Pyelonephritis

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What Is It?

Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder.Women have more bladder infections (also called urinary tract infections) than men because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. Usually, however, the infection remains in the bladder.A woman is more likely to develop pyelonephritis when she is pregnant. Pyelonephritis and other forms of urinary tract infection increase the risk of premature delivery.A man is more likely to develop the problem if his prostate is enlarged, a common condition after age 50. Both men and women are more likely to develop pyelonephritis if they have any of the following conditions:

• An untreated urinary tract infection
• Diabetes
• Nerve problems that affect the bladder
• Kidney stones
• A bladder tumor
• Abnormal backflow of urine from the bladder to the kidneys, called vesicoureteral reflux
• An obstruction related to an abnormal development of the urinary tract

Symptoms

The two primary symptoms of pyelonephritis are pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen. There also can be shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. You may need to urinate more often than normal and urinating may be painful or uncomfortable.

Prevention

To help prevent pyelonephritis if you have had a previous episode or are at risk:

• Drink several glasses of water each day. Water discourages the growth of infection-causing bacteria by flushing out your urinary tract. This flushing also helps to prevent kidney stones, which can increase the risk of pyelonephritis.
• If you are a woman, wipe from front to back. To prevent the spread of intestinal and skin bacteria from the rectum to the urinary tract, women should always wipe toilet tissue from front to the back after having a bowel movement or urinating.
• Decrease the spread of bacteria during sex. Women should urinate after sexual intercourse to flush bacteria from the bladder. Some women who have frequent urinary tract infections after sexual activity can take antibiotics around the time of intercourse to prevent an infection.

Treatment

Doctors treat pyelonephritis with antibiotics. In most uncomplicated cases of pyelonephritis, the antibiotic can be given orally (by mouth), and treatment usually lasts for at least two weeks. Commonly used oral antibiotics include trimethoprim with sulfamethoxazole (Bactrim and others), ciprofloxacin (Cipro) or levofloxacin (Levaquin), but the choice of antibiotic will depend on your history of allergies and laboratory testing of the bacteria causing the infection. Once you finish the full course of antibiotics, your doctor may ask for another urine sample to check that bacteria are gone.If you have high fever, shaking chills or severe nausea and vomiting, you are more likely to become dehydrated and may be unable to take oral antibiotics. In that case, you may require hospital treatment so that antibiotics can be given intravenously (into a vein). High fever and shaking chills also may be signs that your kidney infection has spread to your bloodstream and can travel to others parts of your body. If your doctor is concerned that you may have an obstruction (such as a kidney stone that is stuck in the ureter) or a structural abnormality in your urinary system, other tests may be ordered, such as a (CT) scan, ultrasound, intravenous pyelogram or cystoscopy, an inspection of the inside of the bladder using a thin, hollow, tubelike instrument.