Case Study on Acute Pyelonephritis 2022

RUNNING HEAD: ACUTE PYELONEPHRITIS 1
Case Study on Acute Pyelonephritis
Student Details:

ACUTE PYLONEPHRITIS 2
Contents
Introduction......................................................................................................................................3
Aetiology.........................................................................................................................................3
Pathophysiology..............................................................................................................................3
Evaluation of condition....................................................................................................................4
Nursing care intervention................................................................................................................5
Excess fluid volume.....................................................................................................................5
Activity intolerance.....................................................................................................................5
Ineffective self-health management.............................................................................................5
Anxiety........................................................................................................................................6
Pharmacological treatment with side effects...................................................................................6
Conclusion.......................................................................................................................................8
Bibliography....................................................................................................................................9

ACUTE PYLONEPHRITIS 3
Introduction
Acute pyelonephritis is a microbial contamination which causes irritation of the kidney
and is one of the most shared infections of the kidney. Pyelonephritis happens as difficulty of a
soaring urinary tract infection which blowouts from the bladder to the kidney and their gathering
structures. Indications comprise “fever, flank pain, nausea, and vomiting, burning sensation in
urine, increased frequency and urgency of urination”. This report highlights the situation study
of Miss Adele Onbuku who is 27 year old female and diagnosed with acute pyelonephritis. The
report basically focuses on definition along with symptoms, aetiology, pathophysiology,
assessment of this condition, nursing care intervention procedure, along with pharmacological
treatment with side effects of the medicines.
Aetiology
As per study of Miss Adele Onbuku’s case, the chief reason of acute pyelonephritis is
gram-negative bacteria, the greatest shared presence of Escherichia coli. Additional gram
negative bacterium which reasons this disorder comprises “Proteus, Klebsiell, and
Enterobacter”. In greatest like Miss Adele’s study, the contaminating bacterium will originate
from their fecal flora (Belyayeva & Jeong., 2019). Furthermore, as per case study of Miss Adele,
microorganisms spread to the kidney in two methods: hematogenous blowout and over climbing
contamination from the inferior urinary area. Hematogenous blowout is fewer shared and
typically happens in patients with ureteral obstacles or inmmunocompromised and weakened
enduring. Maximum like Miss Adele get severe pyelonephritis over rising contamination.
Soaring contamination occurs over some stages. Microorganisms will chief confer to urethral

ACUTE PYLONEPHRITIS 4
mucosal epithelial chambers and will then collapsible to the bladder through the urethra
whichever over both arrangement and urinary tract contaminations which happens added
regularly in women. UTIs are further shared in women than in men due to smaller urethras,
hormonal variations, and near detachment to the anus. Urinary tract impediments produced by
somewhat like kidney pebble can also clues to severe pyelonephritis. Furthermore, in females
like Miss Adele, a discharge obstacle of urine can lead to inadequate draining and urinary
stability which reasons microorganisms to increase without being flushed out. A fewer public
reason of acute pyelonephritis is vesicourteral reflux, which is an inherited disorder where urine
streams backward after the bladder into the kidneys (L Robino, 2014).
Pathophysiology
E. coli is the greatest communal microorganisms producing acute pyelonephritis owing to
its exclusive capability to observe to and inhabit the urinary tract and kidneys. E. coli has
bonding agent particles called P-fimbriae which interrelate with receptors on the superficial of
uroepitehlial cubicles. Kidneys contaminated with E.coli can clue to an acute provocative reply
which can reason damaging of the renal parenchyma (H Stunell, 2015). However, the instrument
in which renal damaging happens is still unwell unstated, it has been imagined that the bond of
microorganisms to the renal cells disturbs the defensive fences, which clue to contained
contagion, hypoxia, ischemia, and coagulation in an effort to contain the contagion. Provocative
cytokines, microbial contaminants, and further sensitive procedures additional clue to whole
pyelonephritis and are numerous circumstances universal indications of sepsis and tremor. After
E. coli, less shared causal creatures comprise other Enterbacteriaceae, Pseudomonas aeruginosa,
group B streptococci, and enterococci. The range of pathogens complex in acute pyelonephritis

