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Inflammation of the renal pelvis: symptoms, prognosis

by Josephine Andrews
Published: Last Updated on 330 views

Inflammation of the renal pelvis or pyelonephritis is the most common bacterial infection of the renal pelvis. It is the result of an ascending infection: the pathogens travel up the urethra, bladder, and ureters to the renal pelvis. Find out here what symptoms a kidney infection causes, how long it lasts and how to treat it.

ICD codes for this disease: N12 | N10 | N11

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.
quick overview
  • Symptoms: fever, chills, flank pain and/or nausea/vomiting, in the chronic form also atypical symptoms such as headaches, exhaustion, back pain and loss of appetite
  • Course of the disease and prognosis: With timely treatment, it usually heals well, duration of treatment in the case of an uncomplicated course is about one to two weeks, the chronic form sometimes takes a less favorable course, if left untreated, pyelonephritis sometimes leads to kidney weakness or failure
  • Causes: Mostly bacteria, more rarely other pathogens such as fungi, viruses ; Risk factors include: urinary flow disorders, urinary tract infections, pregnancy, diabetes, urinary catheter
  • Diagnosis: Collection of the medical history, physical examination with tapping of the kidney area, blood pressure measurement, blood test for inflammation values, urine test for pathogens and signs of inflammation, sometimes ultrasound or computer tomography
  • Treatment: antibiotics, if necessary: ​​antipyretics, pain relievers or anticonvulsants, treatment of triggers and risk factors, general measures: bed rest, drinking plenty of fluids
  • Prevention: drinking enough water, regular urination, appropriate personal hygiene (for women, note the wiping direction), healthy lifestyle

What is pelvic inflammatory disease?

Pelvic inflammatory disease, also known as pyelonephritis, is a specific form of kidney inflammation. Here the renal pelvis, a funnel-shaped cavity inside the kidney, is inflamed. The urine coming from the renal tubules collects in the renal pelvis before it reaches the bladder via the ureter.

In most cases, an inflammation of the renal pelvis occurs when bacterial pathogens rise from the inflamed bladder via the ureters up into the renal pelvis. This form of kidney inflammation is one of the upper urinary tract infections and is the most common kidney disease.

Because women have a shorter urethra than men, they are two to three times more likely to get pyelonephritis. People between the ages of 20 and 30 are most commonly affected. Acute pyelonephritis usually occurs suddenly. It is typically accompanied by severe flank pain and fever.

The chronic form often progresses in phases or gradually, the main cause here being problems with the outflow of urine, such as an enlarged prostate . Those affected are tired and less efficient and often have no appetite. Left untreated, chronic pyelonephritis can damage the kidneys to the point of failure.

What are the symptoms?

Inflammation of the renal pelvis (pyelonephritis) is acute or chronic. Usually only one kidney is affected by the inflammation.

Acute pelvic inflammatory disease: symptoms

Acute pyelonephritis usually causes severe symptoms all of a sudden. These include:

  • High fever over 38 degrees Celsius, often combined with chills
  • General malaise and thirst
  • Severe flank pain, i.e. lateral back pain in the area of ​​the affected kidney, sometimes the pain radiates into the pelvis
  • Frequent urination with small amounts of urine (pollakisuria) and/or problems or pain when urinating (dysuria)
  • nausea, vomiting and/or diarrhea
  • Sometimes blood in the urine

Especially in children and older people , non-specific symptoms often appear. Newborns and infants are sleepy and pale, breathe more quickly (tachypnea), and rarely have a fever. In older people, on the other hand, fever is usually the only symptom.

Complicated inflammation of the renal pelvis

In patients with previous illnesses such as diabetes mellitus (diabetes) and infections with so-called “hospital germs”, severe signs of inflammation often appear during the course of the disease, which affect the whole body.

Sometimes an acute inflammation of the renal pelvis results in a kidney abscess (encapsulated collection of pus) or pus collects in the cavities of the kidney (pyonephrosis). If these complications occur, doctors speak of complicated pyelonephritis .

Overall, men, as well as pregnant women and people with a weakened immune system, are more susceptible to complicated pyelonephritis.

