MEDICINE

SALIA S SIAKASILI
INTRODUCTION
 Pyelonephritis also known as Kidney infection
is a type of urinary tract infection (UTI) that
generally begins in the urethra or bladder and
travels to one or both of the kidneys. A kidney
infection requires prompt medical attention. If
not treated properly, a kidney infection can
permanently damage the kidneys or the
bacteria can spread to the blood stream and
cause a life threatening infection.
GENERAL OBJECTIVE

 At the end of the lecture/ discussion students

should be able to gain knowledge in the
management of a patient with pyelonephritis.
SPECIFIC OBJECTIVES
 At the end of the lecture/discussion students should be
able to;
1. Define pyelonephritis
2. State the types of pyelonephritis.
3. Mention the causes of pyelonephritis.
4. State the predisposing factors of pyelonephritis.
5. Describe the pathophysiology of pyelonephritis.
6. State the clinical features of pyelonephritis.
7. Discuss the management of pyelonephritis.
8. State the complications of pyelonephritis.
Definition

1.Pyelonephritis is sudden and severe kidney infection

that causes kidney inflammation, ( Tibor Fulop, 2017)

2.This is inflammation of the renal pelvis and this can be

acute or chronic inflammatory process (Smeltzer et al.,
2010).The inflammation includes the tubule and
interstitial tissue of the kidney. This condition occurs as
an ascending infection
Types

 Acute pyelonephritis: A sudden infection

characterized by enlarged kidneys with
inflammation of the cells.
 Chronic pyelonephritis: A complication of

acute pyelonephritis in which the kidneys

become scarred contracted and non-
functioning.
Causes

 Bacteria such as; Escherichia coli (E. coli) is the usual

cause and other bacteria, like Klebsiella pneumoniae,
the Proteus species, and Staphylococcus pyogeness,
can also cause kidney infections.
Predisposing Factors
1.Female. The urethra is shorter in women than it is in
men, which makes it easier for bacteria to travel from
outside the body to the bladder. The nearness of the
urethra to the vagina and anus also creates more
opportunities for bacteria to enter the bladder. Once in
the bladder, an infection can spread to the kidneys.
2. Pregnant women are at risk-due to the stasis of urine
3. Catheterisation of the urinary tract-can introduce
bacteria in the bladder.
CONT..
4. Obstructed urinary flow from tumours- lead to stasis
of urine. This includes anything that slows the flow of
urine or reduces the ability to empty the bladder when
urinating, including a kidney stone, something
abnormal in the urinary tract's structure or, in men, an
enlarged prostate gland.
CONT
 5. Lowered immune system. This includes medical
conditions that impair the immune system, such as
diabetes, HIV/AIDS and medication that are taken to
prevent rejection of transplanted organs .Certain
medications, such as drugs taken to prevent rejection
of transplanted organs, have a similar effect.
 6. Having damage to nerves around the bladder.

Nerve or spinal cord damage can block the sensations

of a bladder infection so that one is unaware when it's
advancing to a kidney infection.
CONT..
 7. Using a urinary catheter for a long time. Urinary
catheters are tubes used to drain urine from the
bladder. A patient might have a catheter placed during
and after some surgical procedures and diagnostic
tests. A patient might use a continuously if he/she
confined to a bed and this can predisposed to
pyelonephritis.
 8.vesicoureteral reflux, small amounts of urine flow

from the bladder back up into the ureters and kidneys.

People with this condition are at higher risk of kidney
infection during childhood and adulthood.
Pathophysiology
 In most cases, the infection first develops in the lower
urinary tract. If it’s not diagnosed and treated properly,
the infection may spread from the urethra and genital
area to the bladder and then to one or both kidneys.
 Normally, the ureters drain urine from the kidney into

the bladder and out of the body through the urethra.

These changes can lead to problems with proper
drainage of urine from the kidneys, causing the urine to
remain stagnant. As a result, bacteria in the bladder
may migrate to the kidneys rather than being flushed
out of the system.
CONT..
 This causes an infection. The bacteria Escherichia coli
(E. coli) is the usual cause. Other bacteria, like
Klebsiella pneumoniae, the Proteus species, and
Staphylococcus, can also cause kidney infections.
There are two potential routes of bacteria transmission;
 (1) the haematogenous route- this is through the blood

stream.
 (2) The ascending route, from the urethra to the

bladder, then from the bladder to the kidneys via the

ureters.
Clinical features

 Fevers and rigors due to presence of bacteria and

inflammation.
 Urine that looks cloudy, smells foul or unusually strong

due to dead tissue and pus.

