What is pyelonephritis
Most often, the infection enters the kidney via an ascending route: from the bladder up the ureter. Less commonly, bacteria are introduced through the bloodstream from another source of infection.
Inflammation develops in the kidney tissue: it swells, foci of infiltration appear, and in severe cases - ulcers. The body responds with high fever and intoxication, so pyelonephritis is much more severe than cystitis.
It is fundamentally important to separate the two options. Non-obstructive pyelonephritis occurs when urine flows freely and usually responds well to antibiotics. Obstructive occurs when the outflow is blocked by a stone, stricture or external compression: infected urine accumulates under pressure in the kidney, and without drainage, antibiotics simply do not reach the site.
Symptoms of pyelonephritis
- Temperature rises to 38–40 °C, often with shaking chills
- Pain in the lower back or side, usually on one side, dull or bursting
- Severe weakness, fatigue, headache
- Nausea and vomiting
- Frequent and painful urination - if pyelonephritis develops after cystitis
- Cloudy urine, sometimes with an unpleasant odor
- Sweating, lack of appetite
- In older people, confusion and falls due to a mild temperature reaction
Chronic pyelonephritis is milder and more insidious: prolonged low-grade fever, fatigue, periodic aching pain in the lower back, episodes of increased pressure. Sometimes the only sign is changes in urine analysis discovered by chance.
Causes and risk factors
- Urinary tract infection arising from the bladder
- Urolithiasis - the stone disrupts the outflow and serves as a reservoir for bacteria
- Prostate adenoma, urethral stricture, sclerosis of the bladder neck - everything that causes stagnation of urine
- Vesicoureteral reflux - reflux of urine from the bladder back into the ureter
- Pregnancy: the uterus puts pressure on the ureters, and hormones reduce their tone
- Diabetes mellitus
- Decreased immunity, taking immunosuppressive drugs
- Bladder catheterization, stents and nephrostomy tubes
- Anomalies of the kidneys and ureters
- Hypothermia as a provoking factor
Why is pyelonephritis dangerous?
- Apostematous pyelonephritis, carbuncle and kidney abscess are purulent forms that require drainage or surgery
- Paranephritis - spread of pus into the perinephric tissue
- Urosepsis and septic shock are life-threatening conditions
- Acute kidney damage with decreased kidney function
- Chronic pyelonephritis with kidney shrinkage
- Persistent arterial hypertension of renal origin
- Chronic kidney disease with a bilateral process
Diagnostics
- General urine analysis - leukocytes, bacteria, protein, casts
- Urine culture with sensitivity determination - taken before starting antibiotics
- Complete blood count with leukocyte count, CRP
- Blood biochemistry: creatinine, urea, electrolytes, glucose
- Blood cultures for high fever and suspected sepsis
- Ultrasound of the kidneys - assessment of the size, expansion of the pelvis, the presence of stones and purulent foci
- CT scan of the urinary system - if obstruction, abscess is suspected, if there is no effect of treatment within 48–72 hours
- Excretory urography and dynamic nephroscintigraphy in chronic cases
- Consultation with a nephrologist for decreased kidney function
Treatment of acute pyelonephritis
Treatment is determined by whether urine flow is free and how severe the patient's condition is.
- Antibacterial therapy is the basis of treatment; start empirically, then adjust based on culture results; the course is usually longer than for cystitis
- Hospitalization for high fever, vomiting, pregnancy, solitary kidney, diabetes, signs of sepsis
- Fluid therapy and diuresis control
- Pain relief and antipyretics
- Urgent restoration of urine outflow in case of obstruction: ureteral stenting or percutaneous nephrostomy
- Drainage of kidney abscess or paranephrium with purulent complications
- The introduction of antibiotics into the perinephric tissue is an auxiliary method for severe forms
- Surgical treatment up to removal of the kidney - in extreme cases with its purulent destruction
A common mistake is to stop taking the antibiotic as soon as the fever subsides. Clinical improvement occurs in 2–3 days, but complete sanitation of the lesion requires the entire prescribed course. Incomplete treatment is a direct road to chronic form and resistant bacteria.
Chronic pyelonephritis
The chronic form develops when the cause persists: stone, reflux, impaired urine flow, untreated infection. The kidney gradually loses functional tissue, which is replaced by scars.
- Mandatory search and elimination of the cause of urinary stagnation - without this, treatment will not be successful
- Course of antibiotic therapy for exacerbations, strictly according to culture
- Blood pressure control
- Regular monitoring: urine test, creatinine, kidney ultrasound
- Adequate drinking regime and moderate salt restriction
- Observation by a urologist and nephrologist
Prevention
- Timely and completely treat cystitis and other urinary tract infections
- Eliminate the causes of urinary outflow obstruction: stones, adenoma, strictures
- Drink enough fluids and avoid the urge
- Control diabetes
- Pregnant women should have their urine tested regularly, even if there are no complaints.
- Avoid hypothermia
- After suffering from pyelonephritis - control urine tests and ultrasound according to the schedule prescribed by the doctor
Where is pyelonephritis treated in Tashkent
Acute pyelonephritis is a situation where a 24-hour laboratory, ultrasound and CT scanning, a hospital, and the ability to urgently perform stenting or nephrostomy are needed. Only mild non-obstructive forms are treated outpatiently.
In Tashkent, diagnosis and treatment of pyelonephritis, including those complicated by stones and requiring kidney drainage, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have already had an attack of renal colic or are known to have kidney stones, and now your temperature has risen, do not delay calling until the morning and do not start an antibiotic yourself: this blurs the picture and makes it difficult to choose treatment. Clinic contacts and online registration are below.
