Pyelonephritis

WHAT YOU SHOULD KNOW

Pyelonephritis is a bacterial infection of one or both kidneys. Acute (isolated) attacks are quickly remedied with antibiotics. Chronic cases are almost always secondary to some other disorder in the urinary tract.

Causes

Pyelonephritis usually starts when bacteria on the skin enter the urethra (the tube that empties the urine), swarm up into the bladder, and advance onward through the ureters into the kidneys. Invading bacteria are normally thwarted by the outward flow of urine, so any obstruction that causes urine to collect will allow the germs to flourish. Pregnancy, kidney stones, a bladder tumor, or a swollen prostate gland are among the leading culprits. Careless personal hygiene---particularly failure to thoroughly cleanse the area after a bowel movement---further encourages the onset of infection.

Chronic pyelonephritis is always the result of a major underlying disorder, such as an unremedied obstruction, persistent large kidney stones, diabetes, or a constriction of the urinary tract. Some cases are caused by a continual backflow, or reflux, of urine from the bladder into the ureters, a problem that stems from failure of the ureters to close off while the bladder is emptying. In rare instances, bacteria reach the kidneys via the bloodstream rather than the urinary tract.

Signs/Symptoms

Acute attacks of pyelonephritis are usually heralded by pain on either side of the lower part of the back (possibly spreading around and down to the groin), chills, fever, nausea, vomiting, and painful or frequent urination. You may also feel a constant need to urinate, even when your bladder is empty. When you do urinate, the urine may be cloudy or, if blood has leaked into it, light red.

Chronic pyelonephritis is more insidious, rarely producing symptoms until the disease is well established. Even then, initial signs are likely to be subtle: vague pains and intermittent fever. The most common symptoms are those associated with kidney failure, including fatigue, nausea, and itchy skin.

Care

The usual treatment is a course of antibiotics. The doctor may also order blood and urine tests and take an x-ray of the kidneys, particularly if the infection is found in a child, an older adult, or someone who has suffered previous attacks.

Risks

Allowed to progress unchecked, this condition can eventually cause kidney damage or even life-threatening kidney failure. With prompt treatment, however, full recovery can be expected.

WHAT YOU SHOULD DO

• Take the full course of antibiotics prescribed by your doctor. Don't stop when you begin to feel better; some bacteria could survive and cause a relapse.
• Be sure to drink plenty of fluids, particularly water.
• Avoid large quantities of protein and salt.
• Continue regular blood and urine tests to monitor the condition every six to 12 months.
• To avert future infections:
• • Urinate whenever you feel the need, rather than holding it in.
  • Change feminine sanitary protection frequently. Do not use oils, feminine hygiene sprays, or talcum powder in the genital area, and don't douche with chemical additives. Avoid nylon-crotch underwear.
  • Before intercourse, urinate and drink a glass of water. Afterwards, urinate again within 10 minutes.

Call Your Doctor If...

• You do not begin to see improvement after the first 48 hours of antibiotic therapy.
• Your symptoms return shortly after the antibiotics are finished.

Seek Care Immediately If...

• You have intense back pain.
• You see blood in your urine or stool.
• You have chills, fever, or vomiting.