 Back, side (flank) or groin pain due to ascending

infection.
 Abdominal pain due to the presence of infection in the

bladder.
 Frequent urination due to incomplete emptying the

bladder
CONT..
 Burning sensation or pain when urinating due to
inflammation
 Nausea and vomiting due to spread of the infection.
 Pus or blood in your urine (hematuria) due to necrosis

of the walls of the urethra and bladder.

 Urine that smells bad or is cloudy due to presence of

pus.
 Lower abdominal pain and backache due to

inflammation of the bladder.

Management
 Investigations
•Ultrasound scan of the kidney will show enlarged
kidney and obstruction reveal sometimes with a bit of
hydronephrosis.
•Radionuclide imaging to show sites of infection
•Urine culture and sensitivity test to identify the
causative organism
•IV pyelogram may be done in acute pyelonephritis if
functional and structural renal abnormalities are
suspected.
CONT..
•Urinalysis will reveal presence and increase of white
blood cells in urine. It will also reveal presence of
blood, pus and proteins in urine which confirms
infections of the urinary tract.
•Clinical finds such as presence history of passing
blood stained urine, back or flank pain, frequent and
urgency of urinating.
•Blood urea and nitrogen (BUN)-to assess the levels of
urea, nitrogen and creatine.
CONT..
 TREATMENT.
1.Ciprofloxacin
 Presentation:250mg-500mg
 Indication: gram negative and gram positive bacterial

infections
 Dose: 500mg twice daily.
 Side effects: diarrhoea, abdominal pain, white patches

in the mouth or on the tongue, joint pain.

CONT..
2.Norfloxacin
 Presentation:400mg
 Indication: Urinary tract infections
 Dose: 400mg twice daily
 Side effects:anxiety,tinnitus,dermatitis
 Contra-indications: hypersensitive to 4-quinolones or

quinolone group of anti-bacterial

3.niflofurantoin
 Presentation: tablets 50mg 100mg
 Indications: urinary infections due to strains E coli,

enterococci, staphylococcus aureus.

 Dose: 50mg qid for 7 days
 Side effects: dermatitis, rash .
CONT..
4.Ampicillin(principen)
 Presentation: tablet 250mg
 Indication: Urinary tract infection.
 Dose: 500mg four times daily
 Side effects: rash, diarrhoea,nausea,dark urine
NURSING MANAGEMENT
Aims
 To reduce anxiety

 To relieve symptoms and promote healing.

 Maintain nutrition requirements

 Provide knowledge about disease and management.

 To Prevent complications

Environment
 Structuring the environment and activities may help with

coping with the disease in the initial phase. Patient is

nursed in a general medical ward. Environment should be
clean, well ventilated to promote air circulation and quite
to promote rest. It should be well-ventilated room, free
from infection, reverse barrier nursing to prevent infection.
CONT..
Position/Rest
 A patient is positioned in a most comfortable position to

promote comfort. Ensure noise free environment to

promote rest and comfort. Do nursing activities
collectively to avoid disturbances thereby promoting rest
Psychological care
 Explain the disease process in order to raise the

knowledge levels and thereby allay anxiety. Provide

emotional support to the patient and family and answer
patient’s questions faithfully so as to gain confidence.
Explain all procedures to the patient in order to allay
anxiety.
CONT..
 Involve a successfully managed case to come and talk
to the patient in order to raise hope. This will also
expel any misconceptions and instil a sense of hope.
Tell patient that the outcome of the treatment will
depend on his/her compliance in taking the
prescribed medication. Establish rapport by being
attentive, calm and confident
CONT..
Rest
 Nurse patient in noise free environment to promote

rest. Do related procedures collectively to avoid

disturbing the patient during her periods of rest.
Administer prescribed analgesics if patient is in pain to
relieve pain thereby promoting rest. Ensure that
squeaking trolleys are oiled to prevent noise and there
by promote rest
CONT..
Observations
 Do vital signs such as temperature, pulse, Blood

pressure and respirations to act as base line data and

compare with subsequent ones. This helps to know if the
condition is improving or deteriorating.
Hygiene
 Assist patient to take a bath in order to remove dead

epithelium and promote comfort. Do hair care to

promote self-esteem and also prevent pediculosis. Do
nail care to prevent auto infection and mouth care to
prevent halitosis and promote appetite. Change any
soiled linen and clothes to promote comfort.
CONT..
Nutrition
 Provide diet that is nutritious and appetizing to the

