What should I do if pyelonephritis recurs?

Written by Zhou Qi
Nephrology
Updated on September 26, 2024
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Pyelonephritis, also known as upper urinary tract infection, is an inflammatory reaction caused by bacterial infection of the urinary system. Therefore, in cases of recurrence of this condition, it is still necessary to use antibiotics for bactericidal treatment, generally requiring a full two-week course, choosing drugs with low nephrotoxicity. Additionally, it is important to investigate whether there are any complicating factors for pyelonephritis, such as the presence of diabetes, urinary system stones, tumors, or urinary tract anomalies. Identifying and addressing these complicating factors can reduce the likelihood of recurrence of pyelonephritis.

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Written by Zhou Qi
Nephrology
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The difference between pyelonephritis and nephritis

Pyelonephritis and nephritis are two completely different concepts. Pyelonephritis is actually a bacterial inflammation, usually caused by bacteria at the urethral opening ascending into the urinary system and causing inflammation in areas like the renal pelvis and calyces. Patients may experience symptoms such as fever, hematuria, and back pain. In severe cases, it can cause necrosis of the renal papillae, leading to acute renal failure. Some patients may also develop perinephric abscesses, which are caused by bacterial infections. Nephritis, on the other hand, refers to inflammation within the glomeruli. This type of inflammation does not involve bacteria and is related to disorders in the body’s immune function. The disordered immune response is aggressive, attacking the glomerular filtration barrier, leading to proteinuria and hematuria. Therefore, the mechanisms of disease and treatment methods for the two conditions are different.

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Written by Zhou Qi
Nephrology
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What should I do if pyelonephritis recurs?

Pyelonephritis, also known as upper urinary tract infection, is an inflammatory reaction caused by bacterial infection of the urinary system. Therefore, in cases of recurrence of this condition, it is still necessary to use antibiotics for bactericidal treatment, generally requiring a full two-week course, choosing drugs with low nephrotoxicity. Additionally, it is important to investigate whether there are any complicating factors for pyelonephritis, such as the presence of diabetes, urinary system stones, tumors, or urinary tract anomalies. Identifying and addressing these complicating factors can reduce the likelihood of recurrence of pyelonephritis.

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Written by Zhou Qi
Nephrology
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Principles of treatment for pyelonephritis

Pyelonephritis, also known as an upper urinary tract infection, is a bacterial inflammation, with over 95% being caused by bacterial infections, among which 70% are caused by Escherichia coli. Therefore, as a bacterial infection-induced inflammation, antibiotic treatment is of course necessary. Clinically, third-generation cephalosporins or fluoroquinolone antibiotics are often chosen for bactericidal treatment. For acute pyelonephritis, it is generally recommended that medication be administered for 14 days, alongside measures such as increased water intake and frequent urination. In cases of chronic pyelonephritis, a low-dose, long-course antibacterial treatment, such as using nitrofurantoin, may also be employed, with continuous medication for two months. (Please consult a clinical doctor for specific medication use; do not self-medicate.)

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Written by Zhou Qi
Nephrology
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How is pyelonephritis caused?

Pyelonephritis can also be referred to as an upper urinary tract infection. It occurs when bacteria proliferate in parts of the kidney such as the renal pelvis and calyces, leading to inflammation. In most cases, these bacteria enter the urinary system retrogradely from the urethral opening and cause inflammation in areas like the renal pelvis and calyces. Normally, bacteria are already present at the urethral opening, and when the body's immune system is functioning well and the urinary system is unobstructed, it is difficult for these bacteria to enter the urinary system and cause an inflammatory response. However, in patients with weakened immune systems, such as those suffering from a cold, diabetes, or those using steroid medications, bacteria may enter the urinary system and replicate in large numbers. Additionally, if there are obstructive factors in the urinary system, such as prostate enlargement in male patients, or if the patient has urinary system stones or tumors, bacteria are more likely to cause an inflammatory response.

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Is pyelonephritis easy to treat?

Pyelonephritis is generally not difficult to treat. Because the condition often appears quite aggressive, it is caused by bacteria entering the urinary system through the urethra, leading to an inflammatory response. Therefore, the primary treatment involves using antibiotics to kill the bacteria. Most of the bacteria causing pyelonephritis are Gram-negative rods, so antibiotics sensitive to Gram-negative rods are often chosen. After a treatment course of 10-14 days, the patient's condition is generally controllable and curable. However, there are also a few cases of chronic pyelonephritis, involving complex factors related to urinary tract infections, such as urinary tract malformations, urinary system stones, prostate hyperplasia, diabetes, etc., which make treatment more difficult. (Medication should be used under the guidance of a doctor.)