Chronic pyelonephritis is a persistent infection of the kidneys leading to inflammation, scarring, and other permanent damage. It is most commonly seen in patients with underlying anatomical abnormalities predisposing them to infections in the urinary tract and kidneys. Treatment options usually include antibiotic medications to treat the infection and may involve surgery to correct an anatomical problem and prevent future infections, as well as other complications.
In patients with chronic pyelonephritis, the infection often starts lower in the urinary tract, around the bladder, with bacteria or viruses causing infection and obstruction. Urine can back up into the kidneys, causing the infection to spread into the kidneys and leading to widespread inflammation. Symptoms of pyelonephritis can include difficulty urinating, changes in urine color, and painful kidneys. In the case of chronic pyelonephritis, these symptoms persist for an extended period of time, as the inflammation never fully resolves.
Samples of urine can be taken to look for infectious organisms to diagnose infection and patients may also be evaluated with medical imaging studies to look for signs like swelling or other tissue changes in the kidneys. These studies will also reveal variations in the patient's anatomy, such as strictures in the urinary tract, which may explain why the patient developed pyelonephritis initially and why it is so difficult to resolve.
Immediate treatment includes medications to kill the causative organism. Once the infection is resolved, a doctor may suggest other options such as surgery. Patients can also be advised to make dietary modifications to reduce the risk of future urinary tract infections, such as drinking cranberry juice to keep the urine acidic, thereby resisting bacterial growth. Some chronic pyelonephritis patients may also be given a standing prescription for antibiotics they can use when they detect signs of an infection.
If this condition is not treated, the persistent inflammation can be very damaging to the kidneys. Scarring can cause narrowing of the urinary tract, making it harder for patients to express urine, and the kidneys may not function as well. Over time, this may lead to damage to other organs, as once the kidneys start to malfunction, a cascading series of reactions happens because the body can no longer regulate levels of electrolytes and waste products effectively. Treatment of chronic pyelonephritis is critical, as are follow-up appointments to check for recurrence of the condition and provide patients with prophylactic care to prevent urinary tract infections from reaching the kidneys.