47156227 Acute Pyelonephritis

8/20/2019 47156227 Acute Pyelonephritis

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UNIVERSITY OF LA SALETTE

COLLEGE OF NURSING

Santiago City

A CASE STUDY

IN

ACUTE PYELONEPHRITIS

PRESENTED BY:

GROUP C

Balot, Jr,, German M.

Bugarin, Rhadharani aula Mae N.

Buhat, Jann! "ie R.Camangeg #r., Jo$elito M.

Cam%ia, Charlene M.

Cano$a, Julie Ann U.

Can$ino, Rina Antonette .

Cairel, rin&e$$ C.

Cara%a&an, Arleen C.

Carlo$, Ama'ing Gra&e M.

Ca$a!uran, (aren I)! *.

"eal, Joenna Jo! I.

PRESENTED TO:

Mr. Je$+er Ba!aua, RN

Mr$. Mar! Jane Gon'ale$, RN

M$. There$a Bermu$a, RN

M$. ri$tine Gon'ale$, RN


2/22

TABLE OF CONTENTS

I. Introd!tion

A. Ca$e De$&ri+tion

II. D"#ogra$%i! Data

Nr&ing Hi&tory

A. re$ent ealth i$tor!B. a$t Medi&al i$tor!

C. -amil! i$tor!

D. attern o -un&tioning

a. h!$iologi&al ealth

%. So&io/&ultural ealth&. S+iritual ealth

Gordon'& Fn!tiona( Patt"rn

A. ealth er&e+tion

B. Nutrition atternC. Slee+ and Re$t

D. A&ti)it! and E0er&i$e

E. Elimination attern

-. Sel er&e+tionG. Cogniti)e and er&e+tion attern

. Role and Relation$hi+ attern

I. Se0ualit! atternJ. Co+ing o Stre$$ attern

(. *alue and Belie attern

III. Cor&" in t%" )ard

IV. P%y&i!a( A&&"&"nt

V. La*oratory R"&(t

VI. Anato#y and P%y&io(ogy

VII. Pat%o$%y&io(ogy

VIII. Nr&ing Car" P(an

I+. Drg Stdy

+. Di&!%arg" P(anning

+I. R","r"n!"


3/22

INTRODUCTION-ACUTE PYELONEPHRITIS

!elone+hriti$

D",inition

!elone+hriti$ i$ an ine&tion o the 1idne! and the ureter$, the du&t$ that &arr! urinea2a! rom the 1idne!.

A(t"rnati/" Na#"&

Urinar! tra&t ine&tion / &om+li&ated3 Ine&tion / 1idne!3 Com+li&ated urinar! tra&t

ine&tion3 (idne! ine&tion

Ca&"&

!elone+hriti$ mo$t oten o&&ur$ a$ a re$ult o urinar! tra&t ine&tion, +arti&ularl! 2henthere i$ o&&a$ional or +er$i$tent %a&1lo2 o urine rom the %ladder into the ureter$ or an area

&alled the 1idne! +el)i$. See4*e$i&oureteri& relu0

!elone+hriti$ &an %e $udden 5a&ute6 or long/term 5&hroni&6.

•

A&ute un&om+li&ated +!elone+hriti$ i$ the $udden de)elo+ment o 1idne! inlammation.• Chroni& +!elone+hriti$ i$ a long/$tanding ine&tion that doe$ not go a2a!.

!elone+hriti$ o&&ur$ mu&h le$$ oten than a %ladder ine&tion, although a hi$tor! o $u&h

an ine&tion in&rea$e$ !our ri$1. You7re al$o at in&rea$ed ri$1 or a 1idne! ine&tion i !ou ha)ean! o the ollo2ing &ondition$4

• Ba&1lo2 o urine into the ureter$ or 1idne! +el)i$

• (idne! $tone$

• 8$tru&ti)e uro+ath!

• Renal +a+illar! ne&ro$i$

You are al$o more li1el! to get a 1idne! ine&tion i !ou ha)e a hi$tor! o &hroni& or re&urrent urinar! tra&t ine&tion, e$+e&iall! i the ine&tion i$ &au$ed %! a +arti&ularl! aggre$$i)e

t!+e o %a&teria.

A&ute +!elone+hriti$ &an %e $e)ere in the elderl! and in +eo+le 2hoareimmuno$u++re$$ed 5or e0am+le, tho$e 2ith &an&er or AIDS6.

Sy#$to#&

• Ba&1 +ain or lan1 +ain

• Chill$ 2ith $ha1ing

• Se)ere a%dominal +ain 5o&&ur$ o&&a$ionall!6• -atigue

• -e)er

• igher than 9:; degree$ -ahrenheit

• er$i$t$ or more than ; da!$

• General ill eeling

• Chill$ 2ith $ha1ing

• Mental &hange$ or &onu$ion<

• S1in &hange$

-lu$hed or reddened $1in

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Moi$t $1in 5dia+hore$i$6

=arm $1in

Urination +ro%lem$

Blood in the urine

Cloud! or a%normal urine &olor

-oul or $trong urine odor

In&rea$ed urinar! re>uen&! or urgen&!

