Pyelonephritis

Quick Overview

• What is kidney pancreatitis? an infection of the upper urinary tract (mostly by bacteria) and one of the most common kidney diseases.
• symptoms: In acute pyelonephritis fever, chills, flank pain and nausea. In chronic pyelonephritis headache, fatigue, back pain and loss of appetite; in the case of similar discomfort as in acute form.
• Causes: usually bacteria, more rarely other pathogens (such as fungi); Risk factors: urinary tract disorders, urinary tract infections, pregnancy, metabolic disorders, etc.
• Diagnosis: Survey of medical history in conversation (anamnesis), physical examination, blood test (CRP erythrocyte sedimentation rate, etc.), urine examination (creatinine, leukocytes, etc.), if necessary, imaging techniques (ultrasound, computed tomography)
• Treatment: Antibiotics, possibly antipyretics; Treatment of risk factors (e.g., surgery for urinary obstruction due to enlarged prostate)
• Forecast: With timely treatment, the acute form usually heals well. The prognosis of the chronic disease is unfavorable. Left untreated, pyelonephritis can cause severe complications (kidney failure, blood poisoning).
• Prevent: sufficient drinking volume, regular urination, adequate intimate hygiene (not too much and not too little) etc.

Pyelonephritis: symptoms

Pyelonephritis can be acute or chronic. As a rule, only one kidney is affected by the inflammation.

Acute pyelitis: symptoms

In acute pyelonephritis, severe symptoms usually appear suddenly. These include:

• high fever (around 40 ° C), often associated with chills
• severe flank pain (lateral back pain in the area of ​​the affected kidney); the pain can radiate up into the pelvis
• Nausea and vomiting
• Strongly tense musculature during scanning (defense tension) in the transition area from the ribs to the spine
• frequent urination, with only small amounts of urine leaving (pollakisuria); bladder emptying is painful (dysuria)
• sometimes blood in the urine

Note: If there are no clear symptoms such as flank pain and high fever, this is called atypical pyelonephritis.

Especially Children and the elderly In case of a pyelonephritis, symptoms may show that are difficult to associate with the disease, such as headache, abdominal pain, nausea, and mild fever.

In patients with pre-existing conditions such as diabetes mellitus (Diabetes) and infections with so-called “hospital germs” often occur in the course of disease strong signs of inflammation that affect the whole body. Sometimes an acute renal pancreatitis also causes renal abscess (encapsulated collection of pus), or it accumulates pus in the cavities of the kidney (pyonephrosis). Doctors then speak of one complicated pyelonephritis.

Chronic pyelitis: symptoms

If left untreated, acute renal cell inflammation may develop into chronic pyelitis. This form damages the kidney slowly and continuously, the tissue scarred over years. Mostly show no complaints for a long time (“mute” course). Eventually, however, the chronic pyelonephritis can cause symptoms that are, however, less specific:

• a headache
• Tiredness and exhaustion
• dull back pain in the lumbar region
• anorexia
• Stomachache, possibly nausea
• Problems with urination
• loss in weight

Normally, a chronic pyelonephritis without fever (at most slightly elevated body temperature). However, it can happen again and again exacerbations come. These are associated with fever and other symptoms, as they occur in acute pyelonephritis.

Since the kidneys are involved in blood formation, chronic pyelonephritis may be too Anemia to lead. Because the diseased kidney excretes less fluid, can also high blood pressure develop.

Through the chronic inflammatory processes, functional kidney tissue gradually becomes functionless scar tissue transformed. The affected kidney can do worse and worse work – it can be a kidney failure (Kidney failure) to develop chronic renal failure.

Pyelonephritis: treatment

A acute pyelonephritis is caused by bacteria in most cases. It is therefore primarily with antibiotics Treated: The patient must take these for seven to ten days. First, he receives a broad-spectrum antibiotic that works against many different bacteria. As soon as the result of the urine examination is available (ie the exact type of agent is identified), the doctor can switch the treatment to an antibiotic that specifically targets the affected germ.

