8.8 Pyelonephritis
Pyelonephritis refers to a bacterial infection that typically starts as a urinary tract infection (UTI) that progresses up the ureters to the kidneys.
Pathophysiology and Risk Factors
After the bacteria reach the kidneys, they multiply and cause inflammation, often causing classic symptoms of lower back/flank pain and systemic infection. See Figure 8.14[1] for an illustration of a client experiencing flank pain. The inflammatory response within the renal pelvis causes tissue damage and increased permeability of the blood vessels.
Risk factors for developing pyelonephritis include urinary tract obstructions like kidney stones, repeated urinary tract infections, diabetes, pregnancy, and conditions that weaken the immune system. If an infection is not properly treated, the bacteria will continue to multiply, resulting in a sustained infection, kidney abscess, sepsis, or chronic kidney damage.[2]
Assessment
Pyelonephritis is a bacterial kidney infection, resulting in inflammation of the functional parts of the kidney, including the renal cortex (the outermost part of the kidney) and the renal medulla. It is caused by the ascent of bacteria through the urinary tract, thus replicating signs and symptoms of urinary tract infections but leading to severe complications if left untreated. See Table 8.8 for clinical manifestations of pyelonephritis.
Table 8.8. Signs and Symptoms of Pyelonephritis[3],[4]
| Body System | Common Signs and Symptoms in Pyelonephritis |
|---|---|
| General | High-grade fever, chills, general malaise, and fatigue |
| Urinary | Flank/low back pain, dysuria, frequency, urgency, hematuria (blood in urine), and costovertebral angle tenderness (tenderness to palpation over the kidneys) |
| Gastrointestinal | Nausea and vomiting |
| Cardiovascular | Blood pressure fluctuations and tachycardia due to systemic infection |
| Neurological | Confusion (in severe cases with sepsis) |
| Respiratory | Elevated respiratory rate (in severe cases with sepsis) |
Diagnostic Testing
Diagnostic testing for pyelonephritis involves various methods to diagnose and assess the extent of the infection. To diagnose pyelonephritis, providers typically order a urinalysis and urine culture to initially assess for infection. Additional laboratory blood tests may be performed such as a complete blood cell count (to assess white blood cell count), creatinine and BUN levels to assess kidney function, and C-reactive protein (to assess for inflammation). Blood cultures may be performed to assess for systemic infection that can lead to sepsis. Review normal reference ranges for common diagnostic tests in “Appendix A – Normal Reference Ranges.”
Imaging studies may also be ordered to examine the size of the kidneys, any structural abnormalities, and the extent of the infection. Occasionally, nuclear medicine imaging may be ordered to help detect areas of reduced function or scarring.[5]
Nursing Diagnoses
Nursing diagnoses for clients with pyelonephrit