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Also known as a complicated urinary tract infection or kidney infection, pyelonephritis affects either one or both kidneys. Possible scarring of the kidneys is an important reason to recognize, treat and, when possible, to prevent urinary tract infections. Scarring can lead to serious kidney problems years down the road.
Urinary Tract Infections (UTI). Undiscovered infections of the kidney during childhood or later may remain for years without causing noticeable symptoms. Such an infection can cause scarring of the kidney which in turn distorts and destroys parts of the kidney. For most children, teenagers and women the infection does not progress and it is eradicated by the body. The damage done does not affect the ability of the kidneys to do their job. However, in a few people, the continuous destruction of the kidney leads to chronic renal failure which will require treatment.
Incidence; Causes & Development
The infection occurs more frequently in women than in men simply because the opening of the urethra in women is closer to the anus and the bacteria from the bowel.
Pyelonephritis is caused by bacteria, most often from the bowel, entering the urinary system from the outside, up the urethra, into the bladder and then up one or both ureters to the kidneys. Prostatism and kidney stones can also cause infection as they prevent efficient flow of urine from the bladder.
Reflux Nephropathy
For some children and adults the problem is caused by a condition called reflux nephropathy. This is a combination of two problems that make infection more likely to occur.
Firstly, there are little valves at the ends of the two ureters where they join the bladder. These are supposed to prevent urine that has drained from the kidneys being allowed back up the ureters to the kidneys. These valves do not always work properly. When the bladder contracts to push the urine out of the body through the urethra, they allow some urine to escape up into the kidneys again.
Secondly, the bladder may not empty properly each time a person (a child especially) goes to the toilet. With the stale urine that has not emptied out going up into to the kidneys, the chances of infection (i.e. pyelonephritis) are increased.
Signs & Symptoms
The symptoms of kidney infection can include include back pain, side pain and loin pain. You may have a desire to pass urine frequently and urgently. You may experience pain or burning when you do pass urine. You may feel sick and you may also have a temperature.
Diagnosis & Tests
A doctor must find out exactly which bacteria are causing the infection in order to kill it and stop further damage. A urine specimen is sent to a laboratory which identifies the bacteria, allowing the doctor to prescribe the right antibiotic. Prompt and adequate antibiotic treatment is important.
The doctor should try to discover why the infection occurred, in order to reduce the risk of another and to assess how much damage has been caused. Once treatment has started, the doctor will want the patient to undertake a couple of tests in order to find out why the infection happened, and to ascertain what damage has occurred. The patient is usually sent for an ultrasound scan or an X-ray of the kidneys. Ultrasound is a painless procedure that uses sound waves to build up a picture of your kidneys. The X-ray involves injecting a special dye into a vein in the arm; the body naturally removes the dye from the blood through the kidneys into the urine. While this is happening, the dye shows up the structure of the kidney on an X-ray.
Treatment & Prevention
Wiping 'front to back' during toilet visits and avoiding tight-fitting underwear can prevent some urinary tract infections.
Prognosis; Complications
Pyelonephritis may last until treated. Once appropriate treatment is begun, improvement is often rapid. The infection is generally cleared within 2 weeks.
Left untreated, infection can sometimes resolve on its own but, if it persists, it may lead to scarring and damage of the kidneys. Damaged kidneys can cause other conditions, such as high blood pressure or even chronic renal failure, requiring frequent medical attention for the rest of one's life.
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GLOSSARY
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Kidney Stone (Kidney Gravel, Kidney Stones)
A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Pyelonephritis (Pyelitis)
Inflammation of the renal pelvis. Pyelitis: An inflammation of the kidney pelvis, the interface between the urine-secreting inner surface of the kidney and the muscular ureter that drains into the bladder. It can be caused by kidney stones or an infection that has progressed up from the lower urinary tract. It alone is a serious condition; the next stage, pyelonephritis, since it involves the whole kidney, is still worse.
Reflux Nephropathy
Reflux nephropathy occurs when the normally one-direction-only valve-like mechanisms between the ureters and bladder fail. This allows urine to flow back up the ureter directly to the kidney. If the bladder is infected or the urine contains bacteria this exposes the kidney to the possibility of infection (pyelonephritis).
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Urinary Tract (UT)
The kidneys and the lower urinary tract, which includes the ureters, bladder, and urethra.
UTI
Urinary Tract Infection.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Jun 22, 2009
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