Discussion About Pyelonephritis (Kidney Infection)

Pyelonephritis is a sudden infection, which causes a severe inflammation of the renal pelvis, the kidney tissue, and calyces. It is a physical condition, which causes the swelling of the kidneys and their permanent damage. Pyelonephritis leads to death if appropriate treatment and medication are not found. It is also essential to attend the hospital in time in order to take immediate action and reduce the negative influence of the infection. Many patients do not even have an idea that they are already infected with pathogens, which lead to the rapid development of the pyelonephritis. From this perspective, the research is significant for the overall enhancement of the knowledge regarding the disease, its symptoms, and steps towards a rapid and high quality recovery.

The object of the research is pyelonephritis, which is one of the most widespread diseases. In order to know how to cure and prevent the disease, it is essential to learn more about its nature. The following research reflects the essence of the infection by discussing its various aspects in such sections as pathophysiology, prognosis, risk factors, symptoms, diagnoses, outpatient care, inpatient care, surgery, treatment, and medication. Each section is full of information and in the course of discussion reveals the essence of the disease.


Pyelonephritis is a common reaction of the human body to the infection, which spreads in the urinary tract and reaches the kidneys. It also may go through the bloodstream to the kidneys. Various experimental evidences support the idea that intravenous drug ingestion represents a hematogenous source of Staphylococcus, a gram-positive bacteria. Furthermore, the same experimental evidence proves that gram-negative organisms can hardly spread through the bloodstream to the kidneys unless there are circumstances, which can support this process. For example, an obstruction can be a supportive condition in this case. Nevertheless, there is no proof that uropathogens can be transmitted to the kidneys by lymph.

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An ascending UTI, in the majority of cases, is the initial cause of pyelonephritis, which at first manifests itself as cystitis. However, it refers only to the patients with complicated infections and diseases. In addition, there may be an alternative way of the disease’s development, which is characteristic for the majority of women. For example, the infection can start its development from the bacteremia. Some women with pyelonephritis have pathogens, which further reach the kidneys through the ureter and the bladder (Choong, Richter-Dahlfors, & Antypas). Nevertheless, cystitis does not always lead to the damage of kidneys. It may be an asymptomatic pyelonephritis, which does not lead to the severe consequences. However, it does not guarantee that each case of the disease will not have any complications.

In particular, an asymptomatic pyelonephritis requires special consideration and attention in order to understand its threat. In fact, some bacterial strains, producing asymptomatic bacteriuria, may support the protection of the human body against symptomatic infections. However, it may also increase the mortality, which is related to the excessive amount of asymptomatic bacteriuria. In this case, the strains do not produce the adhesins. That is why, the inflammation remains unnoticeable as long as it does not take place. As a result, pathogens continue to grow and persist in the healthy cells. The list of pathogens includes Staphylococcus saprophyticus, Proteus mirabilis, S. aureus, Klebsiella pneumoniae, Enterococci, Enterobacter species, and Pseudomonas aeruginosa (Choong). The same list of pathogens may to lead to the development of cystitis. In addition, it is difficult to determine the bacteria, which caused the inflammation. In fact, it is possible to detect them by using antibiotics.

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As for the male predisposition to pyelonephritis, it is possible to mention prostatitis. It usually leads to the urethral obstruction, which results in bacteriuria. As a result, pyelonephritis starts to develop from the pathogens, which were transmitted by the ureter. A histopathological examination can show the inflammation in the kidney parenchyma, caused by the obstruction of the ureter. Moreover, it is common to face the problem of inappropriate treatment of the ureter obstruction, which leads to the renal abscess. As a result, pathogens start their re-infection, caused by a continuous blockage. Fungal infections may also lead to the origination of the disease from a bone or skin in the kidney.

A normal anatomy of the urinary tract without any preconditions and predispositions to the disease does not mean that there is a guarantee that pyelonephritis will not develop. Uropathogenic E. coli is the primary reason for the development of pyelonephritis among many patients (Choong). The main peculiarity of the uropathogenic E. coli is that it has an outstanding ability to adhere to the urinary tract and to continue colonizing. However, this ability is supported by several factors, which include flagella, haemolysins, and iron-scavenging molecules. All these factors help uropathogenic E. coli to adhere to the epithelial surface of the ureter. In addition, they also assist pathogens and lead to the increased inflammation and the overall development of pyelonephritis, which causes the damage of the kidneys (Choong). In fact, the majority of cases involve the negative influence of the virulence factors, which lead to the development of the disease.

