PyelonephritisIntroduction: Kidney
infections are uncommon in men, largely because of the longer urethra and the
fact that pyelonephritis is usually caused by a retrograde infection from below.
It is much more common in women and is very common in pregnancy and in the first
few weeks after pregnancy. The reasons for this are that pregnancy
slows down the natural peristaltic activity of the ureters and during pregnancy
in the hospital women are very likely to get a urinary catheter or have some minor
instrumentation done to help in the delivery. They may need stitches after the
delivery to attend to some vaginal lacerations. All of this
results in the introduction of bacteria into the normally sterile environment
of the urinary tract. When the urethra and bladder are colonized with bacteria,
the bacteria will migrate against the stream of urine (like salmon swimming against
the stream of water) until they arrive in the center of the kidney. Next the bacteria
invade the tissue of the kidney and will find a home where they can quietly multiply.
The glomerula, which are the mini-filtration units of the kidney tissue, are relatively
resistant to infection, but the tissue and the collecting ducts, which form the
papillae in the renal pelvis, are not. These sensitive structures at the upper
end of the ureter can easily get damaged with conditions like diabetes mellitus,
kidney stones (obstruction), sickle cell anemia and poisoning with analgesics
(Ref. 1, p. 1885). Signs and Symptoms: Often the
patient gets ill very suddenly with a fever and chills. Associated with this is
a flank pain on the side where the kidney is infected and the physician finds
that the kidney area is very tender when tapping the region with a finger (positive
percussion sign). There can also be nausea , vomiting and abdominal pain. With
chronic pyelonephritis symptoms are a lot more blunted or may even be absent and
be replaced by a chronic lack of appetite, weight loss and general fatigue. In
about 30% of cases there is also an infection of the bladder and urethra. Diagnosis:
Other than the tenderness of one or both kidneys and the signs and symptoms, there
are subtle laboratory signs to indicate pyelonephritis. As the infection is centered
histologically around the collecting tubules within the tissue of the kidneys,
one of the most convincing lab findings is the finding of pus cells (neutrophils)
in tubules in the urine or "white blood cell casts". It means that on
a microscopic level some tissue damage in one of the kidneys has been taking place.
Associated with this is a positive urine culture with one of the common bacteria
or more rarely one of the other pathogens (Ref. 1, p.1885).
| Common
pathogens with urinary tract infections |
| Common bacteria: | Less
common pathogens: | E.
coli | Trichomonas |
| Klebsiella | Candida
albicans | | Enterobacter | Blastomyces |
| Proteus | Coccidioides
species | | Pseudomonas | Mycobacterium
tuberculosis | | Anaerobes |
| Enterococci | Schistosoma
species | | Staphylococcus
aureus | | Staphylococcus
saprophyticus | Eccinococcus species
| | Serratia |
In chronic pyelonephritis it would be wise to have the physician
refer the patient to a nephrologist or to a urologist. There can be anatomical
malformations such as kidney cysts or back-up of urine because of a valve problem
between the ureter and the bladder. Also there could be a tortuous ureter
that leads to a higher incident of pyelonephritis on the affected side. There
are a number of tests that can be done to gather information about the anatomical
and functional situation of the urinary tract. Intravenous injection of a dye
followed by X-rays gives a lot of information about the functioning of the kidney
tissue and about any anatomical abnormality. Other tests such as CT scan
and MRI scan can add valuable details. A voiding cystourethrogram in combination
with a cystoscopy can give more details about the lower end of the urinary tract
(Ref.1,p.1888). Treatment: The first goal of therapy
is to eradicate the pathogen that is infecting the urinary tract as the the urinary
tract should be sterile. However, this may involve simultaneous other therapy
such as shock wave lithotripsy for kidney stones to remove foreign bodies within
the renal pelvis or ureter that only attract urinary tract infection. If there
is analgesic abuse, this needs to be stopped. Closely monitoring poorly controlled
diabetes will improve the chances to avoid repeat bacterial urinary tract infections
and also to prevent candidiasis reinfection, in case Candida albicans was the
pathogen. Congenital reflux from the bladder into the ureter can be surgically
corrected by a urologist and helps greatly to prevent future infections. Cranberry
juice should not be overlooked as a cheap and effective preventative therapy once
the pathogens have been eradicated. It has been shown to be effective to a certain
degree (Ref.1,p.1890). Pain relief: There is an FDA approved
non-drug method available, IceWave
patches from Lifewave, which will control pain. This is mentioned in the
book "Breakthrough" by Suzanne Somers (Ref. 6) where newer insights
of antiaging medicine are also reviewed. Although the patches are placed over
acupuncture points, there are no needles involved. Nanotechnology, a newer technology,
was used in the manufacturing of these patches and infrared (heat) waves from
body heat are utilized to stimulate an acupuncture point, which modifies pain
perception and reduces pain to half or less. Medically this would be considered
an excellent pain reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the US a 5 pack of the
IceWave spray is available that can be directly sprayed onto the skin in the area
where the pain is located. |
