American Medical Association Family Medical Guide - American Medical Association [531]
Acute pyelonephritis can also develop when bacteria from an infection in another part of the body are carried through the bloodstream to the kidneys. The condition also sometimes occurs for unknown reasons in otherwise healthy people.
Symptoms
Often the first symptom of acute pyelonephritis is sudden, intense pain in the back just above the waist. Although both kidneys may be affected, the pain is usually worse on one side of the body and spreads around that side and down into the groin. A person with acute pyelonephritis quickly develops a fever (often reaching 102°F to 104°F), which may produce chills or trembling and may be accompanied by nausea and vomiting. He or she may also experience difficult or painful urination and is likely to feel a constant urge to urinate, even when the bladder is empty. The urine is often cloudy and may appear reddish if blood has leaked into it. Rarely, this condition can lead to blood poisoning (see page 937) or shock (see page 579), or can be fatal.
Diagnosis
The diagnosis of acute pyelonephritis is based on the symptoms. Your doctor will probably order blood tests or urine tests to determine the type of bacteria causing the infection. To check for conditions that may be obstructing the flow of urine through the urinary tract, your doctor may order an ultrasound (see page 111) or CT scan (see page 112) to evaluate your kidneys, or cystoscopy (see next page) to examine your bladder. He or she may order a voiding cystourethrogram (see next page) to check for vesicoureteral reflux, a condition in which urine flows backward from the bladder to the kidneys.
Treatment
Treatment for acute pyelonephritis usually includes rest, plenty of fluids (at least eight large glasses of water every day), and antibiotics given intravenously (through a vein) or in pills. People who have a fever, nausea and vomiting, or an elevated white blood cell count, or who are very young or very frail may need to be hospitalized for treatment with intravenous antibiotics. The antibiotics usually bring the infection under control within 24 to 48 hours, although, in some cases, treatment may need to continue for 14 days or longer. The doctor will also treat any underlying condition causing the infection. With prompt treatment, long-term complications are unlikely. People who have repeated episodes of acute pyelonephritis may have an anatomical problem in the urinary tract that requires surgery.
Diagnostic Tests for Disorders of the Bladder or Urethra
Doctors frequently perform the following diagnostic tests to evaluate the condition of the bladder and the urethra and to determine how well the bladder functions.
Cystoscopy
Cystoscopy is a diagnostic imaging technique that allows a doctor to look directly inside the urethra and bladder to examine the bladder, look for any stones or tumors, and check for other abnormalities. Cystoscopy is often done using local anesthesia, but spinal or general anesthesia is sometimes used. The procedure is usually performed on an outpatient basis.
As you lie on your back, the doctor inserts a narrow viewing tube (called a cystoscope) through your urethra and into the bladder. The cystoscope has a tiny light and camera at its tip that enables the doctor to view the urethra and bladder directly or on a video monitor. He or she may also insert a small instrument through the cystoscope to remove a tiny sample of tissue for examination under a microscope (biopsy). In some cases, a doctor may pass water into the bladder to see how much it can hold. Although most cystoscopic examinations do not cause problems, there is a small risk of