Pyelonephritis is a urinary tract infection, usually caused by bacteria that lodges itself in the bladder and then reaches the kidneys causing inflammation. These bacteria are normally present in the gut, but due to some condition can proliferate and reach the kidneys.
E. coli is a gram-negative bacterium that normally inhabits the intestines, accounting for approximately 90% of the cases of pyelonephritis.
This inflammation is more common in infants under one year of age, because of the greater proximity between the anus and the urethra, and in men with benign prostatic hyperplasia because there is an increase in urinary retention.
Pyelonephritis can be classified as:
- Acute pyelonephritis, when the infection arises suddenly and intensely, disappearing after a few weeks or days;
- Chronic pyelonephritis, which is characterized by recurrent bacterial infections that have not been well cured, causing prolonged inflammation in the kidney and serious injuries that can lead to kidney failure.
The most characteristic symptoms of pyelonephritis are lumbar, pelvic, abdominal and back pain. Other symptoms are:
- Pain and burning sensation while urinating;
- Constant urge to urinate;
- Urine with bad smell;
- Blurred urine.
In addition, the urine test detects the presence of numerous bacteria and leukocytes in addition to the presence of blood in some cases. See the symptoms of a urinary tract infection
In addition to the acute and chronic types, pyelonephritis may be called emphysematous or xanthogranulomatous according to the symptoms that arise. In emphysematous pyelonephritis there is accumulation of gases produced by the bacteria present in the kidney, being more common in diabetics, whereas xanthogranulomatous pyelonephritis is characterized by intense and constant inflammation of the kidney, which leads to its destruction.
Pyelonephritis in pregnancy
Pyelonephritis in pregnancy is usually due to a prolonged infection in the bladder, caused by bacteria or fungi such as Candida albicans.
In pregnancy, kidney infections are quite common, because of the increase in hormone levels like progesterone leads to the relaxation of the urinary tract, facilitating the entrance of bacteria in the bladder and its multiplication. When the infection is not diagnosed or treated, the microorganisms multiply and begin to rise in the urinary tract, reaching the kidneys and causing their inflammation.
The treatment of pyelonephritis in pregnancy can be done with antibiotics, which have no effect on the development of the baby, according to the sensitivity profile of the microorganisms and have no effects on the development of the baby.
The treatment of pyelonephritis is usually done with antibiotics according to the sensitivity profile of the microorganism and should start as soon as possible to prevent kidney damage and prevent bacteria from spreading into the bloodstream causing septicemia. Analgesics and anti-inflammatory drugs can be used to relieve pain.
When pyelonephritis is caused by obstruction or malformation of the kidney, surgery may be needed to correct the problem.
Acute pyelonephritis, when untreated, may favor the occurrence of septicemia, renal abscess, renal failure, hypertension, and chronic pyelonephritis. In case of chronic pyelonephritis, severe kidney damage and kidney failure, in addition to the use of antibiotics, it may be necessary to have dialysis every week to filter the blood.
How is diagnosis reached
The diagnosis of pyelonephritis is done by an urologist, who examines your symptoms, does a physical examination such as palpation of the lumbar region and requests a urine teste to identify the presence of blood, leukocytes and bacteria in the urine. Ultrasound, x-ray and CT scans or magnetic resonance imaging may be performed to confirm the diagnosis, depending on each case.
The urine culture and antibiogram may also be requested by the physician in order to identify the agent that caused pyelonephritis, so that the best line of treatment is started. See how a urine culture is done.
Pyelonephritis can be confused with urethritis and cystitis since they are all urinary tract infections. However, pyelonephritis corresponds to an infection that reaches the kidneys, whereas in cystitis the bacteria reaches the bladder and in urethritis, the urethra.