Urinary Tract Infections: How They Occur And Are Manifested And Treated

Diseases A-Z

Uncomplicated UTIs are very common infections. About 30% of women aged 20 to 40 have experienced at least one episode. Women are much more affected than men, because the woman’s urethra, shorter than that of the man, facilitates the entry of bacteria into the bladder. It is estimated that in North America, 20% to 40% of women have had at least one urinary tract infection. Many women will contract many during their lifetime. About 2% to 3% of adult women would have cystitis each year. UTIs are very common infections

Young men are unaffected by this condition, with older men with prostate disorders at higher risk. As for children, they are more rarely affected. About 2% of newborns and infants contract urinary tract infections. It is mostly male babies who have an abnormality of the urinary tract that suffer from it. At age 6, 7% of girls and 2% of boys had urinary tract infection at least once.

Urinary Tract Infections (UTI): explaining the term

The term ‘urinary tract infection’ defines the presence of irritative symptoms of the urinary tract associated with the isolation of pathogenic microorganisms in the urine. Uncomplicated acute urinary tract infections include infections of the lower urinary tract (cystitis, urethritis, prostatitis) and upper urinary tract (pyelonephritis, cystopyelitis).

Cystitis is defined as acute or chronic inflammation of the urinary bladder generally caused by a bacterial infection or, more rarely, by traumas or external agents (for example radiotherapy). The infections that occur in a urinary system that are morphologically and functionally free and in the absence of specific comorbidities are defined as ‘uncomplicated’.

Infections that occur in individuals at particular risk of complications are defined as ‘complicated’ (children, pregnant women, immunosuppressed, diabetic, catheterized subjects, with anatomical or functional alterations of the urinary tract, renal failure, obstructive uropathy, neurological bladder).

Asymptomatic bacteriuria (presence of bacteria in the urine without urinary symptomatology such as pain, burning) is common and is rarely associated with adverse outcomes. Screening or treatment of asymptomatic bacteriuria is not recommended in women of childbearing, non-pregnant age, in elderly or catheterized patients.

Infection occurs through the urethra or by contiguity from within bacteria mostly of intestinal origin. It is a much more common infection in women than in man due to the relative brevity of the female urethra that exposes to the rising of germs. The spectrum of pathogens is superimposable for uncomplicated UTI of the upper and lower urinary tract, with Escherichia Coli as a pathogen responsible for 70-95% of cases and Staphylococcus saprophyticus, epidermidis and fecalis in about 10-15%. Occasionally other Enterobacteriaceae are isolated such as Proteus Mirabilis and Klebsiella spp. or enterococci (especially in positive cultures with multiple micro-organisms, sign of contamination).

UTI: predisposing factors

With the exception of the urethral mucosa, the urinary tract of healthy individuals is resistant to colonization by pathogenic microorganisms, as we have ‘local’ defense mechanisms, in addition to the active participation of the immune system (antibody response, protective role of IgA and IgG). Urine is an excellent growth medium for many bacteria, but not for most of the urethral flora (anaerobes, non-haemolytic streptococci, staphylococci) and thanks to its chemical composition, pH and urinary flow gives effective protection for the excretory apparatus.

It should be noted that colonization of the urinary tract, due to pathogenic microorganisms, does not always cause infection.

In fact, the infectious process depends on:

  • charge, virulence and recurrence of microorganisms;
  • effectiveness of host immune defenses.

In short, the physiological defense of the excretory apparatus is conferred by the following mechanisms:

Physicists

Peristalsis, flushing action of urinary flow, exfoliation of epithelial cells, epithelium of stratified transition in renal excretory ducts, bladder and initial urethral tract;

Chemical

Acid pH of urine, urea contained in urine (acts as an antagonist with respect to anaerobic bacteria);

Biological

Resident bacterial flora, mucosal resistance to colonization, phagocytosis, mucosal inflammatory response and production of immunoglobulins (IgG, IgA), antibacterial activity of the prostatic secretion present in the urine, presence in the urine of the Tamm-Horsfall protein (secreted by cells tubular, contains mannose and eagerly alloyed Escherichia coli endowed with fimbriae 1, favoring its elimination).

