urinary tract infection

1. Guided by
Dr.T.Venu
Pyelonephritis
Presented by
J. Vishnu
RT/2016/604

2. Contents
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 Introduction
 Epidemiology
 Etiology
 Pathophysiology
 Signs and symptoms
 Diagnosis
 Prevention
 Conclusion
 Reference

3. Introduction
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 Upper urinary tract Infections:
 Pyelonephritis
 Inflammation of renal pelvis and parenchyma (functional kidney tissue)
 Results from an infection that ascends to kidney from lower urinary tract

4. Epidemiology
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 Pyelonephritis is significantly more common in females than in
males
 15-17 cases per 10,000 females in a year
 3-4 cases per 10,000 males per year
 Acute pyelonephritis develops in 20-30% of pregnant women
 An estimated 50 % of women report having had a UTI at some
point in their lives.

5. Epidemiology
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 Pyelonephritis shows a trimodal distribution in females
 Elevated incidence in girls aged 0-4 years.
 A peak in women 15-35 years of age.
 Gradual increase after age 50 years.
 In males it shows bimodal distribution
 With an elevated incidence at 0-4 years of age
 It is gradually increase after 35 years of age

6. Etiology
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 Escherichia coli
 Almost 80% pyelonephritis cause by E-coli
 Staphylococcus saprophyticus
 Proteus mirabilis
 Klebsiella
 Enterococcus
 Kidney stones can also contribute to pyelonephritis
• Providing a place for bacteria to grow while evading the body's
defenses.
 People with diabetes or conditions that impair the immune system are
more likely to get pyelonephritis.

7. Pathophysiology
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 Acute pyelonephritis results from bacterial invasion of the renal
parenchyma.
 Bacteria usually reach the kidney by ascending from the lower
urinary tract In all age groups
 Bacteria may also reach the kidney via the bloodstream

8. Pathophysiology
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 Contamination of the periurethral area with a uropathogen from the gut
 Colonization of the urethra and migration to the bladder
 Colonization and invasion of the bladder mediated by pili and adhesion
 Inflammatory response in the bladder and fibrinogen accumulation in the
catheter
 Epithelial damage by bacterial toxins and proteases
 Ascension to the kidneys
 Colonization of the kidney
 Host tissue damage by the bacterial toxins

9. Pathophysiology
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11. What happens to the kidney?
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 The kidney becomes edematous and
inflamed and the blood vessel are
congested
 The urine may be cloudy and contain
pus, mucus and blood
 Small abscesses may form in the
kidney

12. Symptoms of Pyelonephritis
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 Flank pain
 Pyuria (pus in urine )
 Dysuria (painful discharge of urine )
 Hematuria ( blood in urine)
 Increased frequency urine
 Fever (usually present)
 Nausea/Vomiting

13. Diagnosis pyelonephritis
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 Physical Exam:
 CVA tenderness
 CT Scan
 Labs: Urinalysis
• WBCs
• RBCs
• Leukocyte esterase (Helps to screen for pyuria)
• Nitrites(More likely gram-negative rods)
• Urine culture

14. Prevention
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 Increase fluid intake to at least 6- 8 glasses per day to maintain
bladder hygiene.
 Personal hygiene
 Women should avoid prolonged sitting in wet clothes
 Do not postpone urination when feel the urge to urinate
 Empty your bladder completely when urinate

15. Conclusion
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 It is a most common disease for females of 15-35 year age group
 It is mainly caused by the bacterial infection
 Biggest bugs for Pyelonephritis are E. coli (80% )
 It is preventable disease

16. Reference
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 Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based
epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007 , 273-
80.
 Ramakrishnan K, Scheid DC. Diagnosis and management of acute
pyelonephritis in adults. Am Fam Physician. 2005 ,933-42.
 Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic
review. Radiographics.2008 ,255-77.
 Johnson PT, Horton KM, Fishman EK. Optimizing detectability of renal
pathology with MDCT: protocols, pearls, and pitfalls.2010;101-12.

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