What is pyelitis and how is treated?

What is pyelitis?

Pyelitis is an inflammation of the mucous membrane of the renal pelvis. This disease can occur at any age, but children are most often affected. This disease is especially common in girls 2-5 years old. This is due to the structural features of the female urinary system. Commonly, it develops as a complication of chronic cystitis that occurs in 60% of total cases of cystitis due to improper or insufficient treatment.

Short information about pyelitis

Clinical manifestations of the disease

There are localized and general signs of the disease that should be taken into account when the diagnosis is made. The symptoms and course of pyelitis are mostly identical for all types of infection, and only urinalysis can show what bacteria in particular caused the inflammation. Acute pyelitis begins with high fever (39.5-40 C or 103.1-104 F ), chills and general weakness.

Often 3-4 days pass without local symptoms, so the disease can be misdiagnosed as typhoid fever. From this point on, local symptoms should completely take the doctor's attention. Pus and bacteria in the urine may be absent only at the first moment of blockage of the pelvis; with their occurrence, urine becomes uniformly cloudy, giving a more compact sediment during settling than with cystitis. In some cases, erythrocytes are also found.

The detection of the caudate epithelium in the sediment, located among the purulent bodies singly and in layers, clearly characterizes pyelitis, as well as an admixture of cubic epithelium and cylinders speaks for the participation in the process of the renal parenchyma (pyelonephritis).
Pyelitis has 2 forms - acute and chronic. The symptoms depend on the form.

The acute form of pyelitis occurs suddenly and has pronounced symptoms:

- High body temperature up to 40 C (104 F);
- Fever;
- Severe lower back pain radiating to the genitalia and hips;
- Intoxication symptoms (nausea, vomiting, dizziness, etc.);
- Muscle pain;
- Weakness;
- Loss of appetite;
- Increased sweating;
- Headache;
- Violation of urination;
- Discoloration of urine;
- Grayness of the skin.

As a rule, the acute form is provoked by such pathogens as staphylococci, streptococci and E. coli, which enter the body through the urinary tract. In the first few days, symptoms may well indicate other diseases, for instance, severe acute respiratory syndrome (SARS) or cystitis.

The acute stage can last from several days to 3 months. If at this time the correct diagnosis was not made, and, accordingly, there was no necessary therapy, the disease transforms into the chronic form.

Chronic pyelitis during a flare-up has the same symptoms as the acute form. Additional symptoms are:

- Apathy;
- Dehydration;
- Dry tongue and gray coating on it;
- Vomiting.

During the period of remission, chronic pyelitis practically does not manifest itself in any way. The patient can suffer from fatigue and minor discomfort in the lower back. Painful sensations occur rarely and mainly after overcooling.

In the case of damage to both kidneys, the chronic form also manifests in frequent painful urination. In addition, lower back pain is much more common.
Chronic pyelitis can be confirmed by urinalysis. You need to consult a doctor right away, if you ignore this ailment, more serious pathologies may arise.

For example:

- Purulent pyelonephritis;
- Urolithiasis disease;
- Kidney abscess;
- Sepsis;
- Hydronephrosis;
- Ectasia;
- Toxic-resorptive fever.

You should not risk your health by trying to overcome inflammation on your own.

Forecast

After about 24 hours, the severe symptoms of the disease partially disappear. Within 3 days, urination should be completely normal. Acute renal inflammation is treated in most cases without consequences. Pyelitis in infants can be fatal.

Repeated and recurrent courses can lead to functional limitation of the kidneys. In rare cases, pyelitis causes blood poisoning (urosepsis) or accumulation of pus (abscess) in the area of the paired organ. In chronic pyelonephritis, renal failure develops, which does not respond well to conservative or invasive treatment. Sometimes lifelong replacement therapy is needed: dialysis or organ donor transplantation.

If you do not delay treatment, the prognosis is quite favorable. A sick person recovers quite quickly - in 10-14 days.

But if you ignore the symptoms, the patient will live for a maximum of 5 years. In the absence of treatment, as well as with improper treatment, various complications develop, which include:

- The transformation of an acute form into a chronic one.
- The occurrence of paranephritis - inflammation of the perineal tissue - and retroperitonitis - inflammation of the tissue of the retroperitoneal region.
- High arterial pressure.
- Kidney failure.
- The emergence of a number of other diseases: urosepsis, apostematous nephritis; septic and bacteremic shock that can be fatal.
In most patients, pyelonephritis has a chronic latent form. People live normal lives, often without even knowing about kidney disease for years.