In some patients there is a genetic predisposition to urinary infections due to lack of or inadequate congenital production of defensive chemicals. Other favorable circumstances are:

UTI symptomsUTI: predisposing factors

  • Pollachiuria: increased number of micturitions with a reduced amount of urine for each urination.
  • Disuria: difficulty urinating
  • Stranguria: pain or burning during urination, sometimes accompanied by chills and cold
  • Subpubic pain
  • Bladder tenesmus: urgent need to urinate and feeling that the bladder has not been completely emptied
  • Possible blood in the urine
  • Fever: if the infection goes back to the upper urinary tract there can be a high fever and with a shiver

Diagnosing UTI

There are a number of possible UTI conditions that should be ruled out or confirmed. A woman of childbearing and non-pregnant age who presents with acute dysuria usually has one of three types of infection:


  1. Acute cystitis
  2. Acute urethritis from Chlamidia Trachomatis, Neisseria Gonorrhoeae or Herpes simplex
  3. Vaginitis from Candida or Trichomonas vaginalis

A distinction between these three entities can be done with a high degree of safety through medical history and physical examination. The urine test (also with stick) for the search for pyuria (presence of at least 10 leukocytes / mmc), hematuria and nitrite is indicated. The traditional standard for talking about ‘significant’ bacteriuria is > 104 bacteria / ml.

The clinical diagnosis of chronic pyelonephritis is not easy; in fact, if the diagnostic tests are performed in an inactivity phase of the disease, it is possible to discover normal findings. The symptoms reported may vary according to the presence or absence of an infectious process: individuals without infection may be asymptomatic until the most advanced stages of chronic pyelonephritis are reached. Symptoms may be non-specific: high blood pressure (hypertension) and signs of renal failure such as general malaise, feeling of tiredness (asthenia), loss of memory, easy fatigue, nausea and loss of sexual desire (libido). If a kidney infection is present, the individual may complain of symptoms similar to those of acute pyelonephritis, with the rapid development of clinical signs over a period of hours or days.

Patients may report high fever (38.3 ° C to 40 ° C or higher) and chills, flank pain, particularly in the lower back on the right side, increased frequency of urination, pain and a burning sensation at the time of urination (dysuria), nausea and vomiting, loss of appetite (anorexia) and general fatigue.

In the event of an infection, the physical examination may reveal generalized and localized muscle tenderness when pressure is applied to the sides of the abdomen. Fever, high blood pressure and other symptoms can be confirmed during the medical examination. In the absence of acute infection, the objective examination may have a substantially normal outcome.

If a urinary and / or renal tract infection is suspected, the urine culture test allows to determine the bacterial load and to identify the responsible pathogenic species. In the case of positive urine culture, the antibiogram is associated, which allows to evaluate the sensitivity of microorganisms, which intervene in the infection, to the various antibiotics.

The urinary sediment is examined to identify the presence of red blood cells or purulent material (hematuria or pyuria): the urine is often cloudy due to the presence of pus and / or has an opaque appearance due to the presence of erythrocytes, leucocytes, bacteria, epithelial cells or amorphous material.

Urinalysis can reveal the presence of protein (proteinuria, albuminuria) and highlight if the sample is concentrated or diluted abnormally.

Laboratory analyzes may quantitatively reveal if renal function is decreased: the blood urea nitrogen (B lood Urea Nitrogen or BUN) is increased, as is creatinine, which is measured by the measurement of plasma clearance (creatinine) and urine (creatinineuria), collected within 24 hours. In the advanced phase, the most frequent manifestation is polyuria, a high production of urine, an expression of the loss of the power of renal concentration.

