Pyelonephritis is a kidney infection caused by a urinary tract infection that spreads to the kidneys. Symptoms include fever, flank pain, nausea, and painful urination. It is diagnosed through urinalysis showing white blood cells and urine culture. Treatment involves antibiotics to eliminate the bacteria causing the infection. Kidney damage can occur if not treated promptly, especially in high-risk groups like the elderly. Preventive measures include treating UTIs, good hygiene, and cranberry juice.

1. Kidney infection or
Kidney infection or
pyelonephritis
pyelonephritis

Definition
Definition
:
:

Pyelonephritis
Pyelonephritis is an infection of the
is an infection of the
kidney and the urethres
kidney and the urethres
.
.

Causes
Causes 1- urinary tract infection, in
1- urinary tract infection, in
the presence of occasional or
the presence of occasional or
persistent back flow
persistent back flow

2
2
-
-
urine from the bladder into the
urine from the bladder into the
ureters or kidney pelvis
ureters or kidney pelvis
(
(vesicoureteric reflux
vesicoureteric reflux
(.
(.

2. Classification of
Classification of
pyelonephritis
pyelonephritis
Acute uncomplicated
Acute uncomplicated
pyelonephritis
pyelonephritis sudden
sudden
development of kidney
development of kidney
inflammation
inflammation
(.
(.
Chronic pyelonephritis
Chronic pyelonephritis (a long-
(a long-
standing infection that does not
standing infection that does not
clear
clear

3. Causes incidence, and risk
Causes incidence, and risk
factors
factors

The risk is increased if there is a
The risk is increased if there is a history
history
of
of cystitis, renal papillary necrosis,
cystitis, renal papillary necrosis,
kidney stones, vesicoureteric reflux, or
kidney stones, vesicoureteric reflux, or
obstructive uropathy
obstructive uropathy
.
.

Acute pyelonephritis
Acute pyelonephritis can be severe in
can be severe in
the elderly and in people who are
the elderly and in people who are
immunosuppressed (for example, those
immunosuppressed (for example, those
with cancer or AIDS
with cancer or AIDS
(.
(.

4. Symptoms
Symptoms
:
:
-
-
Flank pain or back pain
Flank pain or back pain
.
.
-
-
Severe abdominal pain
Severe abdominal pain

-
-
high fever and persists for more than 2 days
high fever and persists for more than 2 days
.
.

-
-
Chills with shaking.Warm, flushed, moist
Chills with shaking.Warm, flushed, moist
skin
skin
.
.

-
-
Vomiting, nausea
Vomiting, nausea
.
.

-
-
Fatigue and general ill feeling
Fatigue and general ill feeling
.
.
-
-
Painful urination, urinary frequency or urgency
Painful urination, urinary frequency or urgency
nocturia
nocturia
.,
.,

-
-
Cloudy or abnormal urine color, foul or
Cloudy or abnormal urine color, foul or
strong urine odor, and hematuria may occur
strong urine odor, and hematuria may occur
.
.

-
-
Mental changes of confusion
Mental changes of confusion

5. Diagnostic studies
Diagnostic studies


-
-
A urinalysis
A urinalysis commonly reveals white
commonly reveals white
blood cells (WBCs) or red blood cells
blood cells (WBCs) or red blood cells
(RBCs
(RBCs
(.
(.

-
-
A urine culture
A urine culture may reveal bacteria in
may reveal bacteria in
the urine
the urine
.
.

-
-
A blood culture
A blood culture may show an infection
may show an infection
.
.

-
-
An intravenous pyelogram (IVP) or CT
An intravenous pyelogram (IVP) or CT
scan
scan of the abdomen may show
of the abdomen may show
enlarged kidneys with poor flow of dye
enlarged kidneys with poor flow of dye
through the kidneys
through the kidneys
.
.

6. Treatment
Treatment

The goals of treatment are control of
The goals of treatment are control of
the infection and reduction of
the infection and reduction of
symptoms
symptoms
.
.

Acute symptoms usually resolve within 48 to
Acute symptoms usually resolve within 48 to
72 after appropriate treatment
72 after appropriate treatment
.
.

Due to the high mortality rate in the elderly
Due to the high mortality rate in the elderly
population and the risk of permanent kidney
population and the risk of permanent kidney
damage prompt treatment is recommended
damage prompt treatment is recommended
.
.

7. 
antibiotics are selected to treat the
antibiotics are selected to treat the
infection
infection
.
.

Intravenous (IV) antibiotics
Intravenous (IV) antibiotics may be used
may be used
initially to control the bacterial infection if
initially to control the bacterial infection if
infection is severe a
infection is severe a 10- to 14 day
10- to 14 day course of
course of
antibiotics chronic pyelonephritis
antibiotics chronic pyelonephritis

Kidney damage
Kidney damage can result from these
can result from these
infections. The elederly, infants, and people
infections. The elederly, infants, and people
with a compromised immune system
with a compromised immune system


so
so receive frequent monitoring for potential
receive frequent monitoring for potential
problems and to receive IV antibiotics,
problems and to receive IV antibiotics,
additional IV fluids and other medications as
additional IV fluids and other medications as
necessary
necessary

8. 
Complications
Complications
:
:

Recurrence of pyelonephritis
Recurrence of pyelonephritis
.
.

