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Pyelonephritis

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Objectives

By the end of the lesson the student will be able to

1. State the definition of pyelonephritis.

2. Outline the pathophysiology of pyelonephritis.
3. State the causes/risk factors of pyelonephritis.
4. List the signs and symptoms of pyelonephritis.
5. Identify the investigations that would be undertaken to aid
diagnosis of pyelonephritis.
6. Discuss the nursing care for patient with urinary tract
infection.

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Urine Tract Infection

• The urinary tract is normally sterile above the urethra.

• Adequate urine volume, a free flow from the kidneys
through the urinary meatus, and complete bladder empty
are the most important mechanisms maintain sterility.
• Pathogens that enter and contaminate the distal urethra are
washed out during voiding.
• However, when the pathogens enter the urinary tract by
ascending from the mucous membrane of the perineal area
into the lower urinary tract or even ascending further to
upper urinary tract, infection occurs.

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Figure 27–1 A competent vesicoureteral junction. Note how increased intravesicular pressure
during voiding occludes the distal portion of the ureter, preventing reflux.

Images retrieved from LeMone

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Types of urine tract infection

• Lower urinary tract infection:

 Urethritis: inflammation of the urethra
 Prostatitis: inflammation of the prostate gland (male)
 Cystitis: inflammation of the urinary bladder

• Upper urinary tract infection:

 Pyelonephritis: inflammation of the kidneys and renal
pelvis

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Pathophysiology of Acute Pyelonephritis

https://www.youtube.com/watch?v=VXFRWFHx6tA

• Results from an infection that ascends to the kidney from the

lower urinary tract.
• The infection spreads from the renal pelvis to the renal cortex.
• The pelvis, calyces, and the medulla of the kidney are primarily
affected, with WBC infiltration and inflammation.
• The kidney become grossly oedematous.
• Localised abscesses may develop on the cortical surface of the
kidney.
• E. coli is the organism responsible for 85% of the cases of acute
pyelonephritis.

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Risk factors that cause Acute Pyelonephritis

• Pregnancy – slowed ureteral peristalsis
• Urinary tract obstruction
• Congenital malformations
• Urinary tract trauma/scarring
• Calculi
• Kidney disorders such as Polycystic
• Chronic disease such as diabetes.
• Vesicoureteral Reflux: is the backward flow of urine from
the bladder into the kidneys.

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Clinical manifestations of Acute Pyelonephritis

URINARY SYSTEMIC
Urinary Frequency Vomiting
Dysuria Diarrhea
Pyuria Acute Fever
Hematuria Shaking Chills
Flank Pain Malaise
Costovertebral Tenderness

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Costovertebral Tenderness

https://epomedicine.com/clinical-medicine/costovertebral-or-renal-angle-tenderness/
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Causes of Chronic Pyelonephritis

It is a chronic inflammation
process and scarring of tubules
and interstitial tissues of the
kidney.

1. It is common cause of
chronic kidney disease.
2. It may develop as a result
of UTI or other conditions
that damage the kidney,
such as hypertension or
obstruction of the urinary
tract.
https://www.shutterstock.com/search/pyelonephritis

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Clinical manifestations of Chronic

Pyelonephritis
• Usually asymptomatic
• Have mild manifestations such as
 Urine frequency
 Dysuria
 Flank pain

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Urine FEME
Investigations
Haematuria – RBC account
Pyuria – Pus in the urine, lysed WBC Urine culture &
Bacteriuria- colony forming units sensitivity

IV Pyelogram
or urogram- Voiding
to evaluate Cystourethrography – to
structure or detect structural or
functional functional abnormalities
abnormalities of the bladder and
urethral strictures
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Images retrieved from google images
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Investigations
Cystoscopy- to diagnose conditions such
as urethral stricture, bladder calculi,
tumours, polyps, etc.
Tissue biopsy may be taken.

Manual pelvic examination - to

assess for structural changes of
the genitourinary tract, such as
prostate enlargement (male),
cystocele (female).

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Images retrieved from google images
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Haematological investigation
Name of the test Purpose & Description
Blood Urea - Measures urea in the blood.
Nitrogen (BUN) - Increased levels may result from
dehydration, vomiting, diarrhea or
renal failure.
Creatinine (serum) - Used to diagnose kidney dysfunction.
- Creatinine is the by-product of the
breakdown of muscle
- Serum creatinine rises might
indicates the nephron damage.

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Medical Management

 IV Antibiotic to ensure complete eradication the

bacteria.
 Hydration – facilitates flushing of the urinary tract.
Encourage 3 to 4 L/day unless contraindicated
• To dilute urine
• To decrease burning sensation
• To prevent dehydration
 Empty bladder completely
 Maintain personal hygiene

Surgical management will be needed for patient with

recurrent UTI due to calculi, structural abnormalities.

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Impaired urinary elimination related to frequent

urination and urgency
SN INTERVENTIONS RATIONALE
1 Monitor colour, clarity and odour of Urine should return to clear yellow
urine. within 48 hours after the treatment is
initiated.
2 Instruct to avoid caffeinated drinks, Caffeine, citrus juices irritate the
tea, coffee, citrus drinks and colas. bladder mucosa and detrusor muscle
and increase urgency and bladder
spasms.
3 Use strict aseptic technique and a Bacterial colonizing the perineal
closed urinary drainage system tissues and on the nurse’s hands can
when inserting a catheter. be introduced into the bladder during
catheterization.
4 When possible, use intermittent Using intermittent straight
straight catherization to relieve catheterization allows the bladder to
urinary retention. fill and empty in a more normal
manner, maintain physical function.

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Impaired urinary elimination related to f requent

urination and urgency
SN INTERVENTIONS RATIONALE
5 Maintain the closed urinary Bacteria can enter the drainage
drainage system and use aseptic system when its integrity is
technique when emptying the interrupted.
drainage bag.
6 Provide perineal care on a regular Regular cleansing of the perineal
basis and following defecation. tissues reduces the risk of
colonization by bowel or other
bacteria.

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Summary

1. State the definition of pyelonephritis.

2. Outline the pathophysiology of pyelonephritis.
3. State the causes/risk factors of pyelonephritis.
4. List the signs and symptoms of pyelonephritis.
5. Identify the investigations that would be undertaken to aid
diagnosis of pyelonephritis.
6. Discuss the nursing care for patient with urinary tract
infection.

@Ngee Ann Polytechnic INS1 Oct 2022 semester 20

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REFERENCES

• Bauldoff, G., Gubrud, P., & Carno, M. (2019). LeMone and

Burke’s Medical-Surgical Nursing: Clinical Reasoning in
Patient Care (7th ed.). Boston: Pearson.

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