Among the blood tests can be important parameters able to make evident the signs of ???? inflammation in place (high speed of erythrocyte sedimentation, increase in white blood cells etc.).

A very useful contribution can be provided by the radiographic survey: it makes clear a difference in volume between one kidney and another, in the case of monolateral chronic pyelonephritis, or a irregularities in the contour of the organ , due to scarring at the cortical level. Furthermore, an X-ray can reveal stones, tumors or cysts in the kidney or urinary tract.

Reflux nephropathy, a condition favoring chronic pyelonephritis, can only be recognized by cystography, by injecting a contrast medium into the bladder via a catheter.

Also the urography, morphological and functional radiological examination, allows to visualize the kidneys and the urinary tract through the injection of an iodine contrast medium, which, once eliminated by the renal route, can demonstrate or exclude anomalies at the expense apparatus.

Renal ultrasound is also a very useful and easily repeatable investigation: the organs affected by chronic pyelonephritis may appear irregular and asymmetrical, indicating a severe inflammation in progress. In some cases, an abdominal or renal computed tomography (CT) may be indicated, particularly in those with unclear diagnosis or with complicated clinical conditions. Renal biopsy may be recommended in some cases of chronic pyelonephritis, to rule out other possible causes of inflammation.

UTI therapy

Short cycles of antibiotics are very effective in the treatment of uncomplicated acute cystitis in women of childbearing age.

UTI therapyThe high antibiotic concentrations reached in this district due to the elimination of some products solely by urinary route, justify the possibility of performing an extremely short therapy or even a single administration with some types of antimicrobials in simple cystitis (one-shot): the case of second-generation fluoroquinolones. Drugs with slower antibacterial activity (eg betalactam) require longer treatments.

Urinalysis is sufficient for routine follow-up. However, performing urine culture in asymptomatic patients is not recommended because the treatment of asymptomatic bacteriuria in healthy women is not recommended. In women whose symptoms do not resolve before the end of treatment or when the symptoms resolve but reoccur within 2 weeks, urine culture and antibiogram should be performed.

Recurrent (uncomplicated) urinary tract infections in women

Recurrent urinary tract infections (RUTI) are defined in the literature as three episodes of UTI over the last 12 months or as two episodes in the last 6 months. Risk factors for RUTI are genetic and behavioral. The behavioral factors associated with RUTI include sexual activity, with a particularly high risk in women who use spermicides, the frequency of ratios, the use of spermicides, the age of the first UTI and a history of UTI in the mother, what which suggests the role of genetic factors and / or long-term environmental exposures.

After menopause, the risk factors strongly associated with RUTI are bladder prolapse, incontinence and presence of post-voidal residue. For the prevention of RUTI different approaches have been proposed, including non-pharmacological therapies, such as urination immediately after sexual intercourse or cranberry juice and the use of antibiotics as preventive therapy administered regularly or as post-coital prophylaxis in sexually active women.

Urinary tract infections in pregnancy

Urinary tract infections in pregnancyUrinary tract infections during pregnancy are a common occurrence associated with both clinical and asymptomatic signs and symptoms; both forms are associated with a risk of evolution in pyelonephritis and complications for the fetus, so they are always considered with complicated infections. To avoid excess exposure to antibiotics for unnecessary treatments, in asymptomatic forms there is indication to therapy only after two samples of positive urine culture after 1-2 weeks. In the symptomatic forms the standard treatment is the use of beta-lactam or nitrofurantoin for 7 days. There is always an indication of post-therapy control urine culture.

Assistive products and prevention of UTI

Methods such as urine acidification, cranberry juice, bearberry extract and vaginal application of lactobacilli show variable effects but are widely used for the reduced rate of side effects.

D-Mannose

D-mannose is a simple sugar extracted from larch or birch wood that is reabsorbed eight times slower than normal glucose and a good portion is filtered by the kidneys and then expelled with urine, where it seems to possess the property of ‘sticking’ to ‘Escherichia Coli, forming an entity that is more easily eliminated during urination. D-mannose cannot be used as prevention but is only used in the presence of urinary tract infections (acute phase or recurrence).

