Complications of Pyelonephritis: Pathophysiology, Treatment, and Pharmacology

This essay discusses the complications of pyelonephritis, including sepsis, septic shock, and shock. It elaborates on the pathophysiology of acute and chronic pyelonephritis, and the links between them. It also describes an individualized treatment plan using the ABCDE assessment process and pharmacology.

Essay

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
CONCLUSION................................................................................................................................3
REFERENCES ...............................................................................................................................5

INTRODUCTION
Pyelonephritis is sudden and very severe kidney infection illness. It occur due to the renal
infection caused by the gram negative bacteria. Due to this infection kidneys of human being
become swell and may be damage permanently. This disease can be life threatening to the human
being. Pyelonephritis disease may occur in the form of acute or chronic. When persistent or
repeated attacks occur then this condition is known as chronic pyelonephritis. However, chronic
form of pyelonephritis is rarely seen, but it occurs more frequently in children or human beings
with obstructions in urinary (Abi Tayeh and et. al., 2021). Symptoms generally occur within the
two days of this infection. Some of the common symptoms are burning and painful urine, a very
high fever having temp more than 102 degree Fahrenheit or 38.9 degree Celsius, blood or pus in
urine, fishy smell in urine and many more symptoms also associated with urine. In this report,
some of the normal or severe complication which occur due to this disease are go to discuss. This
essay will evaluate the complication which are related to the named sufferer following a
pyelonephritis diagnosis. This piece of essay will elaborating the pathophysiology of sepsis,
septic shock and shock as well as acute pyelonephritis and chronic pyelonephritis separately
prior to the discussion of what is the links associated among all three together (Campanario-
Pérez and et. al., 2018). This paper work will then describe the way of treatment that how the
patient should treat by utilising an individualised way in the way of an assessment process like
ABCDE. Through the ABCDE assessment health worker will concentrates on airways,
breathing, circulation, disability and exposure and and the ways these can be utilised to bring
about sufferer centred treatment and care. In the next aspect of Finally, this segment of essay
will this essay will concentrate on the pharmacology and the various kinds of medication which
can be utilised to the treatment of the conditions present.plan out some ongoing treatment and
care plan particularly tailored for the individual requirements of sufferer. In all sections of the
treatment the consent of patient was looked for and all the sections of treatment are proof based
based practice (CONDE and et. al., 2019).
MAIN BODY
Pyelonephritis is a kind of the urinary tract, kidney and renal pelvis infection where
single or both of the kidneys of human beings become infected either by bacteria or virus. This
disease generally occur when the bacteria is not clear away of the body with urination. This
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infection is a effective life threatening infection which can cause in scarring of the renal system
of human being. There are two types of pyelonephritis, one is acute pyelonephritis which is more
common and frequently occur in human being or children and another one is chronic
pyelonephritis, which rarely occur in the human beings and children. Acute pyelonephritis is also
divided into two types such as primary acute pyelonephritis and secondary acute pyelonephritis.
In primary acute pyelonephritis, some of the complication occur such as in this disease human
beings get inflammation in the renal parenchyma and bacteria and virus also infect one or both
kidney of human beings (Gorsane and et. al., 2018). This is an uncomplicated form of this illness
that is too commonly happens in the female as a outcome of the infection of urinary tract. This
kind of pyelonephritis in 90 percent cases occurs due to the a common bacteria known as
Escherichia coli. Due to this kind of acute pyelonephritis some of the complication occurs in the
human body. Such as person feel loin or low back pain, high fever, localized flank, sweats and
rigours, but also with a nausea, vomiting, headache, renal swelling and general malaise (Grette
and et. al., 2020).
