This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

PYELONEPHRITIS

Acute pyelonephritis is a bacterial infection causing inflammation of the urinary tract and the kidneys. The infection usually affects one kidney but sometimes both kidneys may be involved.

WHAT CAUSES ACUTE PYELONEPHRITIS?

Most cases of acute pyelonephritis are caused by a common intestinal bacteria, E-coli, Proteus, Klebsiella, Enterobacter and Pseudomonas. Some cases of acute pyelonephritis can be caused by a variety of less common microorganisms (such as streptococcus fecalis or staphylococcus aureus). The infection may begin in the bladder and then travel to the kidney. The bacteria may also reach the kidney through the bloodstream from an infection elsewhere in the body. Sometimes no specific cause can be found for pyelonephritis. Possible origins of this bacterial infection are:

a) A blockage in your urinary system, such as from kidney stones or a tumor. The blockage creates an ideal environment for bacteria to grow.

b) Careless hygiene, especially when you wipe yourself after a bowel movement, allowing bacteria to enter the urethra (the tube going from the bladder to the outside).

c) From bacteria introduced into the bladder from a medical procedure such as the insertion of a catheter, or a tube needed for a surgical procedure.

WHO GETS ACUTE PYELONEPHRITIS?

Anyone at any age can get this condition, but it is more common in women. Pregnant women are also at risk for developing acute pyelonephritis. This is due to the pressure that the weight of the baby puts on the ureters (the narrow tubes which carry the urine from the kidneys to the bladder). People with diabetes mellitus, paralysis from a spinal cord injury, a tumor of the bladder or an enlarged prostate are also considered at higher risk for developing this condition.

WHAT ARE THE SYMPTOMS OF ACUTE PYELONEPHRITIS?

The symptoms of acute pyelonephritis appear suddenly. The first symptom is usually an intense pain on one or both sides of your lower back. The pain may spread to the groin area. Your joints and muscles may also ache. Shaking chills with a fever may also accompany the pain. Other early symptoms may include pain when you urinate, and the feeling that you need to urinate frequently, even when you've just emptied your bladder. Your urine may be cloudy (due to pus) and may also contain blood making it slightly red in color.

As symptoms continue, you may find yourself feeling increasingly tired. Nausea and vomiting with diarrhea are also common. The signs and symptoms of acute pyelonephritis can vary, especially in children and in the elderly.

DIAGNOSING ACUTE PYELONEPHRITIS

In diagnosing acute pyelonephritis your doctor will ask you about your medical history and perform a physical examination to differentiate this particular illness from any other condition. A blood test and your a specimen will be sent to the laboratory for culturing to identify the bacteria causing your infection. For this urine test your nurse will ask you to provide a "clean catch" urine specimen. Your nurse will explain how to collect the urine to avoid mixing it with other bacteria.

The results of these tests will tell your doctor what type of bacteria is causing your symptoms, so that the appropriate medication and treatment can be provided. The doctor may also order an intravenous pyelogram (IVP). This is an x-ray examination of your kidney using a dye which is injected into your vein intravenously (IV).

TREATMENT

Your doctor may request that you be hospitalized if your infection is severe or if there are complicating factors. Bed rest is often prescribed until your fever has gone down. Frequent rest periods will also help you to conserve energy and prevent you from getting tired. Antibiotic therapy is started immediately. Once the results from your tests are back, your medication may be changed to treat you for the specific bacteria causing your infection. It may also be altered if your symptoms or fever continue for more than 48 hours on your current antibiotic therapy. For acute pyelonephritis, antibiotic therapy is usually given intravenously for about a week, then is followed up by taking the medication by mouth for an additional two weeks.

It is important that you finish the entire prescription of antibiotics even though your symptoms improve and you are feeling better. Otherwise, the treatment may not be effective and the infection could return. It is important that you let your doctor know if you are allergic to any antibiotics and then follow his or her instructions carefully. If you are not passing urine because you are retaining it, your doctor may want to put in a catheter, (a tube that goes into your bladder to drain urine which is collected in a bag that hangs at the side of your bed, or a bag which is attached to your leg, called a "leg bag").

Pain medication may also be prescribed to relieve your pain and to make you more comfortable. Antipyretics (medication to help lower your fever) and antiemetics (medication to help relieve your nausea) can also be prescribed.

There is no special diet for pyelonephritis, but you may find a light, bland diet is easier for you to digest, especially if you are nauseated.

Additional urine samples will be tested following the completion of your antibiotic therapy, and for a follow-up period of at least 6 months. This is to ensure that the bacteria causing your initial symptoms are gone. If left untreated, chronic kidney infections could develop.

WHAT YOU CAN DO

It is important that you drink at least two quarts of liquid each day. This will help your kidneys flush out the bacteria. Try to avoid wearing nylon underwear which increases moistness, thus providing ideal conditions for bacterial growth.

After a bowel movement, wipe from the front to the back so that any bacteria present cannot travel forward into the urethra. It is best to avoid sexual positions that may hurt or cause irritation to your urethra or bladder, and it is advisable for women to urinate after sexual intercourse.

It is important you keep your follow-up visits to your doctor, to ensure the infection does not reoccur.

COPING

When your illness is diagnosed and treatment has started, complications are usually uncommon. However, the stress of the infections, hospitalization and continuing home care treatment can result in feelings of depression, guilt, or anger. Denying these feelings or covering them up may make them worse. Many people find it helpful to talk to friends or family members, a counselor or your primary nurse. These people can help you express your feelings and enable you to cope with this illness.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

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