Bearberry

Uva ursina is a plant traditionally used in naturopathy in the treatment of urinary tract infections. The active ingredient that Uva ursine contains is arbutin, hydrolysed at the intestinal level, with release of hydroquinone which is eliminated from the urinary tract. The concomitant use of substances or foods that acidify the urine should be avoided, otherwise the antibacterial properties will be lost.

In the absence of work specifically dedicated to the assessment of toxicity (in particular liver) of the plant and its preparations, it is not recommended to use the plant to pregnant women and children under the age of 12 years. Urine tends to alkalinity (pH> 7) in the presence of pathogens capable of cleaving urea (Proteus spp, Klebsiella spp, Bilophila wadsworthia, Cryptococcus neoformans, some Citrobacter spp, some Haemophilus spp), and therefore infections of this type are theoretically treatable with the bearberry.

Cranberry

CranberryOriginally from North America, the cranberry has been used as a traditional treatment for urinary tract infections prior to the introduction of antibiotics, and continues to be widely used as a self-medication for this purpose. The E. coli uropathogenic strains rely on the adhesion of the P-type fimbriae to allow colonization and the related infectious process. The cranberry proanthocyanidins prevent the adhesion of the P-type fimbriae of the E. coli uropathogenic strains. Initially its benefits were attributed to the acidification of urine and its hippuric acid content, but more recent studies indicate that proanthocyanidins interfere with the adhesion of uropathogenic bacteria to the bladder mucosa.

The ability to protect against oxidative stress has also been described. The non-uniformity of cranberry-based standardization is still the major problem in comparing and extrapolating the results of observational studies. The titration of proantiocidines of type A is directly proportional to the efficacy of the product. It can be taken during pregnancy.

Blueberry

The use of blueberry juice is one of the potential solutions that can complement conventional therapeutic procedures. The mechanism of action is linked to the content of proanthocyanidins, which selectively inhibit the adhesins produced by the bacteria, preventing the pathogens from adhering to the urinary mucosa and colonizing it. In the literature, there are encouraging data on the use of blueberry in the prevention of infections of the urinary system, despite the difficulties of a comparative evaluation between the various studies due to differences in the population examined, in the pharmaceutical forms used (concentrated juice, tablets, capsules, etc.) and in the daily dosage.

The studies show that the daily consumption of blueberry, in tablets or in liquid form, prevents infections in young women caused in particular by Escherichia coli. However, further studies are needed to confirm the effectiveness of blueberry and its tolerability in adults and in pediatric age.

L-methionine

A large number of Gram-negative bacteria are able to alkalize the urine by enzymatic degradation of the urea and thus can create advantageous growth conditions. The acidifying effect of L-methionine causes a shift in urinary pH in a pH range between 5.4 and 6.2. This acidic environment decreases the adhesion of pathogenic bacteria to the cells of the urothelium and inhibits the growth of bacterial strains. Chronic urinary infection with alkaline urine can induce the formation and growth of phosphate stones. The acidification of urine with L-methionine improves the solubility of the calculations and is an essential principle to avoid the formation of new ones.

Immune therapy against UTI

There is an immune therapy against recurrent urinary tract infections by E. coli (not marketed in Italy) consisting of Escherichia coli lysate (Uro Vaxom). A meta-analysis of 5 double-blind placebo-controlled studies using oral immunoactive fractions of E. coli gave a significant reduction in RUTI compared to placebo, although practical experience does not seem to reproduce the same results.

Rebalance of intestinal flora

The intestinal bacteria can reach the bladder by contiguity or through the lymphatic pathways and only by correcting the intestinal balance between ‘good’ and pathogenic bacterial flora and thus eliminating the reservoir of dangerous bacteria that feeds this cyclical recurrence of infections, it will be possible to eliminate one of the cause of far more frequent infections of the lower urinary tract.