Perinephric abscess (infection
Perinephric abscess (infection
around the kidney
around the kidney
(.
(.

Sepsis
Sepsis
.
.

Acute renal failure
Acute renal failure
.
.

Chronic renal failure
Chronic renal failure
.
.


9. prevention
prevention

Prompt and complete treatment of
Prompt and complete treatment of
cystitis pyelonephritis. Chronic or recurrent
cystitis pyelonephritis. Chronic or recurrent
urinary tract infection of the kidneys
urinary tract infection of the kidneys
.
.


Preventive measures
Preventive measures may reduce
may reduce
symptoms and prevent recurrence of
symptoms and prevent recurrence of
infection. Keeping the genital area clean and
infection. Keeping the genital area clean and
remembering to from front to back
remembering to from front to back

Urinating immediately
Urinating immediately after sexual
after sexual
intercourse may help eliminate any bacteria
intercourse may help eliminate any bacteria

10. Prevention
Prevention

Increasing the intake of fluids
Increasing the intake of fluids
to encourage frequent urination that
to encourage frequent urination that
flushes bacteria from the bladder
flushes bacteria from the bladder
.
.

Drinking cranberry juice
Drinking cranberry juice
prevents certain types of
prevents certain types of
bacteria
bacteria from attaching to the wall
from attaching to the wall
of the bladder
of the bladder

11. 
Glomerulonephritis
Glomerulonephritis is an
is an
inflammation of the kidney
inflammation of the kidney’
’s filtering
s filtering
mechanisms, called the glomeruli
mechanisms, called the glomeruli
.
.

Glomerulonephritis can
Glomerulonephritis can be acute
be acute,
,
which means it occurs suddenly
which means it occurs suddenly
,
,

or chronic
or chronic, meaning symptoms
, meaning symptoms
develop gradually and continue over a
develop gradually and continue over a
number of years
number of years

12. 
common
common in children between the ages
in children between the ages
of 2 and 12, particularly boys
of 2 and 12, particularly boys
.
.

Children with frequent streptococcal
Children with frequent streptococcal
infections
infections

people with diseases such as hepatitis,, or
people with diseases such as hepatitis,, or
diabetes
diabetes
.
.

What causes it
What causes it

occurs after a streptococcal
occurs after a streptococcal
infection, such as strep throat-
infection, such as strep throat-
certain toxins, such as paints
certain toxins, such as paints

its cause is not known
its cause is not known
.
.

13. 
What are the signs &
What are the signs &
symptoms
symptoms
?
? often flu-like, such as general fatigue,
nausea, vomiting, loss of appetite, fever
,
and abdominal and joint pain. These types
of general symptoms can continue for up to
one month before symptoms of kidney
failure appear

14. 
swelling. They can progress to high blood
pressure, visual disturbances,
shortness of breath, blood in the
urine, and a reduction in urine
production
.


Chronic glomerulonephritis develops so
gradually that it is often not discovered until
a routine physical exam
.

As this condition progresses, it causes high
blood pressure, swelling, and other
symptoms of kidney failure
.

15. 
How is it diagnosed
How is it diagnosed

-
-
complete medical history, physical
complete medical history, physical
examination, and laboratory tests
examination, and laboratory tests
.
.

-
-
check a urine sample
check a urine sample for blood and
for blood and
high levels of protein
high levels of protein

check for high levels of the waste
check for high levels of the waste
products creatinine and urea in blood
products creatinine and urea in blood
.
.

If a streptococcal infection
If a streptococcal infection is suspected,
is suspected,
throat culture, will reveal this bacteria.
throat culture, will reveal this bacteria.
a biopsy, to study under a
a biopsy, to study under a
microscope. An
microscope. An eye exam
eye exam may show
may show
signs of vascular changes in people
signs of vascular changes in people
with chronic glomerulonephritis
with chronic glomerulonephritis
.
.

16. 
the treatment
the treatment

bedrest
bedrest and medications
and medications

1
1
-
-
to cure any infection, increase urine
to cure any infection, increase urine
output, and lower blood pressure
output, and lower blood pressure
,
,

2
2
-
-
to relieve any strain on the kidneys so
to relieve any strain on the kidneys so
they can recover full function
they can recover full function

diet control to
diet control to your intake of sodium,
your intake of sodium,
protein, and fluids. Most children recover
protein, and fluids. Most children recover
fully
fully
,
,

17. 
no treatment
no treatment to stop the
to stop the
progression of chronic
progression of chronic
glomerulonephritis. Once kidney
glomerulonephritis. Once kidney
failure has occurred
failure has occurred
,
,

waste products
waste products must be removed
must be removed
from the bloodstream for the
from the bloodstream for the
kidneys through a process called
kidneys through a process called
dialysis
dialysis
.
.

