UNIVERSITY OF LA SALETTE

COLLEGE OF NURSING
Santiago City

A CASE STUDY
IN

ACUTE PYELONEPHRITIS
PRESENTED BY:
GROUP C
Balot, Jr,, German M.
Bugarin, Rhadharani Paula Mae N.
Buhat, Janny Lie R.
Camangeg jr., Joselito M.
Cambia, Charlene M.
Canosa, Julie Ann U.
Cansino, Rina Antonette P.
Cairel, Princess C.
Carabacan, Arleen C.
Carlos, Amazing Grace M.
Casayuran, Karen Ivy V.
Leal, Joenna Joy I.

PRESENTED TO:
Mr. Jesper Bayaua, RN
Mrs. Mary Jane Gonzales, RN
Ms. Theresa Bermusa, RN
Ms. Pristine Gonzales, RN

TABLE OF CONTENTS

I. Introduction
A. Case Description
II. Demographic Data
Nursing History
A.
Present Health History
B.
Past Medical History
C.
Family History
D. Pattern of Functioning
a. Physiological Health
b. Socio-cultural Health
c. Spiritual Health

Gordons Functional Pattern

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

Health Perception
Nutrition Pattern
Sleep and Rest
Activity and Exercise
Elimination Pattern
Self Perception
Cognitive and Perception Pattern
Role and Relationship Pattern
Sexuality Pattern
Coping of Stress Pattern
Value and Belief Pattern

III. Course in the Ward

IV. Physical Assessment
V. Laboratory Result
VI. Anatomy and Physiology
VII. Pathophysiology
VIII. Nursing Care Plan
IX. Drug Study
X. Discharge Planning
XI. Reference

INTRODUCTION
(ACUTE PYELONEPHRITIS)

Pyelonephritis
Definition
Pyelonephritis is an infection of the kidney and the ureters, the ducts that carry urine
away from the kidney.
Alternative Names
Urinary tract infection - complicated; Infection - kidney; Complicated urinary tract
infection; Kidney infection
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
areimmunosuppressed (for example, those with cancer or AIDS).
Symptoms

Back pain orflank pain

Chills with shaking
Severe abdominal pain (occurs occasionally)
Fatigue
Fever
Higher than 102 degrees Fahrenheit
Persists for more than 2 days
General ill feeling
Chills with shaking
Mental changes or confusion*
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

Outlook (Prognosis)
With treatment, most kidney infections get better without complications. However, the
treatment may need to be aggressive or prolonged.
Pregnant women and persons with diabetes or spinal paralysis should have a urine culture
after finishing antibiotic therapy to make sure that the bacteria are no longer present in the urine.
In rare cases, permanent kidney damage can result when:

Chronic kidney infections occur in a transplanted kidney

Many kidney infections occur during infancy or childhood
Acute kidney injury (acute renal failure) may occur if a severe infection leads to
significantly low blood pressure (shock). The elderly, infants, and persons with a weakened
immune system have an increased risk for developing shock and a severe blood infection
calledsepsis. Often, such patients will be admitted to the hospital for frequent monitoring and IV
antibiotics, IV fluids, and other medications as necessary.
Severe episodes of acute kidney injury may result in permanent kidney damage and lead
to chronic kidney disease.
Possible Complications

Acute kidney failure

Kidney infection returns
Infection around the kidney (perinephric abscess)
Severe blood infection (sepsis)
When to Contact a Medical Professional
Call your health care provider if you have symptoms of pyelonephritis.
Call your health care provider if you have been diagnosed with this condition and new
symptoms develop, especially:

Decreased urine output

Persistent high fever
Severe flank pain or back pain
Prevention
Prompt and complete treatment of bladder infections may prevent development of many
cases of pyelonephritis. Chronic or recurrent urinary tract infection should be treated thoroughly.
You can help preventing kidney infections by taking the following steps:

Keep the genital area clean. Wiping from front to back helps reduce the chance of
introducing bacteria from the rectal area to the urethra.
Urinating immediately after sexual intercourse. This may help eliminate any bacteria that
may have been introduced during sexual activity.
Drink more fluids (64 to 128 ounces per day). This encourages frequent urination and
flushes bacteria from the bladder.
Drink cranberry juice. Doing so prevents certain types of bacteria from attaching to the
wall of the bladder and may lessen your chance of infection.

