What is pyelonephritis and how is it treated?

Pyelonephritis ranks second after upper respiratory tract infections by incidence. Over the past 20 years, the incidence of histological pyelonephritis (pyelonephritis of pregnancy) has increased 5 times.

Pyelonephritis is an infectious, inflammatory kidney disease with the localization of the pathological process in the calyx-pelvic system and in the interstitium. The process is often asymmetric, and leads to deformation of the kidney. The causes of pyelonephritis are often infectious, as well as a violation of the outflow of urine, fluctuations in hormonal levels, and decreased immunity.

Pyelonephritis can be primary and secondary, acute and chronic, unilateral and bilateral.

Short information about pyelonephritis

Primary pyelonephritis is non-obstructive, that is, there are no processes that interfere with the outflow of urine.

Secondary pyelonephritis occurs where there is a violation of the outflow of urine, namely: congenital anomalies, renal duplication, calculi, nephroptosis.

Acute pyelonephritis is more often a one-sided infectious inflammatory process of varying degrees of intensity. It can turn into a chronic form, recovery or death.

Chronic pyelonephritis is a sluggish, periodically exacerbating inflammatory process in the kidneys, leading to sclerosis and kidney deformity, as well as to increased blood pressure and chronic renal failure.

Chronic pyelonephritis often occurs as a consequence of acute pyelonephritis, but it can also be a primary chronic process. Usually, at the same time, patients complain of malaise, desire to lie down, thirst, dry mouth, chills, palpitations, headaches, shortness of breath, joint pains, loss of appetite, nausea. They also often suffer from dull pain in the lumbar region (lower back), frequent urination in small portions, especially at night. The course of the disease can be undulating, hidden.

Disease symptoms

Typical symptoms of pyelonephritis:

- General weakness;
- High fever (up to 40 C or 104 F);
- Chills;
- Puffiness on the face;
- Frequent urination;
- Clouding of urine;
- Pain in the lumbar region (lower back) (unilateral or bilateral).
- Sometimes patients complain of nausea and vomiting, headache and dizziness.

Causes of the disease

The causative agents of pyelonephritis are most often E. coli, Proteus, enterococcus, and staphylococcus. Bacteria enter the kidney ascending, i.e. upwords from the lower urinary tract organs, if there are diseases of the bladder, urethra; and hematogenous, that is, with a blood flow from an infected focus.

Factors contributing to the disease:

- Hypothermia;
- Previous occurrences of pyelonephritis;
- Untimely emptying of the bladder;
- Urinary tract infections and untreated diseases;
- Acute inflammatory diseases - tonsillitis, abscesses;
- Concomitant diseases - diabetes mellitus, infectious diseases, vitamin deficiency.

Diagnostics of pyelonephritis

Diagnosis of pyelonephritis begins with a doctor's consultation. He or she conducts a survey and learns important data for making a diagnosis.
Then laboratory research methods are appointed. These include:

- General urine analysis. With pyelonephritis, protein is detected in the urine, a decrease in the specific gravity of urine, leukocyturia - an increase in the number of leukocytes.
- Culture of urine for sterility is the most important method for diagnosing pyelonephritis. Normally, the urine of a healthy person is sterile. In case of urinary tract infections, microorganisms are found. The analysis helps to identify the pathogen and determine its sensitivity to antibiotics.
- Microscopic urinalysis test shows the number of erythrocytes, leukocytes and cylinders in the urine. With pyelonephritis, all indicators can be increased.
- A general blood test for pyelonephritis will show an increase in leukocytes and ESR.
Further - instrumental methods:
- Ultrasound allows determining the change in the size of the kidney with pyelonephritis, the density of its parenchyma, deformation and expansion of the pyelocaliceal system, obstruction of the urinary tract.
- Excretory urography. The study is performed if no pathologies are detected on ultrasound. With the help of this research method, it is possible to identify obstruction of the urinary tract, to see a change in the contours of the affected kidney, deformation of the calyx-pelvis system.
- Computed tomography (CT) and magnetic resonance therapy (MRI) are prescribed in cases where ultrasound and excretory urography turned out to be uninformative, or if a tumor process is suspected.