ACUTE PYLONEPHRITIS 5
is comparable to that of cystitis but with a little incidence of Staphylococcus saprophyticus (K
Monaghan, Feline acute kidney injury: 1. Pathophysiology, etiology and etiology-specific
management considerations, 2012).
As per case study of Miss Adele, clinical appearances of acute pyelonephritis are
excessive fever overhead than 102 degree F, pain in stomach, spinal, lateral or groin, sore or
scorching urination, overcast urine, recurrent urination, fish odor like urine, frightening and
tremor, nausea, vomiting, overall body pain, exhaustion, moist skin, mental misperception. Signs
may be dissimilar in children and older grownups than they are in other persons. Like, cerebral
confusion is shared in grownup adults and is often their only indication. Persons with chronic
pyelonephritis might face only mild indications or might even lack perceptible signs overall (YJ
Lee, 2014). Temperature may also be inattentive in weak, older people or in
inmmunocompromised people, who also might not reveal other definitive appearances or acute
pyelonephritis. Additionally, females like Miss Adele, early and mid-aged females awarding to
an alternative section with fervor, pyuria, and additional types of upper UTI, 985 obligate acute
pyelonephritis. Above 30% of female offering with cystitis alike indications obligate higher
urinary area participation (“subclinical pyelonephritis”), however these contaminations
infrequently source some cortical impairment (R Vollmann, 2011).
Evaluation of condition
For the assessment of condition of Miss Adele, urine culture and urinalysis approve the
judgment of severe pyelonephritis. The agreement description of pyelonephritis recognized is a
urine sample presenting approximately 10,000 group starting entities per mm and indications
likeminded with the identification and this is prescribes as per standards of Infectious Diseases

ACUTE PYLONEPHRITIS 6
Society of America (IDSA). Inferior amounts are distress in males and pregnant females. Urine
samples frequently are gotten by a midway sanitary catch method, and educations displays that
cleaning does not decrease infection charges in grownups (SH Kim, 2012).
Pyuria is exists practically in all enduring with severe pyelonephritis and could be noticed
quickly through the “leukocyte esterase test or the nitrite test”. The mixture of the leukocyte
esterase and examinations for UTI is added precise but fewer complexes than whichever test
unaccompanied. However, white cell companies might be pragmatic in additional circumstances;
they are sideways with additional structures of Urinary Tract Infections, exact for serious
pyelonephritis. Hematuria might be existent in patient with pyelonephritis (B Becknell, 2015).
Furthermore for better examination of Miss Adele, in certain complex circumstances,
Gram strain investigation of urine can assistance in the selection of early antibiotic treatment.
Additional choice is the usage of the antibody covered microorganisms examine, which might be
obliging in restricting clinical higher UTIs.
For Miss Adele, assessments for research laboratory analysis of Urinary Tract Infection
are mentioned below:
 Urinalysis
 Leukocyte esterase test
 Nitrite test
 Leukocyte esterase and nitrite tests
 Dipstick hematuria
 Gram strain of uncentrifuged urine

ACUTE PYLONEPHRITIS 7
Nursing care intervention
For better improvement of Miss Adele, both the nurse and apothecary play an acute role
in the nursing of the enduring, management of antibiotics and nursing for retrieval. For fitness,
early, premenstrual females, one of the finest conducts to evade acute pyelonephritis is to
emphasis on anticipation of one of the additional shared inclining reasons which are urinary tract
contaminations. While numerous issues might lead to urinary tract contaminations, a decent
method to support in deterrence is to void beforehand and directly after contact as well as
smearing from anterior to posterior after urinating and excreting. This will support to discontinue
the institution of bacteria into the urethra and succeeding climbing constructions (DR Lane,
2011). Additionally, below mentioned are the nursing care interventions based on four basic
activities of daily living.
Excess fluid volume
Upkeep of cautious chronicles of liquid consumption and production is necessary for the
enduring. Educating Miss Adele and household members about the reputation of specific related
histories. If liquids are constrained, elucidate the requirements for the constraint and help the
enduring to strategy the effectiveness and quantities of allowable liquids. Unsolidified constraint
can be very upsetting. It assistances serve liquids in minor containers than serving an ounce or
two in a large tumbler. If the enduring has edema, superior skin care is required. Handle the
enduring mildly since swollen tissue injures easily and reconciles slowly (K Monaghan, Feline
acute kidney injury: 2. Approach to diagnosis, treatment and prognosis, 2012).

