UPPER
URINARY TRACT INFECTION: CHRONIC PYELONEPHRITIS
Repeated
bouts of acute pyelonephritis may lead to chronic pyelone-phritis. Recent
evidence suggests that chronic pyelonephritis is decreasing as a common cause
of end-stage renal disease (ESRD),
while renovascular disease is increasing as one of the most common causes for
ESRD (Fatica, Port & Young, 2001).
The
patient with chronic pyelonephritis usually has no symptoms of infection unless
an acute exacerbation occurs. Noticeable signs and symptoms may include fatigue,
headache, poor appetite, polyuria, excessive thirst, and weight loss.
Persistent and recurring infection may produce progressive scarring of the
kidney, with renal failure the end result.
The
extent of the disease is assessed by an intravenous urogram and measurements of
creatinine clearance and BUN and creatinine lev-els. Bacteria, if detected in
the urine, are eradicated if possible.
Complications
of chronic pyelonephritis include ESRD (from progressive loss of nephrons
secondary to chronic inflammation and scarring), hypertension, and formation of
kidney stones (from chronic infection with urea-splitting organisms).
The
choice of antimicrobial agent is based on which pathogen is identified through
urine culture. If the urine cannot be made bacteria-free, nitrofurantoin or
TMP-SMZ may be used to sup-press bacterial growth. Impaired renal function
alters the excre-tion of antimicrobial agents and necessitates careful
monitoring of renal function, especially if the medications are potentially
toxic to the kidneys.
The
patient may require hospitalization or may be treated as an outpatient. When
the patient is hospitalized, fluid intake and out-put are carefully measured
and recorded. Unless contraindicated, fluids are encouraged (3 to 4 L/day) to
dilute the urine, decrease burning on urination, and prevent dehydration. The
nurse assesses the patient’s temperature every 4 hours and administers
anti-pyretic and antibiotic agents as prescribed. Often the patient is more
comfortable on bed rest during the acute phase of the illness.
Patient
teaching focuses on prevention of UTIs by consuming adequate fluids, emptying
the bladder regularly, and performing recommended perineal hygiene. The
importance of taking anti-microbial medications exactly as prescribed is
stressed to the pa-tient, as is the need for keeping follow-up appointments.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.