Pyelonephritis

Pathology: Pyelonephritis
Victoria Walden
Due Date: 14th of September

Description:

Acute pyelonephritis (also known as acute infective tubulointerstitial nephritis) is a sudden inflammation caused by bacteria that primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. It’s one of the most common renal diseases. With treatment and continued follow-up care, the prognosis is good, and extensive permanent damage is rare.
(Springhouse, 2005)

Pyelonephritis is more common in females and can occur more when the immune system is down in any human body. This infection of the kidneys needs antibiotics as therapy, and treatment of any underlying causes to prevent recurrence.

Etiology:

The main cause of Pyelonephritis is when a kidney produces an infection that usually is caused by bacteria that has travelled to the kidney from an infection in the bladder, when the defences are broken down increasing bacteria flow.
- Women have more bladder infections than men because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. Usually, however, the infection remains in the bladder.
- A women is more likely to develop pyelonephritis when she is pregnant. Peylonephtritis and other forms of urinary tract infection increase the risk of premature delivery.
- A man is more likely to develop the problem if his prostate is enlarged, a common condition after age 50. Both men and women are more likely to develop pyelonephtritis if they have any of the following conditions:

· An untreated urinary tract infection
· Diabetes
· Nerve problems that affect the bladder
· Kidney stones
· A bladder tumor
· Abnormal backflow of urine from the bladder to the kidneys, called vesicoureteral reflux
· An obstruction related to an abnormal development of the urinary tract

- Tests or procedures that involve the insertion of an instrument into the bladder also increase the risk of urinary tract infections and pyelonephtritis.
- Children sometimes develop pyelonephritis because of an abnormality in the bladder that allows urine there to flow backward (reflux) into the ureter, the connection between the kidney and bladder. This can lead to scarring of the kidney.
(About.com)

Through all of these the chances of this infection occurring are very high and can cause pain and further damage, also increasing reoccurrence.
Infections can also come from another part of the body, not just the bladder. Infections can come from the bloodstream. For example: A staphylococcal skin infection can spread to the kidneys through the bloodstream.
Also risk of producing this infection is increased in people with diabetes or with a weak immune system; this reduces their fight against infection.
Pyelonephritis is usually caused by bacteria, but it is rarely caused by tuberculosis, fungal infections, and viruses.
(Shankel, 2007)

Incidence:

Pyelonephritis occurs more commonly in females, probably because of a shorter urethra and the proximity of the urinary meatus to the vagina and the rectum — both conditions allow bacteria to reach the bladder more easily — and a lack of the antibacterial prostatic secretions produced in the male. Incidence increases with age and is higher in the following groups:
- Sexually active females: Intercourse increases the risk of bacterial contamination.
- Pregnant

females: About 5% develop asymptomatic bacteriuria; if untreated, about 40% develop pyelonephritis.
- Diabetics: Neurogenic bladder causes incomplete emptying and urinary stasis; glycosuria may support bacterial growth in the urine.
- Persons with other renal diseases: Compromised renal function aggravates susceptibility.
(Professional Guide to Diseases (Eighth Edition), 2005)

Acute pyelonephritis can occur at any age. In neonates it is 1.5 times more common in boys and tends to be associated with abnormalities of the renal tract. Uncircumcised boys tend to have a higher incidence than circumcised boys. Beyond that age girls have a 10-fold higher incidence. In adult life it reflects the incidence of urinary tract infection (UTI) in that it is much more common in young women. Over 65 the incidence in men rises to match that of women.
(Dr. Knott, 2009)

Signs & symptoms:

The two primary symptoms of pyelonephritis are pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen.
There can also be:
- Shaking chills
- Nausea & vomiting
- Urine maybe cloudly
- Urine can be tinged with blood
- Urine maybe unusually strong or foul-smelling
- Urinate more often
- Urinating maybe painful or uncomfortable.
(About.com)

Shankel says that one or both kidneys may be enlarged and painful, and doctors may find tenderness in the small of the back on the affected side. Sometimes also the muscles of the abdomen are tightly contracted. Spasms can occur when passing urine or kidney stones. If the ureters goes into spasms, people may experience intense pain.

In children, symptoms of a kidney infection often are difficult to recognise. In older generation, pyelonephritis may not cause any symptoms that seem to indicate a problem in the urinary tract. Instead the older generation may have delirium or an infection of the bloodstream (sepsis).
(Shankel, 2007).

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.
(About.com)

Indications and contraindications for massage therapy:

- Do not massage during acute phase
- Encourage the client to take the full course of antibiotics
- Avoid massaging the abdominal area until pain had subsided.
(Dr. Premkumar, 2000)

Risk factors:
- More common in women due to shortness of urethra
- Any kind of obstruction in the urinary tract predisposes to this infection
- Catheterization, pregnancy, loss of bladder control as in spinal, cord injuries, renal stones, birth defects of the urinary tract make a person more susceptible to infection.
(Dr. Premkumar, 2000)

Homecare exercises:

Prevention:
- Drink several glasses of water each day.
- If you are a women, wipe from front to back.
- Decrease the speed of bacteria during sex (urinate after sexual intercourse).
(About.com)

References:

About.com: Health topics A – Z. Retrieved September 13th, 2009 from http://adam.about.com/encyclopedia/infectiousdiseases/Kidney-infection-pyelonephritis.htm

Dr. Knott, L. (2009). Patient UK: Pyelonephritis. Retrieved September 13th, 2009 from http://www.patient.co.uk/doctor/Pyelonephritis.htm

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Schwartz, M, W. (2008). The 5-Mintue Pediatric Consult. Retrieved September 12th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/book-diseases-20a.htm

Shankel, S. (2007). Kidney Infection (Pyelonephritis). Retrieved September, 12th, 2009 from http://www.merck.com/mmhe/sec11/ch149/ch149d.html

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition). Retrieved September 12th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/book-diseases-7a.htm

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition): Prevalence and incidence of Pyelonephritis. Retrieved September 13th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/prevalence.htm

Wikipedia. (2009). Pyelonephritis. Retrieved September 12th, 2009 from http://enwikipedia.org/wiki/pyelonephritis