Given that the kidneys are closely associated with the urinary tract, it’s likely that an infection of the urinary tract could harm the kidneys as well. ‘Kidneys commonly get infected and inflamed when the bacteria spread up the urinary tract or travel through the bloodstream to reach the kidneys,’ says Dr Avinash Ignatius is a Senior Consultant Nephrologist with DaVita NephroLife, Pune.
Pyelonephritis is the medical term used for inflammation of the kidneys. Clinically, it is more commonly referred to as a type of urinary tract infection that spreads to the kidneys. Kidney infection can be caused by viruses or bacteria. But, the bacterium Escherichia coli is the common causative agent for the disease.
‘Pyelonephritis can be either acute or chronic,’ says Dr Avinash.
- Acute pyelonephritis: It occurs rapidly and is a life-threatening infection of the kidneys that can lead to renal scarring.
- Chronic pyelonephritis: It is a permanent damage and scarring of the kidney due to repeated episodes of acute pyelonephritis or even a single episode of severe acute pyelonephritis.
A few people have an increased chance of suffering from pyelonephritis. These include people who have bladder infection, structural or anatomic problem in the urinary tract, diabetic individuals and people with a weak immune system.
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Symptoms of the disease can vary depending on your age and the severity of the condition. Common symptoms include:
- Painful urination
- Pain around the mid back are usual symptoms
‘Severe pyelonephritis may cause septicemia and shock associated with shivering and occasionally disorientation,’ says Dr Avinash. ‘Recurrent episodes or severe episodes of kidney infection can lead to significant scarring and irreversible damage to the kidneys. It can lead to chronic kidney disease (CKD) that gradually progresses to end stage renal disease (ESRD), where dialysis or kidney transplant may be needed,’ he says. Read: 12 symptoms of kidney disease you shouldn’t ignore
Usually, based on the patient’s history and physical examination, the doctor may suggest urinalysis to detect the presence of white blood cells and bacteria in the urine. Some other tests that might be needed include:
- Urine culture: It helps to identify contamination of urine sample with bacteria
- CT scan: It is used to visualize inflammatory masses and obstruction of the urinary tract
- Ultrasonography: This test is also used for identifying urinary obstruction
Dr Avinash says, ‘Acute pyelonephritis usually responds to antibiotics. But in case there are stones or if there is complete obstruction of the urinary tract surgical intervention may be required.’
Usually antibiotic therapy of 2 weeks or more is required to completely eliminate the infection as well as to prevent relapse. Antibiotics like fluoroquinolones or cephalosporine are commonly used.
Surgical procedures include the following:
- Pyeloscopy: This procedure is performed in case there are stones in the kidney. An endoscope is used to visualise the kidney drainage system. The endoscope also has a port and micro-basket that allows introduction of laser to break down larger stones as well as their retrieval.
- Percutaneous nephrostomy or percutaneous nephrolithotomy: It may be done to decompress the obstructed system and create a route for direct delivery of antibiotics at the site of infection, if needed.
‘Acute pyelonephritis can recur, especially if the predisposing cause is not corrected. Some factors like uncontrolled sugar level, abnormalities in the urinary tract, enlarged prostate gland, presence of kidney stones and lowered immunity can increase the risk of recurrence,’ he says.
Here are some expert tips to prevent recurring kidney infection
- Take antibiotics as prescribed
- Ensure you complete the course of antibiotics, even if there are no symptoms
- Drink adequate fluid to have a urine output of about 2.5 liters. However, this may not be possible in patients with CKD or heart failure, as they may need fluid restriction