Pyelonephritis and Abdominal Pain

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[edit] Pyelonephritis

Introduction:

An infection of the kidney tissue is called a pyelonephritis. This can be new, called an acute pyelonephritis, or it can be recurrent, in which case it is a chronic pyelonephritis. Chronic pyelonephritis is usually associated with a valve incompetence between the ureter and the bladder, which leads to vesicoureteral reflux.

With this condition it is possible, particularly in women, for bacteria to travel against the urinary stream into the kidney and then invade the kidney tissue.

Symptoms:

Urinary tract infections are 50-fold more common in women than in men in the middle age group.

With acute pyelonephritis there is an acute onset of a high fever with chills, nausea, vomiting, flank and abdominal pain. The physician will detect a costovertebral tenderness of the kidney on the affected side. In chronic pyelonephritis the symptoms can be much more subtle. In both cases there is usually a urinary tract infection with white blood cell casts in the urine on microscopic examination and with bacteria being cultured from urine samples obtained by sterile technique. In patients with chronic pyelonephritis intravenous urography shows irregularities of the kidney(s) with scarring. A cystogram shows reflux from the bladder into one or both ureters.

Treatment:

Usually a patient with chronic pyelonephritis needs to see a urologist. However, girls with more than 3 urinary tract infections per year likely also should see a urologist, as they are the ones at risk for undetected vesicoureteral reflux, which is amenable to ureter reimplantation. This surgical technique can restore the normal valve function and ensure that no more kidney infections occur.

Urologists advise women who have two to three urinary tract infections per year, but do not need the above mentioned surgery as follows:

1. void immediately after sexual intercourse 2. drink cranberry juice frequently, it may cut down urinary infections 3. if this still is not preventative of urinary infections, then a low-dose prophylactic antibiotic therapy is very successful. Trimethoprim-sulfamethoxazole (brand name: Bactrim) 1/2 regular strength tablet daily or three times weekly is used for this purpose. Alternatively, trimethoprim (brand name: Proloprim) at 100 mg daily or three times weekly can be used. Others used are ciprofloxacin(Brand name: Cipro) or nitrofurantoin (brand names: Furadantin, Macrodantin) at half the dose used otherwise. Sometimes the urologist recommends a 2 or 3 year prophylactic therapy like this. 4. As pregnant women are at a higher risk for pyelonephritis, a similar prophylaxis program as for non pregnant women is given. 5. In postmenopausal women it has been shown that estrogen replacement (systemic and topical) can markedly reduce urinary tract infections.

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References:

1. DM Thompson: The 46^th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".

6. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".

7. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".

8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.