Kidney infection (pyelonephritis) Health Article

Definition

Pyelonephritis is an infection of the kidney and the ducts that carry urine away from the kidney (ureters).

Alternative Names

Urinary tract infection - complicated; Infection - kidney; Complicated urinary tract infection; Pyelonephritis

Causes, incidence, and risk factors

Pyelonephritis most often occurs as a result of urinary tract infection, particularly in the presence of occasional or persistent backflow of urine from the bladder into the ureters or kidney pelvis (vesicoureteric reflux).

Pyelonephritis can be further classified as follows:

• Acute uncomplicated pyelonephritis (sudden development of kidney inflammation)
• Chronic pyelonephritis (a long-standing infection that does not clear)

Although cystitis (bladder infection) is common, pyelonephritis occurs much less often. The risk is increased if there is a history of cystitis, renal papillary necrosis, kidney stones, vesicoureteric reflux, or obstructive uropathy.

The risk is also increased when there is a history of chronic or recurrent urinary tract infection and when the infection is caused by a particularly aggressive type of bacteria.

Acute pyelonephritis can be severe in the elderly and in people who are immunosuppressed (for example, those with cancer or AIDS).

Symptoms

• Flank pain or back pain
• Severe abdominal pain (occurs occasionally)
• Fever
  • Higher than 102 degrees Fahrenheit
  • Persists for more than 2 days
• Chills with shaking
• Warm skin
• Flushed or reddened skin
• Moist skin (diaphoresis)
• Vomiting, nausea
• Fatigue
• General ill feeling
• Painful urination
• Increased urinary frequency or urgency
• Need to urinate at night (nocturia)
• Cloudy or abnormal urine color
• Blood in the urine
• Foul or strong urine odor
• Mental changes or confusion *

* Sometimes in the elderly, mental changes or confusion are the only signs of a urinary tract infection.

Signs and tests

An examination may show tenderness on palpation (pressing) over the kidney.

• A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs) in the urine.
• A urine culture from aclean catch or urine culture (catheterized specimen) may reveal bacteria in the urine.
• A blood culture may show an infection.
• An intravenous pyelogram (IVP) or CT scan of the abdomen may show enlarged kidneys with poor flow of dye through the kidneys. IVP and CT scan of the abdomen can also indicate underlying disorders.

Underlying abnormalities of the kidney that put a patient at high risk for acute pyelonephritis may be discovered by additional tests and procedures, including the following:

• Voiding cystourethrogram
• Renal ultrasound
• Renal scan
• Renal biopsy

Treatment

The goals of treatment are control of the infection and reduction of symptoms. Acute symptoms usually disappear within 48 to 72 hours after appropriate treatment.

Due to the high mortality rate in the elderly population and the risk of complications, prompt treatment is recommended.

After obtaining a urine culture to identify the bacteria, antibiotics are selected to treat the infection.

MEDICATIONS

Intravenous (IV) antibiotics may be used initially to control the bacterial infection if your infection is severe or you cannot take antibiotics by mouth. In acute cases of pyelonephritis, you may receive a 10- to 14-day course of antibiotics.

Chronic pyelonephritis may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include the following:

• Sulfa drugs such as sulfisoxazole/trimethoprim
• Amoxicillin
• Cephalosporins
• Levofloxacin and ciprofloxacin

Permanent kidney damage can rarely result from these infections when they are chronic, when they occur in a transplanted kidney, or when multiple infections occur during infancy or childhood. Acute kidney injury (acute renal failure) may occur when an infection is severe enough to result in shock (low blood pressure). Severe episodes of acute kidney injury may result in permanent kidney damage and lead to chronic kidney disease.

The elderly, infants, and people with a compromised immune system are at increased risk for developing sepsis (a severe blood infection) and shock. Often, these people will be admitted to the hospital to receive frequent monitoring for potential problems and to receive IV antibiotics, additional IV fluids, and other medications as necessary.

MONITORING

In diabetic patients and pregnant women, as well as in people with spinal paralysis, follow-up should include a urine culture at the completion of antibiotic therapy to ensure that bacteria are no longer present in the urine.