Page 123 - Physiology and Pathophysiology MNU 2024-2025 نظرى

Clinical pharmacy 2024/2025 Level 2 Pharm D Physiology and Pathophysiology
(MD303)

2- Pyelonephritis

A) Acute pyelonephritis:
▪ This is an acute microbial infection of the renal pelvis and calyces,
spreading to the kidney substance causing formation of small
abscesses.
▪ The infection may: travel up the urinary tract from the perineum or be
blood-borne.
▪ It is accompanied by: Fever, malaise, loin pain.

B) Chronic pyelonephritis
▪ This usually follows repeated attacks of acute pyelonephritis with scar tissue formation.
▪ It is usually associated with reflux of urine from the bladder to the ureter enabling microbes
to gain access to the kidneys.
▪ A congenital abnormality of the angle of insertion of the ureter into the bladder often
predisposes to the reflux of urine but it is sometimes caused by an obstruction that develops

later in life.
▪ The progressive loss of functioning nephrons leads to chronic renal failure and uremia.
Concurrent hypertension is common.

3- Renal Failure

A) Acute renal failure:
▪ There is a sudden and severe reduction in the glomerular filtration rate and kidney function.
▪ Is usually reversible over days or weeks when treated.
▪ This occurs as a complication of a variety of conditions not necessarily associated with the
kidneys. The causes of acute renal failure are classified as:
✓ Prerenal: the result of reduced renal blood flow, especially severe and prolonged shock
✓ Renal, or parenchymal: damage to the kidney itself due to, e.g., glomerulonephritis
✓ Post-renal: obstruction to the outflow of urine, e.g., tumor of the bladder, large calculus
in the renal pelvis.

❖ Acute renal failure manifestations:
1- Reduced urine volume:
a) Oliguria (less than 400 ml of urine per day in adults)
b) Severe oliguria (less than 100 ml of urine per day in adults)
c) anuria (absence of urine) may last for a few weeks, followed by diuresis.

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