Need to urinate at night 5no&turia6

ainul urination

*omiting, nau$ea

< Mental &hange$ or &onu$ion ma! %e the onl! $ign$ o a urinar! tra&t ine&tion in the

elderl!.

E0a#& and T"&t&

A +h!$i&al e0am ma! $ho2 tenderne$$ 2hen the health &are +ro)ider +re$$e$ 5 +al+ate$6

the area o the 1idne!.

• Blood &ulture ma! $ho2 an ine&tion.• Urinal!$i$ &ommonl! re)eal$ 2hite or red %lood &ell$ in the urine.

• 8ther urine te$t$ ma! $ho2 %a&teria in the urine.

An intra)enou$ +!elogram 5I*6 or CT $&an o the a%domen ma! $ho2 $2ollen 1idne!$.

The$e te$t$ &an al$o hel+ rule out underl!ing di$order$.

Additional te$t$ and +ro&edure$ that ma! %e done in&lude4

• (idne! %io+$!

• (idne! $&an

• (idne! ultra$ound• *oiding &!$tourethrogram

Tr"at#"nt

The goal$ o treatment are to4

• Control the ine&tion

• Relie)e $!m+tom$

Due to the high death rate in the elderl! +o+ulation and the ri$1 o &om+li&ation$, +rom+ttreatment i$ re&ommended. Sudden 5a&ute6 $!m+tom$ u$uall! go a2a! 2ithin ?@ to ; hour$ater a++ro+riate treatment.

Your do&tor 2ill $ele&t the a++ro+riate anti%ioti&$ ater a urine &ulture identiie$ the %a&teria that i$ &au$ing the ine&tion. In a&ute &a$e$, !ou ma! re&ei)e a 9:/ to 9?/da! &our$e o

anti%ioti&$.

I !ou ha)e a $e)ere ine&tion or &annot ta1e anti%ioti&$ %! mouth, !ou ma! %e gi)en

anti%ioti&$ through a )ein 5intra)enou$l!6 at ir$t.

Chroni& +!elone+hriti$ ma! re>uire long/term anti%ioti& thera+!. It i$ )er! im+ortant that

!ou ini$h all the medi&ine.

Commonl! u$ed anti%ioti&$ in&lude the ollo2ing4

• Amo0i&illin

• Ce+halo$+orin

• "e)olo0a&in and &i+rolo0a&in

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5/22

• Sula drug$ $u&h a$ $uli$o0a'oletrimetho+rim

Ot(oo1 -Progno&i&

=ith treatment, mo$t 1idne! ine&tion$ get %etter 2ithout &om+li&ation$. o2e)er, thetreatment ma! need to %e aggre$$i)e or +rolonged.

regnant 2omen and +er$on$ 2ith dia%ete$ or $+inal +aral!$i$ $hould ha)e a urine &ultureater ini$hing anti%ioti& thera+! to ma1e $ure that the %a&teria are no longer +re$ent in the urine.

In rare &a$e$, +ermanent 1idne! damage &an re$ult 2hen4

• Chroni& 1idne! ine&tion$ o&&ur in a tran$+lanted 1idne!

• Man! 1idne! ine&tion$ o&&ur during inan&! or &hildhood

A&ute 1idne! in#ur! 5a&ute renal ailure6 ma! o&&ur i a $e)ere ine&tion lead$ to

$ignii&antl! lo2 %lood +re$$ure 5$ho&16. The elderl!, inant$, and +er$on$ 2ith a 2ea1ened

immune $!$tem ha)e an in&rea$ed ri$1 or de)elo+ing $ho&1 and a $e)ere %lood ine&tion

&alled$e+$i$. 8ten, $u&h +atient$ 2ill %e admitted to the ho$+ital or re>uent monitoring and I*anti%ioti&$, I* luid$, and other medi&ation$ a$ ne&e$$ar!.

Se)ere e+i$ode$ o a&ute 1idne! in#ur! ma! re$ult in +ermanent 1idne! damage and leadto &hroni& 1idne! di$ea$e.

Po&&i*(" Co#$(i!ation&

• A&ute 1idne! ailure

• (idne! ine&tion return$

• Ine&tion around the 1idne! 5+erine+hri& a%$&e$$6

• Se)ere %lood ine&tion 5$e+$i$6

)%"n to Conta!t a 2"di!a( Pro,"&&iona(

Call !our health &are +ro)ider i !ou ha)e $!m+tom$ o +!elone+hriti$.

Call !our health &are +ro)ider i !ou ha)e %een diagno$ed 2ith thi$ &ondition and ne2

$!m+tom$ de)elo+, e$+e&iall!4

•

De&rea$ed urine out+ut• er$i$tent high e)er

• Se)ere lan1 +ain or %a&1 +ain

Pr"/"ntion

rom+t and &om+lete treatment o %ladder ine&tion$ ma! +re)ent de)elo+ment o man!

&a$e$ o +!elone+hriti$. Chroni& or re&urrent urinar! tra&t ine&tion $hould %e treated thoroughl!.

