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 Acute Pyelonephritis
Definition
Pyelonephritis is an infection of the
kidney and the ureters, the ducts that
carry urine away from the kidney.

Alternative Names
a Urinary tract infection -
complicated;
a Infection - kidney;
a Complicated urinary tract infection;
a 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.
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
-Obstructive Urophaty
-Renal Papillary Necrosis
You are also more likely to get a kidney infection if you have a
history of chronic or recurrent UTI, 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 immunosuppresed (for example, those
with cancer or AIDS).
Symptoms
a Back pain or flank
ºSkin changes
pain
-Flushed or reddened
a Chills with shaking skin
a Severe abdominal -Moist skin (diaphoresis)
pain (occurs -Warm skin
occasionally) ºUrination problems
a Fatigue -Blood in the urine
a Fever
-Cloudy or abnormal
urine color
-Higher than 102 -Foul or strong urine
degrees Fahrenheit odor
-Persists for more than -Increased urinary
2 days frequency or urgency
a General ill feeling -Need to urinate at
a Chills with shaking night (nocturia)
-Painful urination
Mental changes or
ºVomiting, nausea
confusion
°xams and Tests
A physical exam may show tenderness when the
health care provider presses (palpates) the area
of the kidney.
a Blood culture may show an infection.
a Urinalysis commonly reveals white or red blood
cells in the urine.
a 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:
a Kidney biopsy
a Kidney scan
a Kidney ultrasound
a Voiding cystourethrogram
Treatment
The goals of treatment are to:
a Control the infection
a 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
are 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:
a Amoxicillin
a Cephalosporin
a Levofloxacin and
ciprofloxacin
a 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:
a Chronic kidney infections occur in a transplanted kidney
a 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 called sepsis. 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.
Name: She Lui
Sex: Female
Address: Plaridel, Santiago City
Birthday: September 5, 1985
Age: 25
Civil Status: Married
Nationality: Filipino
Religion: INC
Occupation: Self °mployed
DOA: Aug. 23, ·10
TOA: 10:03 am
Physician: Dr. Alex Cristobal
Chief Complaint: painful urination, fever with chills, 2
days vomiting & malaise
Admitting Diagnosis: t/c UTI
Final Diagnosis: Acute Pyelonephritis

Initial v/s: BP: 110/80 mmHg T: 38 AA

RR: 21 cpm PR: 81 bpm
 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 BP: 110/80, RR: 21, PR: 81
and T°MP : 38 C.
 History of Past
Illness
According to the patient last
July 2009 she experience fever
and scanty urination. She
consulted at CHO for check up,
the doctor prescribed her
antibacterial.
 Family History

The patient has a family history of

Hypertension on Mother side and
asthma on her Father side.
Health Perception Nutritional-
Pattern Metabolic Pattern
PTA, according to the
patient she loves to
chicken joy and fries
According to the (Jollibee) and eat only
pt she aware small amount of
that she has vegetables. During
snack time her
recurrent UTI, favorite snack is
and takes chippy and soft
antibacterial drinks for at least 2
drugs at first liters a day. She only
consume 4 glasses of
and suddenly water a day.
stops taking it. During hospitalization
the pt is NPO as
ordered due to her
vomiting.
Activity/°xercise
Pattern
PTA, according to the
patient she had a
Coping Pattern
sufficient energy to
require for her ADL
like doing household According to the
chores, bringing her patient every time
daughter going to she feels stress she
school and going to talks to her
their store to sell husband and
clothes.
discuss to him
During hospitalization,
some of her
she can no longer do problems.
her usual habit, but
she can still perform
some of her ADL like
going to the bathroom.
 °limination Sleep -Rest
Pattern Pattern
PTA, the patient
usually voids 5-7 times PTA, the patient sleep 7-
a day and defecates 8 hours a day. She
once a day. According sleep at 9:00 o·clock
to her the color of her and wakes up 5:00
urine is yellow, she o·clock in the morning.
voids for at least She also takes a nap
210ml/day for 5 minutes.

During the During Hospitalization

hospitalization the the patient sleep was
patient voids 10-12 interrupted for 10mins
times a day but according to her,
scanty she voids for because of giving
at least 90 ml within medication and getting
the shift she defecates vital signs.
every other day.
Role Relationship
Pattern
Values Beliefs
PTA, the patient lives
together with her
Pattern
family. She is
The patient is a
responsible in doing
member of Iglesia
the Household
ni Cristo,
chores and caring
for her daughter.
They usually attend
church gathering
During every Sunday.
hospitalization she The family also
can no longer believes in faith
perform her healer.
responsibilities at
home.
 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.
 DRUGS A
D A
 ADVERSE REA
 URSG
SDERA

Generic e:
o reduce or prevent  drowine º Monitor bowel
Metoclopride nue nd voitin
 fti ue ound
Hydrochloride  nue º Monitor pt
cloely
 ontrindiction:  dirrhe epecilly when
Brnd e: Plil Ptient hyperenitive tretent trt or
to dru nd in thoe chn e of do e

lifiction: with
Antieetic pheochroocyto or
eizure diorder
Do e: 1 p
Route: V
Frequency: PR
Generic e: For duodenl nd  verti o º Do not ive
Rnitidine tric ulcer  hedche rnitidine with
Hydrochloride  blurred viion ntcid becue
 ontrindiction: ntcid y
Brnd e: Sinool Ptient hyperenitive interfere rnitidine

to dru º Ae pt for

lifiction: H2 bdoinl pin

blocker nt onit ote preence of

blood in eei
Do e: 1 p tool or tric
Route: V pirte

Frequency: q 8Û
 DRUGS A
D A
 ADVERSE REA
 URSG
SDERA

Generic e: efuroxie Repirtory nd urinry trct  Peudoebrne coliti
oft tiue bone nd joint  norexi a Advie ptient receivin
Brnd e: Zincef infection
onorrhe nd  nue nd voitin dru to report 
other infection  dirrhe dicofort t V
lifiction: Antbiotic ncludin epticei heolytic nei inertion ite

peritoniti nd a For M ue inject deep

Do e: 750 eni iti
prophylxi into  lr e ucle uch
Route: V  int infection in  the luteu xiu
Frequency: q 8 bdoinl pelvi ur ery or the ide of the thi h
where there i increed rik
fro infection

 ontrindiction: Ptient
hyperenitive to dru nd in
thoe with
pheochroocyto or eizure
diorder
Generic e: efuroxie Repirtory nd urinry trct  dizzine
Axetil oft tiue bone nd joint  hedche a
ke ieditely fter
infection
onorrhe nd other  bdoinl pin el
Brnd e: Zinnt infection G diturbnce a Before ivin dru  k
ncludin epticei dirrhe pt
if he i ller ic to
lifiction: Antibiotic peritoniti nd penicillin or
eni iti
prophylxi  int cephloporin¶
Do e: 1 tb infection in bdoinl pelvi a btin pecien for
ur ery where there i
Route: P
 culture nd enitivity
increed rik fro infection

Frequency: BD tet before ivin firt

 ontrindiction: Ptient
doe

herpy y
hyperenitive to dru nd in
iven while witin
thoe with pheochroocyto
reult
or eizure diorder
 DRUGS A
D A
 ADVERSE REA
 URSG
SDERA

Generic e: jundice
Acetinophen heolytic nei a
ke ieditely
 ontrindiction: hypo lycei fter in
Brnd e: Aekil Ptient hyperenitive rh a n children don¶t
to dru nd in thoe exceed five doe in
lifiction: with 24 hour

onopioid nl eic pheochroocyto or

eizure diorder
Do e: 1p
Route: V
Frequency: PR