Pyelonephritis
Overview
Pyelonephritis is a bacterial infection or inflammation of the kidney and renal pelvis—the upper urinary tract.
Active microorganisms moves up from the urinary tract and enters the renal pelvis and activate the inflammatory response, which results in mobilization of white blood cells (WBCs) and local edema.
Pyelonephritis is generally classified as acute or chronic. Acute pyelonephritis is the active bacterial infection, whereas chronic pyelonephritis results from repeated or continued upper urinary tract infections (UTIs) or the effects of such infections. Most commonly, when urine relfuxes from the bladder back into the ureters toward the renal pelvis and kidneys.
Complications include tubular cell necrosis, abscess formation, fibrosis and septicemia.
Inflammation and fibrosis lead to deformity of the renal pelvis and calices. Repeated or continuous infections create additional scar tissue, changing blood vessel, glomerular, and tubular structure causing a reduction in the function of filtration, reabsorption and secretion and kidney functions.
Pregnancy, diabetes mellitus, chronic renal calculi, and urinary catherizations increase the risk for pyelonephritis.
Structural deformities or obstruction with reflux caused by stones, obstruction, and neurogenic impairment involving the voiding mechanism often lead to chronic pyelonephritis.
The most common pyelonephritis-causing organism is E.coli.
If the patient is hospitalized, Enterococcus faecalis, Proteus mirabilis, Klebsiella, and Pseudomonas aeruginosa are common causes
When the infection is bloodborne, common infecting organisms include Staphylococcus aureus and the Candida, and Salmonella species

Patient-Centered Collaborative Care
Assessment
• Obtain patient information about:
1. History of urinary tract and kidney infections
2. History of diabetes mellitus or other conditions and treatment associated with immunocompromise
3. History of stone disease or other structural or functional abnormalities of the genitourinary tract
• Assess for:
1. Pregnancy because pyelonephritis is associated with early onset of labor, compromising fetal health
2. Flank or abdominal discomfort
3. Hematuria, cloudy urine
4. Signs of infection: general malaise, fever, chills
5. Asymmetry, edema, or erythema at the costovertebral angle
6. Presence of leukoesterase, nitrogen, WBCs, or bacteria in the urine

Acute Pyelonephritis
Chronic Pyelonephritis
Fever
Chills
Tachycardia and tachypnea
Flank, back, or loin pain
Tender costovertebral angle
Abdominal, often colicky, discomfort
Nausea and vomiting
General malaise or fatigue
Burning, urgency, or frequency of urination
Nocturia
Recent cystitis or treatment for urinary tract infection (UTI)
Hypertension
Inability to conserve sodium
Decreased urine concentrating ability, resulting in nocturia
Tendency to develop hyperkalemia and acidosis

• Diagnostic testing may include:
1. Urinalysis and urine for culture and sensitivity (obtained by the clean-catch method)
a. Urinalysis shows a positive leukocyte esterase and nitrite dipstick test and the presence of white blood cells and bacteria. The urine is cultured to determine whether gram-positive or gram-negative organisms are causing the infection. The urine sample for culture and sensitivity testing shows the bacterial species and susceptibility or resistance of the specific organism to various antibiotics.
2. WBC count with differential, basic metabolic panel for kidney function
3. X-ray, CT, or cystourethrogram to diagnose stones or obstruction. Ensure that the patient is not pregnant before any imaging study is