You &an hel+ +re)enting 1idne! ine&tion$ %! ta1ing the ollo2ing $te+$4

• (ee+ the genital area &lean. =i+ing rom ront to %a&1 hel+$ redu&e the &han&e o

introdu&ing %a&teria rom the re&tal area to the urethra.

• Urinating immediatel! ater $e0ual inter&our$e. Thi$ ma! hel+ eliminate an! %a&teria that

ma! ha)e %een introdu&ed during $e0ual a&ti)it!.

• Drin1 more luid$ 5? to 9;@ oun&e$ +er da!6. Thi$ en&ourage$ re>uent urination and

lu$he$ %a&teria rom the %ladder.

• Drin1 &ran%err! #ui&e. Doing $o +re)ent$ &ertain t!+e$ o %a&teria rom atta&hing to the

2all o the %ladder and ma! le$$en !our &han&e o ine&tion.

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6/22

DE2OGRAPHIC DATA

Na#": +t. She "ui

Addr"&&: laridel Santiago Cit!

Ag": ; !ear$ old

Birt%day: Se+tem%er , 9@

G"nd"r: -emale

R"(igion: INC

Nationa(ity: -ili+ino

Ci/i( Stat&: Married

O!!$ation: Sel Em+lo!ed

Dat" o, Ad#i&&ion: Augu$t ;F, ;:9:

Ti#" o, Ad#i&&ion: 9:4:F am

Att"nding P%y&i!ian: Dr. Ale0 Cri$to%al

C%i", Co#$(ain: ainul urination, e)er 2ith &hill$, )omiting or ; da!$ and %od! malai$e

Ad#itting Diagno&i&: t& UTI

Fina( diagno&i&: A&ute !elone+hriti$

Initia( Vita( Sign&:

BP: 99:@:

T: F@

RR: ;9

PR: @9


7/22

Nr&ing Hi&tory

Hi&tory o, Pr"&"nt I((n"&&

;da!$ TA, the +atient 2a$ $uering rom e)er and &hill$ a&&om+anied %!

)omiting or $e)en time$. She de&ided to ha)e +rom+t &on$ultation 2hen $he e0+erien&e %od!

malai$e. She 2a$ ru$hed at Callang General o$+ital and Medi&al Center la$t Augu$t ;F, ;:9: at

9:4F: am a&&om+anied %! her ather )ia am%ulator!. Initial *ital i$ ta1en.B99:@: RR;9

R//@9 TEM //F@⁰

Hi&tory o, Pr"&"nt I((n"&&

A&&ording to the +atient $he ha$ %een ho$+itali'ed !ear$ ago due to $en$iti)it!o her +regnan&!. She al$o $uer$ u$ual $i&1ne$$ li1e &ough and &old$. She oten treated it 2ith

8TC drug$ $u&h a$ +ara&etamol and de&onge$tant.

Fa#i(y Hi&tory

The +atient ha$ a amil! hi$tor! o !+erten$ion on Mother $ide and a$thma to

her -ather $ide.


8/22

Gordon'& Fn!tiona( Patt"rn

H"a(t% P"r!"$tion Patt"rnA&&ording to the +t $he i$ not a2are 2ith her health $tatu$. She admit$ that $he

had alread! UTI %eore %ut $he #u$t ignore. -or her health i$ )er! im+ortant %ut then a$ long a$

$he &an tolerate her illne$$ $he doe$nHt e)en ta1e medi&ine$ at all.

Ntritiona(32"ta*o(i! Patt"rnTA, a&&ording to the +atient $he lo)e$ to &hi&1en #o! and rie$ 5Jolli%ee6 and eat

onl! $mall amount o )egeta%le$. During $na&1 time her a)orite $na&1 i$ &hi++! and $ot drin1$

or at lea$t ; liter$ a da!. She onl! &on$ume$ ? gla$$e$ o 2ater a da!.

During ho$+itali'ation the +t i$ N8 a$ ordered due to her )omiting.

A!ti/ity4E0"r!i&" Patt"rnTA, a&&ording to the +atient $he had a ei&ient energ! to re>uire or her AD".

E)er! da! $he i$ in their $tore $elling &lothe$ or the 2hole da!.

During ho$+itali'ation, &an no longer do her u$ual ha%it, %ut $he &an $till +erorm

her AD".

Co$ing Patt"rnA&&ording to the +atient $he i$ inan&iall! +ro%lemati& %e&au$e $he i$ a++l!ing to

a%road. She doe$nHt ha)e enough mone! e$+e&iall! no2. That $he 2a$ %een o$+itali'ed. Shemanaged her +ro%lem$ %! a$1ing hel+ to her +arent$ and through the $u++ort o her hu$%and.

E(i#ination Patt"rnTA, the +atient u$uall! )oid$ / time$ a da! and dee&ate$ on&e a da!.

During the ho$+itali'ation the +atient )oid$ 9:/9; time$ a da! %ut $&ant!. Shedee&ate$ e)er! other da!.

S(""$ R"&t Patt"rnTA, the +atient $lee+ /@ hour$ a da!. She $lee+ at 4:: oH&lo&1 and 2a1e$ u+

4:: oH&lo&1 in the morning.

