Pyelitis and Pyelonephritis

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Inflammation of the kidney pelvis (pyelitis) is due to infection by bacteria but as the condition is usually short-lived it is often neglected, and is probably the starting point for an extension of the infection into the deeper tissues of the kidney which is known as pyelonephlitis.

The condition may arise, via the bloodstream, from existing infection in colitis, cystitis, tuberculosis, influenza, or fevers, or from congestion due to pregnancy, tumours, or stone whereby bacterial infection of the bladder ascends the ureter. The usual infecting bacteria are Escherichia coli, commonly found in the intestines, and Staphylococcus aureus.

Symptoms are Variable

The disease may develop as an acute fever, or as a more chronic disorder with an insidious onset and malaise. In most cases there are usually backache and pain, with cloudy urine and frequency of micturition. In the acute state there is a fairly high temperature, with rigors, prostration, headache, lumbar pain, and sweating. In old people the bladder inflammation tends to be aggravated by prostatic enlargement in men, and by vaginal prolapse in women.

The presence of pus and bacteria in the urine should be confirmed by tests and microscopical examination by a doctor. A mid-stream urine specimen should be utilised; a catheter may reinfect the patient.

In chronic pyelonephritis, symptoms are again very variable. Some patients have no symptoms and only when examined for some associated hypertension or complication is the condition revealed. Others have lumbar backache, pus in the urine, and pain on micturition while a third group shows weight loss, general malaise, and ill health.

There is usually a reduction in output of urine and such renal failure requires investigating with cystoscopy and retrograde pyelography.

Treatment in acute or semi-acute cases consists of rest in bed, with investigation of any underlying condition or general systemic disorder and its specific treatment.

When there is much dull pain in the loins or abdomen, hot bottles or an electrically heated pad may be applied to the back, and aspirin, Anadin or paracetamol tablets may be prescribed. The high temperature may be brought down by careful tepid sponging.

Fluids such as fruit juices, barley water, and weak tea, all given with plenty of glucose, and also milk, amounting in all to up to four to five pints a day, should be given while the fever persists.

As soon as the fever has cleared, the patient is quite able to take a mixed diet with cereals, fish, eggs, meat, vegetables, and fruit.

For the infection itself, the choice of an antibiotic, e.g. ampicillin or cycloserine, will depend upon the micro-organism found in a culture of the urine. Drug therapy is continued until the urine remains sterile after treatment has stopped. The urine should be cultured four days after the end of treatment and again about four weeks later. If the culture indicates infection, though the patient shows no outward symptoms, long term follow-up may be required in order to prevent chronic irreversible disease.

When the temperature runs a normal course, the patient can be allowed to get up for a short time each day but must be very careful to avoid a chill. Exertion must be limited until convalescence is well advanced. Regulation of the bowel action is very important in any attack of pyelonephritis.

Treatment in chronic cases may be surgical to remove a stone or a diseased kidney. In recurrent cases antibiotics may be helpful. Treatment is less successful than in the acute form of the disease.

Prevention

Frequent cleansing of the anogenital area, especially by both partners in sexual intercourse, will prevent many cases of infection leading to chronic pyelonephritis, which in turn is the usual cause of later renal failure.

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