Pyelonephritis : Pathophysiology, Etiology, Signs and Symptoms

Pyelonephritis is a kidney infection and is a form of a urinary tract infection (UTI). Urinary tract infections (UTIs) is one of the most common kinds of viruses prone to everyone. In the United States, about six million Americans and results in more than 100,000 hospitalizations yearly (Kornusky & Cabrera, 2018). Urine is where microorganisms start their growth. Pyelonephritis is a virus of the upper urinary tract. Infections may ascend, arise from organisms in the perineal area and transport in the urinary tract along the continuous mucosa to the bladder and then along the ureters to the kidneys (VanMeter & Hubert, 2017).  Blood-borne contamination may cause urinary tract infection before becoming severe enough to cause pyelonephritis.

Escherichia coli is a common causative organism to pyelonephritis infection. Other causative organism includes Klebsiella, Proteus, Enterobacter, Citrobacter, Serratia, Pseudomonas, Enterococcus, coagulase-negative Staphylococcus, Chlamydia, and or Mycoplasma. Escherichia coli is more present as a contributing factor in the urinary tract because it is a resident flora in the intestine. It can survive by sticking to fimbriae or pili in the bladder mucosa without being washout when the bladder empties (VanMeter & Hubert, 2017). This lead as a medium for growth of infection in the intestine and kidney.

Pathophysiology of pyelonephritis is when infection form in the ureter into the kidney. It may include renal pelvis and medullary tissue. Both kidneys may be infected. The infection spreads, causing the kidney pelvis and calyces to fill with purulent exudate and cause the medulla to inflame. Abscesses and necrosis form in the medulla and may extend through the cortex to the surface of the capsule. In a severe infection, the exudate compresses the renal artery and vein, which then hinder urine flow to the ureter while bilateral barrier may cause acute renal failure (VanMeter & Hubert, 2017). Recurring, severe, and bilateral infection cause fibrous scar tissue to form over a calyx and may result in loss of tubule function, hydronephrosis, and chronic renal failure.

Etiology of pyelonephritis. Women are more susceptible to infection than men because of the short length and width of their urethra, its closeness to the anus, and the frequent irritation to the tissues (VanMeter & Hubert, 2017). Individual who practice improper hygiene practices during sexual activities, feminine hygiene products, defecation, menstruation, and incontinence are at risk for urinary tract infection. Those with incomplete bladder emptying, urine retention, and any obstruction to urine flow will also have an increased risk for urinary tract infection. Children with congenital abnormalities have an increased risk for urinary tract infection. The Elderly population also have a higher risk for infections due to incomplete bladder emptying, retention, reduced fluid intake, the impaired blood supply to the bladder, and immobility. Pregnancy, scar tissue, and renal calculi or kidney stones increase the risk for infection due to urine and contaminants not flowing freely or out of the system. Instruments or catheters may cause bacteria to grow in the bladder and cause an infection as well.

Signs and symptoms of pyelonephritis vary for everyone. Diagnosis of pyelonephritis depends on the severity of the infection, complications, and the overall physical condition of the patient (Kornusky & Cabrera, 2018). Pyelonephritis may include signs of cystitis, such as dysuria. Other signs and symptoms are pain that can be in the abdominal, back, side, groin, and or flank. Chills, fever, nausea, vomiting may be present. Observing urine abnormalities such as cloudy, dark bloody, or foul-smelling is possible signs of pyelonephritis.  The infection can cause ones to have urination abnormalities such as frequent, urge, and or painful urination.

Goal treatment for pyelonephritis is to provide symptomatic relief and to decrease progressing risk of complications. Treatment includes medication and fluid. Treatment for pyelonephritis means curing urinary tract infections. The process will consist of an antibacterial remedy, such as trimethoprim-sulfamethoxazole, nitrofurantoin, cephalosporins, carbapenems, amoxicillin, and or Fosfomycin. Drinking more fluid is also encourage, and cranberry juice are suggested. Having patient compete medication regimen is necessary even after signs and symptoms subside. It is also recommended to recheck pyelonephritis patient’s urine culture after medication regimen for the presence of the infection and to see if the treatment worked.  Depending on the severity of pyelonephritis infection, ones may require hospital treatment. With recurring kidney infection, a kidney specialist or urinary surgeon may necessitate for evaluation. Surgery may be necessary to repair abnormality. After starting antibiotic medication treatment, most pyelonephritis patients start seeing improvement, and the body responds positively to the treatment within 48 hours. In the united stated, there is more drug resistance nowadays, with no development after 48 hours of having antibiotic therapy would indicate that the treatment fails (Kornusky & Cabrera, 2018).  The patient will need to repeat a urine culture, regimen or surgery.

References

• Kornusky, J., & Cabrera, G. (2018). Pyelonephritis. CINAHL Nursing Guide. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=T700575&site=ehost-live
• VanMeter, K. C., & Hubert, R. J. (2017). Pathophysiology for the Health Professions - E- Book. St. Louis, MO: Elsevier Health Sciences.