DEMOGRAPHIC DATA

Name:

pt. She Lui

Address:

Plaridel Santiago City

Age:

25 years old

Birthday:

September 5, 1985

Gender:

Female

Religion:

INC

Nationality:

Filipino

Civil Status:

Married

Occupation:

Self Employed

Date of Admission:

August 23, 2010

Time of Admission: 10:03 am

Attending Physician: Dr. Alex Cristobal
Chief Complain:

Painful urination, fever with chills, vomiting for 2 days and body malaise

Admitting Diagnosis: t/c UTI

Final diagnosis:

Initial Vital Signs:

BP:

110/80

T:

38

RR:

21

PR:

81

Acute Pyelonephritis

Nursing History

History of Present Illness

2days PTA, the patient was suffering from fever and chills accompanied by
vomiting for seven times. She decided to have prompt consultation when she experience body
malaise. She was rushed at Callang General Hospital and Medical Center last August 23, 2010 at
10:30 am accompanied by her father via ambulatory. Initial Vital is taken.BP110/80 RR21
PR--81 TEMP --38

History of Present Illness

According to the patient she has been hospitalized 6 years ago due to sensitivity
of her pregnancy. She also suffers usual sickness like cough and colds. She often treated it with
OTC drugs such as paracetamol and decongestant.

Family History
The patient has a family history of Hypertension on Mother side and asthma to
her Father side.

Gordons Functional Pattern

Health Perception Pattern
According to the pt she is not aware with her health status. She admits that she
had already UTI before but she just ignore. For her health is very important but then as long as
she can tolerate her illness she doesnt even take medicines at all.
Nutritional-Metabolic Pattern
PTA, according to the patient she loves to chicken joy and fries (Jollibee) and eat
only small amount of vegetables. During snack time her favorite snack is chippy and soft drinks
for at least 2 liters a day. She only consumes 4 glasses of water a day.
During hospitalization the pt is NPO as ordered due to her vomiting.
Activity/Exercise Pattern
PTA, according to the patient she had a efficient energy to require for her ADL.
Every day she is in their store selling clothes for the whole day.
During hospitalization, can no longer do her usual habit, but she can still perform
her ADL.
Coping Pattern
According to the patient she is financially problematic because she is applying to
abroad. She doesnt have enough money especially now. That she was been Hospitalized. She
managed her problems by asking help to her parents and through the support of her husband.
Elimination Pattern
PTA, the patient usually voids 5-7 times a day and defecates once a day.
During the hospitalization the patient voids 10-12 times a day but scanty. She
defecates every other day.
Sleep Rest Pattern
PTA, the patient sleep 7-8 hours a day. She sleep at 9:00 oclock and wakes up
5:00 oclock in the morning.
During Hospitalization the patient didnt sleep well. Her sleep was always
interrupted because of giving medication and getting vital signs.
Role Relationship Pattern
PTA, the patient lives together with her family. She is responsible in doing the
Household chores and caring for her daughter.
During hospitalization she can no longer perform her responsibilities at home.
Values Beliefs Pattern
The patient is a member of Iglesia ni Cristo,
They usually attend church gathering every Sunday. The family also believes in
faith healer
Sexuality Pattern

According to the patient she had her 1st menstruation when she was 14 years old.
She has a regular menstruation. They use natural method (withdrawal)for family planning and to
prevent possible pregnancy.

