Transcript Chronic Pyelonephritis

PYELONEPHRITIS
Etiology
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Inflammation of the
structures of the
kidney:
 the renal pelvis
 renal tubules
 interstitial tissue
Almost always caused
by E.coli
Etiology
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Usually seen in association with:
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Pregnancy
diabetes mellitus
Polycystic
hypertensive kidney disease
insult to the urinary tract from catheterization,
infection, obstruction or trauma
What happens to the kidney?
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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
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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
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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
Costovertebral Angle (CVA)
Chronic Pyelonephritis
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
Signs and Symptoms
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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
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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 Tests
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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
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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 broadspectrum medications
Medicines
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Ampicillin or
vancomycin combined
with an aminoglycoside
(Nebcin, Garamycin)
Cipro
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Septra
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Bactrim
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Floxin
Medical Management
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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
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Pt is taught to identify
the S&S of infection:
Elevated temp.
Flank pain
Chills
Fever
Nausea
Vomiting
Urgency
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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
Prognosis
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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