Acute and chronic pyelonephritis

Chronic pyelonephritis (CP)

(AKA interstitial nephritis, chronic atrophic pyelonephritis or reflux nephropathy- which is when scarring occurs in the presence of vesicoureteral reflux) Kidneys are small, atrophic, and shrunken and lose function due to permanent renal tissue scarring or fibrosis- low grade fever, asymptomatic disease that leads to renal damage (Interstitial nephritis)

Clinical manifestations of acute pyelonephritis

(mild or severe)- usually subside, but bacteriuria and pyuria remain. mild fatigue sudden onset of chills fever Nausea/vomiting malaise flank pain LUTS characteristics of cystitis included dysuria, urinary urgency, and frequency. costovertebral tenderness on affected side anorexia pus in urine (foul odor) tachycardia, tachypnea, increased BP

Acute pyelonephritis

(upper urinary tract infection)- an active bacterial infection of the renal pelvis, medulla, calyces, tubules and interstital tissue of one or both kidneys. Due to bacterial infection usually.

CLINICAL MANIFESTATIONS of chronic pyelonephritis

1. headache 2. fatigue 3. decreased appetite 4. polyuria, nocturia 5. excessive thirst 6. weight loss 7. inability to concentrate urine or conserve sodium can lead to uremia, HTN and calculi formation -can lead to renal failure and ESRD

ASSESSMENT/FINDINGS of CP

Diagnostic •Radiologic imaging and histologic testing (rather than clinical features) •Images reveal a small, contracted kidney with a thinned parenchyma •Collecting system may be small or hydronephrotic •Pathologic analysis reveals loss of functioning nephrons, infiltration of the parenchyma with inflammatory cells, and fibrosis

Assessment findings of acute pyelonephritis

Assess for fever, chills, dysuria Elderly commonly have atypical presentation: afebrile, absence of dysuria, loss of appetite, altered mental status. Assess for hematuria: cloudy foul smelling urine, tender, enlarged kidney Diagnostic test and findings include CBC with differential- leukocytosis positive UA for bacteria, pyuria, RBCs and WBCs, and varying degrees of hematuria. positive urine culture- urine culture must be obtained when suspect pyleonephritis. ask about quality of flank pain and check for costovertebral tenderness Imaging studies: IVP, KUB, CT scan or Gallium scan- assess for complications of pyelonephritis such as impaired renal function, scarring, chronic pyelonephritis, or abscesses. ultrasound- used to identify anatomic abnormalities, hydronephrosis, renal abscesses, or the presence of an obstructing stone. urine, C&S blood cultures sedimentation rate BUN and Cr

Pyelonephritis

Inflammation (usually due to infection) of the renal parenchyma and collecting system.

MANAGEMENT AND NURSING CARE of CP

Nursing interventions and strategies to meet or alleviate the SCD associated with pyelonephritis a. increase fluids to 3 liters/day b. monitor weight - put on daily weight c. monitor for signs of fluid retention (lab values, etc) d. monitor for antibiotic Rx and maintain blood levels (P & T) peak and trough e. check C + S of urine for antibiotic sensitivity f. assess for signs and symptoms of infection g. monitor V/S. Give antipyretic for ↑ temperature. (expect with AP) h. Adequate healthy nutrition i. Rest periods as needed from activity

Complication of CP

Often progresses to ESRD when both kidneys are involved

Nursing interventions (for acute and chronic)

increase fluids to 3 liters/day monitor weight - put on daily weight monitor for signs of fluid retention (lab values, etc) monitor for antibiotic Rx and maintain blood levels (P & T) check C + S of urine for antibiotic sensitivity assess for signs and symptoms of infection monitor V/S. Give antipyretic for ↑ temperature. (expect with AP) Adequate healthy nutrition Rest periods as needed from activity

management for acute pyelonephritis

severe infections (N/V and dehydration) need hospitalization mild infections can be treated with antibiotics for 14-21 days. Parenteral antibiotics often given initially in hospital. Ampicillin, vancomycin with gentamycin and later switch to Bactrim, Septra, Cipro, Macrodantin Signs and symptoms resolve around 48-72hrs after starting therapy. Relapses can be treated with 6-week course of antibiotics. Reinfections can be treated as each episode or long term antibiotic therapy. If obstructed, relieve obstruction to prevent kidney damage possible surgery: ureteroplasty, pyelolithotomy, or nephrectomy. Morphine or NSAID agents Encourage patient to drink at least 8 glasses of fluids every day, even after infection is treated.

Causes of acute pyelonephritis

starts as an infection in the lower urinary tract from the normal bacteria found in the intestinal tract (e. coli, proteus, klebsieela, enterobacter). A preexisting factor is vesicoureteral reflux, where there is retrograde movement of urine from the lower to the upper urinary tract. or dysfunction/obstruction from Benign prostatic hyperplasia, a stricture, or a urinary stone. for long-term care patients- indwelling catheters.

Causes of chronic pyelonephritis

usually the outcome of recurring infections involving the upper urinary tract may also occur in the absence of an existing infection, recent infection, or history of UTI's