Upper urinary tract infections

Acute pyelonephritis

When bacteria ascend the urinary tract via the bladder and ureter to the kidney, this can cause an acute purulent infection of the middle part of the kidney (renal pelvis) and the kidney tissue. This is known as pyelonephritis and can also occur in otherwise healthy young people.

Someone with pyelonephritis will usually feel extremely ill, with fever, chills, flank or back pain, and occasionally vomiting. Such symptoms must be taken seriously. Depending on the type and level of inflammatory markers in the blood, inpatient treatment with infusion therapy (a drip) and intravenous antibiotics may be required. Because the condition is often found in conjunction with conditions which inhibit bladder emptying (e.g. urinary tract stones) or cause urine to flow from the bladder back into the upper urinary tract (vesicoureteral reflux), in addition to an ultrasound examination, the doctor will usually perform an x-ray or CT scan of the urinary tract. People with pyelonephritis are at risk of kidney abscesses and of developing chronic pyelonephritis, which in turn carries the risk of kidney atrophy accompanied by kidney failure, anaemia and high blood pressure (hypertension).
Particularly where the disease returns repeatedly, to avoid permanent damage to the kidneys and resulting complications, detailed diagnosis and resolution of the cause is required.

Chronic pyelonephritis

If the cause of acute pyelonephritis (see above) remains untreated, the condition can become chronic. Untreated this generally results in complete failure of the affected kidney, which will ultimately require removal.