Chronic pelvic inflammatory disease: symptoms

If acute pelvic inflammatory disease is left untreated or recurs, there is a possibility that it will develop into chronic pyelonephritis. This form damages the kidneys slowly and continuously, and the tissue scars over years. Usually there are no symptoms for a long time (“silent” course).

Sometimes there are also symptoms of chronic inflammation of the renal pelvis. However, these are often not very specific, such as:

  • headache
  • fatigue and exhaustion
  • Dull back pain in the lumbar region
  • loss of appetite
  • Stomach pain , sometimes with nausea
  • problems urinating
  • weight loss

Chronic inflammation of the renal pelvis usually runs its course without fever (at most a slightly elevated body temperature). In some cases, however, the disease flares up again and again . These are accompanied by fever and other symptoms that also occur in acute pelvic inflammatory disease.

Since the kidneys are involved in blood formation, chronic inflammation of the renal pelvis sometimes leads to anemia . In addition, some sufferers develop high blood pressure because the diseased kidney excretes less fluid.

Kidney tissue also changes over time. Under certain circumstances, the chronic inflammation can lead to functional kidney tissue gradually becoming non-functional scar tissue . As a result, the affected kidney no longer works properly, which increases the risk of kidney weakness (renal insufficiency) or chronic kidney failure .

How long does a kidney infection last?

How long pyelonephritis lasts and how it progresses depends on many factors. Among other things, whether it is the acute or chronic form of inflammation of the renal pelvis and whether there are any complications.

If acute pelvic inflammatory disease is treated early, the prognosis is generally good. It then heals without consequences. The treatment duration of an uncomplicated inflammation of the renal pelvis is about five to ten days. Complicated pyelonephritis takes longer to heal from the inflammation. In this case, the period may be up to six weeks.

The doctor usually checks the success of the treatment using a urine test about two weeks after the end of the therapy. If no more pathogens can then be detected, the inflammation is considered to have healed.

Chronic pyelonephritis has an unfavorable prognosis. In some cases, chronic pyelonephritis does not heal completely. The doctor usually treats the recurring flare-ups with antibiotics to avoid more serious complications. Narrowed urinary tracts are also a risk factor for chronic courses. Regular medical check-ups are necessary here.

If left untreated, both forms of pelvic inflammatory disease severely damage the kidney. Ultimately, it is possible that complete kidney failure (renal insufficiency) can occur, especially without therapy.

The possible complication of an encapsulated accumulation of pus in the tissue (kidney abscess) can also have serious consequences. For this reason, it is imperative that prompt treatment is provided.

In addition, there is a risk of so-called urosepsis in the case of an inflammation of the renal pelvis . Doctors define this as “blood poisoning” (sepsis) originating from the urinary tract. The pathogens spread from the kidneys through the bloodstream throughout the body. If urosepsis occurs, this can be life-threatening under certain circumstances and must be treated in hospital.

The risk of urosepsis in renal pelvic inflammation is particularly high in infants under the age of one year.

How is a kidney infection treated?

Because bacteria cause acute pyelonephritis in most cases , doctors primarily prescribe antibiotics. The patient usually takes this medication as pills over five to ten days. First, he is given a broad-spectrum antibiotic that works against a wide variety of bacteria. After about a day or two, the doctor will check whether the therapy is working or not.

If the antibiotic does not improve after three days, he usually prescribes another antibiotic or he refers the patient to the hospital. Those affected also receive antibiotics there, at least for the first time, but by infusion . Especially if nausea and vomiting also play a role.

As soon as the result of the urine test is available (i.e. the exact type of pathogen has been identified), the doctor may switch the treatment to another antibiotic that specifically helps against the germ in question.

In the case of severe kidney infection, the doctor will usually refer you to the hospital. In most cases, however, outpatient treatment is possible.

In addition to antibiotics, doctors sometimes prescribe antipyretics for pyelonephritis . If there are cramps or pain, the doctor will also prescribe medication. He also advises staying in bed during treatment and drinking a lot (at least two to three liters). The latter helps flush the bacteria out of the kidneys and urinary tract.

In the treatment of chronic pyelonephritis , doctors often also use antibiotics. However, they usually first wait for the result of the so-called antibiogram . This is a microbiological test to test the effectiveness of different antibiotics against the pathogen present. This is how you can find out which antibiotic is most suitable for the treatment.