Physical Assessment

August 23, 2010

(Monday, 6:00pm)
Received patient, lying on bed, conscious and coherent, febrile, with an
ongoing IVF of D5 .9 NaCl @ 21gtts/min, and initial v/s of BP: 90/60 mmHg, RR: 21 cpm,
PR: 87 bpm, & Temp: 38 C.
BODY PARTS
HEAD
Hair

METHOD

FINDINGS

INTERPRETATIOJN

Inspection

Black in color

Normal

Scalp
FACE
*EYES
Eyebrows

Inspection

(-)dandruff

Normal

Inspection

Symmetrically
aligned

Normal

Eyelashes

Inspection

Intact & equally

distributed

Normal

Eyelids

Inspection

Convex

Normal

Conjunctiva

Inspection

Reddish to pinkish in
color

Normal

Sclera

Inspection

White in color

Normal

Pupil

Inspection

PERRLA, 2mm

Normal

*NOSE

Inspection

(-)discharge

Normal

*EARS

Inspection

(-)secretion

Normal

*MOUTH
Lips

Inspection

Dry,
reddish in color

Due to diet (NPO)

Due to fever

Gums

Inspection

Pinkish in color

Normal

Teeth

Inspection

Complete, no
dentures

Normal

Tongue
NECK

Inspection
Inspection

Pinkish,(-)lesions
Symmetrical in both
sides

Normal
Normal

Palpation

Normal

Inspection

No tenderness &
mass nodes
Not distended

Auscultation

(+) bowel sound

Normal

Percussion

(-) dull sound

Normal

Palpation

(-) mass
(-) tenderness

Normal

Inspection

(-)edema,(-)lesions

Normal

Inspection

(-)edema,(-)lesions

Normal

Inspection

Capillary refill 2-3

Normal

ABDOMEN

UPPER
EXTREMITIES
*R arm

Normal

*L arm

*Nails
LOWER
EXTREMITIES
*Nails

sec.
Inspection

(-)bipedal edema

Normal

SKIN

Inspection
Inspection

Short & clean nails

Warm to touch

Normal
Due to fever

DOCTORS ORDER
Date

Progress note

Doctors order

Interpretation

8/23/10

BP: 110/80
Temp. 36.9 C

Admit to ROC

For clients preference

Secure consent

For legal document and to

start treatment and
management

For CBC

To rule out blood

components abnormalities

For U/A

To check if there is
abnormalities.

D5.09 NaCl 1L x 122

Replacement of fluid and

electrolytes imbalances
For fever

Paracetamol 1 amp IV q 82
Ranitidine 1 amp IV now then q
8 for vomiting

H2 blocker antagonist to
prevent or reduce N/V
To check any fluctuations.

v/s q 4
please inform AP
refer accordingly

To update prognosis to
the pt.
To communicate any
untoward signs and
symptoms that may occur.
To prevent recurrent
vomiting.

3:00 pm

NPO temporary

H2 blocker antagonist to
prevent or reduce N/V

Ranitidine 50mg IV q 8

Antibiotic to treat
bacterial infection

Cefuroxime 750mg IV q 8 (-)

ANST

Replacement of fluid and

electrolytes imbalances
and for medication.

IVF d5LR 1L x 8
5:45pm

To sustain metabolic
needs.

T: 38 C
BP: 90/60
May have DAT

8/24/10

Shift IV ranitidine to oral150mg

H2 blocker antagonist to
prevent or reduce N/
Antibiotic to treat
bacterial infection

Continue Cefuroxime IV

Antibiotic to treat
bacterial infection

IVF to follow D5LR 1L x 122

Replacement of fluid and

electrolytes imbalances
and for medication.

 PLR 1L x 122

Replacement of fluid and

electrolytes imbalances
and for medication.

For repeat U/A

For comparison

I will be out of town, Dr.

Butuyan will take over please
inform.

For specialized treatment

and further management

Give last dose of Cefuroxime @

4pm tomorrow

Antibiotic to treat
bacterial infection

8/25/10

Home meds.
1. Zinnat 5oomg BID x 5
days

Antibiotic to treat
bacterial infection

2. Paracetmol q 42

Non Opiod analgesics and

anti pyretic.

