Acute Pyelonephritis

Question 1

What is Acute Pyelonephritis

Answer 1

Inflammation of renal parenchyma and collecting system
Most commonly caused by bacteria
Fungi, protozoa, or viruses can also infect kidneys

Question 2

Can cause urosepsis

what is urosepsis

Answer 2

Systemic infection from urologic source
Prompt diagnosis/treatment critical
Can lead to septic shock and death
Usually begins with colonization and infection of lower tract via ascending urethral route
Frequent causes- Escherichia coli, Proteus, Klebsiella, Enterobacter

Question 3

Preexisting factors that are usually present

Answer 3

Vesicoureteral reflux

Dysfunction of lower urinary tract

Question 4

What is Vesicoureteral reflux

Answer 4

Backward movement of urine from lower to upper urinary tract

Question 5

What causes Dysfunction of lower urinary tract

Answer 5

Obstruction from BPH
Stricture
Urinary stone

Question 6

Clinical Manifestations

Answer 6

Mild fatigue
Chills
Fever
Vomiting
Malaise
Flank pain

Lower urinary tract symptoms characteristic of cystitis
Costovertebral tenderness usually present on affected side
Manifestations usually subside in a few days, even without therapy
Bacteriuria and pyuria still persist

Question 7

Diagnostic Studies

Answer 7

History
Physical examination
Palpation for CVA pain
Laboratory tests
Urinalysis
Urine for culture and sensitivity
CBC with differential
Blood culture (if bacteremia is suspected)- prompt treatment

Ultrasonography
CT urography

Question 8

Collaborative Care

Answer 8

Hospitalization for patients with severe infections and complications
Such as nausea and vomiting with dehydration
Signs/symptoms typically improve within 48 to 72 hours after therapy starts

Question 9

Drug therapy

Answer 9

Antibiotics
Parenteral administration in hospital to rapidly establish high drug levels
NSAIDs or antipyretic drugs
Fever
Discomfort
Urinary analgesics

Question 10

Patient teaching

Answer 10

Relapses may be treated with 6-week course of antibiotics
Follow-up urine culture and imaging studies
Pt teaching to prevent recurrence- drinking water, empty bladder more frequently

Question 11

Health promotion

Answer 11

Early treatment for cystitis to prevent ascending infections
Patients with structural abnormalities are at high risk
Stress the need for regular medical care