During o$+itali'ation the +atient didnHt $lee+ 2ell. er $lee+ 2a$ al2a!$

interru+ted %e&au$e o gi)ing medi&ation and getting )ital $ign$.

Ro(" R"(ation&%i$ Patt"rnTA, the +atient li)e$ together 2ith her amil!. She i$ re$+on$i%le in doing the

ou$ehold &hore$ and &aring or her daughter.

During ho$+itali'ation $he &an no longer +erorm her re$+on$i%ilitie$ at home.

Va("& B"(i",& Patt"rnThe +atient i$ a mem%er o Igle$ia ni Cri$to,

The! u$uall! attend &hur&h gathering e)er! Sunda!. The amil! al$o %elie)e$ in

aith healer

S"0a(ity Patt"rn


9/22

A&&ording to the +atient $he had her 9$t men$truation 2hen $he 2a$ 9? !ear$ old.

She ha$ a regular men$truation. The! u$e natural method 52ithdra2al6or amil! +lanning and to +re)ent +o$$i%le +regnan&!.

P%y&i!a( A&&"&"nt


10/22


11/22


12/22

?456498

6:88 $#

8

Ranitidine 9 am+ I* no2 then >

@ or )omiting

)$ > ?

+lea$e inorm A

reer a&&ordingl!

N8 tem+orar!

Ranitidine :mg I* > @

Ceuro0ime :mg I* > @ 5/6

ANST

I*- d"R 9" 0 @

Ma! ha)e DAT

-or &lient$ +reeren&e

-or legal do&ument and to

$tart treatment andmanagement

To rule out %lood

&om+onent$ a%normalitie$

To &he&1 i there i$

a%normalitie$.

Re+la&ement o luid and

ele&trol!te$ im%alan&e$

-or e)er

; %lo&1er antagoni$t to

+re)ent or redu&e N*

To &he&1 an! lu&tuation$.

To u+date +rogno$i$ to

the +t.

To &ommuni&ate an!

unto2ard $ign$ and

$!m+tom$ that ma! o&&ur.

To +re)ent re&urrent)omiting.


+re)ent or redu&e N*

Anti%ioti& to treat

%a&terial ine&tion



and or medi&ation.

To $u$tain meta%oli&

need$.

?45498 Shit I* ranitidine to oral9:mg

Continue Ceuro0ime I*

I*- to ollo2 D"R 9" 0 92


+re)ent or redu&e N

Anti%ioti& to treat

%a&terial ine&tion

Anti%ioti& to treat

%a&terial ine&tion



and or medi&ation.


13/22


14/22

8?356398 -98:6 a#

HE2ATOLOGICAL REPORT

PARA2ETERS RESULTS RANGES INTERPRETATION

)BC 9.? 59: g"6 .:: O 9:.:: dt ine&tion

RBC .:: 59: 9;"6 ?.:: O .:: Normal

HgB 99; 5g"6 99: O 9@: Normal

HCT F;.@ P ;.: O ?.: Normal

2CV .F 5"6 @.: O 99:

2CH ;;.F 5g6 ;.: O F@.:

2CHC F?9 5g"6 F9: O F: Normal

PLT ;@ 59: g"6 9: O ?:: Normal

RD)3SD F9.9 O F?.9 -l F.: O ?.:

RD)3CV 9?. P 99.: O 9.: Normal

PD) 99. P .: O 9.: Normal

2PV . 5l6 .: O 9F.: Normal

P3LCR ;F.9 P 9F.: O ?F.: Normal

PCT :.; P :.9 O :.F Normal

NEUTROCYTES 9?.:? P 9.: O .::

LY2PHOCYTES :. P 9.:: O F.:

2ONOCYTES :.@ 59: g"6 :.:: O :.: Normal

EOSINOPHIL :.:9 59: g"6 :.:: O :.?: Normal

BASOPHIL :.:9 59: g"6 :.:: O :.9: Normal

8?35638?

URINALYSIS

INTERPRETATION

Co(or Dar1 !ello2 dt ine&tion

Tran&$ar"n!y Tur%id dt ine&tion

$H . + normal

S$"!i,i! 9.:9: 5normal Q 9.:9:/9.:;6 normalProt"in 5K6 F: mgdl dt damage o the 1idne!

G(!o&" 5/6 normal

RBC O 9: dt damage o the un&tiono the 1idne!

P& !"((& 9:: numerou$ to &ount h+- dt ine&tion

E$it%"(ia( !"((& Moderate normal

A#or$%o& #at"ria(& 8&&a$ional normal

2!& t%r"ad& Rare normal

Ba!t"ria 8&&a$ional normal

8?35


15/22


16/22

The 1idne!$ are e$$entiall! regulator! organ$ 2hi&h maintain the )olume and

&om+o$ition o %od! luid %! iltration o the %lood and $ele&ti)e rea%$or+tion or $e&retion o

iltered $olute$.

The 1idne!$ are retro+eritoneal organ$ 5ie lo&ated %ehind the +eritoneum6 $ituated on the

+o$terior 2all o the a%domen on ea&h $ide o the )erte%ral &olumn, at a%out the le)el o the

t2elth ri%. The let 1idne! i$ $lightl! higher in the a%domen than the right, due to the +re$en&e

o the li)er +u$hing the right 1idne! do2n.

