Acute Pyelonephritis or Infection of the Kidney

Acute pyelonephritis (APN) is a technical term for infection of the kidney. It is a part of the spectrum of urinary tract infection or UTI. UTI can occur anywhere from kidney, ureter, urinary bladder, prostate and urethra.

Symptoms of APN

The individual complains of pain abdomen, fever and chills. However there are many who do not suffer from all these symptoms and may only have some of them. Fatigue, generalized weakness and vomiting also are common. They may not have symptoms like burning urination or painful urination. APN usually is seen in middle aged and elderly people and less in young people. It is rarely seen in children.

Causes

APN is almost always caused by infections by common urinary infection causing bacteria like E. coli, Proteus, Enterobacter and Pseudomonas. Most of these infections are hematogenous which means the infection spreads through blood stream. Infection ascending from urinary bladder is less common. Patients with underlying diabetes are especially prone to be affected and those with uncontrolled diabetes even more so. It is also seen in individuals with kidney stones or stones blocking the ureters. Another common but less recognized cause is prostatic enlargement with urinary infection in the elderly males.

Evaluation

APN is diagnosed based on history and clinical examination. The patient will have fever, chills and pain abdomen. There will be pain on pressing the upper back on either side. The urologist will order a set of tests to confirm the diagnosis. These are Complete Blood Count, urine culture and sensitivity, serum creatinine, blood sugar level blood culture and ultrasound of abdomen. In case ultrasound is not conclusive, a CT scan of abdomen is done.

Treatment

The patient is advised hospitalization for ease of evaluation and treatment. The mainstay of treatment is injectable antibiotics, drugs to relieve fever and pain. Rest helps in faster recovery. In patients with diabetes sometimes ultrasound and CT scan show blockage to the kidneys due to pus flakes or sloughed off debris from the kidneys. There could be blockage due to stones too. In such cases endoscopy is done, debris or stone is removed and DJ stent is inserted. This is a synthetic tube to relieve the blockage and control infection. This tube is kept for a few weeks and removed once the infection is controlled. In all cases, the underlying diabetes has to be controlled without which infection control is very difficult. Even after the patient is off antibiotics, strict control of diabetes is mandatory to avoid recurrences. In case the urologist feels that prostate enlargement is the cause of APN, then prostate surgery is warranted.

Outcomes

With modern imaging, antibiotics and endoscopy, acute pyelonephritis doesn’t carry the morbidity it used to have a few decades ago.  However uncontrolled, prolonged and repeated infections can result in permanent kidney damage .Despite modern advances, there are rare situations where it can still result in death of the patient due to severe uncontrolled infection. Therefore it is worth reiterating the importance of controlling diabetes.

 

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