In general, it is possible to outline a two-step pathogenesis of pyelonephritis:

First, pathogens attach to the cells, and it leads to the inflammation, which involves such receptors as Toll-like receptor 4 and glycosphingolipid (Choong). If the anatomy does not have any Toll-like receptor 4, then an asymptomatic pyelonephritis starts its development.

The second way also refers to the inflammatory response, which releases chemokines and allows the pathogens to cross the barrier of the epithelium and reach the urine. Nevertheless, the development of pyelonephritis may be accompanied by a complicated infection. For example, structural, functional, and metabolic abnormalities in the urinary tract can intensify the severe conditions of the disease development. Moreover, there may be unusual pathogens, which reduce the efficacy of antibiotics. As a result, it is impossible to rely on a natural barrier, protecting the urinary tract from the spread of the pathogens. Diabetes mellitus may also be an intensifying factor for the spread of the bacteria, which leads to inflammation and rapid development of the disease.

Risk Factors

First, it is essential to mention that abnormal anatomy of the urinary tract is a natural precondition, which may easily lead to the development of pyelonephritis due to the simplified access of bacteria to the kidneys. An unusual size and shape can also become contributing factors to the development of the disease. Patients with chronic kidney stones and specific bladder conditions also have a high chance of the development of pyelonephritis. If there is any problem related to the normal functioning of the urinary tract, there is a high chance of the bacterial growth along with pathogens’ development, which may cause the disease. In addition, it is possible to consider the peculiarities of the female and male bodies. For example, women have a shorter urethra, which automatically means that it is easier for bacteria to access the body. This fact shows that women are more likely to face pyelonephritis, because there is a high chance of the access of various infections. The elderly patients also fall under the negative influence of risk factors, which lead to the disease. In addition, a suppressed immune system also becomes one of the predispositions of human body to pyelonephritis.

Furthermore, it is possible to discuss various conditions, which may also lead to pyelonephritis. The usage of a catheter removes the natural barrier of the human body, which protects it from various infections, and opens the way to the internal epithelium. The same effect is expected in cases of a cystoscopic examination and a urinary tract surgery. Men with an enlarged prostate, in their turn, also have a high risk of the development of pyelonephritis (Vlachopanos). Finally, it is important to remember about spinal cord and nerve damages, which represent a significant threat of the disease. In general, urinary obstructions often lead to a chronic state of the disease, which can hardly be cured.

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The outcome of the disease fully depends on the timely diagnosis and effective management of pyelonephritis. The inability of the patient to respond to the conventional therapy or a sudden deterioration may lead to various complications, overall resistance of the organism, and comorbidity. In order to ensure that the whole treatment of the disease has an appropriate flow, it is necessary to have several examinations, which would guarantee that there is a satisfactory progression. Recovery should also be complete in order to ensure that the process of the development of pathogens does not continue in the hidden form. A failure to identify the complications or the development of pathogenic bacteria results in unexpected consequences. For example, pregnant women with pyelonephritis have a higher risk of a premature labor if there is not enough medication and treatment.

In fact, uncomplicated diseases, which do not have an additional influence of any other bacteria or infections, have the highest chances for a full recovery with a minimal damage of the kidneys. However, male patients need to have a regular urologic evaluation even in case of a full recovery. It is necessary in order to reduce the chances of the development of a hidden complication. Children also have a chance for a full recovery, but still they need to have a regular urologic examination in order to prevent the development of structural abnormalities (Akl). The antibiotic era made it possible to make uncomplicated pyelonephritis less dangerous and threatening than it used to be before. Pyelonephritis also does not have any fatal outcomes nowadays, in the world full of various medications and treatments, used to detect the development of any bacteria. Nevertheless, the mortality risk increases with the presence of such conditions as perinephric abscess, sepsis syndromes, or emphysematous pyelonephritis (Vlachopanos). In other cases, it should not be difficult to take care of the patient and to prevent the negative outcomes of the disease.

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One of the main symptoms of almost each disease and infection is fever, which indicates that organism faces an inflammation at some level. It is one of the signs that it is important to take immediate action, especially when the temperature exceeds 103°F (Nicolle). Patients with pyelonephritis may also feel costovertebral angle pain (mild, moderate, or severe) and tenderness. In case of tenderness, it is possible to assume the involvement of the damaged kidney. In fact, it is more likely to feel bilateral costovertebral angle tenderness. Nausea and vomiting are also other alarming signs, which may vary in frequency and intensity in different cases. However, they remain some of the symptoms of pyelonephritis, which are accompanied by anorexia in chronic conditions of the disease.

