Chronic Pyelonephritis - Causes, Symptoms, Diagnosis, and Treatment

What Is Chronic Pyelonephritis?

Pyelonephritis results from a bacterial or viral infection. Most kidney infections start as urinary tract infections or bladder infections in particular. Urinary tract infections originate from the urinary tract and migrate to the kidney, causing tubulointerstitial inflammation involving the renal pelvis and the parenchyma. 90 % of kidney infection is caused by Escherichia coli (E coli) bacteria. The bacteria migrate from the genitals through the urethra into the bladder. Bacteria such as Staphylococcus enters the kidneys through the bloodstream causing kidney infections.

In some cases, a kidney infection can happen after surgery if bacteria enter the bloodstream during the procedure and travel to the kidneys. The body can defend against infections in the urinary tract. For example, urine flow is one way away from the kidneys to the bladder. Viruses or bacteria that enter are flushed out by urination; this one-way flow of urine usually prevents infection in the urinary tract.

What Causes Chronic Pyelonephritis?

• Benign Prostatic Hyperplasia - Benign prostatic hyperplasia condition characterized by an enlarged prostate gland resulting in compressing the urethra.

• Vesicoureteral Reflux - Backward flow of the urine from the bladder towards the kidney is vesicoureteral reflux.

• Pregnancy - Enlarged uterus conditions during the pregnancy can squeeze the ureters and reduce the flow of urine, allowing the bacteria to migrate to the kidneys.

• Diabetes Mellitus - Uncontrolled diabetes mellitus can pose a risk for pyelonephritis.

• Immunocompromising Diseases - Systemic diseases causing compromised immunity include HIV (human immunodeficiency virus) infection, cancer, lupus, type of diabetes mellitus, certain medications, or low white blood cell count.

• Structural Abnormalities - Abnormalities blocking the urine flow include stents, stones, surgery, and strictures.

What Are the Symptoms of Chronic Pyelonephritis?

Symptoms of kidney infection depend on age; symptoms may include-

• Fever.

• Cheers.

• Nausea.

• Vomiting.

• Pain in the back, side, or groin.

• Dark, cloudy, foul-smelling urine.

• Painful and frequent urination.

• Younger children of one or two years old may not have any sign of kidney infection except high fever.

• An adult older than 65 years with a kidney infection may not have any typical symptoms but can not have other problems with thinking like confusion, hallucinations, and jumble speech.

What Are the Risk Factors Associated With Chronic Pyelonephritis?

• Being Female - Females have a shorter urethra than men, which makes it susceptible for bacteria to travel from outside the body to the bladder. The small distance between the urethra to the vagina and the vagina to the anus also creates more chances for bacteria to enter the bladder. Once the bladder is infected, it can spread to the kidneys. Pregnant women are at risk of kidney infection.

• Compromised Immunity - Medical conditions that impair the immune system include diabetes, HIV, cancer, and certain drugs taken to prevent rejection of the transplanted organs.

• Damage to Nerves Around the Bladder - Damage to the nerves and spinal cord can prevent the sensations of a bladder infection, and unawareness of having an infection can pose a risk.

• Vesicoureteral Reflux - Small amount of urine flow from the bladder towards the ureters and kidneys is called vesicoureteral reflux.

• Sepsis - Sepsis is a life-threatening condition that a kidney infection can sometimes cause. It occurs when the body's response to an infection damages its own tissues. It may progress to septic shock. Symptoms of sepsis are fever, chills, rash, confusion, rapid breathing, and heart rate.

• Kidney Failure - Chronic infection can cause permanent damage to the kidneys leading to kidney failure.

How Is Chronic Pyelonephritis Diagnosed?

• Urinalysis - Urine analysis is done to check for the presence of renal epithelial cells, granular cast, and white blood cells. The presence of protein is always in the nephrotic range if vesicoureteral reflux causes extensive renal damage. Defects in concentrating ability and hyperchloremic acidosis can appear.

• Urine Culture - Urine culture is done in order to detect the presence of any positive or gram-negative organisms. A urine culture may be sterile or positive, usually for gram-negative organisms.

• Imaging Tests - Ultrasonography, computed tomography scan, or intravenous urography (IVU) are generally done to check for the presence of reflux or obstruction in the urinary tract. Diagnosis is made depending on the presence of a deep or coarse cortical scar, usually extending to one or more of the renal calyces. In addition, ureteral dilation due to severe chronic reflux can be seen.

How to Treat Chronic Pyelonephritis?

• First-generation cephalosporins that includes Penicillins (Amoxicillin) is the drug of choice for treating chronic pyelonephritis. Since the bacteria are gram-negative, the Penicillins have good activity against gram-negative rods and good oral bioavailability.

• In newborns from three to six months aged, therapy changed to Sulfamethoxazole or Nitrofurantoin. Older children and adults can be treated with Trimethoprim-sulfamethoxazole.

• Once the antibiotic regimen is chosen, it is continued without any frequent changes to help prevent the development of resistance.

• A patient undergoing a kidney transplant with chronic pyelonephritis may need a nephrectomy before the transplant.

How to Prevent Chronic Pyelonephritis?

Kidney infections start from lower unity tract infections in the bladder. Therefore, kidney infections are prevented by keeping the bacteria out of the reach of the urinary tract and bladder. Ways to avoid infection and keep the urinary tract healthy include -

• Urinate Completely - Empty the bladder completely while urinating. Delaying urination after an urge and holding in urine can be harmful and promote the growth of bacteria. Urinating every considerable hour can help to wash any bacteria out of the body, preventing it from infection.

• Hydration - Adequate intake of fluid every day is required to prevent infections. The amount can vary if there is the presence of any medical conditions.

• Urinate After Having Sex - Urination after sex helps flush out any bacteria that may have entered the body. Both men and women should do this to prevent infection.

• Practice Good Hygiene - Practicing clean and healthy habits can protect the body from infections. Wipe from front to back after a bowel movement to push bacteria away from the urethra, especially for women.

Conclusion :

Chronic pyelonephritis is a kidney infection caused by bacteria or viruses. Most kidney infections result from infections of the lower urinary tract. The symptoms include fever, nausea, vomiting, chills, and pain in the side. Diagnosis can be made on the basis of clinical history, routine lab tests, and computed tomography (CT) scans. The treatment involves an antibiotic regimen that needs to be followed for about 14 days.