The 1idne!$ ta1e their %lood $u++l! dire&tl! rom the aorta )ia the renal arterie$3 %lood i$

returned to the inerior )ena &a)a )ia the renal )ein$. Urine 5the iltered +rodu&t &ontaining 2a$te

material$ and 2ater6 e0&reted rom the 1idne!$ +a$$e$ do2n the i%romu$&ular r"t"r& and


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&olle&t$ in the *(add"r. The %ladder mu$&le 5the d"tr&or #&!("6 i$ &a+a%le o di$tending toa&&e+t urine 2ithout in&rea$ing the +re$$ure in$ide3 thi$ mean$ that large )olume$ &an %e&olle&ted 5::/9:::ml6 2ithout high/+re$$ure damage to the renal $!$tem o&&uring.

=hen urine i$ +a$$ed, the r"t%ra( &$%in!t"r at the %a$e o the %ladder rela0e$, the detru$or &ontra&t$, and urine i$ )oided )ia the r"t%ra.

Str!tr" o, t%" 1idn"y

8n $e&tioning, the 1idne! ha$ a +ale

outer region/ the !ort"0/ and a dar1er inner region/ the #"d((a.The medulla i$ di)idedinto @/9@ &oni&al region$, &alled the r"na($yra#id&3 the %a$e o ea&h +!ramid $tart$ atthe &orti&omedullar! %order, and the a+e0end$ in the r"na( $a$i((a 2hi&h merge$ toorm the r"na( $"(/i& and then on to orm theureter. In human$, the renal +el)i$ i$ di)ided

into t2o or three $+a&e$ /the #aor !a(y!"&/2hi&h in turn di)ide into urther #inor!a(y!"&. The 2all$ o the &al!&e$, +el)i$ andureter$ are lined 2ith $mooth mu$&le that &an&ontra&t to or&e urine to2ard$ the %ladder %!

+eri$tali$i$.

The &orte0 and the medulla are made

u+ o n"$%ron&3 the$e are the un&tional unit$ o the 1idne!, and ea&h 1idne! &ontain$ a%out 9.Fmillion o them.

T%" n"$%ron i$ the unit o the 1idne! re$+on$i%le or ultrailtration o the %lood andrea%$or+tion or e0&retion o +rodu&t$ in the $u%$e>uent iltrate. Ea&h ne+hron i$ made u+ o4

• A iltering unit/ the g(o#"r(&. 9;mlmin o iltrate i$ ormed %! the 1idne!$ a$ %lood

i$ iltered through thi$ $ie)e/li1e $tru&ture. Thi$ iltration i$ un&ontrolled.

• The $ro0i#a( !on/o(t"d t*(". Controlled a%$or+tion o glu&o$e, $odium, and other

$olute$ goe$ on in thi$ region.

• The (oo$ o, H"n(". Thi$ region i$ re$+on$i%le or &on&entration and dilution o urine %!

utili$ing a counter-current multiplying me&hani$m/ %a$i&all!, it i$ 2ater/im+ermea%le

%ut &an +um+ $odium out, 2hi&h in turn ae&t$ the o$molarit! o the $urrounding

ti$$ue$ and 2ill ae&t the $u%$e>uent mo)ement o 2ater in or out o the 2ater/

+ermea%le &olle&ting du&t.• The di&ta( !on/o(t"d t*(". Thi$ region i$ re$+on$i%le, along 2ith the !o(("!ting d!t

that it #oin$, or a%$or%ing 2ater %a&1 into the %od!/ $im+le math$ 2ill tell !ou that the

1idne! doe$n7t +rodu&e 9;ml o urine e)er! minute. P o the 2ater i$ normall!rea%$or%ed, lea)ing highl! &on&entrated urine to lo2 into the &olle&ting du&t and then

into the renal +el)i$.

B(ood &$$(y

The 1idne!$ re&ei)e %lood rom the renal arterie$, let and right, 2hi&h %ran&h dire&tl!rom the a%dominal aorta. De$+ite their relati)el! $mall $i'e, the 1idne!$ re&ei)e a++ro0imatel!

;:P o the &ardia& out+ut.

Ea&h renal arter! %ran&he$ into $egmental arterie$, di)iding urther into interlo%ar arterie$

2hi&h +enetrate the renal &a+$ule and e0tend through the renal &olumn$ %et2een the renal

+!ramid$. The interlo%ar arterie$ then $u++l! %lood to the ar&uate arterie$ that run through the %oundar! o the &orte0 and the medulla. Ea&h ar&uate arter! $u++lie$ $e)eral interlo%ular arterie$

that eed into the aerent arteriole$ that $u++l! the glomeruli.

