DefinitionAccording to the twenty third edition ofTaber’s Cyclopedic Medical Dictionary (2013), chronic pyelonephritis is definedas sever “inflammation of the kidney and renal pelvis, usually due to abacterial infection that has ascended from the urinary bladder” (pg 1971).
Therenal pelvis being the enlarged part of the ureter where urine flows from thekidneys to the bladder. PathophysiologyPyelonephritis is an infection of one or bothkidneys and the structures connected to the kidneys; renal pelvis, tubules, andinterstitial tissue. In most cases the patient has a preexisting condition suchas kidney stones or obstruction. Bacteria like Staphylococcus and E.
coli,which may have entered the bladder from the bloodstream from intravenous druguse or a condition like endocarditis, multiply in stasis urine, from eitherobstruction or from the patient not emptying the bladder when needed. Thebacteria then travel upward to the kidney(s). EtiologyKidney infections can be caused by bacteria orviruses.
Most kidney infections start as a bladder infection and move up to thekidneys. In most cases, infection in the bladder is caused by bacteria notbeing eliminated during urination. When these bacteria aren’t eliminated in atimely manner, it multiplies. When the bacteria multiply to a number that isdifficult for the body to fight, it creates a bladder infection. Once theinfection is there, and there is no medical treatment, the infection can moveup the urinary tract and into the kidney.SymptomsThere are several symptoms of pyelonephritis.
Physical symptoms may include increased urgency and frequency of urination,fatigue, chills, fever, painful urination, flank pain (pain in the lower back),nausea, and vomiting. Urine will be cloudy and have an increased level of whiteblood cells, red blood cells, bacteria, casts, and be positive for nitrites.Patients younger than 2 years old may only present with a high fever, however,symptoms in elderly patients may also include confusion and hallucinations. DiagnosticTestsAn infection within the urinary tract isdiagnosed in 3 steps. First a visual examination of the urine will determine ifthe potential for infection is there. Urine should be light yellow to amber incolor and clear with no foul odor. Ifthe urine appears to be very dark amber, red, or green in color, cloudy, andhas a foul odor a urinalysis is usually ordered.
A urinalysis is usually doneby the nurse and used to determine if there is anything abnormal in the urine.Normalurinalysis results will be negative for nitrites, have an RBC count of ? 2RBCs/hpf and ? 2-5 WBCs/hpf, 0-5 hyaline casts/lpf, and be negative forbacteria and yeast. If the urinalysiscomes back abnormal, the urine sample will then be sent to the lab for a urineculture to determine if there is bacteria growth. Normal culture results willshow no bacteria growth within 24 to 48 hours. A CBC, complete blood count, mayalso be ordered to determine if there is an elevated white cell count and ifthere is an increase in sedimentation rate. Radiology may be called to performa CT, MRI, or ultrasound to help diagnosis a problem with the kidneys.
TreatmentThe primary treatment for any type of urinarytract infection is antibiotics, which are typically taken twice a day for tento fourteen days. Patients can be given broad spectrum antibiotics until aurine culture determines if a more specific antibiotic is needed. For more severecases that require hospitalization, IV antibiotics and fluids will be given.For patients with recurrent infections, surgery may be needed. PrognosisPatients with pyelonephritis who get treatmentand taken the ordered antibiotics generally recover with no lasting effects.
However, patients with repeated or untreated infections can have scarring orloss of kidney function. PreventionAlthough urinary tract infections cannot be onehundred percent prevented there are several ways to help lessen the chances ofone occurring. Drinking six to eight, eight-ounce glasses of water a day willallow the kidneys to properly filter out toxins. Go to the bathroom as soon asyou feel you need to go and wipe front to back.
Holding urine in the bladdergives bacteria the perfect place to multiply. Avoid douches and condoms withspermicides, as spermicides help bacteria growth and always make sure youurinate after sex to wash away any unwanted bacteria.