Treatment, diagnostic , symptoms

1. PYELONEPHRITIS

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