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 Paula Mae N.
Buhat, Janny Lie R.
Camangeg jr., Joselito M.
Cambia, Charlene M.
Canosa, Julie Ann U.
Cansino, Rina Antonette P.
Cairel, Princess C.
Carabacan, Arleen C.
Carlos, Amazing Grace M.
Casayuran, Karen Ivy V.
Leal, Joenna Joy I.

PRESENTED TO:

Mr. Jesper Bayaua, RN

Mrs. Mary Jane Gonzales, RN
Ms. Theresa Bermusa, RN
Ms. Pristine Gonzales, RN
 TABLE OF CONTENTS

I. Introduction

A. Case Description

II. Demographic Data

Nursing History

A. Present Health History

B. Past Medical History
C. Family History
D. Pattern of Functioning
a. Physiological Health
b. Socio-cultural Health
c. Spiritual Health

Gordon’s Functional Pattern

A. Health Perception
B. Nutrition Pattern
C. Sleep and Rest
D. Activity and Exercise
E. Elimination Pattern
F. Self Perception
G. Cognitive and Perception Pattern
H. Role and Relationship Pattern
I. Sexuality Pattern
J. Coping of Stress Pattern
K. Value and Belief Pattern

III. Course in the Ward

IV. Physical Assessment

V. Laboratory Result

VI. Anatomy and Physiology

VII. Pathophysiology

VIII. Nursing Care Plan

IX. Drug Study

X. Discharge Planning

XI. Reference
 INTRODUCTION
(ACUTE PYELONEPHRITIS)

Pyelonephritis
Definition

Pyelonephritis is an infection of the kidney and the ureters, the ducts that carry urine
away from the kidney.

Alternative Names

Urinary tract infection - complicated; Infection - kidney; Complicated urinary tract

infection; Kidney infection

Causes

Pyelonephritis most often occurs as a result of urinary tract infection, particularly when
there is occasional or persistent backflow of urine from the bladder into the ureters or an area
called the kidney pelvis. See:Vesicoureteric reflux

Pyelonephritis can be sudden (acute) or long-term (chronic).

• Acute uncomplicated pyelonephritis is the sudden development of kidney

inflammation.
• Chronic pyelonephritis is a long-standing infection that does not go away.

Pyelonephritis occurs much less often than a bladder infection, although a history of such
an infection increases your risk. You're also at increased risk for a kidney infection if you have
any of the following conditions:

• Backflow of urine into the ureters or kidney pelvis

• Kidney stones
• Ostructive uropathy
• Renal papillary necrosis
You are also more likely to get a kidney infection if you have a history of chronic or
recurrent urinary tract infection, especially if the infection is caused by a particularly aggressive
type of bacteria.
Acute pyelonephritis can be severe in the elderly and in people who
areimmunosuppressed (for example, those with cancer or AIDS).

Symptoms

• Back pain orflank pain

• Chills with shaking
• Severe abdominal pain (occurs occasionally)
• Fatigue
• Fever
• Higher than 102 degrees Fahrenheit
• Persists for more than 2 days
• General ill feeling
• Chills with shaking
• Mental changes or confusion*
• Skin changes
  Flushed or reddened skin
 Moist skin (diaphoresis)
 Warm skin
 Urination problems
 Blood in the urine
 Cloudy or abnormal urine color
 Foul or strong urine odor
 Increased urinary frequency or urgency
 Need to urinate at night (nocturia)
 Painful urination
 Vomiting, nausea

* Mental changes or confusion may be the only signs of a urinary tract infection in the
elderly.

Exams and Tests

A physical exam may show tenderness when the health care provider presses (palpates)
the area of the kidney.
• Blood culture may show an infection.
• Urinalysis commonly reveals white or red blood cells in the urine.
• Other urine tests may show bacteria in the urine.
An intravenous pyelogram (IVP) or CT scan of the abdomen may show swollen kidneys.
These tests can also help rule out underlying disorders.

Additional tests and procedures that may be done include:

• Kidney biopsy
• Kidney scan
• Kidney ultrasound
• Voiding cystourethrogram

Treatment

The goals of treatment are to:

• Control the infection

• Relieve symptoms

Due to the high death rate in the elderly population and the risk of complications, prompt
treatment is recommended. Sudden (acute) symptoms usually go away within 48 to 72 hours
after appropriate treatment.

Your doctor will select the appropriate antibiotics after a urine culture identifies the
bacteria that is causing the infection. In acute cases, you may receive a 10- to 14-day course of
antibiotics.

