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Abstract
Pyelonephritis is an acute urological condition that involves infection of one or both kidneys. The condition is not generally associated with high levels of mortality, but patients can become acutely ill and experience severe pain. Early recognition and treatment of pyelonephritis may limit morbidity. This article identifies patients at increased risk of pyelonephritis and discusses appropriate strategies to prevent serious complications.
Keywords
Kidney infection, pyelonephritis, renal failure, urinary tract infection
Aims and intended learning outcomes
This article aims to increase the reader's knowledge of pyelonephritis. Epidemiology, assessment, nursing management and treatment of the condition are discussed. After reading this article and completing the time out activities you should be able to:
* Identify the clinical signs and symptoms of pyelonephritis.
* Recognise individuals who may be at increased risk of developing the condition.
* Understand the nurse's role in the assessment and management of patients with pyelonephritis.
* Discuss treatment options for patients with pyelonephritis and offer appropriate advice.
Introduction
Pyelonephritis is a lower urinary tract infection that has ascended to the pelvis of the kidney. Severe cases of pyelonephritis can lead to pyonephrosis (accumulation of purulent material around the affected kidney), systemic sepsis, renal failure, multisystem failure and death (Fulop and Mena 2012).
Complete time out activities 1 and 2
It is estimated that one in every 830 people in the UK develops kidney infection annually (NHS Choices 2011). Females are six times more likely to develop an infection than males for several reasons, including (Shim et al 2009, NHS Choices 2011, Fulop and Mena 2012):
* Females have a shorter urethra than males, making it easier for bacteria to reach the kidneys.
* The proximity of the urethral orifice to the perianal and anal region in females makes them more susceptible to urinary tract infections.
* Pregnancy is associated with increased risk of infection, which is partly due to hormonal changes that reduce urinary flow during pregnancy (Willacy 2011).
* Females may be at increased risk of infection if they are sexually active. Engaging in frequent sex increases the risk of developing kidney infection.
Epidemiology and risk factors
Most cases of pyelonephritis are caused by gram-negative bacterial infection, most typically Escherichia coli, which is transmitted from the anal and perianal region...