Pyelonephritis is an inflammation of the kidney and upper urinary tract, often caused by bacterial infection from the bladder, classified into acute, chronic, and xanthogranulomatous types. Symptoms include fever, flank pain, dysuria, and complications may arise if untreated, necessitating diagnostic tests and antibiotic management. Prevention strategies include increasing fluid intake and consuming certain foods to inhibit bacterial adherence in the urinary tract.

1. PYELONEPHRITIS
Presented by-
PANKAJ SINGH RANA
NURSE PRACTITIONER IN
CRITICAL CARE

2. INTRODUCTION
• PYELONEPHRITIS (Greek means “pyelum”-renal
pelvis,”nephros”-kidney &”itis”-inflammation) is an
ascending urinary tract infection that has reached
the pelvis of the kidney.

3. DEFINITION
It is the inflammation of the kidney & upper urinary
tract that usually results from the bacterial infection
of the bladder.

5. TYPES OF
PYELONEPHRITIS
• Pyelonephritis can be classified in several different
catagories:
• -acute pyelonephritis
• -chronic pyelonephritis
• -xanthogranulomatous pyelonephritis

6. ACUTE
PYELONEPHRITIS

7. ACUTE PYELONEPHRITIS
• Acute pyelonephritis is an sudden development of
kidney inflammation.it can be severe in elderly &
people who have cancer or AIDS.

8. CAUSES
• (Vesicourethral reflux) backward flow of infected
urin e from the bladder to the upper urinary tract
• Kidney stones
• Urinary tract catheterization
• Pregnancy
• Neurogenic bladder (spina bifida)
• Benign prostatic hyperplasia
• Diabetes mellitus

9. MORPHOLOGY
• GROSS ANATOMY
• It show enlarged & swollen kidney that bulges on
section.
• Yellowish raised abscesses are seen on renal surface
on histology.
• MICROSCOPIC EXAMINATION
• It involve the interstitium & causing destruction of the
tubules.
• The renal blood vessels show considerable resistance
to infection & are spared.

10. CLINICAL FEATURES
• Acute onset of pain
• Fiver with chills
• Lumbar tenderness
• Dysuria
• Frequency of micturition
• On examination urine will show bacteria in excess of
100,000/ml,pus cells .

11. COMPLICATIONS
• Papillary necrosis
• Pyonephrosis
• Perinephric abscess

12. CHRONIC
PYELONEPHRITIS

13. CHRONIC
PYELONEPHRITIS
• It implies kidney infection & chronic tubulointerstitial
disease resulting in repeated attacks of
inflammation & scarring.

14. ETIOPATHOGENESIS
• It can be of two types
• CHRONIC OBSTRUCTIVE PYELONEPHRITIS
Obstruction to the outflow of urine at different levels
predisposes the kidney to infection.
• REFLUX PYELONEPHRITIS
Reflux of urine from the bladder into one or both the
ureters during micturition is the major cause of chronic
pyelonephritis .

15. CAUSES
• Flank pain
• Abdominal pain
• Blood in urine
• Signs of infection
• Fiver
• Unintentional weight loss
• Malaise
• Decreased appetite

16. MORPHOLOGY
• GROSS ANATOMY
• Kidney is small & contracted.they show unequal
contraction at various places & this differentiates it from
symmetrical contracted kidneys seen in benign
nephrosclerosis.the scars cause adhesion of capsule of
kidney to cortex.
• MICROSCOPY EXAMINATION
• The changes are seen in interstitium & tubules,there is
chronic interstitial inflammatory reaction composed of
lymphocytes ,plasma cells & macrophafes tubules show
atophy &dilation.

17. CLINICAL FEATURES
• fever
• Lumber tenderness
• Dysuria
• Pyouria
• Hypertension
• Frequency of micturition
• Bacteriuria

18. XANTHOGRANULOMATOUS
PYELONEPHRITIS

19. XANTHOGRANULOMATOU
S PYELONEPHRITIS
• It is an unusual form of chronic pyelonephritis
characterized by granulomatous abscess
formation,severe kidney distruction & clinical
pictures that may resemble renal cell carcinoma &
other inflammatory renal parenchymal diseases.

20. CLINICAL MANIFESTATION
• Urosepsis
• Anemia
• Painful renal mass
• Kidney stones
• Loss of function of the affected kidney

21. MORPHOLOGY
• There are granulomas & lipid laden macrophages.It
is found roughly 20% of specimens from surgically
managed cases of pyelonephritis.

22. DIAGNOSIS
• LABORATORY EXAMINATION
• Urinalysis may show sign of UTI
• Blood test
• Antibiotic sensitivity testing
• Intra venous pyelography

23. The Urine DipstickTest:
• Rapid diagnostic test
• Appearance ofWBC in urine
• test for nitrite & leukocyte esterase ( family
Enterobacteriaceae, in detected in urine PMN )
• Negative outcome ,it s not sufficient for pregnancy
women

24. Urinalysis:
• WBC in Cast shape due to of pyelonephritis
• No WBC ,No Infection
Urine Culture:
• It is positve with colony count equal or more than 10
power 2 In women with dysuria & pyuria
• It is positve with colony count > 10 power 3 In Men

25. MANAGEMENT
• To control the infection & reduce the symptoms.
• Urine culture & antibiotic sensitivity test is performed
on the basis of infecting agents .
• Use antibiotics
• Like-aminoglycosides,cephalosporin &
sulphamethoxazole etc.

26. Risk for Infection related to the
presence of bacteria in the kidneys
Nursing Intervention:
Assess the patient's temperature every 4 hours and report if the
temperature is above 38.50 C
Rational:
Vital signs indicate a change in the body
• Record the characteristics of urine
Rational:
To find out / identify indications of progress or deviations from
expected results.
• Instruct the patient to drink 2-3 liters if no contraindications
Rational:
To prevent urine stasis

27. • Monitor re-examination of the urine culture and sensitivity to
determine response to therapy.
Rational:
Knowing how far the effect of treatment on patient
circumstances.
• Instruct the patient to empty the bladder completely each time
the bladder.
Rational:
To prevent bladder distension
• Give perineal care, maintain to keep them clean and dry.
Rational:
To maintain cleanliness and avoid bacterial infection of the
urethra making.

28. Pain related to infections of the
kidney.
Nursing Intervention:
Assess the intensity, location, and factors that
aggravate or relieve pain.
Rational:
Extreme pain indicates an infection.
• Provide adequate rest periods and activity levels
that can be tolerant.
Rational:
Clients can rest in peace and to relax the muscles.

29. • Encourage drinking plenty of 2-3 liters if no
contraindications
Rational:
To assist clients in micturition.
• Give appropriate analgesic drugs with therapy
programs.
Rational:
Analgesic block the path of pain.

30. PREVENTION
• If pyelonephritis is not treated immediately
,permanent kidney damage can occur.
• Increasing fluid intake ,consuming blueberry juice &
fermented milk products containing probiotic
bacteria have all been shown to inhibit adherence of
bacteria to the epithelial cells of urinary tract &
reduce the recurrence of UTI.

31. SUMMARY