In general, pyelonephritis is a condition of infection in the kidneys. The main focus of this blog will be acute pyelonephritis. We’ll see what this condition is, what causes it, some of the pathophysiology behind the reason it occurs, symptoms and diagnosis of pyelonephritis, and lastly its treatment.
To understand the term pyelonephritis we must break it down. ‘Pyelo’ means pelvis, ‘nephr’ refers to the kidney. So ‘pyelonephr’ refers to the area of the renal pelvis which is the funnel-like structure inside the kidney and which has the functionality to drain urine into the ureter. As ‘itis’ refers to inflammation, pyelonephritis means inflammation of a segment of the kidney. In acute pyelonephritis, the kidney inflamed is developed relatively quickly and the pathogen contributing to this inflammation is usually bacteria. As inflammation is a symptom of infection, pyelonephritis is actually a type of upper urinary tract infection.
Acute pyelonephritis is most often caused by ascending infection of the urinary tract. The bacteria first start by colonizing the urethra and bladder, thus causing lower urinary tract infections. After this colonization, bacteria make their way up to the kidney. This is the reason that the factors causing upper UTI (pyelonephritis) are the same as the factors causing lower UTI. Some of these factors are as follows:
One single major factor that increases the risk of occurrence of upper UTI from the spread of lower UTI upwards is Vesicoureteral reflux. In this condition, the backward movement of urine is not restricted and therefore urine can move up the urinary tract. This is caused by the failure of the Vesicoureteral valve.
Most common pathogens causing pyelonephritis:
The less common reason that causes acute pyelonephritis is hematogenous infection. Pyelonephritis due to this reason is usually a consequence of:
Acute pyelonephritis affects just one kidney in most cases. This means it is a unilateral condition. At the start of the attack, the bacteria adhere to the renal epithelium of the tubules. This triggers an immune response causing inflammation. Chemokines, which are the protein secreted by immune cells, attract neutrophils ( a type of WBC) to the renal interstitium. These neutrophils upon infiltrating and dying off, move through the urinary tract and are expelled through the urine. This is the reason that people with acute pyelonephritis often have white blood cells in their urine.
Pyelonephritis symptoms are most often the same as those of the lower urinary tract infection but some systemic symptoms that often distinguish pyelonephritis from the lower urinary tract infection are as follows:
Oftentimes, the diagnosis of pyelonephritis is done by the clinical examination of the patients in which the following symptoms are searched for:
When the clinical diagnosis is established for pyelonephritis, then the laboratory diagnosis of pyelonephritis is done to evaluate the severity of the condition. Some laboratory diagnostic methods of pyelonephritis are as follows:
After the evaluation of pyelonephritis in a patient through diagnosis, the treatment option suitable for them is decided to implement. Following are all the treatment options for acute pyelonephritis:
Pyelonephritis is a degenerating disease that is not treated properly. For a precise diagnosis of this kidney condition, one must always choose their medical assistance by seeing the experience of the practitioner who will handle them.
At Alfa Kidney Care, you will get the most experienced nephrologists to take care of you.