Pathophysiology: Chronic Pyelonephritis

Pathophysiology Infection and inflammation of the kidneys is called pyelonephritis. Pyelonephritis is a type of urinary tract infection. E. coli is the most common microbe that causes pyelonephritis. It usually begins in the urethra or bladder and travels to the kidneys. There is a chance of it spreading to the calyces and medullary tissues such as the tubules of the nephrons. If not treated the glomeruli will also be infected and inflamed. (Bullock & Hales 2013).
There is both acute pyelonephritis and chronic pyelonephritis. In acute pyelonephritis, phagocytes and inflammatory exudate travel to the infected area blocking tubule function during acute pyelonephritis. Chronic forms of the condition are more common in people with urinary obstructions. UTIs, vesicoureteral reflux, or anatomical anomalies can all be contributing factors to chronic pyelonephritis. Chronic pyelonephritis is more common in children than in adults. Women are also at a
greater risk than men because the urethra is shorter in women than men. Suppuration (process of pus forming) and bleeding usually occurs during this process. Necrotic papillae of the medullary pyramids is common with diabetics. Prolonged and continuing gradual damage and failure of functional kidney tissue becomes chronic pyelonephritis. Scar tissue is usually formed from ongoing damage. Patients with this problem usually show no symptoms until the damage is significant, such as irreversible tissue loss. Other causes such as ageing men with prostate enlargement can exacerbate pyelonephritis and children that have congenital malformations of the vesicoureteral valves.(Bullock & Hales 2013).
Common symptoms for pyelonephritis are fever that spike up to 39.4°C, costovertebral angle pain, and nausea/vomiting. Hematuria (blood in urine) can also occur but is usually rare. Elders usually present with a high fever, mental status change, and generalized deterioration. Children two years or younger have symptoms such as failure to thrive, feeding difficulty, fever, and vomiting.(Medscape 2017). Symptoms that are common in UTIs such as dysuria, increased frequency, and urgency of urination can be accompanied and also masked by pyelonephritis. Flank pain, fever, and tachycardia are the usual symptoms that occur which will cause the symptoms of a UTI to be nonexistent. Hypotension and tachycardia will occur if a person develops sepsis (Bullock & Hales 2013). If the person fails to treat pyelonephritis, complications such as kidney scarring, blood poisoning (septicemia), and pregnancy complications can occur. Kidney scarring can cause high blood pressure, chronic kidney disease, and eventually kidney failure. Septicemia in relation to the kidneys will result in infected blood with bacteria back to the bloodstream rather than filtered blood. (Mayoclinic 2017).
Diagnosing for pyelonephritis involves having multiple test such as a urinalysis and CBC.
A dipstick is used to test urine and a midstream specimen of urine (MSU) sample is collected and sent to the labs for examination and culture. If the person seems to be having sepsis and showing fever, blood is drawn for labs. White blood cells and neutrophils elevation are likely results. If a negative result occurs, infection is not automatically ruled out. A false negative can happen in situations where an antibiotic treatment has started. An intravenous pyelogram, ultrasound, or CT scan may be needed if other causes of diseases need to be excluded. In addition to the tests, a medical history and physical assessment will help find the diagnosis (Bullock & Hales 2013). The patient’s labs such as low Hgb (7.3), Hct (22.8), Rbc (2.52), WBC (3.0), BUN (39), Creatinine (1.3) show signs that she has kidney disease. She is also experiencing the symptoms such as right hip pain and lower back pain which is consistent with
pyelonephritis.