Pathogens may ascending through the urinary tract, or go through the blood to the kidneys.
Pyelonephritis is usually purulent inflammation of the renal pelvis, and below the renal tissue. An entirely self-centered on the renal pelvis inflammation occurs practically not. Pyelonephritis occurs primarily on two different routes of infection:
hematogenously. Here, the agents reach the kidney via the blood. The hematogenous form is often called primary pyelonephritis.
intracanalicular ascendant. Here, the agents arrive on ascending the urinary tract into the kidney. This form is referred to as secondary pyelonephritis.
Pyelonephritis is a common result in narrowing of the urinary tract.
The primary form is often difficult to prevent. It heals but good in the rule. The secondary pyelonephritis in most cases with a narrowing (obstruction) associated within the urinary tract. On average, half of all acute diseases in women and about 98 percent of acute diseases in men are due to an obstruction.
Several risk factors contribute to a disease.
There are a number of other factors that influence favoring the emergence of acute pyelonephritis. These include:
Obstruction
Stones or other debris
congenital kidney disease and abnormalities of the kidneys and urinary tract
chronic diseases such as diabetes mellitus, gout or high blood pressure
Indwelling catheter (often in the elderly)
Drug abuse or for too long taking medication, mostly painkillers (phenacetin)
Pregnancy
Chronic disease processes are more common in predisposing diseases.
Here are diseases such as stones, diabetes mellitus, gout, urinary tract anomalies or indwelling catheters often predisposing causes of chronic pyelonephritis. Also, not healed acute pyelonephritis often lead to the development of chronic pyelonephritis.
In the second half of pregnancy is a common complication of acute pyelonephritis.
The pyelonephritis gravidarum is a common complication in the second half of pregnancy. By the enlarged uterus, there is an increased pressure on the urinary tract. The elevated progesterone levels leads to decreased peristalsis of the intestine and ureter. This carries the urine should be much harder on. Also shifts during pregnancy, the pH and leads to an increased content of amino acids, creatinine, glucose, lactose. These factors favor the rapid multiplication of bacteria. In women in whom an asymptomatic bacteriuria, it comes in the second half of pregnancy to a multiplication of bacteria.
Symptoms
The symptoms appear suddenly and can be very severe.
In acute pyelonephritis put the complaints of a sudden and violent. This can occur:
Flank pain
Back pain
Fever and chills
increased heart rate (tachycardia)
severe malaise
due to a urinary tract infection urinary frequency (frequent, dribbling urination) and dysuria (unpleasant bladder emptying)
intestinal paralysis due to nausea and constipation
Vague complaints often lead to delayed diagnosis.
In some cases, the complaints to be atypical. Even the pain can be shifted into the groin or the scrotum. That will not always considered by those affected as symptoms. Often such "strips complaints" such as on a previous sporting activities are fed back. Therefore are more common in displaced or atypical symptoms delay in diagnosis. In exceptional cases, especially when there is already a kidney problem or a disease of the urinary tract, pyelonephritis, a "dumb" run (without problems).
Children are particularly affected in infancy.
Very often children are affected, especially infants and toddlers. This is due mainly to the relative immaturity of the child's kidney (which makes them more vulnerable) and the not yet fully mature immune system. A first urinary tract infection or pyelonephritis but may also have the first indication of a congenital disease of the urinary tract or an anomaly in this age. The complaints in this age are not typical: dislike drinking, lethargy, fever and abdominal pain and frequent nocturnal enuresis. Uncommon, yet unexplained infections in children by general (often abused by educational level) and kidney infections are caused by overlooked.
Women often suffer from atypical symptoms.
Women, however, can often go through "asymptomatic" pyelonephritis. Is fundamental that offer relocation, known for many women, symptoms of a bladder infection. Noticed the pyelonephritis often in such cases only if it leads to a serious impairment of renal function. It is often then had a contracted kidney or an abscess formed. Increased danger, especially during pregnancy. Then, all urinary tract infections, even if they run free of pain, treated with antibiotics, since they present for the existence of a "silent" pyelonephritis a danger to mother and child .
Indwelling catheters are a potential source of infection. Here the risk is particularly high.
In the (older) man is in most cases, the obstruction of the urethra by the prostate adenoma cause pyelonephritis. The continuous use of a catheter to avoid the consequences of obstruction decreased, while the obstruction, but his hand is a possible source of infection. Thus, without exception all permanent catheter carriers a urinary tract infection that is resistant to treatment, but in most cases and therefore should not be treated with antibiotics, not to increase the number of resistant pathogens. Antibiotic treatment should be performed if symptoms occur such as fever and micturition problems (pain).
