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 Topic: Pyelonephritis

 Your presentation should include an overview of the health problem identified, an in-depth review of the associated anatomy and physiology, an overview of treatment methodologies, and information related to the needs of the patient and/or family related to the problem. Your presentation should be prepared in PowerPoint 

follow the rubric and the sample, also add conclusion.

10-13 pages

Pyelonephritis N10

Overview

Description

This condition is characterized by infection of the renal parenchyma and renal pelvis, which often results in localized back pain and systemic symptoms, including fever, chills, and nausea; the severity of symptoms varies depending on the severity of the infection (Domino et al., 2020).

Chronic pyelonephritis results from recurrent infection, vesicoureteral reflux, or both. It can affect the interstitial space and tubules of the kidney.

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Pyelonephritis

A case of pyelonephritis caused by a typical pathogen, resulting in healthy urinary tract anatomy and normal renal function, is considered uncomplicated.

This infection affects the kidneys and urology Synonym: acute upper urinary tract infection.

In acute pyelonephritis, the kidney can become scarred and may undergo significant damage, kidney failure, abscess formation, and sepsis. Pyelonephritis must be treated with antibiotics to prevent its progression.

Pyelonephritis is highly related to fever, so patients without fever who have non-feverish clinical symptoms should be evaluated for alternative diagnoses (Cash et al., 2020).

INCIDENCE

Pyelonephritis affects between 15 and 17 women per 10,000 compared with 3 to 4 men per 10,000. In pregnancy, 2% of women have pyelonephritis. Women have an average of thirty UTIs throughout their lifetimes.

In comparison to lower UTIs, upper UTIs are less common and more serious. UTIs are more common in females after puberty but remain rare in males (Cash et al., 2020).

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Pyelonephritis

Trivia- Pregnancy consideration

The leading nonobstetric cause of hospitalization during pregnancy is acute pyelonephritis (Cibulka & Barron, 2017). Between 1% and 2% of pregnant women are hospitalized for it.

In most cases, the second and third trimester is the time. Maternal and fetal morbidity and mortality may occur as a result of pyelonephritis (Cibulka & Barron, 2017).

March 16, 2022

Annual Review

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Geriatric Considerations

Pregnancy Considerations

It has been estimated that if asymptomatic bacteriuria (ABU) is not treated during pregnancy, 20-30% of women will develop acute pyelonephritis.
One to two percent of all pregnancies is affected. There is no difference between trimesters when it comes to morbidity.
One to two weeks after therapy, urine is collected for a test of cure.

Pediatric Considerations

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Alterations in mental status are common in this group; absence of fever is common.
Diabetic and pyelonephritic older patients are more likely to suffer from bacteremia, require longer hospitalizations, and die.
In this population, urine dipsticks are less reliable for diagnosing UTI due to the high prevalence of asymptomatic bacteriuria.
Most children over the age of two months to two years experience fevers caused by UTIs without any apparent source in the history or physical examination (Domino et al., 2020).
Patient toxicity and clinical situation should determine the type of treatment (PO or IV; inpatient or outpatient).
The most common pathology in children is vesicoureteric reflux (Cash et al., 2020).

ETIOLOGY AND PATHOPHYSIOLOGY

In cases of acute pyelonephritis, ascending infection is found to be the cause.

Bacteria such as E. coli (>80%).

In addition to Proteus, Klebsiella, Serratia, Clostridium, Pseudomonas, and Enterobacter spp., gram-negative bacteria are found in soil (Domino et al., 2020).

The majority of cases are caused by Gram-negative causative agents; 10% to 15% of cases are caused by Staphylococcus saprophyticus (Cash et al., 2020).

A bloodstream infection from intravenous (IV) drug abuse or endocarditis can also cause bacterial infection of the kidneys.

Pyelonephritis can take the form of either obstructive or reflux pyelonephritis.

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Treatment Methodologies

A broad-spectrum antibiotic should be chosen based on severity, health status, and the likelihood of resistant pathogens, determined by culture and sensitivity results (Domino et al., 2020).