In addition to this lower urinary tract infection symptoms may be reflect and the
noticeable illness can evolve quickly over one or few days. Secondary acute Pyelonephritis
generally happens in the women with some abnormalities in the urinary tract, children, pregnant
females and men and this kind of pyelonephritis is generally recognised as more harmful or
serious condition than the primary acute pyelonephritis. In this kind of pyelonephritis,
predisposing elements can involved immunosuppressive therapy and catheterization of the
bladder following mega-ureter, kidney transplantation, neurogenic bladder, polycystic kidney
disease, certain kidney illness and diabetes mellitus. In the presentation both of the acute
pyelonephritis that is primary or secondary infection resembles, in general Escherichia coli is the
most common or frequently encountered pathogen for this infection but other gram positive
organism and gram negative bacilli bacteria also may be involved in this infection (Jacob and et.
al., 2022). Acute pyelonephritis may have various complication such as formation of perinephric
or renal abscess, renal vein thrombosis, sepsis, papillary necrosis, and acute kidney failure, with
one of the more potent issues being emphysematous pyelonephritis. A probable complication or
issues of acute pyelonephritis is the long term kidney illness also known as chronic kidney
diseases. If the acute infection is continues for the long time, the kidneys of human being may be
permanently damaged or obstructed. However, some time it may also be possible to the infection
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that it can enter the bloodstream of human being. Due to this, these disease can cause a
potentially deadly infection which is known as sepsis (Kolman, 2019).
Some of the other complication associated with the acute pyelonephritis are acute kidney
failure, the infection spreading to the are surrounding the kidneys, recurring kidney infections
and kidney abscess. Pathophysiology of pyelonephritis is described as the Escherichia coli is one
of the most general bacteria which causing acute and chronic pyelonephritis because of its
specific capability to colonize and adhere to the kidneys and urinary tract. Escherichia coli has
some adhesive molecules and structure known as p-fimbriae that interact along with the receptors
present on the uroepithelial cells surface. Kidneys of human beings infected with Escherichia
coli which can direct to a response as acute inflammatory response that can results scarring of the
parenchymal tissue of kidney. However, the mechanism in which scarring of the kidney or renal
pelvis occurs is still very poorly acknowledged, this has been thought that the adhesion process
of bacteria to the cells of kidney obstructs the barriers which is protective, which can direct for
hypoxia, ischaemia, localized infection, and clotting in an try to contain thee infection. Bacterial
toxin and inflammatory cytokines and other reactive procedures further direct to complete
pyelonephritis and in large number of cases systemic symptoms of shock and sepsis. Due to
theses disease, some of the putrid abscess and necrosis formation in the renal parenchyma occurs
in human beings. Due to this the the renal tissue of the urinary system are infiltrated with plasma
cells, macrophages, and neutrophils (Laberge and et. al., 2018).
The diagnosis of the acute pyelonephritis should be acute pyelonephritis and chronic
pyelonephritis should be suspected in accordance with the clinical examination and the history. It
the human urine dipstick is negative to the leukocytes esterase enzyme or nitrates, it does not
keep out the diagnosis, but it should give rise to a re-evaluation of the clinical consideration and
features of other effective diagnoses. Some of the antibiotics which are specifically effective in
the lower urinary tract infections are generally not adequate in acute pyelonephritis. Therefore,
some prolonged therapy is essential to this situation. The pharmacology will concentrate on the
approaches through which health worker can treat sepsis, pyelonephritis and shock by utilising
the medication. In the pharmacology, medication doses as well as contradiction and side effects
of the particular medication (Maanaoui and et. al., 2021). As per the Tait et al. (2016), they
describes shock like a very life threatening form of failure of acute circulatory related to the less
amount of oxygen utilisation by the cells of human body. This is a condition or state in which the
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fluid circulation of human body is not be able to deliver the appropriate amount of oxygen to
fulfil the requirements of the tissues that causes some dysfunction to the cellular activity. There
are 4 stages of shock which are following, the compensatory stage, the initial stage, the refractive
stage and the progressive stage. As per the perspective of Tait et al. (2016), the initial stage is
described as when the body is capable to accommodate and compensate the clinical cause and
triggers (Pais and et. al., 2022).
At this stage, this is not frequently clinically apparent and the shock is reversible with the
intervention and treatment. The compensatory stage is described as when the psychological
systems of the body are provoked or triggered once the main cause of shock remains active.
