Pyelonephritis

Pyelonephritis (pyel(o) – combining form denoting the pelvis of the kidney) is an ascending infection of the kidney. As a rule, it is caused by bacteria that penetrates into the urinary tract from outside through the urethra. It may also ensue in the course of such concomitant diseases as cystitis in women, glomerular nephritis, or urinary stone disease (urolithiasis).

There are two forms of pyelonephritis: acute and chronic ones.

Acute pyelonephritis often begins suddenly with chills. The patient has the general set of symptoms: malaise, headache, profuse sweating, nausea and vomiting. Then, the fever raises rapidly up to 39-40 °C. It is usually accompanied with the dull pain in the loins on the side of the affected kidney. Urination may not be disturbed in uncomplicated cases of pyelonephritis. However, the urine is cloudy and bloody due to the presence of bacteria, protein, and erythrocytes in it. If timely revealed and treated, the patient quickly recovers with the return of the normal kidney function.

Chronic pyelonephritis results from the undertreated acute form of the disease. It is often asymptomatic and can be detected only by means of urinalysis or if the patient has persistent hypertension. In chronic pyelonephritis, the normal renal tissue is replaced by the connective non-functional one. The kidney becomes small and scarred that leads to kidney failure. Among other complications are pyonephrosis (purulent inflammation of the kidney) and urosepsis (presence of urine waste products throughout the body).

A full urological investigation is carried out to determine the underlying cause of pyelonephritis. It includes urinalysis that detects such signs of urinary tract infection as haematuria, albuminuria, bacteriuria, etc.; a urine test strip that reveals the presence of leukocytosis; blood tests; microbiological culture of the urine and antibiotic sensitivity testing.

The first aim of treatment of pyelonephritis consists in removing the underlying abnormalities to prevent the recurrence of disease. Therefore, it includes the administration of appropriate antibiotics to relieve the inflammatory process in the kidney and antibacterial drugs to remove bacteria. The patient must strictly follow a certain diet: one must consume a lot of fruit and vegetables, and drink 3-4 l of water daily. Spicy and fatty food must be avoided. The consumption of salt must be excluded. Surgery is required in severe cases of pyelonephritis or in cases of congenital renal pathologies.

Exercise 6. Answer the questions:

1. What is pyelonephritis?

2. What are the possible causes of the disease?

3. How many forms are there of pyelonephritis?

4. What are the symptoms of acute pyelonephritis?

5. How does chronic pyelonephritis manifest itself?

6. What can chronic pyelonephritis lead to?

7. What investigations are performed to determine pyelonephritis?

8. How is pyelonephritis treated?