Complications of kidneys inflammation

Complications of pyelonephritis are as follows:

- Acute renal failure may develop with bilateral pyelonephritis.
- Chronic renal failure develops as a result of prolonged bilateral pyelonephritis
- Urolithiasis disease (kidney stones formation).
- Pyonephrosis is the final stage of purulent inflammation of the kidney, the organ is completely filled with pus.
- Arterial hypertension of renal origin.

Treatment of the disease

- The most important treatment for pyelonephritis is antibiotic therapy. At the beginning of treatment, broad-spectrum antibiotics are usually prescribed such as Macrobid (Nitrofurantoin). After obtaining the result of urine culture, the most suitable antibiotic is determined specifically for the inoculated pathogen. With pyelonephritis with a hematogenous (through the blood) route of infection, treatment should be aimed at eliminating the primary focus of infection (treatment of chronic tonsillitis, tonsillitis, carious teeth).
- For pain syndrome, pain relievers and antispasmodics are prescribed.
- In the presence of complications, pyonephrosis, urolithiasis, surgical treatment is indicated.

Risk group

Risk groups for pyelonephritis:

- Children;
- Pregnant;
- Men with prostate disease;
- People with urolithiasis;
- People with untreated diseases of the genitourinary system;
- The presence of chronic foci of infection;
- Patients with diabetes mellitus;
- People with impaired urine flow;
- Patients who have undergone invasive manipulations on the bladder (cystoscopy, catheterization).

Prevention of pyelonephritis

Prevention consists in the timely detection and treatment of inflammatory diseases, which in the future can provoke the development of pyelonephritis, in the regular and timely emptying of the bladder, avoiding hypothermia.

Diet and lifestyle

From the menu of a patient with pyelonephritis should be excluded:

- Broths and soups on broths;
- Canned food;
- Smoked meats and fish;
- Pickles;
- Alcohol and soda;
- Spicy dishes;
- Coffee;
- Chocolates, sweets, cakes.

The cooking of allowed food should be made by boiling, stewing, and steaming.

Patients are advised to consume a lot of liquid: fruit drinks, jelly, compotes, rosehip decoction, herbal teas.

A person who has had pyelonephritis is advised to follow a diet; drink herbal preparations and mineral water as prescribed by a doctor, avoid hypothermia, and do not neglect inflammatory diseases of other organs and systems.

Treatment of acute or exacerbation of chronic pyelonephritis

Treatment should be started in a hospital with obligatory adherence to bed rest, diet, prescription of antibacterial drugs, taking into account their specific effect on the causative agent of the disease. The number of bacteria in the urine after the start of treatment rapidly decreases, therefore, the analysis to establish the type of microbe and its sensitivity to anti-inflammatory drugs should be carried out at the very beginning of the disease and then repeated once every 7-10 days.

On the 3-5th day after the start of treatment, the temperature usually decreases, then the pain in the lower back disappears. In the following weeks, urine tests improve, and later blood tests. This requires at least 5 weeks. Before this period, it is prohibited to interrupt antibacterial treatment. In the future, such medications can be taken within six months for 7-10 days every month. A control examination is done once a quarter for 2 years. If during this time the tests are normal, the disease can be considered cured.

In 20-30% of cases, acute pyelonephritis becomes chronic, which proceeds with periods of remission and exacerbation. An exacerbation of chronic pyelonephritis is treated similarly to an acute process. In the phase of remission, it is recommended to constantly follow a diet, and take medicinal herbs.
Treatment of pyelonephritis with herbs

In the treatment of inflammatory kidney diseases, plants with anti-inflammatory and diuretic properties are primarily used, which contain essential oils (juniper fruits, birch buds, elder flowers, leaves, roots and seeds of parsley, hop cones), saponins (steel roots, hernia stems, leaves birch), silicates or silicic acids (horsetail, highlander bird), glycosides (bearberry, lingonberry), alkoloid-like substances (corn) or tannins (strawberries, nettle).

Pharmacological properties of medicinal plants used in the treatment of kidney diseases

Post by: Natalie Keller, M.D. General Health Centre, Minneapolis, Minnesota