Pyelonephritis, Glomerulonephritis Flashcards by Kol Giessel

4 types of UTI

acute
chronic
complicated
uncomplicated

How well did you know this?

Not at all

Perfectly

type of UTI that is more than 2 infections in 6 months or 3 in a year

chronic

How well did you know this?

Not at all

Perfectly

type of UTI that is Invasion of urinary tract by an infectious organism

acute

How well did you know this?

Not at all

Perfectly

examples of complicated UTI’s

‣ Vesicoureteral reflux
‣ infection with multi-drug resistant organism
‣ Pregnancy
‣ CKD

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Bacterial Infection in the kidney and renal pelvis =

Pyelonephritis

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

chronic Pyelonephritis is often related to

‣ Urinary tract defect
‣ Obstruction
‣ Reflux

How well did you know this?

Not at all

Perfectly

which patient population is more likely to have chronic pyelonephritis?

females

- males become more susceptible after the age of 65

How well did you know this?

Not at all

Perfectly

Acute Pyelonephritis Infection almost always comes from…..

lower tract (Ascending)

How well did you know this?

Not at all

Perfectly

patho of acute pyelonephritis

• Inflammation occurs –>Tubular cell necrosis (Abscesses may occur) –> Fibrosis and scar tissue may form

How well did you know this?

Not at all

Perfectly

most common cause of chronic pyelonephritis?

reflux

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

which bacteria is most common cause of pyelonephritis?

E Coli

How well did you know this?

Not at all

Perfectly

assessment for pyelonephritis?

History
Urinary catheter?
Fevers
Urinary problems
Abdominal discomfort
Flank pain assessment
Anxiety

How well did you know this?

Not at all

Perfectly

diagnostics for Pyelonephritis

Urinalysis
Urine Culture (Clean Catch)
“Urinalysis, Culture if Indicated”
Blood Cultures
C-reactive protein
ESR
Xray (KUB)
CT

How well did you know this?

Not at all

Perfectly

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 Taste ```

diagnostics 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