Pathophysiology
Pyelonephritis is infectious and inflammatory kidney disease with an extensive lesion of the pyelocaliceal system and tubules, which gradually passes into the pathological process of the glomerular apparatus. Pyelonephritis is one of the most common pathologies among microbial kidney damage in the world. It can occur both on its own and as a complication of other unnatural processes in the body. This is a poly-etiological pathology caused by various microorganisms, but most often, the disease is caused by the bacterial flora (obligate and optional), which is related to the intestinal microflora. The main infectious agents of pyelonephritis are representatives of the Enterobacteriaceae family.
Uncomplicated pyelonephritis can be caused by Escherichia coli, Staphylococcus saprophyticus, and other pathogens: Enterobacteriaceae (except E. coli), Proteus mirabilis, and Klebsiella pneumonia. Complicated pyelonephritis may result from all of the above, as well as from Pseudomonas aeruginosa, Serratia, Providencia, staphylococci, and fungi (Clementi et al., 2015). It should be mentioned that acute and chronic pyelonephritis has various possible outcomes. In acute pyelonephritis, with a timely request for help, recovery occurs, and in the absence of treatment or the wrong list of prescriptions, the process becomes chronic (Fulop, 2019). Chronic pyelonephritis develops over 10-15 years; its outcome is secondary wrinkling of the kidney and pyonephrosis.
Epidemiology
The disease tends to be widespread and requires significant attention. “Acute pyelonephritis in the United States is found at a rate of 15 to 17 cases per 10,000 females and 3 to 4 cases per 10,000 males annually” (Belyayeva & Jeong, 2020, para. 9). It should also be mentioned that young and sexually active females are the ones who are affected by this disease most frequently. However, pregnant women, the elderly, and infants are at risk too.
Physical exam findings
The examination implies palpation of the kidney area to detect pain. In order to diagnose the disease and obtain its expanded clinical picture, the following should be identified. There should be increased body temperature – sometimes with chills. Then, pain on palpation in the kidney from the affected side (a definite symptom of acute pyelonephritis) is to be also found. Acute pyelonephritis is accompanied by the tension of the anterior abdominal wall on the side of the affected kidney, oliguria, and signs of acute renal failure. Another characteristic is lumbar pain that occurs or worsens when striking in the organs, as well as lower back pain during slight movements or walking. Sometimes a psoas symptom may occur – flexion contracture and external rotation of the thigh.
Differential Diagnoses and Rationale
It seems reasonable to state that when diagnosing the disease, one should keep the differential broad. A physician is to consider a number of other disorders because of “patients present with fever, flank pain, and costovertebral angle tenderness” (Belyayeva & Jeong, 2020, para. 9). Given the fact that symptoms may be variable and that pyelonephritis can develop to sepsis and shock, the list of mimics is substantial and can be as follows. Appendicitis, abdominal abscess, nephrolithiasis, cholecystitis, urinary tract obstruction, pelvic inflammatory disease, pancreatitis, and ectopic pregnancy – and these are not an exhaustive roster (Belyayeva & Jeong, 2020). Hence, it is essential to approach the diagnosing process consistently and critically.
Management Plan
Treatment of pyelonephritis is to correct the pathology of the urodynamics of the calyxes of the kidney, pelvis, and ureter. Then, there should be a proper construction of antibiotic therapy. A urologist prescribes antimicrobials only after identifying the causative agent of the infection and obtaining the results of tests for the sensitivity of the body to antibiotics. “Complicated cases of acute pyelonephritis require intravenous (IV) antibiotic treatment;” these are “piperacillin-tazobactam, fluoroquinolones, meropenem, and cefepime” (Belyayeva & Jeong, 2020, para. 8). One of the crucial factors for the successful completion of treatment of the chronic form and acute pyelonephritis is an adequate dietary adjustment. With pyelonephritis, it is very important to adhere to a proper diet. This means the moderate consumption of lean meat and fish, the consumption of dairy and sour-milk products, fresh vegetables, and fruits. What is more, excessive salt intake is unacceptable; when there are no swelling of the face, arms, and legs, patients are also recommended to drink about 3 liters of fluid in 24 hours.
Surgical treatment of pyelonephritis is indicated in cases when non-invasive methods do not bring the expected effect. The purpose of the operation is to stop the progression of the unnatural process, prevent its development in the second kidney (if only one-sided inflammation is observed), and restore a healthy outflow of urine. After the treatment of pyelonephritis is completed, the patient is monitored with a monthly urine test by a urologist or therapist for six months (sometimes the cure is delayed for longer periods). “Follow up for non-admitted patients for resolution of symptoms should be in 1 to 2 days” (Belyayeva & Jeong, 2020, para. 8). Regarding chronic pyelonephritis – it develops not a single year, so its prevention should be started as early as childhood, instilling hygiene skills in the child. A necessary condition for the prevention of the disease is regular preventive examinations by a nephrologist and urologist.
References
Belyayeva, M. & Jeong, J. (2020). Acute Pyelonephritis. NCBI. Web.
Clementi, A., Scarfia, V. R., Insalaco, M., Fatuzzo, P., & Granata, A. (2015). Pyelonephritis: epidemiology, pathogenesis and management. In L. P. Newport (ed.), Vesicoureteral reflux and pyelonephritis: risk factors, prevalence and treatment approaches. (pp. 1–17). Nova Science Publishers, Inc.
Fulop, T. (2019). Acute Pyelonephritis. Medscape. Web.