Acute Pyelonephritis

What is acute pyelonephritis?

The acute pyelonephritis or kidney infection is infection of the parenchyma and renal pelvis.

Acute pyelonephritis is caused by germs that have escalated through the ureters from the lower urinary tract (bladder and urethra). It is in short, a urinary infection that has reached the kidney, says Urologist in Noida.

According to the Urologist in Greater Noida, Urinary tract infections are a frequent pathology in women and men from 50 years of age.

The germ that produces acute pyelonephritis in the first place is E. coli, which is responsible for 80% of the cases.

The other 20% of cases, on the other hand, are due to germs of the Enterobacteriaceae family (bacteria that are part of the microbiotic of the intestine) such as:

• Klebsiella.
• Proteus.
• Enterobacter.
• Pseudomonas. 
• Citrobacter
• Serratia
• Also, germs such as E. Fecalis, S. aureus and S. epidermidis.

The treatment of trigger situations and antibiotics attenuate the severity of the process.

Causes of acute pyelonephritis

When assessing the causes of upper urinary tract infection (ITUS), it is important to consider first:  the age and sex of the patient, says Urologist in Sector 93 Noida.

Pyelonephritis in children

In children pyelonephritis are infrequent and therefore it is advisable to always rule out a congenital anomaly that favours its appearance. According to the Urologist in Ghaziabad, the congenital anomalies that most often produce pyelonephritis in children are the following:

• Vesico-ureteral reflux.
• Urethral valves
• The stenosis of the pielo-ureteral junction.
• Cystine stones in the kidney.

From this we can conclude that in every child who has recurrent urinary tract infections, complementary tests should be performed.

Pyelonephritis in women

In women, cystitis is very frequent and is therefore the leading cause of pyelonephritis in women. However, when pyelonephritis is repeated frequently, it is advisable to rule out:

• Lithiasis (stones) in the urinary tract.
• Reflux vesicoureteral.
• Cystopathies (diseases of the bladder).

Pyelonephritis in men

In men, pyelonephritis is uncommon before age 50, but even so, it is advisable to rule out when they recur, the presence of:

• Benign prostatic hypertrophy (over 45-50).
• Prostatitis (young men).
• Lithiasis in the urinary tract.

Symptoms of acute pyelonephritis

The three most common symptoms of acute pyelonephritis are:

• Chills (sometimes with intense shivering).
• High fever.
• Pain in the costovertebral angle.

but we must bear in mind, however, that it is often accompanied by symptoms such as:

• Increased micturition frequency
• Voiding pain
• Urinary urgency.

According to the Best Urologist in Noida, Acute pyelonephritis can also present symptoms related to the gastrointestinal tract such as: abdominal pain. nausea and vomiting and sometimes diarrhoea.

Previous situations that may aggravate pyelonephritis

As per the Best Urologist in Ghaziabad, although the ITUS are solved with antibiotics without major problems. There are, however, circumstances that may favour the evolution towards serious conditions such as urinary sepsis or renal failure. These situations are the following:

• Obstruction of the urinary tract by stones.
• Urea degrading bacteria, which favour the appearance of struvite stones.
• Drains with catheter.
• Injuries to the spinal cord.
• Diabetes
• The congenital anomalies.

Tests for the diagnosis of acute pyelonephritis

Undoubtedly the clinical symptoms of high fever, chills and low back pain already suggest the possibility that we are facing acute pyelonephritis. Fortunately, we have several tests that also help us to diagnose:

• Laboratory tests:
  • Urinary sediment: will show the presence of leukocytes, leukocyte cylinders and red blood cells.
  • Urine culture: positive.
  • Blood test: It usually shows an increase in the speed of sedimentation, leucocytosis, increase of C reactive protein and   blood culture.
• Imaging tests: Kidney ultrasound is imprecindible. CT on the other hand, may be indicated in cases with complications (abscesses).

What is the treatment of acute pyelonephritis?

When dealing with the treatment of pyelonephritis, it is first necessary to modify the previous situations that may aggravate the infection, such as, for example, obstruction of the urinary tract (with stenting or percutaneous nephrostomy), says Urologist in Vaishali.

Antibiotics remain the cornerstone of treatment.

Follow-up of patients who have suffered acute pyelonephritis

• A urinalysis with urine culture, two weeks after completing the treatment.
• The renal ultrasound should be performed 6-8 weeks after completing the treatment, to assess if scars have been left in the kidney.
• A blood test with creatinine determination, in cases in which pyelonephritis has been complicated, to assess if there has been deterioration of renal function.

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