Pyelonephritis, ACUTE PYELONEPHRITIS, CHRONIC PYELONEPHRITIS,

Pyelonephritis

It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.

Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis

1. PYELO NEPHRITIS Presented by- PANKAJ SINGH RANA NURSE PRACTITIONER IN CRITICAL CARE

2. INTRODUCTION PYELONEPHRITIS (Greek means “pyelum”-renal pelvis,”nephros”-kidney &”itis”-inflammation) is an ascending urinary tract infection that has reached the pelvis of the kidney.

3. DEFINITION It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.

4. TYPES OF PYELONEPHRITIS Pyelonephritis can be classified in several different catagories: -acute pyelonephritis -chronic pyelonephritis -xanthogranulomatous pyelonephritis

5. ACUTE PYELONEPHRITIS

6. ACUTE PYELONEPHRITIS Acute pyelonephritis is an sudden development of kidney inflammation.it can be severe in elderly & people who have cancer or AIDS.

7. CAUSES (Vesicourethral reflux) backward flow of infected urin e from the bladder to the upper urinary tract Kidney stones Urinary tract catheterization Pregnancy Neurogenic bladder (spina bifida) Benign prostatic hyperplasia Diabetes mellitus

8. PATHOGENESIS The bacteria gain entry into urinary tract either by ascending infection & haemogenous route Escherichia coli Proteus Pseudomonas Enterobactor klebsiella

9. MORPHOLOGY GROSS ANATOMY It show enlarged & swollen kidney that bulges on section. Yellowish raised abscesses are seen on renal surface on histology. MICROSCOPIC EXAMINATION It involve the interstitium & causing destruction of the tubules. The renal blood vessels show considerable resistance to infection & are spared.

10. CLINICAL FEATURES Acute onset of pain Fiver with chills Lumbar tenderness Dysuria Frequency of micturition On examination urine will show bacteria in excess of 100,000/ ml,pus cells .

11. COMPLICATIONS Papillary necrosis Pyonephrosis Perinephric abscess

12. CHRONIC PYELONEPHRITIS

13. CHRONIC PYELONEPHRITIS It implies kidney infection & chronic tubulointerstitial disease resulting in repeated attacks of inflammation & scarring.

14. ETIOPATHOGENESIS It can be of two types CHRONIC OBSTRUCTIVE PYELONEPHRITIS Obstruction to the outflow of urine at different levels predisposes the kidney to infection. REFLUX PYELONEPHRITIS Reflux of urine from the bladder into one or both the ureters during micturition is the major cause of chronic pyelonephritis .

15. CAUSES Flank pain Abdominal pain Blood in urine Signs of infection Fiver Unintentional weight loss Malaise Decreased appetite

16. MORPHOLOGY GROSS ANATOMY Kidney is small & contracted.they show unequal contraction at various places & this differentiates it from symmetrical contracted kidneys seen in benign nephrosclerosis.the scars cause adhesion of capsule of kidney to cortex. MICROSCOPY EXAMINATION The changes are seen in interstitium & tubules,there is chronic interstitial inflammatory reaction composed of lymphocytes ,plasma cells & macrophafes tubules show atophy &dilation.

17. CLINICAL FEATURES fever Lumber tenderness Dysuria Pyouria Hypertension Frequency of micturition Bacteriuria

18. XANTHOGRANULOMATOUS PYELONEPHRITIS

19. XANTHOGRANULOMATOUS PYELONEPHRITIS It is an unusual form of chronic pyelonephritis characterized by granulomatous abscess formation,severe kidney distruction & clinical pictures that may resemble renal cell carcinoma & other inflammatory renal parenchymal diseases.

20. CLINICAL MANIFESTATION Urosepsis Anemia Painful renal mass Kidney stones Loss of function of the affected kidney

21. MORPHOLOGY There are granulomas & lipid laden macrophages.It is found roughly 20% of specimens from surgically managed cases of pyelonephritis.

22. DIAGNOSIS LABORATORY EXAMINATION Urinalysis may show sign of UTI Blood test Antibiotic sensitivity testing Intra venous pyelography

23. The Urine DipstickTest : Rapid diagnostic test Appearance ofWBC in urine test for nitrite & leukocyte esterase ( family Enterobacteriaceae , in detected in urine PMN ) Negative outcome ,it s not sufficient for pregnancy women

24. Urinalysis : WBC in Cast shape due to of pyelonephritis No WBC ,No Infection Urine Culture: It is positve with colony count equal or more than 10 power 2 In women with dysuria & pyuria It is positve with colony count > 10 power 3 In Men

25. MANAGEMENT To control the infection & reduce the symptoms. Urine culture & antibiotic sensitivity test is performed on the basis of infecting agents . Use antibiotics Like-aminoglycosides,cephalosporin & sulphamethoxazole etc.

26. Risk for Infection related to the presence of bacteria in the kidneys Nursing Intervention: Assess  the patient's temperature every 4 hours and report if the temperature is above 38.50 C Rational: Vital signs indicate a change in the body Record the characteristics of urine Rational: To find out / identify indications of progress or  deviations  from expected results. Instruct the patient to drink 2-3 liters if no contraindications Rational: To prevent urine stasis

27. Monitor re-examination of the urine culture and sensitivity to determine response to therapy. Rational: Knowing how far the effect of treatment on patient circumstances. Instruct the patient to empty the bladder completely each time the bladder. Rational: To prevent bladder  distension Give perineal care, maintain to keep them  clean and dry . Rational: To maintain cleanliness and avoid  bacterial infection  of the urethra making.

28. Pain related to infections of the kidney . Nursing Intervention: Assess the intensity,  location , and factors that aggravate or relieve pain. Rational: Extreme pain indicates an infection. Provide adequate rest periods and  activity  levels that can be tolerant. Rational: Clients can rest in peace and to relax the muscles.

29. Encourage drinking plenty of 2-3 liters if no contraindications Rational: To assist clients in micturition. Give appropriate  analgesic  drugs with therapy programs. Rational: Analgesic block the path of pain.

30. PREVENTION If pyelonephritis is not treated immediately ,permanent kidney damage can occur. Increasing fluid intake ,consuming blueberry juice & fermented milk products containing probiotic bacteria have all been shown to inhibit adherence of bacteria to the epithelial cells of urinary tract & reduce the recurrence of UTI.

31. SUMMARY