Module 9 Part 2 Acute Pyelonephritis

Question 1

Question

Answer 1

Answer

Question 2

How can kidney stones lead to pyelonephritis?

Answer 2

Kidney stones can obstruct urine flow, leading to stasis and bacteriuria. The irritation of the epithelial lining can trap bacteria.

Question 3

What is vesicoureteral reflux, and how does it relate to pyelonephritis?

Answer 3

Vesicoureteral reflux is the chronic backflow of urine into the kidney during urination, contributing to bacterial infection.

Question 4

Why does pregnancy increase the risk of pyelonephritis?

Answer 4

Pregnancy can lead to dilation and relaxation of the ureter, causing hydroureter and hydronephrosis. This is partly due to the obstruction from an enlarged uterus and partly due to ureteral relaxation from higher progesterone levels.

Question 5

What is a neurogenic bladder, and how does it contribute to pyelonephritis?

Answer 5

A neurogenic bladder results from neurological impairment, interfering with normal bladder contraction. This can lead to residual urine and ascending infections.

Question 6

How can medical instrumentation lead to pyelonephritis?

Answer 6

The use of catheters and endoscopes for diagnostic purposes in the urinary tract can introduce organisms into the urethra and bladder, increasing the risk of infection.

Question 7

What is the role of female sexual trauma in the development of pyelonephritis?

Answer 7

Female sexual trauma can move organisms from the urethra into the bladder, causing infection and retrograde spread to the kidney.

Question 8

What is acute pyelonephritis?

Answer 8

Acute pyelonephritis is an infection in one or both upper urinary tracts, including the ureter, renal pelvis, and interstitium.

Question 9

What are common causes of acute pyelonephritis?

Answer 9

Common causes include urinary obstruction (blockage in the urinary tract) and vesicoureteral reflux (backflow of urine from the bladder). It is more prevalent in women.

Question 10

Which parts of the urinary tract are affected by pyelonephritis?

Answer 10

Pyelonephritis impacts the upper urinary tracts, involving the ureter, renal pelvis, and interstitium.

Question 11

Which microorganisms are commonly associated with acute pyelonephritis?

Answer 11

Common microbes include E. coli, Proteus, and Pseudomonas.

Question 12

How does the infection typically spread in acute pyelonephritis?

Answer 12

The infection often ascends through the ureters but can also spread via the bloodstream.

Question 13

Which parts of the kidney are primarily affected by the inflammatory process in pyelonephritis?

Answer 13

Inflammation primarily affects the renal pelvis, calyces, and medulla.

Question 14

What happens during the healing process of acute pyelonephritis?

Answer 14

Healing involves fibrosis and atrophy of affected tubules, and the number of bacteria decreases until the urine becomes sterile.

Question 15

How does acute pyelonephritis usually begin in terms of symptom onset?

Answer 15

It typically starts suddenly with an acute onset of symptoms.

Question 16

What are some common systemic signs in acute pyelonephritis?

Answer 16

Patients often experience fever, chills, and pain in the flank or groin.

Question 17

What are some of the urinary symptoms associated with acute pyelonephritis?

Answer 17

Symptoms include frequent urination (frequency), painful urination (dysuria), and tenderness in the lower back near the spine (costovertebral tenderness).

Question 18

How might the symptoms of acute pyelonephritis differ in older adults?

Answer 18

In older individuals, symptoms can be less specific, including a mild fever and a general feeling of discomfort (malaise).

Question 19

Why is it challenging to differentiate between cystitis and pyelonephritis based on clinical assessment alone?

Answer 19

Clinical symptoms of both conditions can overlap, making it difficult to distinguish them.

Question 20

How is the specific diagnosis of pyelonephritis established?

Answer 20

It is confirmed through urine culture, urinalysis, and clinical signs and symptoms.

Question 21

What do white blood cell casts in urine indicate, and when are they found?

Answer 21

White blood cell casts indicate pyelonephritis, but they may not always be present in the urine.

Question 22

What additional tests may be required for complicated cases of pyelonephritis?

Answer 22

Complicated cases may necessitate blood cultures and urinary tract imaging.

Question 23

What is the typical duration of antibiotic therapy for uncomplicated acute pyelonephritis?

Answer 23

Uncomplicated cases are treated with 2 to 3 weeks of antibiotics specific to the causative microorganism.

Question 24

Why are follow-up urine cultures important after treatment for pyelonephritis?

Answer 24

They help monitor the patient’s progress and detect any recurrence of symptoms or antibiotic-resistant microorganisms.

Question 25

In what situations might there be a risk of antibiotic-resistant microorganisms or reinfection in pyelonephritis cases?

Answer 25

This risk is higher in cases involving urinary tract obstruction or reflux.

Question 26

What diagnostic tests can identify surgically correctable lesions associated with pyelonephritis?

Answer 26

Intravenous pyelography and voiding cystourethrography are used for this purpose.