LABORATORY RESULTS

08-23-10 (10:43 am)

HEMATOLOGICAL REPORT
PARAMETERS

RESULTS

RANGES

INTERPRETATION

WBC
RBC
HgB
HCT
MCV
MCH
MCHC
PLT
RDW-SD
RDW-CV
PDW
MPV
P-LCR
PCT
NEUTROCYTES
LYMPHOCYTES
MONOCYTES
EOSINOPHIL
BASOPHIL

15.49 (10 g/L)

5.00 (10 12/L)
112 (g/L)
32.8 %
65.3 (PL)
22.3 (Pg)
341 (g/L)
278 (10 g/L)
31.1 34.1 Fl
14.5 %
11.5 %
9.7 (fl)
23.1 %
0.27 %
14.04 %
0.75 %
0.68 (10 g/L)
0.01 (10 g/L)
0.01 (10 g/L)

5.00 10.00
4.00 5.00
110 180
27.0 54.0
86.0 110
26.0 38.0
310 370
150 400
37.0 54.0
11.0 16.0
9.0 17.0
9.0 13.0
13.0 43.0
0.17 0.35
1.50 7.00
1.00 3.70
0.00 0.70
0.00 0.40
0.00 0.10

d/t infection
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal

08-23-08
URINALYSIS

Color
Transparency
pH
Specific
Protein
Glucose
RBC

Dark yellow
Turbid
6.5 pH
1.010 (normal = 1.010-1.025)
(+) 30 mg/dl
(-)
5 10

Pus cells
Epithelial cells
Amorphous materials
Mucus threads
Bacteria

100 numerous to count/ hpF

Moderate
Occasional
Rare
Occasional

INTERPRETATION
d/t infection
d/t infection
normal
normal
d/t damage of the kidney
normal
d/t damage of the function
of the kidney
d/t infection
normal
normal
normal
normal

yellow

INTERPRETATION
normal

08-25-08
URINALYSIS

Color

Transparency
pH
Specific
Protein
Glucose
RBC

Slightly Turbid
7.0 pH
1.015 (normal = 1.010-1.025)
(-)
(-)
0-2

Pus cells
Epithelial cells
Amorphous materials
Mucus threads
Bacteria

30 40 HPF
Moderate
Occasional
Rare
Occasional

normal
normal
normal
normal
normal
d/t damage of the function
of the kidney
d/t infection
normal
normal
normal
normal

ANATOMY AND
PHYSIOLOGY

The kidneys are essentially regulatory organs which maintain the volume and
composition of body fluid by filtration of the blood and selective reabsorption or secretion of
filtered solutes.
The kidneys are retroperitoneal organs (ie located behind the peritoneum) situated on the
posterior wall of the abdomen on each side of the vertebral column, at about the level of the
twelfth rib. The left kidney is slightly higher in the abdomen than the right, due to the presence
of the liver pushing the right kidney down.
The kidneys take their blood supply directly from the aorta via the renal arteries; blood is
returned to the inferior vena cava via the renal veins. Urine (the filtered product containing waste
materials and water) excreted from the kidneys passes down the fibromuscular ureters and

collects in the bladder. The bladder muscle (the detrusor muscle) is capable of distending to
accept urine without increasing the pressure inside; this means that large volumes can be
collected (700-1000ml) without high-pressure damage to the renal system occuring.
When urine is passed, the urethral sphincter at the base of the bladder relaxes, the detrusor
contracts, and urine is voided via the urethra.