If you have a severe infection or cannot take antibiotics by mouth, you may be given
antibiotics through a vein (intravenously) at first.

Chronic pyelonephritis may require long-term antibiotic therapy. It is very important that
you finish all the medicine.

Commonly used antibiotics include the following:

• Amoxicillin
• Cephalosporin
• Levofloxacin and ciprofloxacin
 • Sulfa drugs such as sulfisoxazole/trimethoprim

Outlook (Prognosis)

With treatment, most kidney infections get better without complications. However, the
treatment may need to be aggressive or prolonged.

Pregnant women and persons with diabetes or spinal paralysis should have a urine culture
after finishing antibiotic therapy to make sure that the bacteria are no longer present in the urine.

In rare cases, permanent kidney damage can result when:

• Chronic kidney infections occur in a transplanted kidney

• Many kidney infections occur during infancy or childhood
Acute kidney injury (acute renal failure) may occur if a severe infection leads to
significantly low blood pressure (shock). The elderly, infants, and persons with a weakened
immune system have an increased risk for developing shock and a severe blood infection
calledsepsis. Often, such patients will be admitted to the hospital for frequent monitoring and IV
antibiotics, IV fluids, and other medications as necessary.

Severe episodes of acute kidney injury may result in permanent kidney damage and lead
to chronic kidney disease.

Possible Complications

• Acute kidney failure

• Kidney infection returns
• Infection around the kidney (perinephric abscess)
• Severe blood infection (sepsis)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of pyelonephritis.

Call your health care provider if you have been diagnosed with this condition and new
symptoms develop, especially:

• Decreased urine output

• Persistent high fever
• Severe flank pain or back pain

Prevention

Prompt and complete treatment of bladder infections may prevent development of many
cases of pyelonephritis. Chronic or recurrent urinary tract infection should be treated thoroughly.

You can help preventing kidney infections by taking the following steps:

• Keep the genital area clean. Wiping from front to back helps reduce the chance of
introducing bacteria from the rectal area to the urethra.
• Urinating immediately after sexual intercourse. This may help eliminate any
bacteria that may have been introduced during sexual activity.
• Drink more fluids (64 to 128 ounces per day). This encourages frequent urination
and flushes bacteria from the bladder.
• Drink cranberry juice. Doing so prevents certain types of bacteria from attaching
to the wall of the bladder and may lessen your chance of infection.
 DEMOGRAPHIC DATA

Name: pt. She Lui

Address: Plaridel Santiago City

Age: 25 years old

Birthday: September 5, 1985

Gender: Female

Religion: INC

Nationality: Filipino

Civil Status: Married

Occupation: Self Employed

Date of Admission: August 23, 2010

Time of Admission: 10:03 am

Attending Physician: Dr. Alex Cristobal

Chief Complain: Painful urination, fever with chills, vomiting for 2 days and body malaise

Admitting Diagnosis: t/c UTI

Final diagnosis: Acute Pyelonephritis

Initial Vital Signs:

BP: 110/80

T: 38

RR: 21

PR: 81
 Nursing History

History of Present Illness

2days PTA, the patient was suffering from fever and chills accompanied by
vomiting for seven times. She decided to have prompt consultation when she experience body
malaise. She was rushed at Callang General Hospital and Medical Center last August 23, 2010 at
10:30 am accompanied by her father via ambulatory. Initial Vital is taken.BP—110/80 RR—21
PR--81 TEMP --38⁰

History of Present Illness

According to the patient she has been hospitalized 6 years ago due to sensitivity
of her pregnancy. She also suffers usual sickness like cough and colds. She often treated it with
OTC drugs such as paracetamol and decongestant.

Family History
The patient has a family history of Hypertension on Mother side and asthma to
her Father side.
 Gordon’s Functional Pattern

Health Perception Pattern

According to the pt she is not aware with her health status. She admits that she
had already UTI before but she just ignore. For her health is very important but then as long as
she can tolerate her illness she doesn’t even take medicines at all.

Nutritional-Metabolic Pattern
PTA, according to the patient she loves to chicken joy and fries (Jollibee) and eat
only small amount of vegetables. During snack time her favorite snack is chippy and soft drinks
for at least 2 liters a day. She only consumes 4 glasses of water a day.

During hospitalization the pt is NPO as ordered due to her vomiting.

Activity/Exercise Pattern
PTA, according to the patient she had a efficient energy to require for her ADL.
Every day she is in their store selling clothes for the whole day.