Note: Severe pyelitis is usually treated in hospital. If the patient suffers from nausea and vomiting, he often receives the antibiotics intravenously, ie administered by infusion.

In addition to the antibiotics, the doctor may have kidney pancreatitis antipyretic meansprescribe so-called antipyretics. Also, patients should be during the treatment bed rest comply and drink a lot (at least two to three liters). The latter helps to flush out the bacteria from the kidneys and urinary tract.

In the treatment of a chronic pyelitis you also use antibiotics. But one waits mostly first the result of the so-called susceptibility from. This is a microbiological study that tests the efficacy of various antibiotics against the pathogen. This makes it possible to find out which antibiotic is most suitable for the treatment in the individual case. The antibiotic therapy then usually takes a week, possibly longer. Subsequent disease relapses are also treated with antibiotics.

If there is no improvement despite antibiotic treatment, patients with chronic pyelonephritis are referred to the hospital. There, the drugs are given as an infusion. Then the therapy often starts faster and better.

Eliminate the trigger

In addition, one should eliminate the cause of kidney inflammation as possible. For example, if a constriction in the urinary tract or an enlarged prostate hinders the urinary drainage and thus promotes pyelonephritis, an operative procedure is often necessary.

Pyelonephritis: causes and risk factors

There are several reasons for pyelitis. The cause is in most cases one ascending bacterial infection: The pathogens pass through the urethra, bladder and ureter to the renal pelvis. Therefore, kidney pelvic inflammation is often preceded by urethritis or cystitis. Rarely are the bacteria causing kidney pancreatitis entering the body through the bloodstream.

In almost 80 percent of all cases, that is Intestinal bacterium Escherichia coli (E. coli) the cause of pyelitis: If the germ (eg lack of intimate hygiene) is abducted by the anus into the urethra, he can ascend to the kidneys. Sometimes other bacteria (such as enterococci, staphylococci) as well as fungi or viruses cause pyelitis.

women are about two to three times more likely to be affected by pyelonephritis than men. This is partly because they have a shorter urethra and the entrance is closer to the anus. (Intestinal) bacteria can therefore easily enter the bladder and from there into the kidneys.

Pyelonephritis: risk factors

There are numerous risk factors that favor kidney pancreatitis. These include, for example urination disorders: The renal pelvis serves as a collection funnel for the urine, which is formed in the kidney, and leads him over the ureter. If the urine can not drain off or only drains off, it builds up. This promotes bacterial growth and thus kidney pelvic inflammation. Urinary obstruction may be congenital, such as when the ureter has a congenital constriction. But they can also be acquired, for example, in prostate enlargement, urinary or bladder stones and infections.

In summary, the following risk factors for renal pelvic inflammation apply:

• high age
• Pregnancy (under the influence of hormones, the urinary tract dilates, making it easier for bacteria to ascend)
• Kidney stones or bladder stones
• Bladder catheter for a long time (indwelling catheter)
• decreased hormone production (eg after menopause)
• Infections of the lower urinary tract
• Metabolic diseases, eg. B. Diabetes (diabetes mellitus)
• enlarged prostate (prostatic hyperplasia) in men
• congenital malformations of the kidney
• vesicoureteral reflux: urinary reflux from the bladder towards the kidney (for example, due to a leaking mouth of the ureter into the urinary bladder)
• general immunodeficiency (eg in case of HIV infection)

Pyelonephritis: examinations and diagnosis

A doctor will first discuss your with you To raise medical history (Anamnesis): Among other things, he interrogates you about your complaints as well as about possible pre- and underlying diseases. Possible questions are:

• Which complaints do you have exactly? Since when do these exist?

• Have you had a lower urinary tract infection (such as bladder infection) in recent months?
• Do you have kidney stones or bladder stones?
• Do you have metabolic diseases such as diabetes (diabetes mellitus)?

Physical examination

Subsequently, the doctor performs a thorough physical examination by. Among other things, he taps and palpates the kidneys, as for a renal pelvic pain in the flanks are typical.

