What is pyelonephritis

Pyelonephritis is constituted by serious infection involving the upper tract of the ureters and the kidney itself, which don’t go away on their own without aggressive antibiotic therapy. Without proper management by a Nephrologist in Lahore, pyelonephritis can result in permanent kidney damage and even spread of infection in the bloodstream—called sepsis. 

Read on to know more about pyelonephritis: its symptoms, diagnosis and treatment: 

What is pyelonephritis?

The life-threatening infection of pyelonephritis leads to swelling of the kidneys, which can subsequently lead to permanent damage without prompt management. The acute form is sudden in onset, while the chronic form occurs secondary to repeat infections. In individuals with ureteric obstruction or anatomical abnormalities, these chronic infections are more frequent. 

Kidney infections are predominantly bacterial in nature, with E. coli responsible for 90 percent of the cases, which travels from the urethra upstream. Pyelonephritis can also occur due to bloodborne infection by staphylococcus bacteria. 

What are the symptoms of pyelonephritis?

Pyelonephritis presents with:

  • Sudden onset of high-grade fever with chills 
  • Pain in the back or groin 
  • Nausea and vomiting 
  • Abdominal pain

Generic symptoms of kidney disease include:

  • Cloudy urine 
  • Painful urination 
  • Blood in the urine 
  • Malaise
  • Difficulty initiating urinary stream 
  • Increased urination 
  • Urinary urgency 
  • Mental confusion—especially in older adults 
  • Moist skin 

What are the causes of pyelonephritis?

Factors that predispose to the development of pyelonephritis include:

  • Enlarged prostate: enlarged prostate and benign prostatic hyperplasia (BPH) causes urinary stasis through compression of urethra. This prevents complete emptying of the bladder and festering of bacteria in the bladder. These bacteria then travel through the ureters into the kidneys to cause infection.  
  • Structural abnormalities: strictures anywhere along the genitourinary tract, kidney or bladder stones and surgery can block the flow of urine and cause festering of bacteria.  
  • Pregnancy: in pregnancy the enlarged uterus may compress the ureters, leading to urinary stasis and superadded bacterial infections in the urinary tract.  
  • Uncontrolled chronic illness: an illness like diabetes, particularly poorly controlled diabetes can predispose the patient to pyelonephritis. 
  • Reflux of urine: backflow of the urine to the kidneys, due to any cause can contribute to bacterial infestation.  
  • Poor immunity: if the defense system of the body is doing poorly, such as with chronic infections like HIV, cancers, low white cell count and use of immunosuppressants, bacterial infection anywhere in the body can be carried to the kidneys.  

How is pyelonephritis diagnosed?

The diagnosis of pyelonephritis begins with a thorough history and physical examination. Thereafter, the investigations performed include:

  • Urine complete examination: urine is tested for presence of bacteria, blood, white cells and crystals of stones. With high white cell count and bacteria, suspicion of pyelonephritis is raised.
  • Blood culture: if the bacteria is blood borne, it can be isolated through blood culture. 
  • VCUG: the Voiding cystourethrogram is an x-ray image of the bladder taken when the bladder is full and after voiding, with the help of a dye. This imaging modality can highlight any anomaly along the bladder and urethra.
  • DMSA scintigraphy: a small amount of radioactive dye is used in this investigation to check for infection and scarring.
  • Imaging tests: CT scan and ultrasound of the kidneys also help in diagnosis.   

What are the risk factors of pyelonephritis?

People who are predisposed to kidney infections include:

  • Individuals with benign prostatic hyperplasia
  • Older adults 
  • Chronic kidney stones 
  • Chronic bladder stone 
  • Patients undergoing chemotherapy
  • Patients on immunosuppressants such as after organ transplant
  • Patients with spinal cord damage 
  • Surgery anywhere along the genitourinary tract 
  • Chronic catheter use 

How is pyelonephritis treated?

The mainstay of treatment in pyelonephritis is antibiotic therapy and dealing with the cause such as enlarged prostate or anatomical abnormality. Depending on the isolation of disease-causing organisms based on the urine and blood culture, the antibiotic is selected. In case of intravenous coverage of antibiotics, patients may be hospitalized and monitored by Best Nephrologist in Rawalpindi. Pyelonephritis secondary to enlarged prostate is treated by getting treatment for BPH. 

By Manali