If the disease flares up repeatedly, antibiotics are also the drug of choice. If there is no rapid improvement despite antibiotic treatment in the form of tablets, the doctor arranges for admission to the hospital.

Eliminate urinary flow disorders as a trigger

If urinary flow disorders are the trigger of the inflammation of the renal pelvis, it is important to treat or eliminate them if possible. If, for example, a constriction in the urinary tract or an enlarged prostate impedes the outflow of urine and thus promotes pyelonephritis, an operation is often necessary.

What happens with a urinary obstruction? The renal pelvis serves as a collection funnel for the urine that the kidneys produce. From the renal pelvis, urine drains through the ureter. If this outflow of urine is not possible or only possible to a limited extent, it accumulates. This promotes bacterial growth and thus inflammation of the renal pelvis.

Some people are born with congenital narrowing of the ureters. In others, they only develop later in life, for example with prostate enlargement, urinary or bladder stones and through scar tissue after infections.

Inflammation of the renal pelvis during pregnancy

Urinary drainage disorders can also occur in pregnant women. In general, urinary tract infections occur more frequently during pregnancy. This has to do with the physical changes during pregnancy. Doctors discuss whether pyelonephritis increases the risk of preterm birth . There is no clear evidence for this.

However, in order not to pose a health risk to the pregnant woman and the unborn child, doctors also treat a kidney infection in pregnant women with antibiotics. To do this, you select a preparation that is suitable for pregnant women, depending on the week of pregnancy in which the woman is.

Home remedies for pelvic inflammatory disease?

Basically, it is important to have pyelonephritis examined and treated by a doctor. Left untreated, pelvic inflammatory disease can cause serious and long-term damage to the kidneys.

In addition to medical therapy or prophylactically before pyelonephritis occurs, there are certain home remedies that are used for urinary tract infections.

Before you use any of these home remedies, it is best to discuss this with your doctor beforehand:

  • Drink a lot: The simplest and most important home remedy is that you drink a lot of fluids, preferably tea or water. If you have heart failure, ask your doctor how much you can drink.
  • Warmth: A hot water bottle or heat pad can relieve some pain and relieve cramps.
  • No to coffee, alcohol, cigarettes and spicy food: try to avoid these stimulants during the illness.
  • Cranberry juice or cranberry products: There are studies that show a preventive effect of cranberries compared to placebo, especially in the case of recurring urinary tract infections.
  • Mannose: Taken at 2 grams per day in a glass of water, believed to reduce the incidence of urinary tract infections.
  • Urinary tract cleansing plants such as bearberry leaves, watercress herb, or horseradish root: These plants are often available as teas or tablets. They are intended to support and/or prevent urinary tract infections. However, doctors do not recommend long-term use of them. In the long run, they may be more damaging to the kidneys.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

How does a kidney infection develop?

There are different reasons for a kidney infection.

In most cases, an ascending bacterial infection causes the disease. The pathogens enter the urinary bladder via the urethra and climb from there via the ureter to the renal pelvis. Therefore, pyelonephritis is often preceded by urethritis or bladder infection (cystitis).

Only in rare cases do the bacteria that cause inflammation of the renal pelvis enter the body via the bloodstream.

In the majority of cases, the intestinal bacterium Escherichia coli (E. coli) is the cause of inflammation of the renal pelvis. The infection is caused, for example, by the intestinal bacteria being carried over from the anus into the urethra. This happens in women, for example, when they wipe from back to front when cleaning the toilet. In this way, the pathogen sometimes rises to the kidneys.

Sometimes other bacteria (such as enterococci, staphylococci) as well as fungi or viruses also cause pelvic inflammatory disease. Infections with other bacteria also occur more frequently after interventions on the upper urinary tract or with urinary catheters. The latter in particular if the catheter remains in the urethra/bladder for a longer or permanent period.

Women are about two to three times more likely to be affected by pyelonephritis than men. One of the reasons for this is that they have a shorter urethra and its entrance is closer to the anus. Men become ill more often as they get older, for example when an anatomical narrowing of the urethra occurs due to an enlarged prostate.