http://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3a.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3b.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3c.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3c.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3d.htmlhttp://en.wikipedia.org/wiki/Renal_arteryhttp://en.wikipedia.org/wiki/Abdominal_aortahttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Interlobar_arterieshttp://en.wikipedia.org/wiki/Arcuate_arterieshttp://en.wikipedia.org/wiki/Interlobularhttp://en.wikipedia.org/wiki/Afferent_arteriolehttp://en.wikipedia.org/wiki/Glomerulushttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3a.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3b.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3c.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case4/kid3d.htmlhttp://en.wikipedia.org/wiki/Renal_arteryhttp://en.wikipedia.org/wiki/Abdominal_aortahttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Interlobar_arterieshttp://en.wikipedia.org/wiki/Arcuate_arterieshttp://en.wikipedia.org/wiki/Interlobularhttp://en.wikipedia.org/wiki/Afferent_arteriolehttp://en.wikipedia.org/wiki/Glomerulus


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The int"r&tit# 5or int"r&titi#6 i$ the un&tional $+a&e in the 1idne! %eneath theindi)idual ilter$ 5glomeruli6 2hi&h are ri&h in %lood )e$$el$. The inter$titum a%$or%$ luidre&o)ered rom urine. *ariou$ &ondition$ &an lead to $&arring and &onge$tion o thi$ area, 2hi&h

&an &au$e 1idne! d!$un&tion and ailure.

Ater iltration o&&ur$ the %lood mo)e$ through a $mall net2or1 o )enule$ that &on)erge

into interlo%ular )ein$. A$ 2ith the arteriole di$tri%ution the )ein$ ollo2 the $ame +attern, the

interlo%ular +ro)ide %lood to the ar&uate )ein$ then %a&1 to the interlo%ar )ein$ 2hi&h &ome to

orm the renal )ein e0iting the 1idne! or tran$u$ion or %lood.

Hi&to(ogy

Renal hi$tolog! $tudie$ the $tru&ture o the 1idne! a$ )ie2ed under a mi&ro$&o+e. *ariou$

di$tin&t &ell t!+e$ o&&ur in the 1idne!, in&luding4

• (idne! glomerulu$ +arietal &ell

• (idne! glomerulu$ +odo&!te

• (idne! +ro0imal tu%ule %ru$h %order &ell

• "oo+ o enle thin $egment &ell

• Thi&1 a$&ending lim% &ell• (idne! di$tal tu%ule &ell

• (idne! &olle&ting du&t &ell

• Inter$titial 1idne! &ell

Inn"r/ation

The 1idne! and ner)ou$ $!$tem &ommuni&ate )ia the renal +le0u$, 2ho$e i%er$ &our$e along the

renal arterie$ to rea&h the 1idne!. In+ut rom the $!m+atheti& ner)ou$ $!$tem trigger$

)a$o&on$tri&tion in the 1idne!, there%! redu&ing renal %lood lo2. The 1idne! i$ not thought tore&ei)e in+ut rom the +ara$!m+atheti& ner)ou$ $!$tem. Sen$or! in+ut rom the 1idne! tra)el$ to

the T9:/99 le)el$ o the $+inal &ord and i$ $en$ed in the &orre$+onding dermatome. Thu$, +ain inthe lan1 region ma! %e reerred rom the 1idne!.

Fn!tion&

The 1idne! +arti&i+ate$ in 2hole/%od! homeo$ta$i$, regulating a&id/%a$e %alan&e, ele&trol!te&on&entration$, e0tra&ellular luid )olume, and regulation o %lood +re$$ure. The 1idne!

a&&om+li$he$ the$e homeo$tati& un&tion$ %oth inde+endentl! and in &on&ert 2ith other organ$, +arti&ularl! tho$e o the endo&rine $!$tem. *ariou$ endo&rine hormone$ &oordinate the$eendo&rine un&tion$3 the$e in&lude renin, angioten$in II, aldo$terone, antidiureti& hormone, and

atrial natriureti& +e+tide, among other$.

Man! o the 1idne!7$ un&tion$ are a&&om+li$hed %! relati)el! $im+le me&hani$m$ o iltration,rea%$or+tion, and $e&retion, 2hi&h ta1e +la&e in the ne+hron. -iltration, 2hi&h ta1e$ +la&e at the

renal &or+u$&le, i$ the +ro&e$$ %! 2hi&h &ell$ and large +rotein$ are iltered rom the %lood to

ma1e an ultrailtrate that 2ill e)entuall! %e&ome urine. The 1idne! generate$ 9@: liter$ o iltratea da!, 2hile rea%$or%ing a large +er&entage, allo2ing or onl! the generation o a++ro0imatel! ;

liter$ o urine. Rea%$or+tion i$ the tran$+ort o mole&ule$ rom thi$ ultrailtrate and into the

%lood. Se&retion i$ the re)er$e +ro&e$$, in 2hi&h mole&ule$ are tran$+orted in the o++o$itedire&tion, rom the %lood into the urine.

