Symptoms of Acute Pyelonephritis and Vesicoureteral Reflux

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Lesson 8 Cases

1. Ms. Cornwall is admitted with pyelonephritis. She has chills and her temperature is 101° F. She is complaining of flank pain, frequency, and dysuria. Her urine has white blood cell casts, and her urine culture is growing Escherichia coli. Why does she have bacteria and white blood cell casts in her urine?

• Please first give good definition for pyelonephritis (need citation and resource for the definition) then start talking about why s Why does she have bacteria and white blood cell casts in her urine? (need back citation from the text book and outside the text book to support your idea)

1. Describe the different grades in vesicoureteral reflux (VUR).  First define the (VUR) and answer the question and we  need citation and reference

This bellow note is from our text book- maybe it will help you for your writing- I put the reference at the end of the page. So, this is kindle book. Please let me know if you have any further questions. Thank you.

Acute Pyelonephritis Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney interstitium). Common causes are summarized in Table 39.4. Urinary obstruction and reflux of urine from the bladder (vesicoureteral reflux) are the most common underlying risk factors. Most cases occur in women

TABLE 39.4 COMMON CAUSES OF PYELONEPHRITIS

PREDISPOSING FACTORS Kidney stones -- PATHOLOGIC MECHANISMS Obstruction and stasis of urine contributing to bacteriuria and hydronephrosis; irritation of epithelial lining with entrapment of bacteri

PREDISPOSING FACTORS  is Vesicoureteral reflux ---- PATHOLOGIC MECHANISMS   Chronic reflux of urine up the ureter and into kidney during micturition, contributing to bacterial infection

PREDISPOSING FACTORS is  Pregnancy---- PATHOLOGIC MECHANISMS =Dilation and relaxation of ureter with hydroureter and hydronephrosis; partly caused by obstruction from enlarged uterus and partly from ureteral relaxation caused by higher progesterone level

PREDISPOSING FACTORS is Neurogenic bladder Neurologic-- PATHOLOGIC MECHANISMS impairment interfering with normal bladder and urethral sphincter contraction with residual urine and ascending infectio

PREDISPOSING FACTORS is Instrumentation ---I PATHOLOGIC MECHANISMS -ntroduction of organisms into urethra and bladder by catheters and endoscopes introduced into the urinary tract for diagnostic purpose

PREDISPOSING FACTORS is Female sexual trauma ---- PATHOLOGIC MECHANISMS --Movement of organisms from the urethra into the bladder with infection and retrograde spread to kidney

Pathophysiology. Microorganisms usually associated with acute pyelonephritis include E. coli, Proteus, and Pseudomonas. The latter two microorganisms are more commonly associated with infections after urethral instrumentation or urinary tract surgery. These microorganisms also split urea into ammonia, making alkaline urine that increases the risk of stone formation. The infection is probably spread by ascending uropathic microorganisms along the ureters. Dissemination also may occur by way of the bloodstream, and both kidneys are usually involved. The inflammatory process is usually focal and irregular, primarily affecting the pelvis, calyces, and medulla. The infection causes medullary infiltration of neutrophils with tubulointerstitial inflammation, renal edema, and purulent urine. In severe infections, localized abscesses may form in the medulla and extend to the cortex. Primarily affected are the renal tubules; the glomeruli usually are spared. Necrosis of renal papillae can develop. After the acute phase, healing occurs with deposition of scar tissue, fibrosis, and atrophy of affected tubules (Fig. 39.7). 67 Acute pyelonephritis rarely causes renal failure. 68

Clinical Manifestations. The onset of symptoms is usually acute, with fever, chills, and flank or groin pain. Symptoms characteristic of a UTI, including frequency, dysuria, and costovertebral tenderness, may precede systemic signs and symptoms. Older adults may have nonspecific symptoms, such as low-grade fever and malaise.

Differentiating symptoms of cystitis from those of pyelonephritis by clinical assessment alone is difficult. The specific diagnosis is established by urine culture, urinalysis, and clinical signs and symptoms. White blood cell casts indicate pyelonephritis, but they are not always present in the urine. Complicated pyelonephritis requires blood cultures and urinary tract imaging. 69 Uncomplicated acute pyelonephritis responds well to 2 to 3 weeks of microorganism-specific antibiotic therapy. Follow-up urine cultures are obtained at 1 and 4 weeks after treatment if symptoms recur. Antibiotic-resistant microorganisms or reinfection may occur in cases of urinary tract obstruction or reflux. Intravenous pyelography and voiding cystourethrography identify surgically correctable lesions.

Chronic Pyelonephritis- Chronic pyelonephritis is a persistent or recurrent infection of the kidney leading to scarring of the kidney. One or both kidneys may be involved. The specific cause of chronic pyelonephritis may be unknown (idiopathic) or associated with chronic UTIs, vesicoureteral reflux, renal stones, or obstructive uropathy. Recurrent infections from acute pyelonephritis may be associated with chronic pyelonephritis. Causes other than chronic pyelonephritis include drug toxicity from analgesics such as nonsteroidal antiinflammatory drugs, ischemia, irradiation, and immune-complex diseases. 70 Pathophysiology. Chronic urinary tract obstruction prevents elimination of bacteria and starts a process of progressive inflammation, alterations of the renal pelvis and calyces, destruction of the tubules, atrophy or dilation and diffuse scarring, and, finally, impaired urine-concentrating ability, leading to chronic kidney failure. The lesions of chronic pyelonephritis are sometimes termed chronic interstitial nephritis because the inflammation and fibrosis are located in the interstitial spaces between the tubules (see Fig. 39.7). Clinical Manifestations. The early symptoms of chronic pyelonephritis are often minimal and commonly include frequency, dysuria, and flank pain and may include hypertension. Progression of disease leads to renal failure, particularly in the presence of other risk factors (i.e., obstructive uropathy or diabetes mellitus). There is an inability to conserve sodium with loss of tubular function, and development of hyperkalemia and metabolic acidosis. Risk for dehydration must be considered if there is loss of the ability to concentrate the urine. Evaluation and Treatment. Urinalysis, intravenous pyelography, and ultrasound are used diagnostically. Treatment is related to the underlying cause. Obstruction must be relieved. Antibiotics may be given, with prolonged antibiotic therapy for recurrent infection.

McCance, Kathryn L.; Huether, Sue E.. Pathophysiology - E-Book: The Biologic Basis for Disease in Adults and Children (Kindle Locations 70659-70662). Elsevier Health Sciences. Kindle Edition.