Pyelonephritis – Causes, Symptoms and Treatment
Pyelonephritis is a bacterial infection of the renal pelvis and kidney tissue. It requires prompt medical treatment to prevent serious complications.
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Pyelonephritis is a bacterial infection of the renal pelvis and kidney tissue. It requires prompt medical treatment to prevent serious complications.
What Is Pyelonephritis?
Pyelonephritis, commonly known as a kidney pelvis inflammation or kidney infection, is a bacterial infection affecting the renal pelvis and kidney tissue. It is one of the most common upper urinary tract infections and can occur in both acute and chronic forms. Women are significantly more affected than men, largely due to the shorter urethra, which allows bacteria to reach the bladder and kidneys more easily.
Causes
Pyelonephritis is most commonly caused by bacteria that ascend from the lower urinary tract. In rare cases, bacteria may reach the kidneys through the bloodstream.
- Most common pathogen: Escherichia coli (E. coli), responsible for approximately 80% of cases
- Other pathogens: Klebsiella, Proteus, Enterococcus, and Staphylococci
- Contributing risk factors: bladder infection (cystitis), urinary obstruction, kidney stones, urinary catheters, weakened immune system, pregnancy, and diabetes mellitus
Symptoms
The symptoms of acute pyelonephritis often develop rapidly and can be pronounced:
- High fever (often above 38.5 °C / 101.3 °F) with chills
- Flank pain, usually one-sided, which may radiate to the back or abdomen
- Tenderness when tapping the kidney area (costovertebral angle tenderness)
- Frequent and painful urge to urinate
- Cloudy or foul-smelling urine
- Nausea, vomiting, and general malaise
In chronic pyelonephritis, symptoms may be milder or develop gradually, making early diagnosis more challenging.
Diagnosis
Diagnosis is based on a combination of clinical examination and laboratory or imaging tests:
- Urinalysis and urine culture: Detection of bacteria, white blood cells, and nitrites in the urine
- Blood tests: Elevated inflammatory markers such as CRP, white blood cell count, and ESR
- Kidney ultrasound: To rule out urinary obstruction or kidney stones
- CT or MRI scan: In complicated cases or when an abscess is suspected
Treatment
Treatment depends on the severity of the infection and the results of urine culture testing.
Mild to Moderate Cases
Uncomplicated pyelonephritis is typically treated on an outpatient basis with oral antibiotics. Commonly used agents include ciprofloxacin, trimethoprim/sulfamethoxazole, or cephalosporins. The treatment duration is usually 7 to 14 days.
Severe Cases
When patients present with high fever, vomiting, or signs of sepsis (blood poisoning), hospitalization and intravenous antibiotics are required. Antipyretics and adequate fluid intake are also essential components of treatment.
Chronic Pyelonephritis
In chronic or recurrent cases, underlying causes such as kidney stones or structural abnormalities of the urinary tract must be addressed. Long-term antibiotic prophylaxis may be considered in selected patients.
Prevention
- Drink sufficient fluids (at least 1.5 to 2 liters per day)
- Wipe from front to back after using the toilet (especially important for women)
- Treat bladder infections promptly before they can ascend to the kidneys
- Have kidney stones and urinary tract abnormalities evaluated and managed
References
- European Association of Urology (EAU): Guidelines on Urological Infections, 2023. Available at: https://uroweb.org
- Hooton, T. M.: Uncomplicated Urinary Tract Infection. New England Journal of Medicine, 366(11):1028-1037, 2012.
- World Health Organization (WHO): Antimicrobial Resistance Global Action Plan, 2015. Available at: https://www.who.int
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Related search terms: Kidney Pelvis Inflammation + Pyelonephritis + Kidney Pelvic Inflammation