Pyelonephritis

Bacteria first enters the urinary system through the urethra, which causes signs of a urinary tract infection (UTI). Sometimes an individual may appear asymptomatic, delaying them from seeking medical attention. Sometimes prescriped antibiotics fail to treat the infection, because of the sensitivity to the bacterium. Subsequently causing an upward spread to the kidneys. This leads to progression of the infection involving the kidneys, making it a more difficult infection to treat. Sepsis can result if proper treatment is not administered. Sepsis is a more severe infection, that systematically affects the body. This may cause high fevers, hypotension, and ultimately organ failures.This is a bacterial infection of the kidneys. It can affect one or both of them. It is a very serious infection that requires urgent medical attention. Escherichia coli. is usually the causative agent for most of the infections.

Bacteria first enters the urinary system through the urethra, which causes signs of a urinary tract infection (UTI). Sometimes an individual may appear asymptomatic, delaying them from seeking medical attention. Sometimes prescriped antibiotics fail to treat the infection, because of the sensitivity to the bacterium. Subsequently causing an upward spread to the kidneys. This leads to progression of the infection involving the kidneys, making it a more difficult infection to treat. Sepsis can result if proper treatment is not administered. Sepsis is a more severe infection, that systematically affects the body. This may cause high fevers, hypotension, and ultimately organ failures.

Signs and Symptoms

Signs and symptoms of acute pyelonephritis usually develop rapidly over a few hours to days. Elevated temperature, pain on urination, abdominal and flank (back) pain with nausea and vomiting.

Tenderness in the flank area, with foul or malodorous urine, decrease appetite, and malaise. Burning on urination, blood in the urine. The individual may be hypotensive and tachycardic if the infection is severe.

Causes

E coli. is a common causative agent. In most cases, the infection presents as lower urinary tract infection, such as cystitis or prostatitis. Vesicoureteral reflux ( back flow of urine from the bladder into the ureters). Kidney stones, causing obstructions, urinary catheterization, ureteral stents or any surgical procedures in the urinary tract. Pregnancy, diabetes or any other immunocompromised state. Poor hygene after sexual intercourse, and the use of spermicide. Close family members with frequent urinary tract infections.

Making The Diagnosis

A simple urinalysis may reveal signs of a UTI. Precisley, the presence of nitrites, and white blood cells. Blood tests such as a complete blood count (CBC) may reveal leukocytosis (elevated white blood cells). Urine culture is also done. If it is suspected that a kidney stone is the cause, a KUB Xray or CT scan maybe done. Ultrasound findings may reveal an enlarged kidney, or swelling of the ureters.

Emergency Management

Antibiotic treatment needs to be started immediately, because a urine culture for sensitivity takes 24 hrs to identify specific bacteria. The antibiotics of choice are usually Floroquinolones like cephalosporins and bactrim. Once the urine culture has resulted, it will identify if there are any sensitivity to any particular bacterium. The healthcare provider can adjust the antibiotics as needed. To begin treatment in the emergency room (ER), the patient may be started on a third generation cephalosporin such as ceftriaxone IV. Patients are usually admitted for at least 24 hrous for IV antibiotic therapy. If they have stable vital signs with the absence of fever, and good pain control, they maybe dischared home with prescription. If the patient has a high fever and leukocytosis, hospitalization is necessary. These patients have to be kept well hydrated with intravenous fluids such as normal saline or lactated ringers solution to remain hydrated. If you are discharge home from the (ER) with a diagnosis of aucte pyelonephritis. Ensure you complete all prescribed antibiotics, and follow the directions of your healthcare provider. Return to the ER if symptoms persist.