During hospitalization, can no longer do her usual habit, but she can still perform
her ADL.

Coping Pattern
According to the patient she is financially problematic because she is applying to
abroad. She doesn’t have enough money especially now. That she was been Hospitalized. She
managed her problems by asking help to her parents and through the support of her husband.

Elimination Pattern
PTA, the patient usually voids 5-7 times a day and defecates once a day.

During the hospitalization the patient voids 10-12 times a day but scanty. She
defecates every other day.

Sleep Rest Pattern

PTA, the patient sleep 7-8 hours a day. She sleep at 9:00 o’clock and wakes up
5:00 o’clock in the morning.

During Hospitalization the patient didn’t sleep well. Her sleep was always
interrupted because of giving medication and getting vital signs.

Role Relationship Pattern

PTA, the patient lives together with her family. She is responsible in doing the
Household chores and caring for her daughter.

During hospitalization she can no longer perform her responsibilities at home.

Values Beliefs Pattern

The patient is a member of Iglesia ni Cristo,

They usually attend church gathering every Sunday. The family also believes in
faith healer”

Sexuality Pattern
 According to the patient she had her 1st menstruation when she was 14 years old.
She has a regular menstruation. They use natural method (withdrawal)for family planning and to
prevent possible pregnancy.

Physical Assessment
 August 23, 2010
(Monday, 6:00pm)

Received patient, lying on bed, conscious and coherent, febrile, with an

ongoing IVF of D5 .9 NaCl @ 21gtts/min, and initial v/s of BP: 90/60 mmHg, RR: 21 cpm,
PR: 87 bpm, & Temp: 38 ˚C.

BODY PARTS METHOD FINDINGS INTERPRETATIOJN

HEAD
Hair Inspection Black in color Normal

Scalp Inspection (-)dandruff Normal

FACE
*EYES
Eyebrows Inspection Symmetrically Normal
aligned

Eyelashes Inspection Intact & equally Normal

distributed

Eyelids Inspection Convex Normal

Conjunctiva Inspection Reddish to pinkish in Normal

color

Sclera Inspection White in color Normal

Pupil Inspection PERRLA, 2mm Normal

*NOSE Inspection (-)discharge Normal

*EARS Inspection (-)secretion Normal

*MOUTH
Lips Inspection Dry, Due to diet (NPO)
reddish in color Due to fever

Gums Inspection Pinkish in color Normal

Teeth Inspection Complete, no Normal

dentures

Tongue Inspection Pinkish,(-)lesions Normal

NECK Inspection Symmetrical in both Normal
sides

Palpation No tenderness & Normal

mass nodes
ABDOMEN Inspection Not distended Normal

Auscultation (+) bowel sound Normal

Percussion (-) dull sound Normal

Palpation (-) mass Normal

(-) tenderness
UPPER
EXTREMITIES Inspection (-)edema,(-)lesions Normal
*R arm
Inspection (-)edema,(-)lesions Normal
*L arm
Inspection Capillary refill 2-3 Normal
 *Nails sec.
LOWER
EXTREMITIES
*Nails Inspection (-)bipedal edema Normal

Inspection Short & clean nails Normal

SKIN Inspection Warm to touch Due to fever

DOCTORS ORDER

Date Progress note Doctors order Interpretation

8/23/10 BP: 110/80  Admit to ROC  For clients preference
̊
Temp. 36.9 C
 Secure consent  For legal document and to
start treatment and
management

 For CBC  To rule out blood

components abnormalities

 To check if there is
 For U/A abnormalities.

 Replacement of fluid and

 D5.09 NaCl 1L x 12̊ electrolytes imbalances

 For fever
 Paracetamol 1 amp IV q 8̊
 H2 blocker antagonist to
 Ranitidine 1 amp IV now then q prevent or reduce N/V
8 for vomiting
 To check any
 v/s q 4 fluctuations.

 To update prognosis to
 please inform AP the pt.

 To communicate any
 refer accordingly untoward signs and
symptoms that may
occur.

3:00 pm  To prevent recurrent

 NPO temporary vomiting.

 H2 blocker antagonist to
 Ranitidine 50mg IV q 8 prevent or reduce N/V

 Antibiotic to treat
 Cefuroxime 750mg IV q 8 (-) bacterial infection
ANST
 Replacement of fluid and
 IVF d5LR 1L x 8 electrolytes imbalances
and for medication.

5:45pm ̊
T: 38 C
BP: 90/60  To sustain metabolic
 May have DAT needs.

