Pyelonephrosis: More Than Just a Uti

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Pyelonephrosis: More than just a UTI
Tanya A. Woods

A Paper

Submitted in partial fulfillment of the requirements for

NU 327-801Pathophysiological Bases of Nursing

University of South Alabama

College of Nursing

Fall 2010

Pyelonephrosis: More than just a UTI
The purpose of this paper is to evaluate the pathophysiology of pyelonephrosis and to correlate that pathophysiology to the symptoms that accompany this disease process. This paper will also correlate the treatments and interventions which are appropriate for the nursing management and facilitation of wellness. Defining Pyelonephrosis

Pyelonephrosis is a common result of ascending urinary tract infection and is evidenced by infection of the renal parenchyma and the renal calices (Sheffield & Cunningham, 2005). According to Sheu, Chen, Meng and Leu (2010), urinary tract infections (UTI)s are the leading cause of bacterial infection in infants and children. While many UTIs are relatively benign, a simple lower UTI or cystitis can quickly become more serious as it ascends the urinary tract to invade the structures of the kidneys. Sheffield and Cunningham (2005) noted that Escherichia coli are responsible for up to 80 percent of all urinary tract infections including pyelonephrosis. The bacterium’s virulence is related to its ability to colonize and invade the urinary epithelium through the adhesins p-fimbria and s-fimbria. These adhesions bind to the epithelial membranes and inhibit the host’s cells bactericidal response (Sheffield & Cuningham, 2005). Predisposing factors which increase the likelihood of pyelonephrosis include diabetes, obesity, instrumentation, and obstructive conditions. Obstruction is the most common predisposing risk factor for urinary tract infections in adults and can be caused by urolithiaisis, pregnancy, and ureters or urethral stricture anomalies. However, Chishti, Maul, Nazario, Bennett, and Kiessling (2010) state that vesicular urethral reflux (VUR) accounts for 30-50 percent of all childhood UTIs and subsequent pyelonephrosis. Signs & Symptoms In adults the symptoms of pyelonephrosis include: abrupt onset of fever, chills, anorexia, dysuria, frequency, and urgency with aching flank pain and intense costovertebral pain to percussion (Sheffield & Cunningham, 2005). However, children under five often have vague symptoms such as nonspecific malaise, fever, and abdominal pain (Chishti et al., 2010). Complications

Early treatment is essential to prevent complications. Renal scaring occurs in up to 65 percent of all cases of pyelonephrosis and increases the risk of progressive kidney disease including renal insufficiency and failure. Pyelonephrosis is responsible for 10-24 percent of all childhood end stage renal failure requiring dialysis (Sheu et al., 2010). According to Duggal, Koury, and Kaur-Waraich (2010) emphysematous pyelonephritis has a high risk or mortality and occurs as a result of gas byproducts of bacteria within the hypoxic tissue of the renal medulla. The symptoms of emphysematous pyelonephritis include varying degrees of renal failure with metabolic acidosis, confusion, hyperglycemia, thrombocytopenia, and septic shock. Nursing Management Many patients can be managed as outpatients if they are able to tolerate oral intake and have no evidence of serious underlying complications. Inpatient nursing management should focus on providing adequate hydration, antibiotics as ordered, and monitoring for complications such as decreased renal function and sepsis from emphysematous pyelonephrosis. Fluid loss due to fever, emesis, and polyuria from the decreased ability to reabsorb sodium may require fluid boluses as aggressive fluid resuscitation can reduce secondary renal injury by 15 percent (Sheffield & Cunningham, 2005). Nurses should expect to administer IV antibiotics which provide empiric...
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