Chronic pyelonephritis is often silent, but then develops an acute episode.
A chronic pyelonephritis usually runs silently and does not cause symptoms until an acute episode is again seen. Every woman should vote against all suspected recurrent cystitis. In young people should be thinking in longer-lasting headaches, constant thirst and reduced performance in chronic pyelonephritis. Other nonspecific symptoms can be fatigue, loss of appetite with nausea, and sometimes closer to localized back pain that is often referred to as "lumbago" or "sciatica" dismissed by those affected.
Diagnosis
Specific questions the way.
Important and groundbreaking is a detailed medical history with pyelonephritis. The physician must ask many specific questions, all of the possible causes carefully noted. This also includes questions on previous symptoms or events. As a general reference to the following list of questions:
Has there ever been similar complaints with dysuria, fever, flank pain, etc?
Have you ever had kidney stones?
If there is kidney disease in the family?
Was there urinary symptoms in childhood nocturnal enuresis example?
Did you have urinary symptoms during pregnancy? Examination findings are often recorded here in the mother's passport.
They had gynecological surgery?
Do you suffer from: arthritis, diabetes mellitus or arterial hypertension?
What medications you take regularly?
How is your urine runs normally?
Blood and urine tests are the basis of diagnosis.
In the laboratory, both the blood and the urine examined. Urinalysis for detailed descriptions can be found here. When a urinary tract bacteriuria and leukocyturia often is detected. Occasionally, occurs as a sign of involvement of the renal tissue and proteinuria.
Bacterial infections are most common.
In primary pyelonephritis that occurs hematogenously (see above), a bacterial infection is common in bacteria detected in the blood, usually staphylococcus aureus. But also fungi (Candida and other fungi) and other pathogens (Chlamydia, Mycoplasma) may be the primary cause pyelonephritis. In the secondary form, it is mainly the fecal bacteria such as E. coli, leading to an ascending infection.
Chronic diseases can damage the kidneys permanently. This damage is visible at a urography.
To exclude a stasis is usually performed an ultrasound examination. The standard radiological methods in chronic infections is the urography. With her typical can change, such a narrowing of the renal tissue, a Verplumpung the kidney tissue or even a contracted kidney are detected. The following diagram shows a schematic picture of these changes.
The backflow of urine from the bladder is made visible.
Especially in children is acute pyelonephritis after a voiding cystourethrogram performed frequently. It is important to prevent the development of chronic pyelonephritis, which can be easily developed if there is a Harnrückfluss (reflux) from the bladder into the kidneys. This reflux can be determined using the voiding cystourethrogram.
Therapy
Strict bed rest and drinking plenty are cornerstones of treatment.
The main principles of therapy of acute pyelonephritis is an abundant fluid intake (more than 2 liters / day) and strict bed rest. The hydration is very important, so a frequent urination occurs. It also reduces the number of bacteria. In a complicated pyelonephritis should be treated in hospital.
Antibiotics must be given sufficient time.
A bacterial pyelonephritis is treated with antibiotics. Since the beginning we still do not know which pathogen has caused the infection, it begins with the administration of a broad-spectrum antibiotic. Then a targeted antibiotic therapy for at least 14 days is up to 21 days. Frequently, antipyretic and analgesic drugs are used to reduce the discomfort. It is important that at the latest after the acute (or renewed) research is a cause of infection in order to prevent a recurrence.
When developing a Renal must be operated on immediately.
Attack the drug treatment of acute pyelonephritis in 3 to 5 days, not so the cause can be a Renal abscess. Renal a must as soon as possible (Notfalloperation!) via a drainage system or be drained surgically, because the complications of Renal abscess is dangerous, and the mortality is very high. For rapid diagnosis, the removal of the kidney in most cases is to avoid. If left untreated, leads to a Renal urosepsis and often death.
Causes of disease must be eliminated.
In chronic pyelonephritis is the basis of adequate antibiotic therapy is a treatment taking into account all possibilities. A protracted chronic pyelonephritis leads to renal atrophy and dialysis. The elimination of the causes of acute pyelonephritis is the best treatment and prevention of chronic pyelonephritis. Is there a unilateral chronic pyelonephritis then the removal of this kidney (nephrectomy) may be needed
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