The symptoms of pyelonephritis occur within hours or during the day. In some cases, when there are no symptoms, it means that the disease has complications, which do not allow it to manifest itself. In addition, there are many differences in symptoms of children and adults. For example, symptoms observed in adults are usually absent in children and infants (Akl). Children under the age of 2 years often have such symptoms as fever, vomiting, failure to grow, and feeding problems (Akl). Elderly patients, in their turn, may attend the hospital with such symptoms as overall deterioration of state, fever, mental changes, or decompensation of other organ systems. In general, it is essential in all cases to attempt to monitor all changes within the organism in order to detect the most essential deviations. All symptoms need to undergo a specific consideration and examination, so that to make a final conclusion and to diagnose the disease in an appropriate way. Otherwise, it would be impossible to address the health issue. From this perspective, it would be sensible to pay attention to the diagnoses, based on the diversity of cases, faced by patients, who belong to different age and gender groups.


The outpatient treatment involves using various options to diagnose pyelonephritis. First, a patient’s history can be helpful for the consideration of the infections and diseases, faced by the individual. In addition, a physical examination is always a useful element in making appropriate conclusions regarding the physical condition of a patient. Urinalysis is another element, which accompanies the examination and can indicate the presence of inflammation in the urine specimen. It is possible to collect urine specimen by using a clean catch, suprapubic needle aspiration, or urethral catheterization. Urinalysis may also include such examinations as a screening of pyuria, bacteriuria, hematuria, and proteinuria. Urine culture is a mandatory element for the treatment in both outpatient and inpatient settings. It helps to find an appropriate treatment of pyelonephritis due to the possible resistance of the human organism to antibiotics. In addition, it is possible to use various imaging studies, which may be helpful in the identification of pyelonephritis. Computed tomography scanning can help to find perinephric fluid, nonrenal disease, alterations in renal parenchymal perfusion, gas-forming infections, hemorrhage, and obstruction (Nicolle).

Moreover, it can help to see the presence of the inflammatory masses, which should be considered during the prescription of the medication and treatment. Magnetic resonance imaging is also effective in the identification of the renal infection, urinary obstruction, and renal vasculature. In addition, ultrasonography is another method, which screens the human body in search for urinary obstruction and renal abscesses. Moreover, it is a useful tool in the detection of stones in the kidney, which may change the course of the medication and treatment. Focal renal abnormalities, in their turn, can be detected by scintigraphy. All these procedures should be carefully conducted in order to guarantee a full recovery of the patient with a minimal threat of complications.

Outpatient Care

If a patient does not have a natural resistance to antibiotics, it is most advisable to use the medication, based on antibiotics, as long as it can rapidly decrease the inflammation. In general, the majority of cases allow using antibiotics as one of the major source of treatment. However, additional sensitivity tests can be helpful in selecting appropriate antibiotics, which boost the process of recovery. They also prevent the progression of the disease and eliminate its negative effects. In order to provide a patient with the most suitable care, it is important to make regular urine culture and sensitivity testing. These procedures are necessary for the evaluation of the empirical therapy, aimed to reduce the presence of uropathogen until it disappears. Nevertheless, it is essential to remember that patients with complicated pyelonephritis cannot be cured in an outpatient setting, because there is a need to provide an inpatient care, otherwise, it would be impossible to address multiple health problems and to take immediate action as soon as any complications occur.

An outpatient care can be appropriate for patients with an uncomplicated form of the disease, which does not require a continuous examination, conducted by healthcare professionals. It means that the patient is capable of taking care of himself without additional supervision of a doctor. If there is no need in hospitalization, patients may be treated with a single dose of parenteral antibiotics and oral therapy. In such cases, pyelonephritis may be cured within 2 days without any need to repeat or continue the treatment (Nicolle). In general, the treatment takes two weeks and includes taking such antibiotics as levofloxacin, co-trimoxazol, ampicillin, and ciprofloxacin (Nicolle). However, it is also important to have an additional examination at the end of the medication in order to ensure that there are no complications.