ACUTE PYLONEPHRITIS 8
Activity intolerance
Activity intolerance might be due to contamination, collected poisons, or anemia. Throughout
the acute disease, disappoint activity to permit the kidneys to reconcile. Clarify the prominence
of rest for retrieval. Schedule actions to permit for stages of continuous relaxation. The patient
like in Miss Adele’s case study, on bed relaxation is at hazard for difficulties of motionlessness:
“skin breakdown, pneumonia, muscle weakness, joint stiffness, constipation and thrombus
formation”. Consequently have Miss Adele to change situations, cough and deep respired and
mildly workout joints occasionally (R Colgan, Diagnosis and treatment of acute uncomplicated
cystitis, 2011).
Ineffective self-health management
Miss Adele necessities to comprehend that relaxation, nutritional limitations and
medicines endorse retrieval. Offer help with ADL. Highlight the essential for follow up upkeep.
When the long-suffering is discharged, strengthen the prominence of recording any indications
of reappearance such as variations in urine appearances or edema. Educate Miss Adele to
upsurge doings progressively as the edema and exhaustion determination (AJ Montgomery,
2011).
Anxiety
Miss Adele with acute pyelonephritis may be disturbed about the probability of emerging
a lingering, life intimidating disorder. Obliging interferences comprise sympathetic attending, on
condition that factual material, and transfers to other specialists (Cappell, 2017).

ACUTE PYLONEPHRITIS 9
Pharmacological treatment with side effects
Though Miss Adele with severe pyelonephritis usually admitted in hospice and cured
with venous antibiotics, casualty oral treatment is positive with straightforward serious
pyelonephritis that can stand oral consumption, will be acquiescent with the management
routine, will reappearance for initial follow up, and must passable communal provision. People
suffering with complex severe pyelonephritis who are further sick or have not answered to
casualty treatment must be hospitalized. Additional selection is first treatment with parenteral
antibiotics in an inpatient reflection area, shadowed by oral rehabilitation as an outpatient.
Additionally, of the mutual uropathogens, confrontation to “fluoroquinolones” residues actually
little (1 to 3%). “Fluoroquinolones” are captivated thriving after the GI tract area and obligate
outstanding kidney diffusion. The common side effects of fluoroquinolones are nausea, headache
and photosensitivity. In designated persons with reasonable or acute pyelonephritis, scientific
consequences are equal with venous and oral ciprofloxacin (Cipro) treatment. Consequently, for
empiric treatment in “uncomplicated acute pyelonephritis”, the IDSA suggests the usage of an
oral fluoroquinolones. Side effects of oral amoxicillin are gastro-intestinal side effects (R
Colgan, Diagnosis and treatment of acute pyelonephritis in women, 2011).
If Miss Adele necessitates treatment in the hospital, the IDSA strategies endorse below
mentioned original venous treatments:
 An aminoglycoside through or deprived of ampicillin
 Cephalosporin with or deprived of an aminoglycoside
 A fluoroquinolone
 An extended-spectrum