Use of fluoroquinolone, trimethoprim-sulfamethoxazole (TMP-SMX), or broad-spectrum ß-lactam.

GENERAL MEASURES

An American College of Physicians recent guideline suggests treating men or non-pregnant women with uncomplicated pyelonephritis with a fluoroquinolone for a short period of time (5 to 7 days) or with trimethoprim/sulfamethoxazole for 14 days, depending on antibiotic susceptibility (Lee et al., 2021).

MEDICATIONS

Infection control and symptom reduction are the main goals of treatment. Based on the patient’s symptoms and comorbidities, the decision should be made to treat empirically and admit the patient for intravenous antibiotic therapy.

Severely ill patients with marked debility or multiple comorbidities, pregnancy, and uncertainty about the diagnosis.

Indications for hospitalization include inability to maintain oral hydration or adherence to the medication regimen, Hypotension, Vomiting, Dehydration, Sepsis, High WBC count, patients with a temperature >102.2ºF (39.0ºC)

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Antibiotics: Empiric antibiotic selection should be guided by local antibiotic resistance patterns, allergies, and culture results. Patients with delayed response to therapy should also receive a longer course of antibiotics of 14 to 21 days.

The first line of therapy is Ciprofloxacin (Cipro) 500 mg twice daily for seven days, or CiproXR 1,000 mg once per day for seven days. The first line of treatment is Levofloxacin (Levaquin) 750 mg two to three times daily for five to seven days.

In second-line management: Trimethoprim and sulfamethoxazole (TMP-SMX) 160 mg and 800 mg twice daily for 7 to 10 days. Due to the high resistance rate of E. coli, the empirical use of TMP-SMX should be avoided in patients who require hospitalization.

The recommended dosage for children ages 10-14 is cefdinir at 14 mg/kg/day for 10-14 days; ceftibuten at 9 mg/kg/day for 10-14 days; cefixime at 8 mg/kg/day for 10-14 days.

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Differential Diagnosis

Pain at the RLQ at McBurney’s point is common in the beginning, followed by anorexia and dull, steady periumbilical pain.

Appendicitis/acute abdomen

Pancreatitis

Filled and inflamed diverticula cause this condition.

Diverticulitis

PID

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A rise in serum amylase is associated with pancreatitis.

Cholecystitis

In chronic cholecystitis, biliary sludge is present.

An upper genital tract infection causes an inflammation.

Care for the patient and the family

Education – Treatment

Educate them to obtain the entire course of outpatient antibiotics.

Eat a regular diet if the patient can tolerate it.

It is recommended that the patient drink eight to ten glasses of water every day.

The patient should avoid caffeine-containing beverages.

It is suitable for urinary tract problems to drink cranberry juice (100%) and take cranberry and blueberry capsules.

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Abscess of the renal region; abscess of the perinephric region

Infections that spread to the skeletal system, endocardium, eyes, and meningitis with seizures

May lead to septic shock and death

Acute/chronic renal failure

Costovertebral angle tenderness (CVA) is a characteristic sign of a pulmonary embolus

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Special Considerations- Patients

Laboratory results may be affected by recent antibiotic use.

The majority of patients notice an improvement in their symptoms within 48 hours after initiation of antibiotic therapy. After 72 hours, almost ninety five percent of patients are asymptomatic and afebrile.

Test Interpretation- Acute: neutrophil response with abscess formation Chronic: fibrosis with reduced renal tissue

Monitor the child’s response with the parents.

A repeat culture should be performed 1 to 2 weeks after graduating therapy for men, children, adolescents, and patients with recurrent infections. In case of a new episode of pyelonephritis occurs again, a urologic examination is required (Domino et al., 2020).

It is not recommended to routinely repeat cultures on women unless symptoms recur after two weeks, and an evaluation by a urologist is then required (Domino et al., 2020).

References

THANK YOU

Monica Naugle

Week 3 – Disease Presentation

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