Pyelonephritis

In case you did not know, urine infections are one of the most common and recurrent conditions in humans, even many times they go unnoticed . But could it harm other body organs like the kidneys? The truth is that yes, as is the case with pyelonephritis , so be sure to be alert and read this interesting article to the end.

Faced with kidney inflammation caused by a bacterial infection, in most cases, warning symptoms appear that allow knowing the presence of an infection , such as: fever , general malaise, vomiting, abdominal pain or urination, as well as burning ; which is very uncomfortable. However, it can sometimes be asymptomatic bacteriuria, which is when there are no symptoms of discomfort.

What is pyelonephritis?

Pyelonephritis, or also known as an upper urinary tract infection , is an infectious condition that attacks the kidney and involves the renal parenchyma , the renal pelvis, and the renal calyces. Generally, the germs or bacteria that produce it focus on the bladder and travel to the parenchyma . Part of the main symptoms that occur are pain when urinating, fever, chills, pain in the flank and lower back, nausea and vomiting.
Its complications are really striking, since it can cause unpleasant consequences. However, in most cases with pyelonephritis, a diagnosis is made in time hand in hand with specialized treatment , which allows a favorable evolution in the patient. But when this does not happen, acute pyelonephritis can take two directions, such as complicated and uncomplicated.

This will also depend on the existence of an anatomical or functional disorder in the urinary tract, since if so, it could influence the response to the treatment that is prescribed and the improvement of the infection suffered by the patient. An important detail is that, when suffering from pathologies such as cystitis , kidney stones, alterations in the kidneys or in the urinary tract, the risk of developing pyelonephritis is increased.

Specialists have determined that this infection can affect 4 or 8 people per 100,000 inhabitants, so it is not a simple complication in the urinary tract, but quite the opposite. Regularly, it is much more frequent in women than in men , this due to the anatomy and complexity of the female reproductive system , where the urethra becomes shorter and is more exposed to the outside, which facilitates the entry of bacteria into the bladder, and that these in turn reach the kidneys through the ureters.

However, men also get their time over the years when they present the enlargement and extensive development of the prostate , which increases the possibility of suffering from pyelonephritis.

Symptoms of pyelonephritis

Like most general infections, and even more so in the urinary tract, its recognition is completely natural through the symptoms they present , which can serve as an alert to get down to work and go to a specialist:

• Fever and chills
• Pain in the lumbar region.
• Nausea and vomiting
• Decreased appetite.
• Headache.
• Increased frequency of urination, but not much.
• Stinging or pain when urinating.
• Feeling of not having completely emptied urine.
• Not being able to hold urine.
• Urgent need to urinate due to the risk of urinary incontinence .
• Abdominal pain in the lower abdomen.

If the fever lasts for more than 72 hours, even when treatment has already been prescribed or there are signs of worsening symptoms , it may be an effect resistant to the treatment provided or kidney complications.

Types of pyelonephritis

Before classifying pyelonephritis, it is important to consider what complications may occur. Therefore, we will show you below which are the most common types of kidney infection among patients:

• Acute pyelonephritis

When it comes to acute pyelonephritis, it is generally generated by the presence of a common urinary infection , such as cystitis . However, although it is a more serious and complex infectious picture, it can be managed without problems with the correct treatment. In some cases with elderly or cancer-diagnosed patients, more severe pyelonephritis may occur.

• Chronic pyelonephritis

As the name implies, the infection is much more complicated, as the condition could spread throughout the body, causing kidney failure , an inability of the kidney to make urine, or sepsis .

When indicating medical treatment, it would be alarming if the fever did not cease with antibiotics, so it would be recommended to apply additional tests such as urinary tests of the upper part, which will allow to accurately detail the state of the urine and other complications.

Pyelonephritis aguda

In more detail, acute pyelonephritis refers to inflammation of the renal pelvis and kidney. To determine exactly which area is actually being affected, this is possible thanks to the presence of pain or sensitivity in the flank . And clinically, the origin can be confirmed by a urine sample that shows the presence of bacteria or pyuria, as well as a urine culture that shows significant concentrations of a urinary pathogen.

Some of the following factors may increase your chances of getting pyelonephritis :

1. Diabetes .
2. Advanced age.
3. Diseases that affect personal care habits.
4. Trouble completely emptying the bladder.
5. Have a urinary catheter.
6. Bowel incontinence
7. Enlarged prostate, narrow urethra, or any other factor that blocks the flow of urine.
8. Kidney stones
9. Staying immobile for a long time.
10. Pregnancy.
11. Surgery or other procedure in the urinary tract.

Pyelonephritis xantogranulomatosa

It is a rare variant that refers to an infiltration of the renal parenchyma by foamy lymphocytes, associated with a very frequent kidney infection with severe characteristics . In these cases, it presents morphological similarity of lipid-loaded macrophages, xanthomatous cells, or clear cells of renal carcinoma, which hinder and tend to confuse the architecture of the tissue. Generally, a surgical intervention is presented as the only acceptable solution to xanthogranulomatous pyelonephritis, which is called a nephrectomy .

Chronic pyelonephritis

The most recurrent causes of a chronic infectious panorama are based on the company of other pathologies such as obstructive uropathy , struvite stones and vesicoureteral reflux , which would be the most frequent. When it comes to pyelonephritis of this type, atrophy and calyceal deformity with fibrosis of the parenchyma are observed.

The tricky thing about this, as we explained above, is that chronic kidney disease can develop in the not too distant future . Given this, it is possible that people suffering from pyelonephritis contain residual infectious foci, which makes them susceptible to predisposing bacteria.