But in some patients, frequent relapses occur, the renal tissue undergoes serious inflammatory-dystrophic changes, as a result of which secondary arterial hypertension, chronic renal failure, and urosepsis may develop.

These complications can significantly worsen the prognosis of not only the underlying disease, but also the duration and quality of life.

Typical disease dynamics

Acute pyelitis is distinguished by the following symptoms:

- Clouding of urine and a delay in its outflow;
- Fever with a variable temperature up to 39 degrees;
- Headache and soreness in the kidney area;
- Weakness, general intoxication;
- Grayish skin tone, increased sweating;
- Poor appetite.

With chronic pyelitis, the symptoms are even more dangerous:

- Fever with sudden changes in temperature.
- Intense low back pain.
- Vomiting.
- Dehydration.
- The tongue becomes gray and dry.
- Weakness with signs of apathy.

The course of acute pyelitis is extremely diverse: in some cases, the temperature lasts for 3-7 days and with its fall, all symptoms of pyelitis subside; in other cases, the fever may last up to 14-18 days. There are cases when acute pyelitis begins with a slight rise in temperature and a slight general malaise.
Also, pyelonephritis, mostly of urogenic origin, can begin differently. Often one has to meet with chronic pyelitis without an acute onset and without any special subjective complaints. This pyelitis occurs with prostate hypertrophy, urethral strictures, canal fistulas, cystitis and other chronic diseases of the lower urinary tract.

Everything seems to be going well; while the inflammation is limited to only one pelvis and there is a free outflow of purulent urine. But as soon as there is retention of urine in the pelvis and the sequential absorption of toxins from it, general severe phenomena immediately appear. The same retention is the main reason for the spread of the inflammation to the kidneys, i.e. pyelonephritis.

The main mistake is neglecting the disease! The sooner you start treating cystitis, the better. There is a medicine advised for self-treatment and prophylaxis of cystitis at home - Macrobid which you can buy online without a prescription ad always have at hand.

The diagnosis of pyelitis is based on a symptom complex, urine analysis and ureteral catheterization data. The history and course of the disease adequately outline the disease of the pelvis, in contrast to cholecystitis and appendicitis. Costovertebral angle (CVA) tenderness, i.e. pain that results from touching the region inside of the costovertebral angle, i.e. the acute angle on side of the back between the twelfth rib and the vertebral column, is a very valuable sign.

The study of urine shows the presence of pus, epithelium of the pelvis and a significant number of microbes, the determination of which requires careful collection of urine by a catheter into a sterile container - especially in women, so as not to mistake a simple admixture of vaginal secretions for pyuria.
Determination of flora is necessary to clarify the etiology and type of infection. There are cases of aseptic pyuria, characteristic primarily of renal tuberculosis, as well as chronic deep-seated staphylococcal infections of the urinary tract.

Cystoscopy can sometimes give a positive result in unilateral lesions, when there is a change in the bladder wall on the diseased side and the removal of turbid urine from the ureter. For the diagnosis of pyelitis, an overview and excretory urography is also appointed.

A valuable method of research is ureteral catheterization, which quite accurately establishes a unilateral or bilateral disease, its intensity, and the degree of change in the pelvis.

How to treat pyelitis?

It is much more difficult to suspect kidney inflammation in children, despite the fact that they suffer from pyelitis much more often than adults. The clinical picture of the disease is usually unclear. In addition, symptoms that are not typical of this ailment often occur.

The symptomatology of pyelitis in children depends on the age of the small patient. In preschool children, inflammation is accompanied by such signs as:

- An increase in temperature (can be both insignificant and very high);
- Chills;
- Back pain;
- Violation of urination;
- Pain in the lower abdomen;
- Urinary incontinence;
- Vomiting;
- Cardiopalmus;
- Pain when urinating;
- Intoxication.

According to urine tests, the doctor diagnoses Leukocyturia (the presence of leukocytes in urine), which is the main reason for determining pyelitis. It is worth noting that leukocytes in urine may appear for several months after the completion of treatment. Pediatricians call this recurrent leukocyturia.
The anatomical features of the urethra of little girls (a wide but short urethra) lead to the fact that almost all bacteria from the genitals freely rise to the kidneys. Therefore, girls of preschool and primary school age are most susceptible to this disease. Quite often, pyelitis is a complication after cystitis.
Young children, up to a year, cannot complain of pain in the lower back or lower abdomen. Therefore, if the child is restless, refuses food, and he has a fever, it is necessary to do a urinalysis to exclude inflammation of the renal pelvis.

