KIDAPAWAN DOCTORS COLLEGE INC.

CLINICAL MICROSCOPY

February 12-16, 2018

Acute pyelonephritis

In Partial Fulfillment

Of the Requirement for Clinical Microscopy

Section in Socsargen County Hospital Inc.

Malasan, Princess Sharmaine

Portaje, Princess Dawn
Abellera, Randiey John
Eyong, Myke angelo
Cabardo, Marjorie
Dorado. Antonette
Doctor, April

Group 6

February 19, 2018

Objectives:
This case presentation seeks to provide different information about the disease to be
presented and about the client being considered with the following specific objectives

-Give a brief introduction about Acute Pyelonephritis together with its signs and
symptoms.

-Present the abnormal results of the Physical Assessment made on the client

-Present the different laboratory results or test done to the client

-Explain the Pathophysiology of Acute Pyelonephritis

Chapter I – Introduction
Acute pyelonephritis is a potentially organ- and/or life-threatening infection that
often leads to renal scarring. Acute pyelonephritis results from bacterial invasion of the
renal parenchyma. Bacteria usually reach the kidney by ascending from the lower
urinary tract. Bacteria may also reach the kidney via the bloodstream.

Symptoms of acute pyelonephritis usually develop over hours or over the course of a
day but may not occur at the same time. If the patient is male, elderly, or a child or has
had symptoms for more than 7 days, the infection should be considered complicated
until proven otherwise.

Chapter II – Patient’s data

A recently sexually active 18 year old white female is admitted to the emergency
department with left flank pain and blood in the urine. She explains to the doctor that
she has been seen multiple times in the last 6 months by her family doctor as well as the
local emergency department and medical aid unit for recurrent left flank pain that is
often, but not always, associated with a lower urinary tract infection. She was recently
diagnosed two months ago with a nonobstructive kidneys stone in her right ureter. Her
most recent doctor visit was with her family physician 2 weeks ago for an UTI and was
given a 7 day treatment of bactrium to clear the infection.
Chapter III

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, episodes of bacteriuria occur commonly, but most are asymptomatic and do not
lead to infection. The development of infection is influenced by bacterial factors and
host factors.

Bacteria may also reach the kidney via the bloodstream. Hematogenous sources of
gram-positive organisms, such as Staphylococcus, are intravenous drug abuse and
endocarditis. Experimental evidence suggests that hematogenous spread of gram-
negative organisms to the kidney is less likely unless an underlying problem exists, such
as an obstruction. Little or no evidence supports lymphatic spread of uropathogens to
the kidney.

Most bacterial data are derived from research with Escherichia coli, which accounts for
70-90% of uncomplicated UTIs and 21-54% of complicated UTIs (ie, UTIs that are
secondary to anatomic or functional abnormalities that impair urinary tract drainage;
are associated with metabolic disorders; or involve unusual pathogens). A subset of E
coli, the uropathogenic E coli (UPEC), also termed extraintestinal pathogenic E coli
(ExPEC), accounts for most clinical isolates from UTIs.

UPEC derives commonly from the phylogenetic groups B2 and D, which express
distinctive O, K, and H antigens. UPEC genes encode several postulated virulence factors
(VFs), including adhesins, siderophores, protectins, and toxins, as well as having the
metabolic advantage of synthesizing essential substances.

Chapter IV – Presentation of Data

A CAT scan is ordered along with a urinalysis. The CAT scan shows 2 stones, a
2.0mm stone in the right kidney and a 2.5mm stone in the left kidney. The urinalysis
results are:

Color

Red
Appearance

Hazy

Specific Gravity

1.025

pH

8.5

Protein

300 mg/dL

Glucose

Negative

Ketones

Negative

Bilirubin

Trace

Blood

Moderate

Urobilinogen

0.2 mg/dL

Nitrite

Positive

Leukocyte

Moderate

Microscopic results:
20-50 wbc/hpf

loaded bacteria

0-2 wbc cast/lpf

Chapter V- Summary, Conclusion and Recommendation

Reference(s):
 Urinalysis and Body Fluids 6th edition, Strasinger & Lorenzo 2014

 Nyhan W, Barshop B, Al-Aqeel, A. Atlas of Inherited Metabolic Diseases – 3rd

Edition. Hodder-Arnold, London; 2012.