These clinical characteristics involved an enhancement in the pulse a decrement in the blood
pressure and increment in the respirations process. Tait et al. (2016) describes that it is a flight or
fight response which starts cascade process in the physiological responses as an endeavour to
fulfil to the loss of homeostasis. The compensatory stage of shock is reversible together with
sufficient assessment and interventions. The third or progressive stage of the shock is describe as
when the fundamental impact or cause continue and physiologically the human body has utilised
all the compensatory procedures present in a try to manage homeostasis but has not success to
fulfil or compensate. Because of this failure to maintain homeostasis can results in hypoxia and
tissue ischaemia. Progressive stage of shock is reversible in the early stages of its with an
relevant management and assessment. Refractive stage the last and final stage of the shock. This
stage of refractive shock is irreversible as the human body physiologically has been not be able
to compensate, which then directs to multiple organ dysfunction system, cell death and tissue
death. Sepsis is described as a response of systemic inflammatory response to identified infection
(Vernuccio and et. al., 2020).
An severe infection occurs in the human body when the human body has been exposed
for the organism which is pathogenic and which damaged and invade the tissues and cells of the
human body. The immune system of the human body identifies these harmful infectious agent
and offers defence against the attack through attacking and containing the invader. This type of
responses is known as the inflammatory response. As per the statement of Peate (2018) this
evidence of the widespread inflammatory responses syndrome that SIRS indicators. Systemic
inflammatory response syndrome is identified as the presence of two or more than two of the
following that is a temperature above 38 degree Celsius and below 36 degree Celsius, a pulse
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more than 90 beats per minutes, a pace of respiration is more than 20 breaths per minutes or a
blood gas reflecting a partial pressure of Carbon dioxide of less than 32 mm of Hg. In the human
body, When the responses occurs locally this can be managed and contained and direct to the
recovery process, sometimes with the support of antibiotics. Although, in particular cases the
situation can progress from bacterial infection for sepsis and in some of the cases very severe
sepsis – the responses of the body for very severe infection (Yagihashi and et. al., 2018).
As per the Tait et al. (2016), sepsis affects human beings of all the age groups, all the
health care premises as for example: hospital setting, community settings and human beings from
a full ranges of the life styles to healthy human being from an unhealthy human being. However
sepsis does not bias or discriminate, there are a set of human beings who are at very higher risk
of evolving sepsis, these involve; the too old and very young human being with their co-
morbidities, human being with invasive interventions as for the example Intravenous catheters or
urinary catheters. Septic shock is described as a type of shock which occurs as a outcome of
widespread infection of bacteria. This form of septic shock is generally related to the release of
gram positive bacteria and gram negative bacteria into the blood stream of human beings
circulatory system. This is a condition which is also known as bacteraemia in which the release
of toxin by the pathogens into the blood stream causes in hypotension due to the massive
vasodilation. According to the Portsmouth hospitals NHS trust 2016, states that these septic
shock is sepsis sub- set in which the basic cellular and circulatory metabolic abnormalities are
profound too enough for enhance mortality rate.
Pyelonephritis is described by grant and Waugh (2014) as an acute infection of bacteria of the
calyces and pelvis, that prevalence to the renal substances resulting small abscesses. Gram
negative and gram positive bacteria generally reach to the renal system of human being by
travelling up to the urinary tract of the human being from the perineum layer but are sometimes it
is blood borne. Viral and bacterial infection the tissue of kidney causes destruction and
suppration of the nephrons. The prevalence of the diseases depends on the amount of healthy
renal tissue remaining after subsides of infections. Necrotic tissue is finally changed by some of
the fibrous tissue but there may be occurrence of some hypertrophy of the healthy nephrons. As
per the Grant and Waugh 2014, the results are healing, fresh occur, specially if there is some
structurally abnormalities of the tract of urinary system of the human being and nephropathy
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reflux which is also known as chronic pyelonephritis. Papillary necrosis is a very rare issues ,
generally occurring if the condition is not treated well (Вафоева, 2020) .
CONCLUSION
As per the above discussion, it has been concluded that Pyelonephritis is very sudden and
too severe kidney infection illness. It occur due to the renal infection caused by the gram
negative bacteria. In this essay some of the complication of pyelonephritis has been discussed
which are sepsis and septic shock. Finally some the assessment and caring plan of the
complication also has been discussed in this essay.