8/24/10  Shift IV ranitidine to oral150mg  H2 blocker antagonist to

prevent or reduce N/
Antibiotic to treat
bacterial infection

 Continue Cefuroxime IV  Antibiotic to treat

bacterial infection

 IVF to follow D5LR 1L x 12̊  Replacement of fluid and

electrolytes imbalances
and for medication.
  PLR 1L x 12̊  Replacement of fluid and
electrolytes imbalances
and for medication.

8/25/10
 For repeat U/A  For comparison

 I will be out of town, Dr.  For specialized treatment

Butuyan will take over please and further management
inform.

 Give last dose of Cefuroxime @  Antibiotic to treat

4pm tomorrow bacterial infection

 Home meds.

1. Zinnat 5oomg BID x 5  Antibiotic to treat

days bacterial infection
2. Paracetmol q 4̊  Non Opiod analgesics and
anti pyretic.

LABORATORY RESULTS
08-23-10 (10:43 am)

HEMATOLOGICAL REPORT

PARAMETERS RESULTS RANGES INTERPRETATION

WBC 15.49 (10 ̂ g/L) 5.00 – 10.00 d/t infection

RBC 5.00 (10 ̂ 12/L) 4.00 – 5.00 Normal
HgB 112 (g/L) 110 – 180 Normal
HCT 32.8 % 27.0 – 54.0 Normal
MCV 65.3 (PL) 86.0 – 110
MCH 22.3 (Pg) 26.0 – 38.0
MCHC 341 (g/L) 310 – 370 Normal
PLT 278 (10 ̂ g/L) 150 – 400 Normal
RDW-SD 31.1 – 34.1 Fl 37.0 – 54.0
RDW-CV 14.5 % 11.0 – 16.0 Normal
PDW 11.5 % 9.0 – 17.0 Normal
MPV 9.7 (fl) 9.0 – 13.0 Normal
P-LCR 23.1 % 13.0 – 43.0 Normal
PCT 0.27 % 0.17 – 0.35 Normal
NEUTROCYTES 14.04 % 1.50 – 7.00
LYMPHOCYTES 0.75 % 1.00 – 3.70
MONOCYTES 0.68 (10 ̂ g/L) 0.00 – 0.70 Normal
EOSINOPHIL 0.01 (10 ̂ g/L) 0.00 – 0.40 Normal
BASOPHIL 0.01 (10 ̂ g/L) 0.00 – 0.10 Normal

08-23-08
URINALYSIS

INTERPRETATION
Color Dark yellow d/t infection
Transparency Turbid d/t infection
pH 6.5 pH normal
Specific 1.010 (normal = 1.010-1.025) normal
Protein (+) 30 mg/dl d/t damage of the kidney
Glucose (-) normal
RBC 5 – 10 d/t damage of the function
of the kidney
Pus cells 100 numerous to count/ hpF d/t infection
Epithelial cells Moderate normal
Amorphous materials Occasional normal
Mucus threads Rare normal
Bacteria Occasional normal

08-25-08
URINALYSIS

INTERPRETATION
Color yellow normal
Transparency Slightly Turbid normal
pH 7.0 pH normal
Specific 1.015 (normal = 1.010-1.025) normal
Protein (-) normal
Glucose (-) normal
RBC 0-2 d/t damage of the function
of the kidney
Pus cells 30 – 40 HPF d/t infection
Epithelial cells Moderate normal
Amorphous materials Occasional normal
Mucus threads Rare normal
Bacteria Occasional normal

ANATOMY AND
PHYSIOLOGY
 The kidneys are essentially regulatory organs which maintain the volume and
composition of body fluid by filtration of the blood and selective reabsorption or secretion of
filtered solutes.

The kidneys are retroperitoneal organs (ie located behind the peritoneum) situated on the
posterior wall of the abdomen on each side of the vertebral column, at about the level of the
twelfth rib. The left kidney is slightly higher in the abdomen than the right, due to the presence
of the liver pushing the right kidney down.

The kidneys take their blood supply directly from the aorta via the renal arteries; blood is
returned to the inferior vena cava via the renal veins. Urine (the filtered product containing waste
materials and water) excreted from the kidneys passes down the fibromuscular ureters and
collects in the bladder. The bladder muscle (the detrusor muscle) is capable of distending to
accept urine without increasing the pressure inside; this means that large volumes can be
collected (700-1000ml) without high-pressure damage to the renal system occuring.
When urine is passed, the urethral sphincter at the base of the bladder relaxes, the detrusor
contracts, and urine is voided via the urethra.

