Overview
Most people have two kidneys. Your kidneys filter water and waste products from your blood, cleaning your blood and making urine. Urine drains into your bladder through tubes called ureters. When you pass urine, your bladder contracts, squeezing urine out of your body through a tube called the urethra.
Pyelonephritis is a bacterial infection of one or both of your kidneys. It can be either acute or chronic. This factsheet focuses on acute pyelonephritis. Acute and chronic refer to how long the condition lasts for, rather than how severe it is.
Symptoms
The symptoms of acute pyelonephritis often develop quickly (over a few hours to a day). Your symptoms may include : -
- A fever (over 37.5°C)
- Shivering
- Pain in the lower part of your back on either side
- Feeling sick
- Vomiting
- Diarrhoea
Around one in three people with acute pyelonephritis will also have symptoms of a lower urinary tract infection (cystitis).
These Can Include:
- A stinging or burning sensation when you pass urine
- The need to urinate more often than you usually do
- Feeling the need to urinate urgently even if you pass very little or no urine
- Passing urine that is cloudy or dark coloured, which may have a strong smell
- Blood in your urine
Although not necessarily a result of pyelonephritis, if you have these symptoms you should see your doctor.
Complications
Acute Pyelonephritis Can Sometimes Cause : -
- An abscess (pus-filled area) in your kidney
- Inflammation (swelling) of the kidney
- Blood poisoning (septicaemia), which can occur if bacteria causing the pyelonephritis gets into your blood stream
However, you are unlikely to get complications if your kidneys worked normally before you developed pyelonephritis.
Pregnant women (see Special considerations) and people with diabetes are more likely to have complications.
Some people with chronic pyelonephritis develop severe kidney damage or kidney failure, but this is rare.
Causes
Pyelonephritis is a bacterial infection. It's usually caused by a bacterium called Escherichia coli (E. coli for short), which normally lives harmlessly in your bowel. The infection usually occurs when bacteria from your urethra and bladder travel up your ureters to your kidneys.
Bacteria can enter your urinary tract from the surrounding skin of your genital area and travel up towards your bladder, causing cystitis. Pyelonephritis usually occurs when the bacteria continue to travel up the urinary tract from the bladder and then into the ureters and kidneys. However, most people with cystitis don't go on to get pyelonephritis, as flow of urine usually stops the infection travelling up the urinary tract.
There are other causes of pyelonephritis but they aren't as common. Sometimes pyelonephritis can occur without a bladder infection. If your urinary tract or kidney gets blocked, for example by a kidney stone or an enlarged prostate, you are more likely to get pyelonephritis. This is because bacteria can then start to grow in the trapped urine. The infection can also be carried to the kidneys from another part of your body in your bloodstream.
You are more likely to Develop Pyelonephritis if you : -
- Have an obstruction to your ureters or kidneys
- Are pregnant
- Have diabetes
- Have a weakened immune system (which reduces your ability to fight infection)
Diagnosis
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your symptoms are severe, you have complications or you are pregnant (see Special considerations), your GP may refer you to a hospital for tests and treatment.
Most people don't need to go to hospital for pyelonephritis. Your GP can usually diagnose pyelonephritis and give you treatment.
Your doctor will also ask you for a urine sample. He or she may test your urine with a "dipstick" or may send the sample to a laboratory for more detailed tests. Your doctor may also ask you for a blood sample. These tests will find out which type of bacteria is causing the infection and helps your doctor decide which antibiotics would be most appropriate.
You may also need to have X-rays or scans to check whether there are any problems or obstructions in your ureters or kidneys.
Treatment
Your GP will usually prescribe antibiotics immediately if he or she suspects that you have a kidney infection. The tests will let your doctor know if there is another antibiotic that would be more effective. You should always take the full course of antibiotics to get rid of the bacteria completely, even if your symptoms clear up before you finish the course.
Over-the-counter painkillers such as paracetamol, ibruprofen and aspirin can reduce a fever and can ease pain and discomfort. Follow the instructions in the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If you have pyelonephritis, you should also drink plenty of fluids, at least two litres every 24 hours.
You should start to feel better after a day or so taking the antibiotics. But if your symptoms get worse or you don't feel any better after 24 hours, you should get advice from a doctor as soon as possible. You may need to go to hospital.
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