Pyelonephritis is a bacterial inflammation of the kidney and renal pelvis caused by an ascending infection of germs. The starting point for pyelonephritis is an untreated or inadequately treated bladder infection. Women are more frequently affected than men.
You can find out below which doctor treats pyelonephritis and what the treatment looks like. You can also find selected specialists for the treatment of pyelonephritis here.
Very rare special forms are emphysematous pyelonephritis, which is characterized by gas formation in the kidney or in the tissue surrounding the kidney, and xanthogranulomatous pyelonephritis. Diabetes, a urinary drainage disorder or other diseases that weaken the immune system are favorable factors. The symptoms are similar to ordinary pyelonephritis, but the disease progresses quickly and dramatically. The patient often experiences no improvement under the antibiotic therapy initiated.
In xanthogranulomatous pyelonephritis, there are tissue-destroying changes in the kidney. The kidney is also often stone-bearing(kidney stones). Confusion with a malignant tumor of the kidney is possible and can often not be ruled out with absolute certainty using imaging diagnostics (computer tomography), but only becomes apparent intraoperatively during kidney surgery. The name of the disease is based on the fat-bearing cells (xanthoma cells) found in the histological examination of the kidney.
Recurrent pyelonephritis can lead to scarring within the kidney over the long term and ultimately to loss of function. An existing reduction in kidney function can no longer be reversed.
Inflammation of the renal pelvis can also be chronic, in which case the patient does not have to present any complaints or symptoms. A urine culture only shows bacteria in the case of an active infection. Chronic pyelonephritis can also lead to a reduction in kidney function. Particularly in children with recurrent or chronic pyelonephritis, an anatomical or functional cause (e.g. vesicoureteral reflux, neurogenic bladder emptying disorder) should be excluded or treated.
Acute pyelonephritis is characterized by a general feeling of illness with fever, chills and pain in the kidney area. This is usually preceded by typical symptoms of cystitis (painful urination, frequent urge to urinate with small portions of urine, frequent urination). The symptoms can vary in intensity. In older people, the symptoms may be atypical. If left untreated, this disease can lead to sepsis (blood poisoning).
Acute pyelonephritis is diagnosed clinically on the basis of the typical symptoms. In addition, the rapid urine test shows typical signs of a urinary tract infection (white and red blood cells, nitrite as indirect evidence of bacteria). The blood also shows increased signs of inflammation (erythrocyte sedimentation rate, leukocytosis, C-reactive protein).
A so-called urine culture should be taken before starting antibiotic therapy and the causative germ should be cultured specifically. Different antibiotic groups should be tested in order to be able to switch to a suitable antibiotic (without resistance) if necessary. Escherichia coli (E. coli) is the most common germ, accounting for 80 percent. Other causative germs are Klebsiella, Proteus and Enterobacter.
A supplementary ultrasound examination of the kidneys and urinary tract can rule out or confirm other causative factors such as a stone disease or an obstruction to the outflow of the kidneys. In addition, an accumulation of pus in the kidney (renal abscess) can often be detected.
If the clinical picture is uncertain or there is no response to the antibiotic therapy initiated, a computer tomography (CT) scan should be performed. Changes in renal blood flow with areas of different computed tomography patterns and changes in kidney size indicate acute pyelonephritis or kidney inflammation.
The treatment of pyelonephritis depends on the severity of the disease. Effective antibiotic therapy should be started as early as possible. In the case of incipient inflammation with an unchanged general condition, oral antibiotics and physical rest are usually sufficient. In the case of severe findings with the threat of or already existing blood poisoning (approx. 60 percent of cases), however, the patient must be admitted to hospital.
Bed rest, adequate hydration and immediate antibiotic treatment as an infusion with a broad-spectrum antibiotic are essential. Antipyretic and anti-inflammatory measures are also used. A urinary outflow obstruction that promotes infection (e.g. due to a ureteral stone, residual bladder urine) must be urgently remedied by allowing the infected urine to flow out unhindered via a ureteral catheter or a so-called renal fistula.
Most renal pelvic inflammatory disease heals without consequences if these measures are taken.
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