What is Pyelonephritis?

Common urinary tract infections (UTIs) involve the urethra and bladder. However, a serious form of UTI develops when it progresses towards the upper urinary tract, i.e. the ureters and kidneys. This form of UTI is known as pyelonephritis. This form of UTI is further classified as:

Acute pyelonephritis - It is a localized inflammation of kidney and pelvic area.
Chronic pyelonephritis - This is a form of recurrent kidney infection.
Xanthogranulomatous pyelonephritis - It is a severe form of the chronic infection that shows kidney damage, abscess formation and other inflammatory diseases.

According to a top urologist in Mumbai,

The causes pyelonephritis are most often similar to those of a typical UTI. The gut bacterium, Escherischia coli (E. coli) or bacteria from the skin can cause this infection. A reduced urine flow (due to stones, cancer or other masses) also makes it easier for bacteria to travel upwards towards the ureters. Further, diabetic people with weakened immune system are more prone to this UTI.

What are the symptoms or signs?

Pyelonephritic infection symptoms begin as a classic UTI - urgent, painful and frequent urination. However, once the infection reaches the kidneys, more severe symptoms result:

Fever or chills
Back pain
Nausea or vomiting
Sick feeling, confusion
Blood in urine
Painful urination

Which specialist should be consulted in case of signs and symptoms?

An experienced urologist treats conditions of the urinary tract in men. Women can consult a gynecologist who deals with gynaecological problems with a urological setting.

What are the screening tests and investigations done to confirm or rule out the disorder?

A urinary tract infection that has spread to the kidneys may be diagnosed based on additional signs like fever and back pain. The urologists, typically, suggest the following tests to confirm diagnosis:

Lab tests - Urine sample looks for bacteria, pus or blood. A urine culture helps identify the type of bacteria causing the infection. A blood culture will also test for bacteria in blood.
Imaging tests - A CT scan or ultrasound creates images of ureters and kidneys and identifies any stones, blockages or abscesses.

What treatment modalities are available for management of the disorder?

The first line of treatment involves antibiotics. The exact drug and its duration depends on the type of bacteria and severity of infection, though symptoms begin to clear up in the first few days of treatment. The entire course must be completed to eliminate all bacteria. Severe cases may require intravenous injection of antibiotics upon hospitalization. Recurrent upper UTI infections signal a deeper problem like urologic abnormality in structure, which may require surgery.

What are the preventive measures?

The risk of upper UTI can be prevented by taking the following measures:

Drinking sufficient fluids every day
Urinating frequently
Emptying bladder after sex
Wiping front to back after urination or bowel movementUrologist

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