Structure of the kidney

On sectioning, the kidney has a pale

outer region- the cortex- and a darker inner
region- the medulla.The medulla is divided
into 8-18 conical regions, called the renal
pyramids; the base of each pyramid starts at
the corticomedullary border, and the apex
ends in the renal papilla which merges to
form the renal pelvis and then on to form the
ureter. In humans, the renal pelvis is divided
into two or three spaces -the major calyces-
which in turn divide into further minor
calyces. The walls of the calyces, pelvis and
ureters are lined with smooth muscle that can
contract to force urine towards the bladder by
peristalisis.

The cortex and the medulla are made

up of nephrons; these are the functional units of the kidney, and each kidney contains about 1.3
million of them.

The nephron is the unit of the kidney responsible for ultrafiltration of the blood and
reabsorption or excretion of products in the subsequent filtrate. Each nephron is made up of:

• A filtering unit- the glomerulus. 125ml/min of filtrate is formed by the

kidneys as blood is filtered through this sieve-like structure. This filtration is
uncontrolled.
• The proximal convoluted tubule. Controlled absorption of glucose,
sodium, and other solutes goes on in this region.
• The loop of Henle. This region is responsible for concentration and
dilution of urine by utilising a counter-current multiplying mechanism- basically, it is
water-impermeable but can pump sodium out, which in turn affects the osmolarity of
the surrounding tissues and will affect the subsequent movement of water in or out of
the water-permeable collecting duct.
• The distal convoluted tubule. This region is responsible, along with the
collecting duct that it joins, for absorbing water back into the body- simple maths will
tell you that the kidney doesn't produce 125ml of urine every minute. 99% of the water
is normally reabsorbed, leaving highly concentrated urine to flow into the collecting
duct and then into the renal pelvis.

Blood supply

The kidneys receive blood from the renal arteries, left and right, which branch directly
from the abdominal aorta. Despite their relatively small size, the kidneys receive approximately
20% of the cardiac output.

Each renal artery branches into segmental arteries, dividing further into interlobar arteries
which penetrate the renal capsule and extend through the renal columns between the renal
pyramids. The interlobar arteries then supply blood to the arcuate arteries that run through the
boundary of the cortex and the medulla. Each arcuate artery supplies several interlobular arteries
that feed into the afferent arterioles that supply the glomeruli.
 The interstitum (or interstitium) is the functional space in the kidney beneath the
individual filters (glomeruli) which are rich in blood vessels. The interstitum absorbs fluid
recovered from urine. Various conditions can lead to scarring and congestion of this area, which
can cause kidney dysfunction and failure.

After filtration occurs the blood moves through a small network of venules that converge
into interlobular veins. As with the arteriole distribution the veins follow the same pattern, the
interlobular provide blood to the arcuate veins then back to the interlobar veins which come to
form the renal vein exiting the kidney for transfusion for blood.

Histology

Renal histology studies the structure of the kidney as viewed under a microscope. Various
distinct cell types occur in the kidney, including:
• Kidney glomerulus parietal cell
• Kidney glomerulus podocyte
• Kidney proximal tubule brush border cell
• Loop of Henle thin segment cell
• Thick ascending limb cell
• Kidney distal tubule cell
• Kidney collecting duct cell
• Interstitial kidney cell

Innervation

The kidney and nervous system communicate via the renal plexus, whose fibers course along the
renal arteries to reach the kidney. Input from the sympathetic nervous system triggers
vasoconstriction in the kidney, thereby reducing renal blood flow. The kidney is not thought to
receive input from the parasympathetic nervous system. Sensory input from the kidney travels to
the T10-11 levels of the spinal cord and is sensed in the corresponding dermatome. Thus, pain in
the flank region may be referred from the kidney.

Functions

The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte

concentrations, extracellular fluid volume, and regulation of blood pressure. The kidney
accomplishes these homeostatic functions both independently and in concert with other organs,
particularly those of the endocrine system. Various endocrine hormones coordinate these
endocrine functions; these include renin, angiotensin II, aldosterone, antidiuretic hormone, and
atrial natriuretic peptide, among others.

Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration,
reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the
renal corpuscle, is the process by which cells and large proteins are filtered from the blood to
make an ultrafiltrate that will eventually become urine. The kidney generates 180 liters of filtrate
a day, while reabsorbing a large percentage, allowing for only the generation of approximately 2
liters of urine. Reabsorption is the transport of molecules from this ultrafiltrate and into the
blood. Secretion is the reverse process, in which molecules are transported in the opposite
direction, from the blood into the urine.

