American Medical Association Family Medical Guide - American Medical Association [533]
Full bladder
Normal flow of urine
Abnormal flow of urine in vesicoureteral reflux
Symptoms
Chronic pyelonephritis often does not produce symptoms until years after the condition develops. Eventually, early symptoms of kidney failure may develop, including fatigue, nausea, and itching skin. If you have recurring mild urinary tract infections, or any symptom of chronic kidney failure, see your doctor.
Diagnosis
If you have recurring urinary tract infections, your doctor will examine you and will probably order blood and urine tests to determine the type of bacteria that is causing the infection. He or she may also order an ultrasound (see page 111) or CT scan (see page 112) to evaluate your kidneys, cystoscopy (see page 805) to examine your bladder, or a voiding cystourethrogram (see page 805) to find out how your bladder functions during urination. In many cases, the condition is detected at an earlier stage by a blood or urine test performed for another purpose.
Treatment
If you have chronic pyelonephritis but no symptoms, your doctor may recommend that you drink plenty of fluids (at least eight large glasses of water every day) and limit your intake of foods high in protein and sodium to avoid overworking your kidneys. Your doctor may also recommend that you have blood tests every 6 to 12 months to monitor your condition and watch for infections.
Treatment for chronic pyelonephritis depends on how advanced the condition is when it is diagnosed. Surgery to repair the faulty valvelike action at the openings of the ureters into the bladder may be performed on a child, but the procedure is usually not performed on adults. Your doctor will treat any underlying cause of the chronic infections, such as kidney stones. He or she will probably prescribe an antibiotic to take for a specified amount of time whenever you have a urinary tract infection. Alternatively, a doctor may prescribe a low dose of an antibiotic to take for 3 to 6 months to try to keep the urine free of bacteria.
Because chronic pyelonephritis progresses slowly, your doctor may recommend that you watch for symptoms of kidney disease (such as frequent urination, abnormal-looking urine, pain in your side or back between the rib cage and hip, or puffiness in your face) and have regular checkups.
Glomerulonephritis
Glomerulonephritis refers to several related diseases that damage the kidneys. Some types of glomerulonephritis are linked to disorders in which the immune system mistakenly attacks the glomeruli (the network of tiny blood vessels inside the nephrons, the basic filtering units of the kidneys).
In a healthy kidney, blood passes through the glomeruli, which filter out chemicals including waste products. Most of the water and essential chemicals (such as glucose, sodium, and potassium) are reabsorbed into the bloodstream. The remaining waste materials collect as urine and pass down the ureters to the bladder for storage until you urinate.
If the glomeruli are damaged, red blood cells can leak through them into the urine, and protein can pass from the blood into the urine. If the loss of protein is excessive, it can cause a condition called nephrotic syndrome (see page 429). As more of the glomeruli are damaged, the kidneys become less efficient as filters and regulators of the chemical content of the blood. Waste products accumulate in the blood and can damage the kidneys.
Glomerulonephritis can be mild or severe, and it may be acute, flaring up over a few days, or chronic, taking months or years to develop. The condition is not common, but approximately 60 percent of people who have end-stage kidney failure (see page 819) first have signs and symptoms of chronic glomerulonephritis. Acute glomerulonephritis can result from infections such as HIV (see page 909), hepatitis (see page 786), or endocarditis (see page 593). It also can occur as a result