Pathophysiology of UTI and Sepsis

Running head: NURSING
Nursing
Name of the University:
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Author’s note

1NURSING
UTI is a type of urinary infection occurring in the urinary system such as kidneys, ureters
and bladders that occurs because of interaction between uropathogen and the host. The
uropathogen attach to the epithelial surface, colonizes and ascend to the urinary bladed resulting
in symptomatic and symptomatic bacteria (Dreger et al., 2015). Once the bacterium has ascended
to the bladder, they increase in number and cause inflammation of the bladder. The bacteria
affects the epithelium cells and the bacteria replicates and produces biofilms. This replication of
pathogenic bacteria leads to urinary tract irritation and infection and also result in the impairment
of bladder emptying. Bladder outlet obstruction may lead to ascending of urine into the ureters
and lastly to the kidney leading to a condition called pyelonephritis. Pathogenesis of
pyelonephritis takes two steps (McLellan & Hunstad, 2016). First, the Bacteria attaches to the
epithelium activating an inflammatory response which involves toll-like receptor 4 (TLR4) and
glycosphingolipid (GSL) receptors. Second, the receptors release chemokine’s that causes
increased blood flow to the infected area and stimulation of nerves which causes right abdominal
pain, radiating into the right flank (Biroga, Bosner, & Becker, 2016). Abdominal pain affects the
diaphragm and the outer intercostal muscles making it not possible to move air in and out of the
lungs. This causes the activation of additional muscles known as the accessory muscles. In case
of the patient, Mr Kirkman, it was observed from his vital symptoms that he was suffering from
urinary tract infection associated with severe sepsis. The blood pressure was very low as
compared to the normal range. The pyelonephritis results in tubular injury and impediment,
which further results in the development of interstitial nephritis (Artero et al., 2016). The
development of interstitial nephritis increases the potential risk of pathogenic bacteria to escalate
from the kidney and affect the blood resulting in the condition of urosepsis. The development of
urosepsis condition leads to septic shock that disturbs the systemic reaction by releasing

2NURSING
cytokines to dilate the blood vessels, hence permitting extra blood to flow from the infected area.
The dilation of blood vessels (vasodilation) in this condition results in low blood pressure in the
patient as the renin-angiotensin system is altered.
The heart rate of the patient was very high as compared to the usual range due to
infection of pathogenic bacteria that invades the urinary bladder and results in high heart rate.
The individual who is suffering from urinary tract infection (UTI) associated with severe sepsis
exhibited the symptom of high heart rate and high respiratory rate (Gupta, Grigoryan & Trautner,
2017). Tachypnea is a condition that develops in the patient with UTI as the invading pathogen
reduces the body’s immune system or capability to fight, which in turn decreases the blood flow
rate thus making the immune system very weak and ineffective. The pathogenic bacteria
decreases the flow of pure oxygenated blood throughout the body that increases the body’s
demand to breathe as the oxygenated blood cannot reach the brain. Hence, the respiratory and
heart rate is more in case of the patient (Reinhart et al., 2017). The examination of full blood
count of patient shows normal value for haemoglobin, red cell count and platelet. However, the
WBC count has increase. The increase in WBC count for Mr. Kirkman in full blood count is also
explained by activation of the rennin angiotensin system due to inflammatory response during
sepsis. Systematic inflammatory response syndrome in patient with sepsis is manifested by high
heart rate, high WBC count and high respiratory rate (Bellomo et al., 2017)). For this reason,
WBC count and respiratory rate of Mr. Kirkman was high. The haemoglobin level and of patient
is within normal range.
Urosepsis is caused by pathogens like E. coli, Proteus spp and Enterobacter spp and this
result in bacterimia in patient. Mr. Kirkman also experienced burning sensation during urination
because of bacterial infection of the urinary tract. For this reason, urine testing is done for