Pyelonephritis treatment

To determine an optimal treatment that really attacks the kidney infection that is occurring, it is important to make an effective and thorough diagnosis that reveals the causes, consequences, possible complications and all the details. In this sense, the physical examination is a valid option that allows a good analysis to be guided in the event of pyelonephritis.

If you maintain a suspicion of possible pyelonephritis, you should perform one of these complementary tests that you will read below:

• Blood analysis : It is necessary to include a hemogram, which will allow obtaining information about the different types of cells present in the blood, hand in hand with a biochemistry , to check the functioning of the kidney.
• Urinalysis : Although the presence of pyuria, which is pus in the urine, is a regular and constant feature in urine samples, it should also be monitored for nitrites, although the germs and bacteria that cause pyelonephritis are not always from this type .
• Urine culture or uroculture : This test is essential to clarify which are the microorganisms that are causing pyelonephritis in the patient. This is possible after collecting a stream of urine, without adding the first part of urination and after cleaning the genital area . Urine culture should be performed before starting medical treatment with antibiotics.
• Blood culture or culture of a blood sample : It is possible to do it as long as the patient has fever. Generally , it is positive in 30% when it comes to the elderly , diabetics, patients with kidney failure or urinary flow obstruction.
• Imaging tests : They are not completely necessary for pyelonephritis, but it would be useful if the specialist requires it, to determine if there are serious complications, signs of sepsis or risk factors for abnormalities in the urinary tract, which will help to rule out any possible existence urinary obstruction . In addition, if the fever persists for more than 48 hours, despite having an antibiotic treatment, it is ideal to perform an abdominal ultrasound to rule out the existence of a kidney abscess.

Once each of these steps has been carried out with the respective clinical guide, one can proceed to the medical indications for an effective treatment that eliminates pyelonephritis. In view of the fact that it is an infectious disease, the administration of antibiotics is totally necessary , either orally or intravenously, depending on the circumstances of each patient.

1. Antibiotics : If it is a serious infection and the risk of complications is high, antibiotics must be given through an IV . To determine which may be the most effective, without contraindications, it is prudent to perform an antibiogram of the urine culture to highlight the most potent antibiotics against bacteria.
2. Analgesics and antipyretics : They should be ingested only if there are pain, fever or general malaise.
3. Intravenous fluids : It is prudent that serums can be given during the first days of treatment, this in order to hydrate the patient with pyelonephritis as best as possible and speed up the arrival of antibiotics to the kidney.

This treatment should be used for 14 days, if it is an uncomplicated pyelonephritis, and if it is a more complex infection, the antibiotic should be given for 21 days .

In general, when a patient is faced with acute pyelonephritis, the treatment is usually empirical, that is, he self-medicates with whatever antibiotic he considers pertinent , without knowing in detail what are the germs or bacteria that have caused the disease. infection.

However, sometimes the treatment of pyelonephritis can be carried out on an outpatient basis, from the home of each patient with the respective medical consideration, but in other cases admission to a clinical center and hospital is necessary, since there may be local complications such as emission of blood during urine , kidney failure or severe pain, or general complications such as diabetes, tumors, cirrhosis , aging, which could affect the response to the treatment in question, either because it cannot be given or there is no evolution after 12 hours.

The antibiotics to be used will depend on the case of each patient and their level of infection. For this reason, patients at risk of suffering from pyelonephritis due to resistant germs , must use a much stronger drug than other patients.

Hand in hand with these treatments, it is very important to follow some general recommendations to achieve a truly positive result, without difficulties. Take note:

• Rest for several days if the general condition is affected.
• Drink plenty of fluids daily to increase the amount of urine, as long as there are no urinary obstruction problems.
• Maintain fever-reducing and pain-relieving medication, if necessary.
• If there is vomiting or nausea, medication should be continued for it.

What can be the improvements?

When making a timely diagnosis and starting antibiotic treatment quickly and correctly, the prognosis of improvement in acute pyelonephritis is extremely effective in most cases . However, the patient could suffer from important diseases such as diabetes, cirrhosis, kidney failure, among others, which could increase the infectious picture and complicate the evolution of the disease.

One of the most common difficulties that can be generated by acute pyelonephritis is the existence of permanent kidney damage, which can lead to chronic kidney failure, the development of a kidney abscess or the appearance of sepsis, which is a potential cause. death, especially in elderly patients.

How to prevent urinary or kidney infections?

1. Maintain good intimate hygiene : This applies to men and women, but especially in women, especially during the menstrual cycle . It is important that cleaning is only with water or with special soaps according to the pH of each person; It is not advisable to include scent soaps.
2. Avoid humidity in the genital area : For this it is important to dry the genitals well when going to the bathroom or shower, since humidity is the main source of infections .
3. Clean from front to back : When defecating, you must remember that many bacteria from the intestine accumulate in the anus, which could move towards the genitals if a correct direction is not used in cleaning.
4. Consume large amounts of fluids and avoid constipation : If you take care of your body to prevent urinary incontinence , you will also be taking care of it from presenting infections in the urine , and water is an essential factor to always eliminate toxins and waste.
5. Completely empty the bladder : When urinating, try to dedicate the time necessary to do so, as the storage of urine could be contagious , as well as holding the urge to urinate for very long periods of time. It is advisable to go to urinate every 3 or 4 hours .
6. Urinate after sexual intercourse : Doing this will help the passage of urine through the genitals to naturally clean all bacteria that may have entered the urethra.
7. Wear cotton underwear and loose clothing. Tight pants and synthetic fabrics absorb moisture and therefore create a perfect environment for bacteria .
8. Avoid diaphragms and spermicides.
9. Suspend sexual intercourse for as long as a urinary infection is known.