Urinalysis

Very important in the diagnosis of pyelitis is the analysis of a urine sample: It checks whether in urine bacteria and white blood cells (leukocytes) can be found and if so, in what quantity. An increased number of both parameters indicates inflammation of the urinary tract.

To identify the pathogen, one becomes urine culture Applied: The urine sample is exposed to conditions that are ideal for bacterial growth. Thus, the pathogen can multiply in the sample and then easily detect. In addition, a antibiogram Thus one tests the effectiveness of different antibiotics against the present pathogen. That helps with therapy planning.

blood test

Especially in cases of suspected chronic pyelitis, a blood sample is taken and analyzed in the laboratory. Inflammatory parameters such as blood sedimentation rate (BSG) and C-reactive protein (CRP) are measured. Both values ​​indicate inflammation in the body when elevated.

In addition, the creatinine value is determined in the blood analysis. An elevated level can be a warning sign that the kidneys may already be damaged.

Imaging procedures

Using a conventional Ultrasound (Sonography) allows the doctor to assess the location, shape and size of the kidneys. Also, urinary and kidney stones and a possible urinary retention as a trigger of inflammation can be detected. In addition, ultrasound can detect scar tissue in the kidneys, as is the case with chronic pyelonephritis.

A special form of ultrasound examination is the Miktionsurosonografie, It is often used in children. Ultrasound is used to check whether the urine flows from the bladder back to the kidney (vesicoureteral reflux), which favors kidney pelvic inflammation. In the run-up to the examination, the patient receives a contrast agent that makes the return of urine easier to visualize.

In some cases of renal pelvic inflammation, other imaging techniques are useful. For example, a Computed tomography (CT) are used when the finding of the ultrasound examination is unclear. A X-ray examination of the urinary tract (urography) can detect, among other things narrowing of the urinary tract and urinary stones or kidney stones.

Pyelonephritis: course and prognosis

Will one acute pyelonephritis Recognized and treated in good time, the prognosis is generally good. It then heals without consequences. The doctor usually checks the treatment success by means of a urine examination two weeks after the end of the therapy. If no pathogens can be detected, the inflammation is considered healed.

A chronic pyelitis threatens when acute pyelonephritis is treated too late or inadequately. The prognosis is then unfavorable. In many cases, chronic pyelonephritis does not completely heal. The recurrent inflammatory episodes must each be treated with antibiotics to avoid more serious complications. In addition, a regular medical check is necessary.

Left untreated, both forms of pyelitis severely damage the kidney. Ultimately it can become a complete one kidney failure (Kidney failure) come.

Another possible complication of pyelitis may be the formation of an encapsulated pus in the tissue (Renal), This needs to be dealt with quickly because otherwise it can be dangerous.

In addition, there is a risk of a so-called kidney infection urosepsis, By this one understands an emanating from the urinary tract “septicemia” (sepsis), which means: The pathogens spread from the kidney through the bloodstream throughout the body. This can be life threatening under certain circumstances!

Pyelonephritis: prevention

There are some measures you can take to reduce the risk of pyelitis:

• Drink enough and regularly (eg water or tea). This cleanses the urinary tract and flushes out any germs.
• Regular urination also helps to flush pathogens out of the urinary tract. Especially after sexual intercourse you should go to the toilet soon.
• Women should always wipe themselves from the vagina to the anus after bowel movements. In the opposite case, it is easy for intestinal bacteria to be carried off the anus to the nearby urethral opening.
• For both sexes a proper intimate hygiene is advisable to prevent a pyelonephritis. Both lacking and exaggerated intimate care can promote the growth of germs. For example, do not use any disinfectants for intimate hygiene, only warm water.
• Cystitis can lead to pyelitis. Therefore, avoid hypothermia caused by warm clothing. Change wet clothing (eg wet swimsuits or sweaty sportswear) as soon as possible.
• For a recurring Pyelonephritis is possibly a so-called Infektdauerprophylaxe in question. For a longer period of time (initially six months), patients must take a preventive dose of a low-dose antibiotic.