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REFERENCES
Books and Journals
Abi Tayeh, G., Safa, A., Sarkis, J., Alkassis, M., Khalil, N., Nemr, E. and El Helou, E., 2022.
Determinants of pyelonephritis onset in patients with obstructive urolithiasis. Urologia
Journal, 89(1), pp.100-103.
Addae-Konadu, K., Wein, L.E., Federspiel, J.J., Hughes, B. and Dotters-Katz, S., 2021.
Postpartum pyelonephritis and risk of severe maternal morbidity. American Journal of
Perinatology, (AAM).
Campanario-Pérez, R., Sáiz-Marenco, R., Amores-Bermúdez, J., Arroyo-Maestre, J.M.,
Quintero-Gómez, V., Ruíz-Rosety, E., Fuentes-Curtido, M., De Paz-Suárez, M. and Juárez-
Soto, Á., 2018. Laparoscopic nephrectomy for the management of xanthogranulomatous
pyelonephritis: still a challenging procedure. Journal of Endourology, 32(9), pp.859-864.
CONDE, M.C., Chamorro, E.M., Nacenta, S.B., Pérez, C.C., Prieto, J.G., Sanchez, J.A.,
FERNANDEZ-SILGADO, I.N. and GALARRAGA, G.G., 2019, January. Imaging
spectrum of bacterial pyelonephritis in adults and its complications. European Congress of
Radiology-ECR 2019.
Gorsane, I., Barrah, S., Barbouch, S., Kaaroud, H. and Harzallah, A., 2018. Management of acute
pyelonephritis. La Tunisie Medicale, 96(1), pp.42-47.
Grette, K., Cassity, S., Holliday, N. and Rimawi, B.H., 2020. Acute pyelonephritis during
pregnancy: a systematic review of the aetiology, timing, and reported adverse perinatal
risks during pregnancy. Journal of Obstetrics and Gynaecology, 40(6), pp.739-748.
Jacob, A., Sahni, R.D., Bharathy, M., George, T., Rebekah, G. and Sudarsanam, T.D., 2022.
Clinical features, outcomes and predictors of drug resistance and complications in patients
admitted with pyelonephritis. Tropical Doctor, p.00494755221125627.
Kolman, K.B., 2019. Cystitis and pyelonephritis: diagnosis, treatment, and prevention. Primary
Care: Clinics in Office Practice, 46(2), pp.191-202.
Laberge, M., Kulkarni, G.S. and Sreeharsha, B., 2018. Pyeloduodenal fistula complicating
xanthogranulomatous pyelonephritis. International Urology and Nephrology, 50(6),
pp.1071-1073.
Maanaoui, M., Baes, D., Hamroun, A., Khedjat, K., Vuotto, F., Faure, E., Lopez, B., Bouyé, S.,
Caes, T., Lionet, A. and Lebas, C., 2021. Association between acute graft pyelonephritis
and kidney graft survival: A single center observational study.‐ American Journal of
Transplantation, 21(11), pp.3640-3648.
Pais, J.S., Rocha, M.B., Muglia, V.F., Chahud, F., Molina, C.A.F., Ruellas, H.R. and Tucci, S.J.,
2022. Xanthogranulomatous pyelonephritis: Case series–Clinical, radiologic, therapeutic,
and histological aspects. Urology Annals.
Vernuccio, F., Patti, D., Cannella, R., Salvaggio, G. and Midiri, M., 2020. CT imaging of acute
and chronic pyelonephritis: A practical guide for emergency radiologists. Emergency
Radiology, 27(5), pp.561-567.
Yagihashi, Y., Shimabukuro, S., Toyosato, T. and Arakaki, Y., 2018. Can excretory phase
computed tomography predict bacteremia in obstructive calculous
pyelonephritis?. International Urology and Nephrology, 50(12), pp.2123-2129.
Вафоева, Н.А., 2020. FEATURES OF THE CLINICAL PICTURE OF CHRONIC
PYELONEPHRITIS IN WOMAN. Вестник науки и образования, (18-2), pp.92-94.
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