Acute Pyelonephritis Acute pyelonephritis is a potentially organ- and/or life-threatening infection that often leads to renal scarring.

Acute pyelonephritis results from bacterial invasion of the renal parenchyma. Bacteria usually reach the kidney by ascending from the lower urinary tract. Bacteria may also reach the kidney via the bloodstream. Timely diagnosis and management of acute pyelonephritis has a significant impact on patient outcomes. In 80 percent of acute pyelonephritis cases, Escherichia coli is the responsible pathogen in women, although it is not as common in older persons.5 After E. coli, less common causative organisms include other Enterobacteriaceae, Pseudomonas aeruginosa, group B streptococci, and enterococci. The spectrum of pathogens involved in acute pyelonephritis is similar to that of cystitis but with a lower frequency of Staphylococcus saprophyticus. Risk factors for acute pyelonephritis in nonpregnant women include sexual intercourse three or more times per week during the previous 30 days, UTIs in the previous 12 months, diabetes, stress incontinence in the previous 30 days, a new sex partner in the previous year, recent spermicide use, and a history of UTIs in the patient's mother. Older women, women who are menopausal or pregnant, and women who have preexisting urinary tract structural abnormalities or obstructions have a higher risk of UTI, but not necessarily of acute pyelonephritis. Causes Pyelonephritis most often occurs as a result of urinary tract infection, particularly when there is occasional or persistent backflow of urine from the bladder into the ureters or an area called the kidney pelvis. See: Vesicoureteric reflux Pyelonephritis can be sudden (acute) or long-term (chronic). Acute uncomplicated pyelonephritis is the sudden development of kidney inflammation. Chronic pyelonephritis is a long-standing infection that does not go away. Pyelonephritis occurs much less often than a bladder infection, although a history of such an infection increases your risk. You're also at increased risk for a kidney infection if you have any of the following conditions: Backflow of urine into the ureters or kidney pelvis Kidney stones Ostructive uropathy Renal papillary necrosis You are also more likely to get a kidney infection if you have a history of chronic or recurrent urinary tract infection, especially if the infection is caused by a particularly aggressive type of bacteria. Acute pyelonephritis can be severe in the elderly and in people who are immunosuppressed (for example, those with cancer or AIDS) Symptoms

Back pain or flank pain Chills with shaking Severe abdominal pain (occurs occasionally) Fatigue Fever Skin changes Flushed or reddened skin Moist skin (diaphoresis) Warm skin Urination problems Blood in the urine Cloudy or abnormal urine color Foul or strong urine odor Increased urinary frequency or urgency Need to urinate at night (nocturia) Painful urination Vomiting, nausea Mental changes or confusion may be the only signs of a urinary tract infection in the elderly.

Exams and Tests A physical exam may show tenderness when the health care provider presses (palpates) the area of the kidney. Blood culture may show an infection. Urinalysis commonly reveals white or red blood cells in the urine. Other urine tests may show bacteria in the urine. An intravenous pyelogram (IVP) or CT scan of the abdomen may show swollen kidneys. These tests can also help rule out underlying disorders. Additional tests and procedures that may be done include: Kidney biopsy Kidney scan Kidney ultrasound Voiding cystourethrogram

Treatment The goals of treatment are to: Control the infection Relieve symptoms Due to the high death rate in the elderly population and the risk of complications, prompt treatment is recommended. Sudden (acute) symptoms usually go away within 48 to 72 hours after appropriate treatment.

Your doctor will select the appropriate antibiotics after a urine culture identifies the bacteria that is causing the infection. In acute cases, you may receive a 10- to 14-day course of antibiotics. If you have a severe infection or cannot take antibiotics by mouth, you may be given antibiotics through a vein (intravenously) at first. Chronic pyelonephritis may require long-term antibiotic therapy. It is very important that you finish all the medicine. Commonly used antibiotics include the following: Amoxicillin Cephalosporin Levofloxacin and ciprofloxacin Sulfa drugs such as sulfisoxazole/trimethoprim

Nursing Interventions Supportive care Monitoring of urine and blood culture results Monitoring of comorbid conditions for deterioration Maintenance of hydration status with IV fluids until hydration can be maintained with oral intake IV antibiotics until defervescence and significant symptomatic improvement occur; convert to an oral regimen tailored to urine or blood culture results Monitor urine output to changes in color, odor and voiding pattern, input and output every 8 hours and monitor the results of repeated urinalysis. Record the location, duration, intensity scale (1-10) the spread of pain. Provide comfort measures, such as back massage, environment, rest, sleep. Help or encourage the use of focused relaxation breathing. Give perianal care.