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Pyelonephritis

Pyelonephritis is a urinary tract infection that is ascending reaching the pelvis of the kidney. Urosepsis is the term if the condition becomes severe meaning it has spread throughout the different systems of the body because of infection. It may cause septic shock with symptoms of low blood pressure, increased heart rate and rapid breathing. Antibiotics are required for therapy and any cause involved preventing recurrence. It can also be called as nephritis or pyelitis.

Symptoms include, dysuria or pain in urination, abdominal pain radiating at the back and bladder tenderness at the side of the involved kidney. Fever, shivering especially with increasing temperature, vomiting and headache are some symptoms of systemic cases. Delirium may be present.

Pyelonephritis occurs in twelve to thirteen women per 10,000 population and three to four per 10,000 population in men. Young women are mostly affected especially the ones engaging in sexual activity. Elderly and infants have increase risk due to hormonal and anatomical changes.

Diagnosis

PyelonephritisDoing a dipstick test with presence of white blood cells and nitrate in the urine with usual symptoms is acceptable to confirm presence of pyelonephritis. It is an indication that practical treatment should be done. If the source of infection is doubtful, formal tests like urine cultures should be done.

A suspected kidney stone with colicky pain and bloody urine features brings the patient to the X-ray room for x-ray of the kidney, ureter and bladder to confirm diagnosis.

Causes

Pyelonephritis that is community-acquired is due to organisms in the bowel entering the urinary tract. E. coli comprises 70% to 80% of infection. Enterococcus faecalis is another causative agent. Hospital-acquired infections are due to enterococci and coliforms. Most pyelonephritis starts in the lower urinary tract with prostatitis and cystitis.

· Mechanical cause

Structural abnormalities involving the kidney and urinary tract, calculi or kidney stones, vesicoureteral reflux in young children, drainage procedure like nephrostomy, neurogenic bladder, pregnancy and prostate disease can be the causes of pyelonephritis.

· Consitutional cause: immunocompromised and diabetes mellitus patients

· Behavioural cause: sex partner change and use of spermicides

· Family members with frequent UTIs

Treatment

Antibiotics are the main treatment of pyelonephritis because it is mainly caused by bacteria. Oral antibiotics may be prescribed in mild cases but intravenous antibiotic therapy should be initiated as an initial stage of treatment.

Antibiotics may include beta lactams such as cephalosporin and amoxicillin; flouroquinolones like ciprofloxacin; and trimethoprim in combination with sulfamethoxazole. Antibiotics with increased toxicity like aminoglycosides are avoided.

Intravenous fluids are administered to reduce oral intake and to compensate for insensible water loss because of increased temperature and vasodilation and to increase output of urine. Percutaneous nephrostomy is indicated for septic patients.

In patients having recurrence, surgery is indicated to treat abnormalities. But if no abnormality is identified, the doctor suggests consuming antibiotics as treatment for long term use. Drinking of cranberry juice is also a helpful measure.

Also, drinking of blueberry juice, increase oral fluid intake and milk products that are fermented containing probiotic bacteria has shown to inhibit bacteria adherence to the urinary tract’s epithelial cells.

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