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Pyelonephritis: Symptoms, causes, prevention, and treatment

Pyelonephritis: Symptoms, causes, prevention, and treatment

Recurrent UTI, kidney stones, diabetes and low immunity increase the risk of developing a kidney infection, medically called pyelonephritis

Pyelonephritis, a kidney infection occurs due to recurrent UTIs

A 36-year-old woman from Hyderabad, suddenly collapsed and was taken to the emergency room, unconscious. Veena’s (name changed) blood pressure had declined drastically, and she went into cardiac arrest. However, she was revived on time. She was a diabetic who had recurrent urinary tract infection (recurrent UTI) that led to a complicated kidney infection, medically called pyelonephritis.

Veena, however, didn’t consult the relevant doctors when she had recurrent UTIs. “As she didn’t get the required treatment for her symptoms in the initial stage, it led to a severe kidney infection,” says Dr Mallikarjuna Reddy, senior consultant in urology, Citizens Specialty Hospital, Hyderabad.

What is pyelonephritis

According to the US government’s National Institute of Health, pyelonephritis or kidney infection is a type of urinary tract infection (UTI). Bacteria or viruses that first infect the lower urinary tract, typically the bladder, are the culprits of kidney infections.

In some circumstances, if bacteria enter the body during a surgical procedure and travel via the blood to the kidneys, one could develop a kidney infection after surgery.

There are two types- acute pyelonephritis and chronic pyelonephritis. Acute pyelonephritis tends to be sudden and severe. “Chronic kidney infection is defined as multiple episodes of acute pyelonephritis. This makes the kidney harbour bacteria that causes kidney infection continuously, resulting in gradual loss of kidney function,” explains Dr Reddy.

Signs of kidney infection

According to Dr Reddy, the following symptoms are observed in pyelonephritis:

  • Flank pain (pain in the part of the body between abdomen and the back)
  • Fever
  • Nausea or vomiting
  • Severe hypotension at times (significant decrease in blood pressure)

Kidney infection causes

According to Dr Kaushik Sinha, a urologist in Fortis Hospital Kidney Institute, Kolkata, the following are risk factors of developing pyelonephritis:

  • Recurrent UTIs (frequently seen in women)
  • Poor personal hygiene, especially after sexual intercourse
  • Compromised immune system
  • Diabetes
  • Structural problem in the urinary tract like vesicoureteral reflux (abnormal, backward flow of urine from bladder to ureters or kidneys)
  • Urinary tract obstruction like kidney stones (obstruction of urine flow causes bacteria to multiply leading to kidney infection)

The ureter, which is a tube which connects the kidney to the bladder, propels urine out of the kidney into the bladder. “The movement of the ureters is less during pregnancy. Also, pregnancy results in a decrease in immunity of the body. In such cases, even a mild kidney infection can have severe implications,” mentions Dr Reddy.

Diagnosing kidney infection

“When people complain of fever, painful urination and flank pain, experts recommend a urine routine exam and culture sensitivity test when they suspect a kidney infection,” says Dr Sinha.

“An ultrasound or CT scan is also done to check for any abnormalities in the kidneys like presence of kidney stones which might be causing pyelonephritis,” he adds.

Kidney infection treatment

The treatment depends on the diagnosis. Antibiotics for kidney infection are usually the first line of treatment if it is a mild infection. “The course usually runs for two weeks and should be completed. It is also important to identify the cause to prevent recurrence,” says Dr Reddy.

He adds that if there is pus formation or swelling in the kidneys, it indicates a complicated infection, requiring a more aggressive treatment like pus drainage and cystoscopy (a procedure to diagnose and monitor conditions affecting the bladder and urethra).

“We found pus inside Veena’s kidneys. Once we removed it, her kidneys returned to normal functioning within two weeks,” says Dr Reddy.

How to prevent pyelonephritis

Dr Reddy and Dr Sinha recommend the following ways to prevent kidney infection:

  • Consult a urologist if you notice any changes when passing urine. Burning sensation while urinating, increased frequency, low urine output might be an indication of UTI. It requires prompt treatment to avoid pyelonephritis.
  • A person suffering from constipation has got a 60% higher chance of developing UTI. Treating constipation is key to avoiding recurrent UTIs that might lead to pyelonephritis.
  • Do not hold in your pee for a long time. “Most people do not use public washrooms fearing that they might contract a UTI from a toilet seat, which is not true at all. People should understand that not urinating will actually lead to infection,” explains Dr Reddy.
  • In case of recurrent UTIs, ensure that there is no anatomical problem in the kidney, like hydronephrosis (a buildup of urine in kidneys resulting in kidney infection).
  • Maintain personal hygiene, especially after sexual intercourse.
  • People with diabetes should monitor their blood sugar levels as they have low immunity and are at a higher chance of contracting UTI.


  • Recurrent UTI is the most common cause of kidney infection or pyelonephritis.
  • Symptoms like flank pain, fever and painful urination can indicate a kidney infection which can be diagnosed through a urine routine and culture tests.
  • Maintaining personal hygiene and finishing a course of antibiotics when you get a mild infection are imperative to prevent UTI and kidney infections.

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