Pyelonephritis, Glomerulonephritis Flashcards
4 types of UTI
acute
chronic
complicated
uncomplicated
type of UTI that is more than 2 infections in 6 months or 3 in a year
chronic
type of UTI that is Invasion of urinary tract by an infectious organism
acute
examples of complicated UTI’s
‣ Vesicoureteral reflux
‣ infection with multi-drug resistant organism
‣ Pregnancy
‣ CKD
uncomplicated vs complicated UTI
uncomplicated- type of uti Not associated with any anatomic or functional abnormality that complicates treatment
complicated type of uti that is associated with any anatomic or functional abnormality that complicates treatment
Bacterial Infection in the kidney and renal pelvis =
Pyelonephritis
acute vs chronic Pyelonephritis
- Acute = active infection/ presence of bacteria
* Chronic = Repeated or continued infections (>2 infections in 6 month or >3 in 1 year)
chronic Pyelonephritis is often related to
‣ Urinary tract defect
‣ Obstruction
‣ Reflux
which patient population is more likely to have chronic pyelonephritis?
females
- males become more susceptible after the age of 65
Acute Pyelonephritis Infection almost always comes from…..
lower tract (Ascending)
patho of acute pyelonephritis
• Inflammation occurs –>Tubular cell necrosis (Abscesses may occur) –> Fibrosis and scar tissue may form
most common cause of chronic pyelonephritis?
reflux
patho of Chronic Pyelonephritis
- Inflammation occurs
- Repeated insults leads to more scar tissue
- This changes vessel, glomerular and tubular structure
- Leads to impairment of filtration, reabsorption and secretion
- OVERALL KIDNEY FUNCTION IS IMPAIRED
causes of pyelonephritis?
- *Bedrest and immobility (urinary stasis)
- Structural deformities
- Obstruction (stones, cancer, scarring)
- Reflux (scarring, anatomic anomalies, tumor, prostate, stones, reduced bladder tone)
- *Urinary catheter
which bacteria is most common cause of pyelonephritis?
E Coli
assessment for pyelonephritis?
- History
- Urinary catheter?
- Fevers
- Urinary problems
- Abdominal discomfort
- Flank pain assessment
- Anxiety
diagnostics for Pyelonephritis
- Urinalysis
- Urine Culture (Clean Catch)
- “Urinalysis, Culture if Indicated”
- Blood Cultures
- C-reactive protein
- ESR
- Xray (KUB)
- CT
how do we get clean catch urine sample with foley that is already inserted? max time foley can be for collecting a sample?
-foley has to be less <72 hours, max time for collecting sample from indwelling Cath.
–>If >72 hours take it out, wait 1 hour and put a new one back in
interventions for pyelonephritis?
• Antibiotics- Broad Spectrum vs Specific antibiotics
◦ Clean catch urine culture before start abx
• Nutrition therapy
◦ Fluid intake @ 2L/day
-Surgery
surgery for pyelonephritis
- Used to correct structural problems (causing obstruction or reflux)
- Remove source of infection
- IV antibiotics
- Pyelolithotomy
- Nephrectomy
- Ureteroplasty
- Ureteral Implantation
- Ureteral diversion
community based care for pyelonephritis?
- Assess level of need
- Assistance with adherence to antibiotics
- Assistance with wound/incision care
- Transportation
- Nutrition and hydration
- Assistance with ADL’s
what is Glomerulonephritis? what can it lead to?
• Injury of the glomeruli (functional filters of the kidney) –> Proteinuria, Hematuria, Decreased GFR, Edema, Hypertension
◦ Immunologic changes injure the glomeruli
‣ Immune complexes form in the glomeruli (Antigen and antibody)
types of Glomerulonephritis
Acute or Chronic, Primary or Systemic (ex:systemic lupus causes)
patho of glomerulonephritis
◦ Immunologic changes injure the glomeruli
‣ Immune complexes form in the glomeruli (Antigen and antibody)
• Antigens
◦ Bacteria
◦ Viruses
◦ Toxins…
- These complexes trigger inflammatory mediators
- Overwhelms the glomeruli –> Injury
most common cause of acute glomerulonephritis
infection- Step A! –> leads to cute post-streptococcal glomerulonephritis
is Acute post-streptococcal glomerulonephritis a death sentence?
• Most people recover quickly and completely
◦ 1% of children do not recover
◦ 10% of adults do not recover
Assessment for Acute Glomerulonephritis
- History- did you recently have an infection (strep a)
- *Edema- due to fluid overload
- *Blood pressure
- Fluid overload/ Sodium retention
- Changes in urine, voiding patterns
- Weight
- Nausea, vomiting
- Fatigue
Diagnostics for Acute Glomerulonephritis
- Urinalysis
- Decreased GFR (50ml/hr)
- Total protein assay
- Serum albumin
- Kidney biopsy
Interventions for Acute Glomerulonephritis
- Antibiotic therapy
- Immune suppression
- Fluid intake limited to 24-hr output of previous day+ 500-600 mL
- Possible K+ and protein restrictions (oliguria)
- Anti-hypertensives
- Dialysis
- Coordinate care
- Patient Education
how do we determine fluid restrictions for acute Glom. Nephritis?
• Fluid intake limited to 24-hr output of previous day+ 500-600 mL
causes of Rapidly Progressive Glomerulonephritis
- May be infection or systemic disease
- 1% of children with AGN
- 10% of adults with AGN
onset of Rapidly Progressive Glomerulonephritis
• Develops over several weeks- months
another name for Rapidly Progressive Glomerulonephritis
• Crescentic glomerulonephritis
Rapidly Progressive Glomerulonephritis often progresses to
end stage renal failure
how long does it take for chronic Glom. Nephritis to develop?
20-30 years
s/s of
Chronic Glomerulonephritis
• Mild proteinuria, hematuria, hypertension, fatigue, edema
patho of Chronic Glomerulonephritis
- Changes in kidneys from hypertension, inflammation, infection or hypo-perfusion
- Kidney tissue atrophies
- Loss of functional nephrons -> reduced glomerular filtration
chronic glom. nephritis will always lead to
end stage renal disease
assessment for chronic glom. nephritis
Similar to Acute:
• Fluid Overload
• Low Urinary output
• Uremia
◦ Confusion
◦ Itching
◦ Fatigue
◦ Weight loss
-Abnormal Tastediagnostics for chronic glom. nephritis
• Urinalysis • GFR • Creatinine • BUN • Electrolytes (BMP) ◦ Na ◦ K+ • Blood gas- metabolic acidosis typically for renal failure • X-ray
interventions for chronic glom. nephritis?
- Slow down the progression of renal failure
- Prevent complications
- Diet changes
- Sufficient fluid intake
- Medications
- Dialysis
normal urine specific gravity
1.003 - 1.030 (higher number means higher concentration)
normal urine pH
4.6- 8.0