E0!r"tion o, ;a&t"&

The 1idne!$ e0&rete a )ariet! o 2a$te +rodu&t$ +rodu&ed %! meta%oli$m. The$e in&lude the

nitrogenou$ 2a$te$ urea, rom +rotein &ata%oli$m, and uri& a&id, rom nu&lei& a&id meta%oli$m.

http://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Scarringhttp://en.wikipedia.org/wiki/Congestionhttp://en.wikipedia.org/wiki/Congestionhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Cell_typehttp://en.wikipedia.org/wiki/Kidney_glomerulus_podocytehttp://en.wikipedia.org/wiki/Kidney_proximal_tubule_brush_border_cellhttp://en.wikipedia.org/wiki/Loop_of_Henle_thin_segment_cellhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Kidney_distal_tubule_cellhttp://en.wikipedia.org/wiki/Kidney_collecting_duct_cellhttp://en.wikipedia.org/wiki/Nervous_systemhttp://en.wikipedia.org/wiki/Renal_plexushttp://en.wikipedia.org/wiki/Renal_plexushttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Renal_blood_flowhttp://en.wikipedia.org/wiki/Parasympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Dermatome_(anatomy)http://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Acid-base_balancehttp://en.wikipedia.org/wiki/Acid-base_balancehttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Extracellular_fluid_volumehttp://en.wikipedia.org/wiki/Extracellular_fluid_volumehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Endocrine_systemhttp://en.wikipedia.org/wiki/Endocrine_systemhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Atrial_natriuretic_peptidehttp://en.wikipedia.org/wiki/Atrial_natriuretic_peptidehttp://en.wikipedia.org/wiki/Nephronhttp://en.wikipedia.org/wiki/Nephronhttp://en.wikipedia.org/wiki/Renal_corpusclehttp://en.wikipedia.org/wiki/Renal_corpusclehttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Catabolismhttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Nucleic_acidhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Scarringhttp://en.wikipedia.org/wiki/Congestionhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Cell_typehttp://en.wikipedia.org/wiki/Kidney_glomerulus_podocytehttp://en.wikipedia.org/wiki/Kidney_proximal_tubule_brush_border_cellhttp://en.wikipedia.org/wiki/Loop_of_Henle_thin_segment_cellhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Kidney_distal_tubule_cellhttp://en.wikipedia.org/wiki/Kidney_collecting_duct_cellhttp://en.wikipedia.org/wiki/Nervous_systemhttp://en.wikipedia.org/wiki/Renal_plexushttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Renal_blood_flowhttp://en.wikipedia.org/wiki/Parasympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Dermatome_(anatomy)http://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Acid-base_balancehttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Extracellular_fluid_volumehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Endocrine_systemhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Atrial_natriuretic_peptidehttp://en.wikipedia.org/wiki/Nephronhttp://en.wikipedia.org/wiki/Renal_corpusclehttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Catabolismhttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Nucleic_acid


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A!id3*a&" %o#"o&ta&i&

T2o organ $!$tem$, the 1idne!$ and lung$, maintain a&id/%a$e homeo$ta$i$, 2hi&h i$ the

maintenan&e o + around a relati)el! $ta%le )alue. The 1idne!$ &ontri%ute to a&id/%a$e

homeo$ta$i$ %! regulating %i&ar%onate 5C8F/6 &on&entration.

Oo(a(ity r"g(ation

An! $ignii&ant ri$e or dro+ in +la$ma o$molalit! i$ dete&ted %! the h!+othalamu$, 2hi&h

&ommuni&ate$ dire&tl! 2ith the +o$terior +ituitar! gland. An in&rea$e in o$molalit! &au$e$ the

gland to $e&rete antidiureti& hormone 5AD6, re$ulting in 2ater rea%$or+tion %! the 1idne! andan in&rea$e in urine &on&entration. The t2o a&tor$ 2or1 together to return the +la$ma o$molalit!

to it$ normal le)el$.

AD %ind$ to +rin&i+al &ell$ in the &olle&ting du&t that tran$lo&ate a>ua+orin$ to the mem%rane

allo2ing 2ater to lea)e the normall! im+ermea%le mem%rane and %e rea%$or%ed into the %od! %!

the )a$a re&ta, thu$ in&rea$ing the +la$ma )olume o the %od!.

There are t2o $!$tem$ that &reate a h!+ero$moti& medulla and thu$ in&rea$e the %od! +la$ma )olume4 Urea re&!&ling and the 7$ingle ee&t.

Urea i$ u$uall! e0&reted a$ a 2a$te +rodu&t rom the 1idne!$. o2e)er, 2hen +la$ma

%lood )olume i$ lo2 and AD i$ relea$ed the a>ua+orin$ that are o+ened are al$o +ermea%le to

urea. Thi$ allo2$ urea to lea)e the &olle&ting du&t into the medulla &reating a h!+ero$moti&$olution that 7attra&t$7 2ater. Urea &an then re/enter the ne+hron and %e e0&reted or re&!&led again

de+ending on 2hether AD i$ $till +re$ent or not.

The 7Single ee&t7 de$&ri%e$ the a&t that the a$&ending thi&1 lim% o the loo+ o enle i$

not +ermea%le to 2ater %ut i$ +ermea%le to NaCl. Thi$ mean$ that a &ounter&urrent $!$tem i$

&reated 2here%! the medulla %e&ome$ in&rea$ingl! &on&entrated $etting u+ an o$moti& gradientor 2ater to ollo2 $hould the a>ua+orin$ o the &olle&ting du&t %e o+ened %! AD.