patient. Small, frequent feedings may be in offered. The

diet should include carbohydrates such as nshima to
provide energy, proteins such as beans, fish to repair
worn out tissues and Vitamins such as vegetables and
fruits to boost the immunity. Intake and output chart
should be maintained to avoid renal failure and also to
monitor fluid overload. Serve meals in pleasant
surroundings to stimulate patient’s appetite. Take weight
on same scale, at the same time, with same clothing to
monitor weight loss secondary to poor appetite.
CONT..
Acute Pain intervention
 Assess client’s description of pain such as quality,

nature and severity of pain, this will help in

determining the choice of pain intervention. Give
prescribed analgesic such as Panadol
CONT..
Infection prevention
 Instruct the female client to wipe the perineal area from

front to back and the avoidance of bath tubs. Proper

perineal care helps in minimizing the risk of
contamination and re-infection. Maintain an acidic
environment of the bladder by the use of agents such as
Vit.C, Mandelamine (a urinary antiseptic) when
appropriate, to prevent the occurrence of bacterial
growth.
CONT..
 Encourage perineal hygiene such as bathing at least
twice in a day and frequent change of sanitary pads
whenever they are soiled to prevent worsening the
infection or reinfection. Assess for signs and
symptoms of urinary tract infections such as fever,
dysuria and history of catheter use, and risk factors
for urinary tract infections for these increases risk of
kidney infections. Urine for culture and sensitivity
should be done, this will help determine the type of
antibiotics to use.
CONT..
Exercises
 If patient is confined to bed, help patient do passive

exercises like limb movement and massage in order

to prevent muscle atrophy and promote blood
circulation. Encourage the patient to do deep
breathing exercises in order to promote lung
expansion. Encourage early ambulation as soon as the
condition permits in order to prevent deep vein
thrombosis and other complications of immobility.
Prevention
 Reduce the risk of kidney infection by taking steps to
prevent urinary tract infections. Women, in particular,
may reduce their risk of urinary tract infections if they:
 Drink fluids, especially water. Fluids can help remove

bacteria from the body when the patient urinates.

 Avoid delaying urination when one feel the urge to

urinate.
 Empty the bladder after intercourse. Urinating as soon

as possible after intercourse helps clear bacteria from

the urethra, reducing the risk of infection.
CONT…
 Wipe the perineal area carefully. Wiping from front to
back after urinating and after a bowel movement
helps prevent bacteria from spreading to the urethra.
 Avoid using feminine products in the genital area.

Using products such as deodorant sprays in your

genital area or douches can be irritating.
Complications

 Peri-renal abscess due to spread of bacteria.

 Acute renal failure due to disease burden or

progression.
 Renal papillary necrosis as a result of damaged cells

during inflammatory process.

 Kidney scarring. This can lead to chronic kidney disease

and kidney failure.

 Blood poisoning (septicaemia). Kidneys filter waste

from your blood and return your filtered blood to the

rest of your body. Having a kidney infection can cause
the bacteria to spread through your bloodstream.
CONT..
 Blood poisoning (septicaemia). Kidneys filter waste
from your blood and return your filtered blood to the
rest of your body. Having a kidney infection can
cause the bacteria to spread through your
bloodstream.
 Pregnancy complications. Women who develop a

kidney infection during pregnancy may have an

increased risk of delivering low birth weight babies.
SUMMARY

 Pyelonephritis is an infection of the upper urinary tract

that involves both the parenchyma and kidneys pelvis
and generally caused by E. coli, but diabetes, prior
infections, indwelling catheters, calculi, and
immunosuppression add a spectrum of other causative
factors. Renal damage is not always found with
pyelonephritis, but is predisposed by delay in
diagnosis, ineffective antibacterial therapy.
Furthermore the complication can be so severe and life
threatening like acute renal failure, kidney scarring and
septicaemia.
EVALUATION
 What is pyelonephritis?
 What are the main types of pyelonephritis?
 What are the causes of pyelonephritis?
 What are the predisposing factors of pyelonephritis?
 What is the pathophysiology of pyelonephritis?
 What is the clinical features of pyelonephritis?
 What is the management of pyelonephritis?
 What are the complications of pyelonephritis?
ASSIGNMENT
 Read and write short notes on the complications of

pyelonephritis. Due date 23th November 2022.

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 Lewis, S.H., Heitkemper, M.M. & Dirksen, S.R.

(2012). Medical Surgical Nursing: Assessment and

Management of Clinical Problems.10th edition,
Elsevier Inc. St Louis Missouri USA.
 Phipps, W.J. et al., (2007). Medical-Surgical Nursing,

C.V Mosby co., St Louis