenteral antimicrobial therapy may be necessary if patient cannon tolerate oral intake and is dehydrated; [usually admitted to hospital if patient is acutely ill].
Complications
1. Renal abscess requiring Treatment by percutaneous drainage or prolonged antibiotic therapy.
2. Perinephric abscess.
Nursing interventions
1. Administer antibiotic as prescribed a monitor for effectiveness and side effect
2. Administer antibiotic indication as prescribed of according to temp.
3. Assess vital signs frequently and monitor IO; administer Antiemetics to control nausea and vomiting
4. Use measures to decrease body temperature if indicated: cooling blanket, application of ice to armpits and-groins.
5. Correct dehydration by replacing fluids, orally if possibly or IV.
6. Monitor urine culture results for resolving infection.
7. Administer analgesic medication and monitor their effectiveness.
8. Use comfort measures such as positioning to locally relieve flank pain.
9. Explain to patient possible cause of pyelonephritis and its s/s; review also s/s of lower urinary tract infection.
10. Explain preventive measures including good fluid intake, personal hygiene measures and healthy voiding habits.