B(ood $r"&&r" r"g(ation

"ong/term regulation o %lood +re$$ure +redominantl! de+end$ u+on the 1idne!. Thi$

+rimaril! o&&ur$ through maintenan&e o the e0tra&ellular luid &om+artment, the $i'e o 2hi&hde+end$ on the +la$ma $odium &on&entration. Although the 1idne! &annot dire&tl! $en$e %lood

+re$$ure, &hange$ in the deli)er! o $odium and &hloride to the di$tal +art o the ne+hron alter the

1idne!7$ $e&retion o the en'!me renin. =hen the e0tra&ellular luid &om+artment i$ e0+anded

and %lood +re$$ure i$ high, the deli)er! o the$e ion$ i$ in&rea$ed and renin $e&retion i$de&rea$ed. Similarl!, 2hen the e0tra&ellular luid &om+artment i$ &ontra&ted and %lood +re$$ure

i$ lo2, $odium and &hloride deli)er! i$ de&rea$ed and renin $e&retion i$ in&rea$ed in re$+on$e.

Renin i$ the ir$t in a $erie$ o im+ortant &hemi&al me$$enger$ that &om+ri$e the renin/

angioten$in $!$tem. Change$ in renin ultimatel! alter the out+ut o thi$ $!$tem, +rin&i+all! the

hormone$ angioten$in II and aldo$terone. Ea&h hormone a&t$ )ia multi+le me&hani$m$, %ut %othin&rea$e the 1idne!7$ a%$or+tion o $odium &hloride, there%! e0+anding the e0tra&ellular luid

&om+artment and rai$ing %lood +re$$ure. =hen renin le)el$ are ele)ated, the &on&entration$ o

angioten$in II and aldo$terone in&rea$e, leading to in&rea$ed $odium &hloride rea%$or+tion,e0+an$ion o the e0tra&ellular luid &om+artment, and an in&rea$e in %lood +re$$ure. Con)er$el!,

2hen renin le)el$ are lo2, angioten$in II and aldo$terone le)el$ de&rea$e, &ontra&ting thee0tra&ellular luid &om+artment, and de&rea$ing %lood +re$$ure.

Hor#on" &"!r"tion

The 1idne!$ $e&rete a )ariet! o hormone$, in&luding er!thro+oietin, &al&itriol, and renin.

Er!thro+oietin i$ relea$ed in re$+on$e to h!+o0ia 5lo2 le)el$ o o0!gen at ti$$ue le)el6 in the

renal &ir&ulation. It $timulate$ er!thro+oie$i$ 5+rodu&tion o red %lood &ell$6 in the %one marro2.Cal&itriol, the a&ti)ated orm o )itamin D, +romote$ inte$tinal a%$or+tion o &al&ium and the

http://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Plasma_osmolalityhttp://en.wikipedia.org/wiki/Plasma_osmolalityhttp://en.wikipedia.org/wiki/Hypothalamushttp://en.wikipedia.org/wiki/Posterior_pituitary_glandhttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Extracellular_fluidhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Chloridehttp://en.wikipedia.org/wiki/Nephronhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Erythropoietinhttp://en.wikipedia.org/wiki/Erythropoietinhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Erythropoietinhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Erythropoiesishttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Plasma_osmolalityhttp://en.wikipedia.org/wiki/Hypothalamushttp://en.wikipedia.org/wiki/Posterior_pituitary_glandhttp://en.wikipedia.org/wiki/Antidiuretic_hormonehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Extracellular_fluidhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Chloridehttp://en.wikipedia.org/wiki/Nephronhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Erythropoietinhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Erythropoietinhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Erythropoiesishttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Calcitriolhttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Calcium


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21/22

PATHOPHYSIOLOGY

OF

ACUTE PYELONEPHRITIS

Etiolog!4 redi$+o$ing a&tor$4

Ba&teria4 e$&heri&hia &oli Modiia%le4 Non/modiia%le4


22/22

urinar! retention age

dia%ete$ mellitu$ gender 5emale6

+regnan&!

in$trumentation o urinar! tra&t

re&urrent UTI

Ba&teria atta&he$ and &oloni'e$ the

E+ithelium o the urinar! tra&t

Anti%od! ormation

Antigen/anti%od! &om+le0

-e)er

Inlammation or trauma o urethral mu&o$a Nau$ea and )omiting urinar! tra&t im+eded

8utlo2 o%$tru&ted

D!$uria

-re>uent, $&ant! urination ormation o re$idual urine

I* mi&ro%ial gro2th

Blood )e$$el &om+re$$ed %a&teriuria

mu&o$al deen$e

no&turia

Inlammation o the %ladder

Su+ra+u%i& or +el)i& +ain hematuria

*e$i&oureteral rele0

-lan1 +ain e0udate$ ill$ the 1idne! +el)i$ &loud!, oul $melling urine

A%$&e$$ and ne&ro$i$ in the &al!0

"o$$ o tu%ule un&tion h!drone+hro$i$

Chroni& Renal -ailure

DEAT

47156227 Acute Pyelonephritis

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Transcript of 47156227 Acute Pyelonephritis