W#8 Patho reply posts.

POST #2 SYDNEY

Pyelonephritis Pyelonephritis is a bacterial infection that occurs in the kidney and renal pelvis (Belyayeva & Jeong, 2020). Pyelonephritis typically occurs from a urinary tract infection that spreads to the kidney. The kidney pelvis becomes filled with purulent exudate, which inflames the medullary tissue. Many times, E. coli is the bacteria that causes pyelonephritis because it has the ability to cling to the urinary tract and colonize (2020). One or both kidneys may be involved in infection. Once the infection from the E. Coli enters the kidney, the purulent exudate starts to form in the renal pelvis.  According to Hubert & Vanmeter (2018), the exudate can create abscesses and necrosis in the medulla of the kidney. It may also reach the cortex and surface of the capsule of the kidney. When the infection is at its worst, the exudate can block the urine flow to the ureter because it compresses on the renal veins and arteries (2018). While pyelonephritis is typically acute, it can be a chronic issue for some patients. Chronic pyelonephritis can lead to loss of tubule function and hydronephrosis; a blockage in the ureter (2018). This can occur because of fibrous scar tissue forming due to chronic or reoccurring infection in the kidney (2018).  There are a few diagnostic tests that diagnose pyelonephritis. The first diagnostic test is a urinalysis that can show white blood cells and microscopic hematuria in the urine (Colgan et al, 2011). It is important for patients that may have pyelonephritis to have a urine culture to find bacteria that cause the infection in the urinary tract (2011). The bladder is a sterile organ; therefore, the presence of bacteria is not a normal finding. Another good diagnostic test to determine pyelonephritis is a CT scan of the kidney. The author states that this shows the structural abnormalities in the kidney. The provider can easily diagnose it and get a better understanding of what parts of the kidney are affected by the pyelonephritis.  When the patient has a diagnosis of pyelonephritis, they need to be started on antibiotics to decrease the infection in the kidney. Antibiotics slow down growth and kill bacteria that is causing the infection. The common antibiotics used to treat pyelonephritis are Bactrim, Keflex and Amoxicillin (Hubert & Vanmeter, 2018). The patient is also encouraged to drink plenty of water, because it can dilute the urine and increase elimination of the bacteria (Belyayeva & Jeong, 2020). The patient is encouraged to follow up in four to six weeks after the initial antibiotic treatment to ensure that the infection is out the urinary tract (2018). Patients may also be encouraged to drink cranberry juice because the tannin in the juice reduces the ability of E. Coli to stay in the mucosa of the bladder (2018).  The prognosis for pyelonephritis is typically good. Many patients heal with oral antibiotics (Belyayeva & Jeong, 2020). This is mostly an outpatient treatment as well. The authors state that there are still some cases of mortality and morbidity when the case of pyelonephritis is severe. There is an increase in mortality if the patient is an elder or already has renal issues because there is a better chance of complication from pyelonephritis to occur. If there is a prompt intervention and treatment is adequate, there are typically good outcomes for patients who have severe pyelonephritis.  In my practice as a WHNP, I feel that this could be an issue that could occur in my female patients. The most common group to get pyelonephritis are sexually active young adult women (2020). The author states that this is because women have a much shorter urethra than men, making it much easier for bacteria to enter the urinary tract. Pregnant women are also at risk for pyelonephritis, as around 20-30% are diagnosed with this during their second trimester (Belyayeva & Jeong, 2020). It is important for women to receive treatment for pyelonephritis as it can cause serious damage and possibly sepsis from the infection in the kidney (2020). Once the patient is diagnosed, my plan of care would include starting an antibiotic for the patients and making sure that they return for a follow up to be sure that the infection is gone. If the patient needs further treatment, I would refer the patient to a urologist who specializes in disorders of the kidney. This would allow for the patient to have the best outcome from pyelonephritis. References Belyayeva, M., & Jeong, J. M. (2020). Acute pyelonephritis. Retrieved from  https://www.ncbi.nlm.nih.gov/books/NBK519537/ Colgan, R., Williams, M., & Johnson, J. R. (2011). Diagnosis and treatment of acute pyelonephritis in women. Retrieved from  https://www.aafp.org/afp/2011/0901/p519.html Hubert, R. J. & VanMeter, K. C. (2018). Gould's pathophysiology for the health professions. St. Louis, MO: Elsevier Saunders.