pyelonephirits

urinary tract infection

1. Guided by Dr.T.Venu Pyelonephritis Presented by J. Vishnu RT/2016/604

2. C ontents 11/8/2016 Pyelonephritis 2 Introduction Epidemiology Etiology Pathophysiology Signs and symptoms Diagnosis Prevention Conclusion Reference

3. Introduction 11/8/2016 Pyelonephritis 3 Upper urinary tract Infections: Pyelonephritis Inflammation of renal pelvis and parenchyma (functional kidney tissue) Results from an infection that ascends to kidney from lower urinary tract

4. Epidemiology 11/8/2016 Pyelonephritis 4 Pyelonephritis is significantly more common in females than in males 15-17 cases per 10,000 females in a year 3-4 cases per 10,000 males per year Acute pyelonephritis develops in 20-30% of pregnant women An estimated 50 % of women report having had a UTI at some point in their lives.

5. Epidemiology 11/8/2016 Pyelonephritis 5 Pyelonephritis shows a trimodal distribution in females Elevated incidence in girls aged 0-4 years. A peak in women 15-35 years of age. Gradual increase after age 50 years. In males it shows bimodal distribution With an elevated incidence at 0-4 years of age It is gradually increase after 35 years of age

6. Etiology 11/8/2016 Pyelonephritis 6 Escherichia coli Almost 80% pyelonephritis cause by E-coli Staphylococcus saprophyticus Proteus mirabilis Klebsiella Enterococcus Kidney stones can also contribute to pyelonephritis P roviding a place for bacteria to grow while evading the body's defenses. People with diabetes or conditions that impair the immune system are more likely to get pyelonephritis.

7. Pathophysiology 11/8/2016 Pyelonephritis 7 Acute pyelonephritis results from bacterial invasion of the renal parenchyma. Bacteria usually reach the kidney by ascending from the lower urinary tract In all age groups Bacteria may also reach the kidney via the bloodstream

8. Pathophysiology 11/8/2016 Pyelonephritis 8 Contamination of the periurethral area with a uropathogen from the gut Colonization of the urethra and migration to the bladder Colonization and invasion of the bladder mediated by pili and adhesion Inflammatory response in the bladder and fibrinogen accumulation in the catheter Epithelial damage by bacterial toxins and proteases Ascension to the kidneys Colonization of the kidney Host tissue damage by the bacterial toxins

9. Pathophysiology 11/8/2016 Pyelonephritis 9

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11. What happens to the kidney? 11/8/2016 Pyelonephritis 11 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

12. Symptoms of Pyelonephritis 11/8/2016 Pyelonephritis 12 Flank pain Pyuria (pus in urine ) Dysuria (painful discharge of urine ) Hematuria ( blood in urine ) Increased frequency urine Fever (usually present) Nausea/Vomiting

13. Diagnosis pyelonephritis 11/8/2016 Pyelonephritis 13 Physical Exam: CVA tenderness CT Scan Labs : Urinalysis WBCs RBCs Leukocyte esterase (Helps to screen for pyuria) Nitrites(More likely gram-negative rods) Urine culture

14. Prevention 11/8/2016 Pyelonephritis 14 Increase fluid intake to at least 6- 8 glasses per day to maintain bladder hygiene . Personal hygiene Women should avoid prolonged sitting in wet clothes Do not postpone urination when feel the urge to urinate Empty your bladder completely when urinate

15. Conclusion 11/8/2016 Pyelonephritis 15 It is a most common disease for females of 15-35 year age group It is mainly caused by the bacterial infection Biggest bugs for Pyelonephritis are E. coli (80% ) It is preventable disease

16. Reference 11/8/2016 Pyelonephritis 16 Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis . 2007 , 273-80. Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005 , 933-42 . Craig WD, Wagner BJ, Travis MD. P yelonephritis: radiologic-pathologic review. Radiographics.2008 ,255-77. Johnson PT, Horton KM, Fishman EK. Optimizing detectability of renal pathology with MDCT: protocols, pearls, and pitfalls.2010;101-12.

17. 11/8/2016 Pyelonephritis 17 Any Questions ? Thank you