A kidney transplant
A kidney transplant may also
may also
be an option
be an option
.
.

18. 
You can help prevent acute
You can help prevent acute
glomerulonephritis by treating
glomerulonephritis by treating
streptococcal infections following the
streptococcal infections following the
full course of medication
full course of medication

Nursing intervention
Nursing intervention

1
1
-
-
reliefe symtoms
reliefe symtoms &prevention
&prevention
complication
complication

2
2
-
-
Diatery intake
Diatery intake :protein restriction
:protein restriction –
–
increase cho
increase cho
.
.

3
3
-
-
Monitor
Monitor I &O -vital signs-activity
I &O -vital signs-activity
level-edema-hypertentio
level-edema-hypertentio

Proternurea &hematuria
Proternurea &hematuria

4
4
-
-
Patient education
Patient education (medication
(medication
,diet,avoidance of trams ,infection
,diet,avoidance of trams ,infection
&follow -up
&follow -up

19. Nephrotic syndrome
Nephrotic syndrome

IS
IS condition marked by very high levels of
condition marked by very high levels of
protein in the urine; low levels of protein in
protein in the urine; low levels of protein in
the blood; swelling
the blood; swelling

of Nephrotic syndrome
of Nephrotic syndrome

Symptoms of Nephrotic syndrome
Symptoms of Nephrotic syndrome

Frothy urine
Frothy urine

Proteinuria
Proteinuria

Low serum protein
Low serum protein

Lipiduria
Lipiduria

Swelling around the eyes
Swelling around the eyes

20. it
it results from
results from a specific glomerular defect
a specific glomerular defect
and indicates renal damage. The prognosis
and indicates renal damage. The prognosis
is highly variable, depending on the
is highly variable, depending on the
underlying cause. Some forms may
underlying cause. Some forms may
progress to end-stage renal failure
progress to end-stage renal failure
.
.

Causes
Causes About 75% of nephrotic syndrome
About 75% of nephrotic syndrome
cases result from primary (idiopathic)
cases result from primary (idiopathic)
glomerulonephritis
glomerulonephritis
1
1
-
-
Some tubules may contain increased lipid
Some tubules may contain increased lipid
deposits
deposits

2
2
-
-
lesion in patients with adult idiopathic
lesion in patients with adult idiopathic
.
.

21. 
Other causes of nephrotic
Other causes of nephrotic

1
1
-
-
metabolic diseases such as
metabolic diseases such as
diabetes mellitus
diabetes mellitus
;
;

collagen-vascular disorders, such
collagen-vascular disorders, such
as
as 2
2-systemic lupus
-systemic lupus
erythematosus and polyarteritis
erythematosus and polyarteritis

3
3
-
-
circulatory diseases, such as
circulatory diseases, such as
heart failure and sickle cell
heart failure and sickle cell
anemia;
anemia; 4-
4-nephrotoxins, such as
nephrotoxins, such as
mercury, gold, and nonsteroidal
mercury, gold, and nonsteroidal 5-
5-
anti-inflammatories; allergic
anti-inflammatories; allergic
reactions; infections, such as
reactions; infections, such as

22. 
Diagnosis
Diagnosis

Consistent proteinuria
Consistent proteinuria in excess of 3.5
in excess of 3.5
g/24 hours strongly suggests syndrome
g/24 hours strongly suggests syndrome
;
;

examination of urine
examination of urine reveals an
reveals an
increased number of granular, and waxy,
increased number of granular, and waxy,
fatty casts, and oval fat bodies
fatty casts, and oval fat bodies
.
.

Serum values
Serum values that support the diagnosis
that support the diagnosis
are increased cholesterol, phospholipid, and
are increased cholesterol, phospholipid, and
triglyceride levels and decreased albumin
triglyceride levels and decreased albumin
levels
levels
.
.

Histologic identification
Histologic identification of the lesion
of the lesion
requires a kidney biopsy
requires a kidney biopsy

23. 
Treatment
Treatment

1
1
-
-
correction of
correction of the underlying cause
the underlying cause
.
.

2
2
-
-
Supportive treatment
Supportive treatment consists of
consists of
protein replacement with a nutritional diet of
protein replacement with a nutritional diet of
1 g protein/kg of body weight, with restricted
1 g protein/kg of body weight, with restricted
sodium intake
sodium intake
.
.

3
3
-
-
a
a diuretic for
diuretic for edema; and an antibiotic
edema; and an antibiotic
for infection
for infection
.
.

4
4
-
-
Immunosuppressants
Immunosuppressants ,
,
antihypertensives, and diuretics
antihypertensives, and diuretics
.
.

5
5
-
-
Angiotension-converting enzyme
Angiotension-converting enzyme
inhibitors
inhibitors can decrease protein loss in urine
can decrease protein loss in urine

24. Nursing intervention
Nursing intervention