Understanding the Pathogenesis of Urinary Tract Infection and Sepsis

Running head: HEALTH VARIATION
HEALTH VARIATION
Name of the Student:
Name of the University:
Author note:

HEALTH VARIATION1
Mr Kirkman was a 75 years old man, who was admitted to an emergency department
associated with the complain of burning sensation while urinating and lower abdominal pain
radiating into his right flank. He was diagnosed with urinary tract infection (UTI). There are
three routes leading to urinary tract infection namely ascending route, haematogenous route
and lymphatic route. The pathogens colonizes in the periuretheral region and rises from the
urethra towards the urinary bladder (Rossaint & Zarbock, 2015). The pathogenic bacteria
reaches the epithelial cells, as fimbria allows the attachment of pathogenic bacteria to the
epithelial cells and hence, these bacteria replicate and form biofilms. These active replication
of pathogens causes irritation in urinary tract infection and the person suffering from this
condition often feels the urge to urinate frequently and while urinating they suffer the burning
sensation (Gotts & Matthay, 2016). Due to pathogen replication, acute inflammation takes
place in urinary bladder that result in distress upon narrowing during urinating resulting in
dysuria. The capacity of urinary bladder is reduced because of inflammatory edema causing
declined pain and compliance because of bladder distension. The primary pathogenesis
resulting in edema formation that further result in pain involves the colonization of bacteria in
the ureter affecting the kidney. Fimbria is responsible for the ascending process of pathogen
towards the kidney thereby affecting the renal parenchyma and causing an inflammatory
reaction known as pyelonephritis. This inflammatory cascade continues leading to tubular
damage and obstruction that results in interstitial edema (McKibben et al., 2015). Hence, the
clinical symptom of burning sensation and pain in the patient suffering with urinary tract
infection is due to the invading bacterial pathogen and formation of interstitial edema.
From the clinical symptoms of Mr Kirkman, it was also evident that his condition was
deteriorating as his heart rate was very high from the normal range. The heart rate for a
healthy person lies between the range of 60 to 100 bpm, but in case of Kirkman, his heart rate
was 135bpm. As the pathogen had invaded the renal parenchyma resulting in inflammatory

HEALTH VARIATION2
response that leads to pyelonephritis (Wright, 2018). In case of late diagnosis of
pyelonephritis, it result in urosepsis, where the urinary tract infection (UTI) spreads or radiate
from urinary tract to the blood stream thereby leading to systematic infection, which
circulates in the body through bloodstream. The condition of sepsis results in lowering of
blood pressure, decreased urine output, difficulty in breathing and amplified heart rate that
eventually results in high heartbeat. Thus the patient was suffering from urinary tract
infection associated with sepsis that resulted in his high heartbeat condition. It was identified
from his clinical symptoms that he was suffering from hypotension as his blood pressure was
very low. The normal blood pressure ranges between 120/80 mm HG and in case of Kirkman,
his blood pressure was 80/42 mm HG, which is considered as very low (John, Mboto &
Agbo, 2016). When the inflammatory pyelonephritis leads to tubular damage and obstruction
it results in interstitial edema that further leads to interstitial nephritis. This chronic condition
will increase the risk of fatal bacterial pathogen to move from the infected kidney to the
blood that can be life threatening and thus result in urosepsis. The condition of urosepsis
results in septic shock, where various systemic reaction takes place and activates the release
of cytokines by the immune system to fight against the bacterial infection. The cytokines
released results in dilation of blood vessels thereby allowing more amount if blood to pass
through the infected area (Polat et al., 2017). Thus this dilated blood vessels in sepsis results
in the drop of blood pressure from the average range and thus result in extremely low blood
pressure affecting the overall body’s function.
The person suffering from urinary tract infection associated with severe sepsis often
have high heart rate and respiratory rate due to the condition of tachypnea, which is a major
clinical symptom of UTI and sever sepsis. In sepsis, the body’s immunity system to fight
against the invading pathogen decreases and thus the rate of blood flow slows down making
the immune system of the patient less effective (Vincent, Mira & Antonelli, 2016). Hence,