In babies in the first months of life, typical symptoms may be absent altogether. In such cases, a nonspecific course of the disease is observed, accompanied by such signs as:

- Increased breast sucking;
- Vomiting;
- Diarrhea;
- Yellow tint of the skin;
- Drowsiness;
- Sleep apnea (breathing disorder).

At this age, it is very difficult to notice a violation of urination. It is worth suspecting pyelitis if the child's body temperature rises for no reason and diarrhea occurs. Signs of urinary tract damage at an early age are usually absent. However, long-term indigestion (parenteral dispersion) is observed.

Most often, a diagnosis in a child (of any age) is made based on criteria such as:

- A history of kidney disease;
- Pain in the lower abdomen;
- Leukocyturia.

It is difficult to completely cure pyelitis in children, it will take more than one week, and in case of violation of the doctor's recommendations - even years, during which the disease will either recede or return.

After the end of treatment, the child's condition is normalized, however, an admixture of pus in the urine, due to which it becomes cloudy, is observed for several more months. You shouldn't worry too much about this, but a consultation with a pediatrician at least once every 2-3 weeks is necessary.
Treatment of pyelitis aims to overcome the infection and restore the impaired function of the pelvis. It should be started without delay, as soon as the first symptoms of the disease appear and a diagnosis is made. The first thing to consider is diet.

It is necessary to exclude from the diet foods that irritate the kidney parenchyma. We are talking about alcohol, smoked meats, salt, etc. But daily drinking of liquids - up to 4 liters, dairy products, fruits and freshly squeezed juices, fruits and vegetables - on the contrary, are recommended.
An additional help in the treatment of pyelitis will be herbs - horsetail, bear's ear, and cranberry, lingonberry and juniper teas, and special urological herbal teas.

To fight the infection, after determining the type of pathogen, appropriate antibiotics are prescribed, for example, Nitrofurantoin, Levomycetin, Cefatoxim, Amoxicillin, Cefazolin, etc. Antimicrobial drugs are also prescribed to the patient: Biseptol, Streptocid, Monural n etc.

In fever, antipyretic drugs are indicated - in particular, paracetamol. Given the presence of pain, analgesics are prescribed, including, for example, No-spa, Spazgan, Spazmalgin, etc.

But not all pain relievers can be recommended for this condition. So, Ibuprofen and Nimesulide will be toxic to the kidneys.
Also, infusion-detoxification, physiological and anti-inflammatory therapy is carried out.

Treatment of severe acute pyelitis and pyelonephritis, if therapy does not give an effect - operative: renal decapsulation, nephrotomy, nephrectomy are performed.

Pyelitis is a term for inflammatory processes in the mucous membrane of the renal pelvis. If the pathology is not treated, small abscesses can develop in the paired organ, which leads to a recurrent course or kidney failure.

The chronic form of pyelitis can be asymptomatic for several years. If the urinary tract becomes inflamed for a longer period of time (due to vesicoureteral reflux, urethral ganglia), acute pyelitis becomes chronic.

All patients must comply with bed rest so that the body does not lose excess energy. It is advisable to drink plenty of fluids to cleanse the urinary tract. If much less urine is excreted from the body than is consumed, you should see your doctor and have your kidney function checked.

It is important to take antibiotics even after the condition improves. A patient who stops using the drug too early increases the risk of relapse.

Women are more likely to suffer from pyelitis than men, because their urethra is very close to the anal canal; this makes it easier for bacteria to enter the kidney. Therefore, patients should pay attention to hygiene advice: after sexual activity, it is imperative to cleanse the genitals. After completing the act of defecation, it is always necessary to wipe the skin from the vagina to the anal passage.

To prevent cystitis and subsequent inflammation, the patient must avoid hypothermia and adverse weather conditions. In summer, you need to change your swimwear after swimming. In winter, a woman should wear thicker tights to keep her belly warm. Failure to follow the above tips can lead to serious complications and relapse of the disease.

Post by: Kylie Richardson, General Practitioner, Rotterdam, Netherlands