In general, an outpatient form of healthcare is appropriate for patients with healthy indicators in other body systems. For example, the majority of non-pregnant women are capable of handling the outpatient care because of its simplicity. The emergency department treats such patients with oral fluids, pain-relieving medication, and parenteral antibiotics. An outpatient form of care is as effective as the inpatient one. However, it is less costly and is appropriate only for a certain group of patients, suffering from the uncomplicated pyelonephritis.
In some cases drug therapy may be ineffective, which automatically means that a healthcare professional should take another approach to the recovery process of the patient. If there are any deviations from the normal performance of the urinary tract, it is important to restart the examinations in order to find the reason of it. Other forms of pyelonephritis require an inpatient care, which should deal with a complicated condition of the disease.

Inpatient Care

When the disease has a complicated condition, it is important to start inpatient care as soon as possible. First, a patient may need an intravenous ingestion of antibiotics, which will increase the ability of a human body to activate the natural shield protecting the cells from pathogens. In combination with supportive care, a patient receives a comprehensive monitoring of changes in the development of the disease. A regular monitoring of the urine and blood culture can be helpful in changing the course of medication, which can help to reduce the negative effects of pyelonephritis (Kanno, Matsuda, Sakamoto, Higashi, & Yamada). In addition, a monitoring of comorbidity conditions can also be helpful in taking action as soon as the risk of it raises. One of the most important aspects of inpatient care is that nurses and healthcare professionals are capable of monitoring the hydration status. It continues until the moment, when the patient becomes capable of controlling the hydration without additional help. In this situation, oral intake should be enough for the improvement of the human organism hydration. In general, the main advantage of the inpatient care is that regular urine examination and blood culture results are effective in the establishment of the new options for the recovery (Kanno). In addition, it may help to stop the drugs intake, if they became useless and have no effect on the overall improvement of the patient’s condition. Nevertheless, there are cases, when it is impossible to avoid surgery for some reasons.

It is important to remember that there is a number of factors, which determine the complicated form of pyelonephritis. They include structural abnormalities, metabolic diseases, impaired host defenses, and pregnancy. In addition, patients on the outpatient care should switch to another form of treatment as soon as they cannot take care of their own hydration, or when having debilitating pain and inadequate homecare.

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In addition to the prescribed drugs, the patients with pyelonephritis may require a surgery, which can help to solve several problems. In the majority of cases, it is applied to the patients suffering from the complicated pyelonephritis. Surgery can help to remove a renal abscess with the help of the surgical drainage (Nicolle). It also may be necessary when patients have a resistance to antibiotics or when the therapy did not have positive results. In addition, it is possible to prescribe enucleation of the carbuncle if other methods have low chances to succeed. A surgery may also solve the problem of the perinephric abscess and renal papillary necrosis. In general, it is obvious that pyelonephritis requires surgery, when it has complications and other health problems. Patients should be ready to take decisions quickly without any delay in order to guarantee a safe recovery from the disease. Otherwise, it would be difficult to avoid a fatal outcome. Nevertheless, surgery remains an accompanying method in the majority of complicated cases of the disease, when it cannot be cured by common means of medication.


The paper successfully discussed the essence of pyelonephritis with its pathophysiology, prognosis, symptoms, diagnoses, and risk factors contributing to the development of the disease. The research helped to find facts proving that pyelonephritis is a serious disease, which may have both complicated and uncomplicated forms. In both cases, it is a mandatory rule to attend the hospital in order to ensure that the recovery process will have an appropriate flow without any risk to face a complication. In general, pyelonephritis has a complex nature, which means that there are multiple ways to cure the disease. Unfortunately, individuals with abnormal structural characteristics (such as short urinary tract) have more chances to fall under the negative influence of the disease. The described symptoms represent a small part of a large number of indicators, which may help to diagnose the disease.

A regular examination of the urine specimen and attendance of a healthcare institution should be mandatory for patients with a chronic form of the disease. Immediate action and timely medication, accompanied by appropriate hydration and drugs intake, can help to reduce the risk of facing the kidney damage. However, the pathophysiology of the disease proved that there are multiple ways of being infected. It means that nobody is protected from pyelonephritis, which remains one of the most widespread problems. In fact, healthcare has many options, which can not only detect any deviations in the recovery, but also define the most effective drugs for each individual. A detailed discussion of outpatient and inpatient care proved that there is a solution for each patient, based on his or her specific condition. Finally, the availability of the contemporary instruments, drugs, and examinations provides the results with high accuracy. In this way, patients should not worry about their health if they timely address the issue.

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