A B C D E F G H I J K L M N O P R S T U V W

PYELONEPHRITIS - CYSTITIS - URINARY TRACT INFECTION

What is Pyelonephritis ?

The two kidneys are situated in the back of the abdomen. They remove excess waste products and water from blood to make urine. The urine then moves down through the ureter on each side, into the bladder. Urine is passed by the bladder contracting, forcing urine out through the urethra. The structures through which the urine passes, from its formation to its excretion, are called the urinary tract. Infections of the urinary tract can affect just the bladder (cystitis). Infections of the kidney(s) cause back and loin pain as well. However, one or both kidneys may become infected (pyelonephritis). The symptoms of cystitis are pain or burning on passing urine, and having to pass urine more often (frequency). There may be some blood in the urine. Fever usually only occurs with pyelonephritis, rather than cystitis.

How does Pyelonephritis occur ?

Urinary infection is due to germs entering the urinary tract. The most usual route is up through the urethra and into the bladder. The most usual germs are those found in the bowel which spread to the groins and then up the urethra. Once the germs are in the urinary tract they can be difficult to get rid of if the urinary tract is abnormal in some way. Urinary infection can then recur even after a course of antibiotics.

Why does Pyelonephritis occur ?

Urinary infections are much more common in women than in men. Many women get urinary infections without any abnormality of their urinary tract. On the other hand, it is unusual for a man to get a urinary infection unless there is something else wrong with the urinary tract. This is because the longer urethra of men makes it difficult for germs to travel upwards. It is not known why some women get repeated cystitis and others do not. Frequent intercourse, especially with a new partner, can cause cystitis so-called honeymoon cystitis . Any abnormality of the urinary tract can increase the chances of getting a urinary infection. Kidney stones can act as a reservoir of infection since antibiotics cannot penetrate into a stone. The bladder may not empty fully. This happens in men with a large prostate gland or in some diabetics. Certain children are born with a defect that makes urine pass up the ureters as well as down the urethra when the bladder contracts. This is called reflux nephropathy and is an important cause of urinary infection in childhood.

Treatment Involved for Pyelonephritis

The doctor will commence you on an antibiotic which is likely to control the infection. Before starting, he may wish to find out which type of germ is causing the infection, and whether the antibiotic chosen is likely to get rid of it. This is done by collecting a sample of urine from the middle of the stream (MSU mid-stream urine). Antibiotics must be taken for 5 to 7 days even though the symptoms get better within the first 2 to 3 days. It is important to drink lot of fluids: 3 pints (2 litres) minimum per day. If the infection is severe with high fevers and has involved the kidney (pyelonephritis), the antibiotics are sometimes given by injection into a vein. This may mean staying in hospital for a few days. Once infection has been treated, the next step is to find out why it happened. In women, unless the infection is severe or has recurred, further tests are not done. Men normally have further tests even after a first infection. These tests involve either an ultrasound or x-rays of the kidneys. Ultrasound involves having the kidneys scanned by an instrument like a radar, using sound waves. Kidney x-rays are done by injecting a special dye into an arm vein. The dye is tracked into the kidneys by a series of x-ray films. Both techniques are capable of showing abnormalities in different parts of the urinary tract. Kidney stones and abnormalities of the ureters or bladder are just some of the conditions which may be found. Sometimes an operation may need to be done to correct this abnormality.

During Treatment for Pyelonephritis

The infection should get better within 2 to 3 days of starting antibiotics. If it does not, then you should tell your doctor. He will then change the antibiotic, if possible using the information that he gets from the laboratory. Unless allergic to the antibiotic, there should not be any side-effects.

After Treatment for Pyelonephritis

In some people, the urinary infection tends to recur even if their urinary tract is found to be completely normal. This is much more common with cystitis than pyelonephritis. If this happens, often a long course of antibiotics may be needed. This usually consists of a small dose taken just at night. In children who have reflux nephropathy, flow-back of infected urine into the kidney can cause scarring. This can produce high blood pressure and chronic kidney failure in adult life. In certain cases, an operation can be done to prevent the flow-back from occurring. Except for this small group, repeated urinary infection does not affect kidney function and does not cause kidney failure.

If Pyelonephritis is Left Untreated

Many episodes of cystitis get better on their own, provided a lot of fluid is drunk. An attack of pyelonephritis with high fevers may take much longer to get better without treatment. Because urinary infection may be the first sign that there is something wrong with the urinary tract, failure to have tests may lead to kidney damage. If the infections of reflux nephropathy are not treated, particularly in children, then further scarring of the kidneys will occur, making the kidney function worse.

Effects on Family of Pyelonephritis

Most infections of the urinary tract are not contagious. However, it is wise to avoid intercourse until the course of antibiotics has been completed.