acute Pyelonephritis

Understanding pyelonephritis

Key points

1. Pyelonephritis is a severe kidney infection that may require hospitalization.
2. Common symptoms include high fever, bloody or cloudy urine, and pain in the torso or groin.
3. Pregnant women have a higher risk of pyelonephritis.
                           

Symptoms

Symptoms usually appear within two days of infection. Common symptoms include:

• a fever greater than 102°F (38.9°C)
• pain in the abdomen, back, side, or groin
• painful or burning urination
• cloudy urine
• pus or blood in the urine
• urgent or frequent urination
• fishy-smelling urine

Other symptoms can include:

• shaking or chills
• nausea
• vomiting
• general aching or ill feeling
• fatigue
• moist skin
• mental confusion

                                                                                

• Causes
• 
  
• The infection usually starts in the lower urinary tract as a urinary tract infection (UTI). Bacteria enter the body through the urethra and begin to multiply and spread up to the bladder. From there, the bacteria travel through the ureters to the kidneys.
• Bacteria such as E. coli often cause the infection. However, any serious infection in the bloodstream can also spread to the kidneys and cause acute pyelonephritis.

Diagnosing pyelonephritis

Urine tests

A doctor will check for fever, tenderness in the abdomen, and other common symptoms. If they suspect a kidney infection, they will order a urine test. This helps them check for bacteria, concentration, blood, and pus in the urine.

Imaging tests

The doctor may also order X-rays or an ultrasound to look for cysts, tumors, or other obstructions in the urinary tract.

In people who do not respond to treatment within 72 hours, a CT scan (with or without injectable dye) may be ordered. This test can also detect obstructions within the urinary tract.

                                 

Radioactive imaging

A dimercaptosuccinic acid (DMSA) test may be ordered if your doctor suspects scarring as a result of pyelonephritis. This is an imaging technique that tracks an injection of radioactive material. A healthcare professional injects the material through a vein in the arm. The material then travels to the kidneys. Images taken as the radioactive material passes through the kidneys will show infected or scarred areas.

Treating pyelonephritis

Antibiotics

Antibiotics are the first course of action against acute pyelonephritis. However, the type of antibiotic your doctor chooses depends on whether or not the bacteria can be identified. If not, a broad-spectrum antibiotic will be used. Although drugs can cure the infection within two to three days, the medication must be taken for the entire prescription period (usually 10 to 14 days). This is true even if you feel better.

The antibiotic options are:

• levofloxacin
• ciprofloxacin
• cotrimoxazole
• ampicillin

Hospital admission

In some cases, drug therapy is ineffective. For a severe kidney infection, your doctor may admit you to the hospital. The length of your stay depends on the severity of your condition and how well you respond to treatment. Treatment may include intravenous hydration and antibiotics for 24 to 48 hours. While you’re in the hospital, doctors will monitor your blood and urine to track the infection. You’ll likely receive 10 to 14 days’ worth of oral antibiotics to take after you’re released from the hospital.

                                        

Surgery

Recurrent kidney infections may result from an underlying medical problem. In those cases, surgery may be required to remove any obstructions or to correct any structural problems in the kidneys. Surgery may also be necessary to drain an abscess that doesn’t respond to antibiotics.

In cases of severe infection, a nephrectomy may be necessary. In this procedure, a surgeon removes part of the kidney.