Excretion of wastes

The kidneys excrete a variety of waste products produced by metabolism. These include the
nitrogenous wastes urea, from protein catabolism, and uric acid, from nucleic acid metabolism.
Acid-base homeostasis

Two organ systems, the kidneys and lungs, maintain acid-base homeostasis, which is the
maintenance of pH around a relatively stable value. The kidneys contribute to acid-base
homeostasis by regulating bicarbonate (HCO3-) concentration.

Osmolality regulation

Any significant rise or drop in plasma osmolality is detected by the hypothalamus, which
communicates directly with the posterior pituitary gland. An increase in osmolality causes the
gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and
an increase in urine concentration. The two factors work together to return the plasma osmolality
to its normal levels.

ADH binds to principal cells in the collecting duct that translocate aquaporins to the membrane
allowing water to leave the normally impermeable membrane and be reabsorbed into the body by
the vasa recta, thus increasing the plasma volume of the body.

There are two systems that create a hyperosmotic medulla and thus increase the body
plasma volume: Urea recycling and the 'single effect.

Urea is usually excreted as a waste product from the kidneys. However, when plasma
blood volume is low and ADH is released the aquaporins that are opened are also permeable to
urea. This allows urea to leave the collecting duct into the medulla creating a hyperosmotic
solution that 'attracts' water. Urea can then re-enter the nephron and be excreted or recycled
again depending on whether ADH is still present or not.

The 'Single effect' describes the fact that the ascending thick limb of the loop of Henle is
not permeable to water but is permeable to NaCl. This means that a countercurrent system is
created whereby the medulla becomes increasingly concentrated setting up an osmotic gradient
for water to follow should the aquaporins of the collecting duct be opened by ADH.

Blood pressure regulation

Long-term regulation of blood pressure predominantly depends upon the kidney. This
primarily occurs through maintenance of the extracellular fluid compartment, the size of which
depends on the plasma sodium concentration. Although the kidney cannot directly sense blood
pressure, changes in the delivery of sodium and chloride to the distal part of the nephron alter the
kidney's secretion of the enzyme renin. When the extracellular fluid compartment is expanded
and blood pressure is high, the delivery of these ions is increased and renin secretion is
decreased. Similarly, when the extracellular fluid compartment is contracted and blood pressure
is low, sodium and chloride delivery is decreased and renin secretion is increased in response.

Renin is the first in a series of important chemical messengers that comprise the renin-
angiotensin system. Changes in renin ultimately alter the output of this system, principally the
hormones angiotensin II and aldosterone. Each hormone acts via multiple mechanisms, but both
increase the kidney's absorption of sodium chloride, thereby expanding the extracellular fluid
compartment and raising blood pressure. When renin levels are elevated, the concentrations of
angiotensin II and aldosterone increase, leading to increased sodium chloride reabsorption,
expansion of the extracellular fluid compartment, and an increase in blood pressure. Conversely,
when renin levels are low, angiotensin II and aldosterone levels decrease, contracting the
extracellular fluid compartment, and decreasing blood pressure.

Hormone secretion

The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin.
Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the
renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow.
Calcitriol, the activated form of vitamin D, promotes intestinal absorption of calcium and the
renal reabsorption of phosphate. Part of the renin-angiotensin-aldosterone system, renin is an
enzyme involved in the regulation of aldosterone levels.
 PATHOPHYSIOLOGY
OF
ACUTE PYELONEPHRITIS

Etiology: Predisposing factors:

Bacteria: escherichia coli Modifiable: Non-modifiable:
 >urinary retention >age
>diabetes mellitus >gender (female)
>pregnancy
>instrumentation of urinary tract
>recurrent UTI

Bacteria attaches and colonizes the

Epithelium of the urinary tract

Antibody formation

Antigen-antibody complex
Fever
Inflammation or trauma of urethral mucosa
Nausea and vomiting urinary tract impeded
Outflow obstructed
Dysuria
Frequent, scanty urination formation of ↑ residual urine

↑ IVP microbial growth

Blood vessel compressed bacteriuria

↓ mucosal defense

nocturia
Inflammation of the bladder
Suprapubic or pelvic pain hematuria
Vesicoureteral reflex

Flank pain exudates fills the kidney pelvis cloudy, foul smelling urine

Abscess and necrosis in the calyx

Loss of tubule function hydronephrosis

Chronic Renal Failure

DEATH