According to the twenty third edition of
Taber’s Cyclopedic Medical Dictionary (2013), chronic pyelonephritis is defined
as sever “inflammation of the kidney and renal pelvis, usually due to a
bacterial infection that has ascended from the urinary bladder” (pg 1971). The
renal pelvis being the enlarged part of the ureter where urine flows from the
kidneys to the bladder.
Pyelonephritis is an infection of one or both
kidneys and the structures connected to the kidneys; renal pelvis, tubules, and
interstitial tissue. In most cases the patient has a preexisting condition such
as kidney stones or obstruction. Bacteria like Staphylococcus and E. coli,
which may have entered the bladder from the bloodstream from intravenous drug
use or a condition like endocarditis, multiply in stasis urine, from either
obstruction or from the patient not emptying the bladder when needed. The
bacteria then travel upward to the kidney(s).
Kidney infections can be caused by bacteria or
viruses. Most kidney infections start as a bladder infection and move up to the
kidneys. In most cases, infection in the bladder is caused by bacteria not
being eliminated during urination. When these bacteria aren’t eliminated in a
timely manner, it multiplies. When the bacteria multiply to a number that is
difficult for the body to fight, it creates a bladder infection. Once the
infection is there, and there is no medical treatment, the infection can move
up the urinary tract and into the kidney.
There are several symptoms of pyelonephritis.
Physical symptoms may include increased urgency and frequency of urination,
fatigue, chills, fever, painful urination, flank pain (pain in the lower back),
nausea, and vomiting. Urine will be cloudy and have an increased level of white
blood cells, red blood cells, bacteria, casts, and be positive for nitrites.
Patients younger than 2 years old may only present with a high fever, however,
symptoms in elderly patients may also include confusion and hallucinations.
An infection within the urinary tract is
diagnosed in 3 steps. First a visual examination of the urine will determine if
the potential for infection is there. Urine should be light yellow to amber in
color and clear with no foul odor. If
the urine appears to be very dark amber, red, or green in color, cloudy, and
has a foul odor a urinalysis is usually ordered. A urinalysis is usually done
by the nurse and used to determine if there is anything abnormal in the urine.
urinalysis results will be negative for nitrites, have an RBC count of ? 2
RBCs/hpf and ? 2-5 WBCs/hpf, 0-5 hyaline casts/lpf, and be negative for
bacteria and yeast. If the urinalysis
comes back abnormal, the urine sample will then be sent to the lab for a urine
culture to determine if there is bacteria growth. Normal culture results will
show no bacteria growth within 24 to 48 hours. A CBC, complete blood count, may
also be ordered to determine if there is an elevated white cell count and if
there is an increase in sedimentation rate. Radiology may be called to perform
a CT, MRI, or ultrasound to help diagnosis a problem with the kidneys.
The primary treatment for any type of urinary
tract infection is antibiotics, which are typically taken twice a day for ten
to fourteen days. Patients can be given broad spectrum antibiotics until a
urine culture determines if a more specific antibiotic is needed. For more severe
cases that require hospitalization, IV antibiotics and fluids will be given.
For patients with recurrent infections, surgery may be needed.
Patients with pyelonephritis who get treatment
and taken the ordered antibiotics generally recover with no lasting effects.
However, patients with repeated or untreated infections can have scarring or
loss of kidney function.
Although urinary tract infections cannot be one
hundred percent prevented there are several ways to help lessen the chances of
one occurring. Drinking six to eight, eight-ounce glasses of water a day will
allow the kidneys to properly filter out toxins. Go to the bathroom as soon as
you feel you need to go and wipe front to back. Holding urine in the bladder
gives bacteria the perfect place to multiply. Avoid douches and condoms with
spermicides, as spermicides help bacteria growth and always make sure you
urinate after sex to wash away any unwanted bacteria.