Risk factors of renal pelvic inflammation

There are numerous risk factors that favor renal pelvic inflammation. The following factors include:

  • High age
  • Pregnancy: Under the influence of hormones, the urinary tract expands, which makes it easier for bacteria to ascend
  • Decreased hormone production, like after menopause
  • Bladder catheter over a long period of time (permanent catheter)
  • Lower urinary tract infections, such as a bladder infection
  • Diabetes mellitus (diabetes)
  • Urinary flow disorders, such as an enlarged prostate in men, congenital malformations of the kidneys or urinary stones
  • Immune deficiency, such as from taking immunosuppressive drugs or from HIV infection
  • Backflow of urine from the bladder towards the kidneys (vesicoureteral reflux), more common after kidney transplants

How is a kidney infection diagnosed?

First, a doctor collects your medical history (anamnesis): He asks you, among other things, about your symptoms and any previous and underlying diseases. Possible questions are:

  • What complaints do you have exactly? How long have these existed?
  • Have you had a lower urinary tract infection, such as a bladder infection, in the past few months?
  • Do you have kidney or bladder stones?
  • Do you have metabolic diseases such as diabetes mellitus (diabetes)?

Physical examination

The doctor then performs a thorough physical exam . Among other things, he taps and feels the kidneys, since pain in the flanks is typical of a kidney infection. In addition, he sometimes measures the temperature and blood pressure to detect fever and high blood pressure.

urine test

The analysis of a urine sample is very important in the diagnosis of pelvic inflammatory disease. If bacteria and white blood cells ( leukocytes ) are found in the urine in increased amounts, this indicates an inflammation of the urinary tract.

To identify the pathogen, the doctor can create a urine culture . This examination is carried out in the laboratory. There, the urine sample is exposed to conditions ideal for bacterial growth. In this way, the pathogens multiply in the urine sample and can then be easily detected.

The doctor also has an antibiogram drawn up: This is about testing which antibiotics work best against the pathogen present. This will help you plan your therapy.

blood test

If a kidney infection is suspected, the doctor takes a blood sample and has it analyzed in the laboratory. Inflammation parameters such as blood flow rate (ESR) and C-reactive protein (CRP) are measured. Both values ​​indicate inflammation in the body when they are elevated.

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

Imaging procedures

With the help of a conventional ultrasound examination (sonography), the doctor assesses the position, shape and size of the kidneys. Urinary and kidney stones as well as possible urinary retention as a trigger of the inflammation can also be detected in this way. In addition, he also detects scar tissue in the kidneys in the ultrasound, as it forms with chronic inflammation of the renal pelvis.

A special form of ultrasound examination is voiding urosonography . It is often used with children. Ultrasound is used to check whether the urine is flowing back from the bladder towards the kidneys (vesicoureteral reflux), which promotes pyelonephritis. In the run-up to the examination, the patient is given a contrast medium that makes the urine reflux more visible.

In some cases of inflammation of the renal pelvis, further imaging methods are useful. Computed tomography (CT) is also used when the findings of the ultrasound examination are unclear. An X-ray examination of the urinary tract (urography) sometimes shows narrowing of the urinary tract and urinary stones or kidney stones.

How do you prevent pelvic inflammatory disease?

There are some measures that can reduce the risk of pelvic inflammatory disease:

  • Drink enough and regularly, preferably water or tea. This cleans the urinary tract and flushes out any germs.
  • Regular urination also helps to flush pathogens out of the urinary tract. Going to the toilet as soon as possible is particularly important after intercourse.
  • For women, the direction of wiping on the toilet is important: Always wipe from the vagina towards the anus after a bowel movement. In the opposite case, it is easy to carry intestinal bacteria from the anus to the nearby urethral opening.
  • Appropriate intimate hygiene is advisable for both sexes in order to prevent inflammation of the renal pelvis. Both insufficient and excessive intimate hygiene promote the growth of germs. For example, do not use disinfectants for intimate hygiene, only warm water.
  • In some cases, a bladder infection develops into a kidney infection. You should therefore avoid hypothermia by wearing appropriately warm clothing. Change out of wet clothing, such as wet bathing suits or sweaty gym clothes, as soon as possible.

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