ACUTE PYLONEPHRITIS 10
Adverse effects of “aminoglycosides are ototoxicity and nephrotoxicity”. Additionally,
adverse effects of cephalosporins are leukopenia and increased liver enzymes levels. Through
“gram-positive cocci, ampicillin-sulbactam (Unasyn)” with or deprived of an aminoglycoside is
suggested. Furthermore, aminoglycosides must be evaded in enduring with prevailing renal
illness. A 7 to 14-day sequence of antibiotics is operative in females who are immunocompetent
and does not show fundamental disease. Temperature usually firms inside 72 hours of
preliminary antibiotic treatment. Severe microbial nephritis might develop to inflammation and
necessitates a prolonged sequence of antibiotics. Release of obstacle and antibiotic treatment
may be positive in emphysematous pyelonephritis, nevertheless nephrectomy should be
powerfully measured in Miss Adele through unsympathetic contaminations. If the microbe’s
cause’s reinfection is dissimilar from the imaginative bacteria, two weeks of management are
adequate. Instant announcement of any current obstacle mutual with a 14-day sequence of
suitable antibiotics reduces disappointment and reappearance (MT Hecker, 2014).

ACUTE PYLONEPHRITIS 11
Conclusion
As per Miss Adele Onbuku case of acute pyelonephritis, this report focuses on the
treatment of acute pyelonephritis which highlights the introduction of the condition, aetiology
and occurrence of the situation, pathophysiology and clinical appearances, laboratory tests
required for the evaluation of condition, nursing care interventions on the basis of four activities
of daily living along with pharmacological treatment with possible side effects. As per studies
and investigation, Miss Adele will be able to recover the condition easily by consuming proper
medicines and maintaining proper hygiene.

ACUTE PYLONEPHRITIS 12
Bibliography
AJ Montgomery, C. B. (2011). A review of self-medication in physicians and medical students.
Occupational, 61(7), 490-497.
B Becknell, M. S. (2015). The diagnosis, evaluation and treatment of acute and recurrent
pediatric urinary tract infections. Expert review of anti-infective therapy, 13(1), 81-90.
Belyayeva, M., & Jeong., J. M. (2019). Acute Pyelonephritis. StatPearls [Internet], 1-3.
Cappell, M. (2017). Principles and practice of hospital medicine. New York: McGraw-Hill
Education Medical.
DR Lane, S. T. (2011). Diagnosis and management of urinary tract infection and pyelonephritis.
Emergency medicine clinics, 29(3), 539-552.
H Stunell, O. B. (2015). Imaging of acute pyelonephritis in the adult. European radiology, 17(7),
1820-1828.
K Monaghan, B. N. (2012). Feline acute kidney injury: 1. Pathophysiology, etiology and
etiology-specific management considerations. Journal of feline medicine, 14(11), 775-
784.
K Monaghan, B. N. (2012). Feline acute kidney injury: 2. Approach to diagnosis, treatment and
prognosis. Journal of feline medicine, 14(11), 785-793.
L Robino, V. G.-F. (2014). Urinary tract infection in Uruguayan children: Aetiology,
antimicrobial resistance and uropathogenic Escherichia coli virulotyping. Journal of
global antimicrobial resistance, 2(4), 293-298.
MT Hecker, C. F. (2014). Effect of a stewardship intervention on adherence to uncomplicated
cystitis and pyelonephritis guidelines in an emergency department setting. PloS one, 9(2),
e87899.
R Colgan, M. W. (2011). Diagnosis and treatment of acute pyelonephritis in women. American
family, 84(5), 519.
R Colgan, M. W. (2011). Diagnosis and treatment of acute uncomplicated cystitis. American
family physician, 84(7), 771.
R Vollmann, G. S. (2011). Clinical significance of periportal tracking as an extrarenal
manifestation of acute pyelonephritis. Abdominal, 36(5), 557-560.

ACUTE PYLONEPHRITIS 13
SH Kim, Y. K. (2012). Serious acute pyelonephritis: a predictive score for evaluation of
deterioration of treatment based on clinical and radiologic findings using CT. Acta
Radiologica, 53(2), 233-238.
YJ Lee, S. C. (2014). Unilateral and bilateral acute pyelonephritis: differences in clinical
presentation, progress and outcome. Postgraduate medical journal, 90(1060), 80-85.