aka Kidney Infection (pyelonephritis),

glomerulonephritis,

Definition:

Pyelonephritis = a specific type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels up into your kidneys.

Glomerulonephritis = a type of kidney disease that damages your kidney’s ability to remove waste and excess fluids

Etiology and PathophysiologyAffects the renal pelvis and parenchymaInfection develops in scattered areas and

spreads from renal pelvis to cortexKidney becomes edematousAbscesses may develop Tissue destruction primarily affects the

tubulesScar tissue replaces normal tissue and

affected tubules atrophy

E-coli is the most common causeProteus and Klebsiella bacteria are less

commonAcute form: usually caused by bacterial

infectionChronic form: associated with nonbacterial

infections such as metabolic, chemical, or immunologic disorders.

Vesicoureteral reflux

Symptoms of Kidney InfectionFeverBack, flank, or groin painAbdominal painFrequency in urinationStrong urge to urinateBurning or pain on urinationPus or blood in the urine

Causes of Kidney InfectionTypically occurs when bacteria enters the

urinary tract through the urethraBacteria from infection elsewhere in the body

can spread through the bloodstream and infect the kidneys.

Rarely, after kidney surgery

Risk FactorsFemale anatomyPoor hygieneObstruction in the urinary tractWeakened immune systemDamage to nerves around the bladderProlonged use of a urinary catheterUrine flowing the wrong wayCongenital malformationsDiabetes mellitus

Complications of Kidney InfectionPermanent kidney damageSepticemiaPregnancy complications

Tests and TreamentsUrine studies: urinalysis and urine culture;

24-hour urine collection, clean catch urine specimen or urinary catheterization (creatinine clearance, or protein)

Ultrasonography: size, shape and positionBlood studies: BUN, Serum creatinine

clearance

Treatment MEDICATIONS

Antimicrobials – Sulfonamides (Bactrim; Septra)

Antispasmodics – Phenazopyridine (Pyridium)Urine color is reddish-orangeStains clothing

Analgesics – Acetaminophen, Ibuprofen

**lots of choices, these are examples of each

Non-Pharmacologic therapiesApply heat

If a heating pad is used, it should only be set on low and used for 30-45 minutes and then removed for 1 hour. (the rebound phenomenon kicks in if used for a longer period of time).

Hydration – helps flush bacteria from the body (no caffeine, citrus or alcohol until the infection has cleared (these products promote urgency and frequency)

PreventionDrink plenty of fluids, especially waterUrinate frequentlyEmpty the bladder after intercourseAvoid feminine products in the genital areaUse proper hygiene

GlomerulonephritisA type of kidney disease that damages the

kidneys’ ability to remove waste and excess fluids

PrimarySecondary

Signs and SymptomsCola-colored or ice-tea-colored urineFoamy urineHigh blood pressureFluid retention (edema)FatigueLess frequent urination than usual

CausesFrequently unknown

Infections:Post-streptococcal glomerulonephritisBacterial endocarditisViral infections

Immune DiseasesLupusGoodpasture’s syndromeIgA nephropathy

VasculitisPolyarteritisWegener’s granulomatosis

Conditions that cause scarring of the glomeruliHTNDiabetic kidney diseaseFocal segmental glomerulosclerosis

ComplicationsAcute Kidney FailureChronic Kidney FailureHigh Blood PressureNephrotic Syndrome

Tests and DiagnosisBlood tests = creatinine, BUNUrinalysis Kidney BiopsyImaging tests

IVP (kidney x-ray)CT Scan(computerized tomography scan)

Treatment and DrugsTreatment is dependent on:

Whether you have an acute or chronic form of the disease.

The underlying causeThe type and severity of your signs and

symptoms

To control HTN and slow the decline of kidney function:DiureticsAngiotensin-converting enzyme (ACE)

inhibitorsAngiotensin II receptor agonists

Treatment of Underlying Causes

R/T bacterial infections = appropriate antibiotic

R/T Lupus or Vasculitis = corticosteroids and immune-suppressing drugs

R/T IgA nephropathy = fish oil supplements are under study

Goodpasture’s syndrome = Plasmapheresis

Patient EducationSeek prompt treatment of a strep infection

causing a sore throat or impetigoTo prevent infections such as HIV and

hepatitis, use safe sex practices and avoid IV drug use

Control blood sugar to help prevent diabetic nephropathy

Control your blood pressure