Pathophysiology
E. coli is the most common bacteria that cause pyelonephritis. This bacterial infection causes inflammation of the kidneys due to its ability to its adherence and colonization of both the urinary tract and kidneys. This disease of the urinary tract spreads from the urinary bladder to kidneys and down to their collecting systems. The renal scarring that occurs results from the release of bacterial toxins and inflammatory cytokines as well as other reactive processes that cause complete pyelonephritis (Choong, Antypas & Richter-Dahlfors, 2015). Some of the symptoms include nausea, fever, burning sensation during urination, plank pain and increased frequency and urgency of urination.
Epidemiology
In America, the prevalence rate of pyelonephritis is approximately fifteen cases for every 10,000 females and approximately three cases for every 10,000 males on an annual basis. Young women who are sexually active are the people most prone to be affected by pyelonephritis. Both the elderly and infant groups are also at risk for developing this disease due to the hormonal changes and anatomy abnormalities that they get. 20% to 30% of pregnant women are also at risk of developing pyelonephritis, most often during the second and initial stages of their third trimesters (Belyayeva & Jeong, 2018). There is no racial predisposition with pyelonephritis.
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Physical Exam Findings
The General appearance of individual patients during physical examination procedures is most often variable. Some patients appear ill, weak and uncomfortable. Others, on the other hand, appear quite healthy and strong. Patients that appear flashed have high fevers that need to be stabilized. Abdominal examinations always show tenderness in the regions of the affected. The tenderness may range from mild to moderate.
Differential Diagnoses and Rationale
When diagnosing pyelonephritis, it is important to keep in mind the differential broadness of the symptoms that accompany this disease. It is critical for physical examiners like doctors to consider other disorders that may be the cause of the symptoms presented by the patients. Due to the variability of the symptoms like radiating, bilateral, unilateral dull or sharp pain, it could be an indicator of pyelonephritis progressing to sepsis and shock and hence, the need for appropriate emergency responses (Hooton & Gupta, 2018). Some of the conditions that are closely related to pyelonephritis are appendicitis, Urinary tract obstruction, abdominal abscess, cholecystitis, pelvic inflammatory disease, nephrolithiasis, ectopic pregnancy, and pancreatitis.
Management Plan
Management of pyelonephritis is either through inpatient or outpatient care. Individuals who appear healthy and strong are given outpatient care while those who appear very weak and sick are treated through inpatient care. Some of the medicines that are given to patients with pyelonephritis are antibiotics, antipyretics, and analgesics. For the outpatient care, patients are required to visit the hospital after one or two days depending on their doctor’s orders. This way, proper follow up can be done and good care provided. Non-steroidal anti-inflammatory drugs are also used to treat the fever and pain associated with pyelonephritis (Goonewardene, Pietrzak & Albala, 2019). Most often, in the event of the severity of pyelonephritis, patients are referred to urologists, obstetricians, and gynecologists as well as infectious disease specialists to have the disease analyzed further.
References
Belyayeva, M., & Jeong, J. M. (2018). Pyelonephritis, Acute. In StatPearls [Internet]. StatPearls Publishing.
Choong, F. X., Antypas, H., & Richter-Dahlfors, A. (2015). Integrated Pathophysiology of Pyelonephritis. Microbiology spectrum, 3(5).
Goonewardene, S. S., Pietrzak, P., & Albala, D. (2019). Management Pathway for Pyelonephritis. In Basic Urological Management (pp. 111-111). Springer, Cham.
Hooton, T. M., & Gupta, K. (2018). Acute complicated urinary tract infection (including pyelonephritis) in adults. In UpToDate. Waltham, Mass.: UpToDate.
