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- QUESTION
Ms. Cornwall is admitted with pyelonephritis. She has chills, and her temperature is 101°F. She is complaining of flank pain, frequency, and dysuria. Her urine has white blood cell casts and shows growth of Escherichia coli (E. coli).
Based on the above scenario, answer the following questions:
Why does she have bacteria and white blood cell casts in her urine? Include the pathophysiological response of body for your analysis.
What are the differences when comparing prerenal acute renal failure, intrarenal acute renal failure, and postrenal acute renal failure? Give examples of each and pathological processes related to each disease process.
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Nursing |
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4 |
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APA |
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Answer
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Urinary Tract Infections
Pyelonephritis
According to the urinalysis, Ms. Cornwall had bacteria and white blood cells cast in her urine. Bacteria can be present in female urine due to the numerous normal flora of the vagina (Bethel, 2012). However, increased bacterial count in urine is a symptom of urinary tract infection. Bacteria can reach the kidney via the bloodstream or by ascending from the lower urinary tract (Bethel, 2012). Escherichia coli, specifically, is an uropathogenic bacterium and its presence in urine confirm acute pyelonephritis (Bethel, 2012). The presence of white blood cells indicates an inflammation of her kidney. The attachment of E. coli to the renal epithelium induces inflammatory response whereby the renal vessels dilate, and blood and leukocytes aggregate to form pus around the kidney (Bethel, 2012). In the case of a severe infection, systemic inflammation induces sepsis and fever.
Acute renal failure
Acute renal failure can be a resultant of pre-renal, intrinsic or post-renal factors. The main difference in these factors is the site of obstruction to blood or urine flow (Bellomo, Kellum, & Ronco, 2012). Pre-renal acute renal failure is caused by a decrease in the effective blood flow to the kidney. Prolonged diarrhea causes dehydration that reduces blood volume (Bellomo, Kellum, & Ronco, 2012). Consequently, cardiac output decreases and less blood reaches the kidneys. Therefore, the kidneys suffer the effects of ischemia and the kidneys losses their functions. Intra-renal acute renal failure is caused by intrinsic tubular, glomerular, interstitial, or vascular, renal damage (Bellomo, Kellum, & Ronco, 2012). For instance, glomerulonephritis causes inflammation of the glomeruli. Hence, the glomeruli become more porous and thus reducing renal function. Lastly, post-renal acute renal failure is a result of urinary tract obstruction due to tumors, prostatic hypertrophy, urinary catheter or kidney stones (Bellomo, Kellum, & Ronco, 2012). These obstructions will reduce urine output and therefore, the waste products such as urea will not be excreted efficiently.
References
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Bellomo, R., Kellum, J. A., & Ronco, C. (2012). Acute kidney injury. The Lancet, 380(9843), 756-766.
Bethel, J. (2012). Acute pyelonephritis: risk factors, diagnosis, and treatment. Nursing Standard, 27(5), 51-56.
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