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Etiology
Inflammation of the
structures of the
kidney:
the renal pelvis
renal tubules
interstitial tissue
by E.coli
Etiology
Pyelonephritis
1.
Inflammation of renal pelvis and
parenchyma (functional kidney tissue)
2.
Acute pyelonephritis
a. Results from an infection that ascends to
kidney from lower urinary tract
Risk factors
1. Pregnancy
2. Urinary tract obstruction and congenital
malformation
3. Urinary tract trauma, scarring
4. Renal calculi
5. Polycystic or hypertensive renal disease
6. Chronic diseases, i.e. diabetes mellitus
7. Vesicourethral reflux
Pathophysiology
1. Infection spreads from renal pelvis to
renal cortex
2. Kidney grossly edematous; localized
abscesses in cortex surface
3. E. Coli responsible organism for 85% of
acute pyelonephritis; also Proteus, Klebsiella
Manifestations
1. Rapid onset with chills and fever
2. Malaise
3. Vomiting
4. Flank pain
5. Costovertebral tenderness
6. Urinary frequency, dysuria
Clinical Manifestations
Acute pyelonephritis may be unilater or
Acute Pyelonephritis
Affects cortex with sparing of glomeruli and
vessels. White cell casts in urine are
pathognomonic.
Bacteria infection can result from
hematogenous spread or from ascending
infection (usually due to predisposing
condition)
Usually: E. coli. Also: Proteus, Klebsiella, and
enterobacter.
Presents with fever/CVA tenderness
Its just a cute pyelonephritis (Not too bad)
PIELONEFRITIS AKUT
-Gejala cepat berkembang ( jam s/d hari)
-Demam, mual, muntah, diare
-Takhikardi
-Nyeri otot
-Sepsis
-Leukositosis
-Pyuria dengan leukosit cast
-Hematuria (mula-mula)
DD : - BSK
- TBC ginjal
- Tumor ginjal
significant!
Presence
suggests
pyelonephriti
s
Acute uncomplicated
pyelonephritis in young
Largely a clinical diagnosis
women
Pyuria is usually present; about 20% have
Chronic
The
autopsy
Pyelonephritis
specimen
consists of a bisected
kidney which is
markedly shrunken
because of chronic
inflammation and
Scarring.
(B) multiple calculi in
the proximal ureter
(A) Calyceal system
Chronic pyelonephritis
a.
Involves chronic inflammation and
scarring of tubules and interstitial tissues
of kidney
b.
Common cause of chronic renal failure
c.
May develop from chronic hypertension,
vascular conditions, severe vesicourteteral
reflux, obstruction of urinary tract
d.
Behaviors
1. Asymptomatic
2. Mild behaviors: urinary frequency,
dysuria, flank pain
Chronic Pyelonephritis
Coarse, asymmetric
corticomedullary scarring.
Thyroidization of the Kidney
Eosinophilic casts seen in
tubules
Chronic Pye &
T - Thyroidization
E - Eosinophilic Casts
A - Assymetric Scarring
PIELONEFRITIS KRONIK
-Abnormalitas urologik
-Gejala klinis (-), Lab (-)
-Urine sering steril
-Waktu serangan : - pyuria dengan leukosit cast
- IVP Outline ireguler, caliectasis,
cortical scar
-Patologi : - Ginjal tidak simetris
- Permukaan ireguler
- Banyak jaringan parut
- Leukosit cast
- Eosinofilia
GEJALA KLINIK
chronic disease:
elevated BP
Vomiting
Diarrhea
Diagnostic Tests
Diagnosis is confirmed by bacteria and pus
Diagnostic
Tests
Medical Management
Pt w/ mild signs and symptoms may be
TERAPI :
-AB Sesuai Sensitifiti test
-OAH
Medicines
Ampicillin or
vancomycin combined
with an aminoglycoside
(Nebcin, Garamycin)
Cipro
Septra
Bactrim
Floxin
Medical Management
Adequate fluids at least eight 8-oz. glasses
per day
Urinary analgesics such as Phenazopyridine
(Pyridium)
is helpful
Follow up urine culture is indicated
Nursing Intervention
& Patient Teaching
Pt is taught to identify Fatigue
the S&S of infection: General malaise
Pt should also be taught:
Elevated temp.
Indications
Flank pain
Chills
Dose
Fever
Nausea
Length of course
Side effects
Vomiting
Importance of follow up
Urgency
Prognosis
Prognosis is dependent upon early detection