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Biol 405 Pyelonephritis Paper

By beeherenow Jun 07, 2013 864 Words

BIOL 405 pyelonephritis paper
Deb Puterbaugh
Midwives College of Utah

The Medical Dictionary defines pyelonephritis as “the inflammation of the kidney and upper urinary tract that usually results from noncontagious bacterial infection of the bladder”. This source goes on to states that it is statistically found at the highest rate in adult sexually active females. However, it can affect people of either sex or any age. The origin of this condition can be traced to untreated cases of cystitis.[1] My reading suggests that about 25% of untreated cases of cystitis progress to pyelonephritis. The condition is characterized by a sudden onset, with symptoms that often are mistaken for lower back strain. As the results the condition often goes untreated for too long. Pyelonephritis may be complicated by systemic infection, as the body becomes overwhelmed by its efforts to fight the infection. If the condition is left untreated or unresolved, it can progress to a chronic condition that lasts for months or years, leading to scarring and possible loss of kidney function.[2] Clinical features often include painful urination in uncomplicated urethritis or cystitis to severe systemic illness associated with abdominal or back pain, fever, sepsis and decreased kidney function in some cases of acute pyelonephritis. The etiologic or causative agent is usually, Escherichia coli, but other enterobacteriaceae are also possible causes of infection. Statistically about 75% of all cases can be linked to E. coli. Severe infections associated with sepsis have been known to be fatal. [1] Transmission is usually through fecal contamination of the bacterial Escherichia coli in to the urinary tract. As stated earlier the primary risk group is sexually active women, making this condition of special interest to midwives as they seek to provide optimal care to women during the childbearing years.[2][4] Client history provides the bases for diagnosis of pyelonephritis, physical examination, laboratory tests and imaging all help in determining the condition. During the physical examination, the health care provider will touch (palpate) the patient's abdomen carefully in order to rule out appendicitis or other causes of severe abdominal pain. Next, a clean catch of urine will be requested this samples will be sent for urinalysis and urine culture and sensitivity tests. Finally, blood will be drawn and checked for a blood cell count. If the client has pyelonephritis, the blood tests will show the presence of white blood cells, and bacteria in the urine. Bacterial counts of 100,000 organisms or higher per milliliter of urine point to a urinary tract infection. The presence of antibodycoated bacteria (ACB) in the urine sample distinguishes kidney infection from bladder infection, because bacteria in the kidney trigger an antibody response that coats the bacteria. The blood cell count usually indicates a sharp increase in the number of white blood cells.[4] In a study conducted at University of Texas Southwestern Medical Center at Dallas, a team of doctor’s compared for a two year period a maternal population at risk for pyelonephritis with the general maternal population. The conclusion of their research showed that the: “the incidence of pyelonephritis has remained low in the era of routine prenatal screening for asymptomatic bacteriuria. First-trimester pyelonephritis accounts for over 1 in 5 antepartum cases. Gram-positive uropathogens are found more commonly as pregnancy progresses. Maternal complications continue, but poor obstetrical outcomes are rare.” [3]

Treatment of acute pyelonephritis may require hospitalization if the patient is severely ill or has complications. Therapy most often involves a two- to three-week course of antibiotics, with the first few days of treatment given intravenously. The choice of antibiotic is based on laboratory sensitivity studies. The antibiotics used most often include ciprofloxacin (Cipro), ampicillin (Omnipen), or trimethoprim-sulfamethoxazole (Bactrim, Septra). The prognosis for most patients with acute pyelonephritis is quite good if the infection is caught early and treated promptly. The client is considered cured if their urine remains sterile for a year. The importance of teaching preventative techniques to persons with a history of urinary tract infections is emportant for midwives to understand. Clients should be encouraged to urinate frequently, and drink plenty of fluids at the first sign of infection. Women should void after intercourse which may help flush bacteria from the bladder. Girls should be taught to wipe their genital area from front to back after urinating to avoid getting fecal matter into the opening of the urinary tract. [1][4] Increasing antibiotic resistance among E. coli and other Enterobacteriacae to many commonly used antibiotics are on the rise, according to the Center for Disease Control and Prevention. Teaching women how to improve their immune systems, and how to maintain a healthy urinary system is an important first step in the prevention of pyelonephritis and other UTIs in the high-risk groups population that midwives serve. [4]

Referances
1. (n.d.). Retrieved from http://medical-dictionary.thefreedictionary.com/Pyelonephritis

2. Tortora, G. J., Funke, B. R., & Case, C. L. (2004). Microbiology: an introduction. (8th ed ed.). San Francisco, CA: Benjamin-Cummings Publishing Co. 3. (Master's thesis)Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15625136

4. (n.d.). Retrieved from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/urinarytractinfections_t.htm

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