Structure of the kidney

On sectioning, the kidney has a pale
outer region- the cortex- and a darker inner
region- the medulla.The medulla is divided
into 8-18 conical regions, called the renal
pyramids; the base of each pyramid starts at
the corticomedullary border, and the apex
ends in the renal papilla which merges to
form the renal pelvis and then on to form the
ureter. In humans, the renal pelvis is divided
into two or three spaces -the major calyceswhich in turn divide into further minor
calyces. The walls of the calyces, pelvis and
ureters are lined with smooth muscle that can
contract to force urine towards the bladder by
peristalisis.
The cortex and the medulla are made
up of nephrons; these are the functional units of the kidney, and each kidney contains about 1.3
million of them.
The nephron is the unit of the kidney responsible for ultrafiltration of the blood and
reabsorption or excretion of products in the subsequent filtrate. Each nephron is made up of:
A filtering unit- the glomerulus. 125ml/min of filtrate is formed by the kidneys as blood
is filtered through this sieve-like structure. This filtration is uncontrolled.
The proximal convoluted tubule. Controlled absorption of glucose, sodium, and other
solutes goes on in this region.
The loop of Henle. This region is responsible for concentration and dilution of urine by
utilising a counter-current multiplying mechanism- basically, it is water-impermeable
but can pump sodium out, which in turn affects the osmolarity of the surrounding
tissues and will affect the subsequent movement of water in or out of the waterpermeable collecting duct.
The distal convoluted tubule. This region is responsible, along with the collecting duct
that it joins, for absorbing water back into the body- simple maths will tell you that the
kidney doesn't produce 125ml of urine every minute. 99% of the water is normally
reabsorbed, leaving highly concentrated urine to flow into the collecting duct and then
into the renal pelvis.

Blood supply
The kidneys receive blood from the renal arteries, left and right, which branch directly
from the abdominal aorta. Despite their relatively small size, the kidneys receive approximately
20% of the cardiac output.
Each renal artery branches into segmental arteries, dividing further into interlobar arteries
which penetrate the renal capsule and extend through the renal columns between the renal
pyramids. The interlobar arteries then supply blood to the arcuate arteries that run through the
boundary of the cortex and the medulla. Each arcuate artery supplies several interlobular arteries
that feed into the afferent arterioles that supply the glomeruli.

The interstitum (or interstitium) is the functional space in the kidney beneath the
individual filters (glomeruli) which are rich in blood vessels. The interstitum absorbs fluid
recovered from urine. Various conditions can lead to scarring and congestion of this area, which
can cause kidney dysfunction and failure.
After filtration occurs the blood moves through a small network of venules that converge
into interlobular veins. As with the arteriole distribution the veins follow the same pattern, the
interlobular provide blood to the arcuate veins then back to the interlobar veins which come to
form the renal vein exiting the kidney for transfusion for blood.
Histology
Renal histology studies the structure of the kidney as viewed under a microscope. Various
distinct cell types occur in the kidney, including:
Kidney glomerulus parietal cell
Kidney glomerulus podocyte
Kidney proximal tubule brush border cell
Loop of Henle thin segment cell
Thick ascending limb cell
Kidney distal tubule cell
Kidney collecting duct cell
Interstitial kidney cell

Innervation
The kidney and nervous system communicate via the renal plexus, whose fibers course along the
renal arteries to reach the kidney. Input from the sympathetic nervous system triggers
vasoconstriction in the kidney, thereby reducing renal blood flow. The kidney is not thought to
receive input from the parasympathetic nervous system. Sensory input from the kidney travels to
the T10-11 levels of the spinal cord and is sensed in the corresponding dermatome. Thus, pain in
the flank region may be referred from the kidney.

Functions
The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte
concentrations, extracellular fluid volume, and regulation of blood pressure. The kidney
accomplishes these homeostatic functions both independently and in concert with other organs,
particularly those of the endocrine system. Various endocrine hormones coordinate these
endocrine functions; these include renin, angiotensin II, aldosterone, antidiuretic hormone, and
atrial natriuretic peptide, among others.
Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration,
reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the
renal corpuscle, is the process by which cells and large proteins are filtered from the blood to
make an ultrafiltrate that will eventually become urine. The kidney generates 180 liters of filtrate
a day, while reabsorbing a large percentage, allowing for only the generation of approximately 2
liters of urine. Reabsorption is the transport of molecules from this ultrafiltrate and into the
blood. Secretion is the reverse process, in which molecules are transported in the opposite
direction, from the blood into the urine.
Excretion of wastes
The kidneys excrete a variety of waste products produced by metabolism. These include the
nitrogenous wastes urea, from protein catabolism, and uric acid, from nucleic acid metabolism.

