Pyelonephritis Treatment in Delhi, India

Pyelonephritis is a bacterial infection causing inflammation of the renal pelvis. It is usually caused as a result of a urinary tract infection and affects the kidneys. In most cases, oral antibiotics can successfully treat this infection.

Associated Anatomy of Pyelonephritis

Pelvis, urethra, ureter, urinary bladder, kidney

Alternate Name of Pyelonephritis

Acute pyelonephritis, Chronic pyelonephritis

Pyelonephritis Causes

• Gram-negative bacteria cause kidney infection by entering the urethra and reproducing in the bladder. Escherichia coli is the most common causative organism. Other causative organisms include Proteus and Klebsiella enterobacter.
• Primary congenital defect of the vesicoureteral orifice
• Obstruction of the urinary bladder outlet
• Hematogenous infection is less common. It can occur as a result of septicemia, infective endocarditis, or bacteremia.
• Weakened immune systems
• Female physiology. The shorter urethra in females makes it easier for bacteria to reach the kidneys.
• The presence of kidney stones can cause infection.

Pyelonephritis Symptoms

Pyelonephritis Symptoms often develop in hours or days.

• Chills and fever
• Flank pain
• Back pain
• Costovertebral angle pain
• Nausea and vomiting
• Anorexia
• Urinary tract infection (UTI) symptoms include smelly or cloudy urine, urgency, frequency, and a burning sensation while urinating.

Atypical symptoms

• Epigastric pain
• Lower abdominal pain

Severe cases

• Bacteremia
• Sepsis, shock
• Multiple organ system failures
• Acute renal failure

Stages of Pyelonephritis

• Acute pyelonephritis is an infection that develops quickly. It is an upper urinary tract infection. An ascending infection most often causes acute pyelonephritis.
• Chronic pyelonephritis results from recurrent or inadequately treated episodes of acute pyelonephritis. Predisposition to infection, such as vesicoureteral reflux or chronically obstructing kidney stones. Chronic pyelonephritis results in scarring of the kidney.

Pyelonephritis Diagnosis & Test

Two common laboratory tests are advised.

• Routine urinalysis helps to check for pus or pyuria (present in nearly all patients), bacteria or bacteriuria, and the presence of WBCs and RBCs in urine.
• Urine culture to check for bacterial growth in urine. It helps choose the treatment depending on the type of bacteria strain cultivated.

If additional problems are suspected, imaging tests are advised.

• The doctor may order an ultrasound to look for cysts, cancer/tumours, or other obstructions in the urinary tract.
• A CT scan (with or without injectable dye) may be conducted if a patient does not respond to treatment within 72 hours. This test can also detect obstructions in the urinary tract.
• Radioactive imaging to check for scarred lesions.

Differential Diagnosis of Pyelonephritis

The differential diagnosis for pyelonephritis includes inflammatory disease of the pelvis, cholecystitis, and appendicitis.

Pyelonephritis Treatment

• Rehydration
• Oral antibiotics are taken for 7–14 days, including oral fluoroquinolones and aminoglycosides.
• In severe infections, hospitalisation and intravenous administration of ceftriaxone and fluoroquinolones are usually advised.
• A surgical procedure is required if a structural problem with the urinary tract is causing recurrent infections.

Risk Factor of Pyelonephritis

• It can affect any age group. Most commonly in older adults and children.
• Young females are more susceptible than males. The female urethra is much shorter than the male.
• Pregnant women
• Kidney stones or people suffering from bladder conditions
• Individuals suffering from vesicoureteral reflux, where small amounts of urine back up from the bladder into the ureters and kidneys.
• Kidney transplant
• Immunocompromised individuals, such as HIV/AIDS
• Sexual intercourse
• Indwelling catheter
• Urinary Tract Obstruction
• Certain medications

Pyelonephritis Preventions

Infections of the kidney begin as bladder infections in the lower tract. Keeping bacteria out of the urinary system and bladder can help prevent kidney infections. Some preventive measures include

• Drink plenty of fluids to prevent the buildup of germs.
• Using the toilet in a sitting position instead of squatting can relax the pelvic floor muscles and ensure the bladder empties well.
• Do not rush while urinating.
• Use a heating pad on your belly, back, or side.

Possible Complications of Pyelonephritis

Chronic kidney disease is a complication of pyelonephritis. The kidneys may be irreparably damaged if the infection persists.

Other complications include:

• Renal abscess formation
• Recurrent infections (usually seen in people with an anatomic problem that allows bacteria to cause infection easily)
• Renal scarring or high blood pressure
• The infection spreads in and around the kidneys.
• Papillary necrosis, or death of the renal papillae tissue, has a much worse prognosis because it can affect the kidney's overall ability to function.
• Acute renal failure
• Bacteria from the kidneys can enter the bloodstream, causing life-threatening sepsis.

Epidemiology of Pyelonephritis

• It occurs more often in females than males, with an annual rate of 15-17 cases per 10,000 females compared to 3-4 cases per 10,000 males.
• Young, sexually active females are the most at-risk group.
• Pregnant patients are at a higher risk.
• Patients with kidney stones have an increased risk of pyelonephritis.

Expected Prognosis of Pyelonephritis

If diagnosed and treated early, pyelonephritis responds well to treatment. It is important to undergo all laboratory investigations and take all medications prescribed by the doctor.

Natural Progression of Pyelonephritis

If left untreated, pyelonephritis can lead to potentially serious complications such as papillary necrosis and scarring of the kidneys. This scarring leads to chronic kidney disease, high blood pressure, septicemia, and renal failure. Abscess formation in or around the renal tissue is also possible.