Acid-base homeostasis
Two organ systems, the kidneys and lungs, maintain acid-base homeostasis, which is the
maintenance of pH around a relatively stable value. The kidneys contribute to acid-base
homeostasis by regulating bicarbonate (HCO3-) concentration.
Osmolality regulation
Any significant rise or drop in plasma osmolality is detected by the hypothalamus, which
communicates directly with the posterior pituitary gland. An increase in osmolality causes the
gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and
an increase in urine concentration. The two factors work together to return the plasma osmolality
to its normal levels.
ADH binds to principal cells in the collecting duct that translocate aquaporins to the membrane
allowing water to leave the normally impermeable membrane and be reabsorbed into the body by
the vasa recta, thus increasing the plasma volume of the body.
There are two systems that create a hyperosmotic medulla and thus increase the body
plasma volume: Urea recycling and the 'single effect.
Urea is usually excreted as a waste product from the kidneys. However, when plasma
blood volume is low and ADH is released the aquaporins that are opened are also permeable to
urea. This allows urea to leave the collecting duct into the medulla creating a hyperosmotic
solution that 'attracts' water. Urea can then re-enter the nephron and be excreted or recycled again
depending on whether ADH is still present or not.
The 'Single effect' describes the fact that the ascending thick limb of the loop of Henle is
not permeable to water but is permeable to NaCl. This means that a countercurrent system is
created whereby the medulla becomes increasingly concentrated setting up an osmotic gradient
for water to follow should the aquaporins of the collecting duct be opened by ADH.
Blood pressure regulation
Long-term regulation of blood pressure predominantly depends upon the kidney. This
primarily occurs through maintenance of the extracellular fluid compartment, the size of which
depends on the plasma sodium concentration. Although the kidney cannot directly sense blood
pressure, changes in the delivery of sodium and chloride to the distal part of the nephron alter the
kidney's secretion of the enzyme renin. When the extracellular fluid compartment is expanded
and blood pressure is high, the delivery of these ions is increased and renin secretion is
decreased. Similarly, when the extracellular fluid compartment is contracted and blood pressure
is low, sodium and chloride delivery is decreased and renin secretion is increased in response.
Renin is the first in a series of important chemical messengers that comprise the reninangiotensin system. Changes in renin ultimately alter the output of this system, principally the
hormones angiotensin II and aldosterone. Each hormone acts via multiple mechanisms, but both
increase the kidney's absorption of sodium chloride, thereby expanding the extracellular fluid
compartment and raising blood pressure. When renin levels are elevated, the concentrations of
angiotensin II and aldosterone increase, leading to increased sodium chloride reabsorption,
expansion of the extracellular fluid compartment, and an increase in blood pressure. Conversely,
when renin levels are low, angiotensin II and aldosterone levels decrease, contracting the
extracellular fluid compartment, and decreasing blood pressure.
Hormone secretion
The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin.
Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the
renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow.
Calcitriol, the activated form of vitamin D, promotes intestinal absorption of calcium and the

renal reabsorption of phosphate. Part of the renin-angiotensin-aldosterone system, renin is an

enzyme involved in the regulation of aldosterone levels.

PATHOPHYSIOLOGY
OF
ACUTE PYELONEPHRITIS

Etiology:
Bacteria: escherichia coli

Modifiable:

Predisposing factors:
Non-modifiable:

>urinary retention
>age
>diabetes mellitus
>gender (female)
>pregnancy
>instrumentation of urinary tract
>recurrent UTI

Bacteria attaches and colonizes the

Epithelium of the urinary tract
Antibody formation
Antigen-antibody complex
Fever
Inflammation or trauma of urethral mucosa
Nausea and vomiting

urinary tract impeded

Outflow obstructed
Dysuria

Frequent, scanty urination

formation of residual urine

IVP

microbial growth

Blood vessel compressed

bacteriuria

mucosal defense
nocturia
Inflammation of the bladder
Suprapubic or pelvic pain

hematuria
Vesicoureteral reflex

Flank pain

exudates fills the kidney pelvis

cloudy, foul smelling urine

Abscess and necrosis in the calyx

Loss of tubule function

hydronephrosis

Chronic Renal Failure

DEATH