Rebalance of intestinal floraIf the dysbiosis is not eliminated then, each antibiotic will have a momentary effect on the bladder, without treating the origin of the problem but going to increase the resistance of intestinal pathogenic bacteria, when they are in excessive numbers.

Lactic ferments and probiotics are used. The probiotic that can persistently colonize the intestine, in quantity and for an adequate time and that is stable over time as conservation and characteristics, should be preferred.

Pyelonephritis: a serious UTI condition

Pyelonephritis is an inflammatory disease, acute or chronic, of the kidney and of the renal pelvis, usually accompanied by an infection of the parenchymal tissue of the organ. The symptomatology of the disease is characterized by fever, low back pain and symptoms of the lower urinary tract.

The origin of pyelonephritis is bacterial and the pathways through which infection spreads may be different. Colonization mediated by pathogens can in fact take place through:

Ascending path from the bladder (the most frequent): from the perineum (or from the vaginal vestibule, in the case of female patients), the microorganisms go back into the urethra, then into the bladder, up to the kidney; the main causes of infection for women consist in deformation of the urethra during sexual intercourse, while for men it is often secondary to prostatitis. Pielonephritis In catheterized patients, the contamination can occur as a result of the placement or manipulation of the catheter, with consequent possible bladder recovery of pathogens.

Blood descending path: through the bloodstream, during septicemia, pathogens reach the kidney causing renal abscesses and abscesses.

Lymphatic descending route: a network of lymphatic vessels connects the ascending colon with the right kidney and the descending colon with the left kidney.

The microorganisms involved in pyelonephritis are usually the same responsible for infections of the urinary tract, genital and gastro-enteric, then at the bladder, prostate, cervix, vagina, urethra or rectum: Escherichia coli, Klebsiella spp., Proteus spp., Enterococcus spp. etc.

In most cases, these pathogens represent the bacteria of the faecal flora, which take the ascending pathway although in general the peristalsis (movements of contractions and distension of the walls of the urinary tract) performs an effective protective action against infections. Other unusual microorganisms are occasionally reported: mycobacteria, yeast and fungi, as well as opportunistic pathogens such as Corynebacterium urealyticum.

An anatomical and functional predisposition makes some patients more susceptible to the onset of pyelonephritis. Some of these ‘critical’ factors are: urine stagnation, the presence of stones or other kidney obstructions (eg prostatic hypertrophy or tumor), immunosuppression debilitation or peripheral neuropathy (example: spinal cord injury).

Acute and chronic pyelonephritis

Pyelonephritis occurs more frequently in acute form, but the recurrence of infection can lead to chronic pyelonephritis. The two forms of disease are distinguished by the anatomical-pathological aspects and by the timing that distinguish the infection.

Acute and chronic pyelonephritisAcute pyelonephritis has elevated fever, back pain in the lumbar region, painful urination, pressure on the renal region, nausea and signs of infection of the lower urinary tract (eg haematuria, dysuria). The prognosis of the acute form is positive: if proper therapy is used, the symptoms of pyelonephritis tend to regress in approximately two weeks.

Chronic pyelonephritis has less intense symptoms and can be caused by recurrent infections (caused by the same microbial strain) or by re-infections (caused by different microorganisms). The recurrent form of the pathology is often responsible for significant inflammatory changes in the excretory system. In fact, the evolution of chronic pyelonephritis can induce pionephrosis (severe and extensive kidney disease characterized by the collection of pus, with destruction of the renal parenchyma), urosepsis (systemic inflammatory response propagated by the urinary tract), renal failure and, in the terminal phase, it can even lead to the need for an organ transplant.

The diagnostic approach is based on the research of the etiologic agent in the urine sample (urine culture + direct microscopic examination) and on the evidence of an anti-serum antibody response to the infecting bacteria (common reaction in pyelonephritis).

The pathology requires antibiotic therapy that, if timely, leads to healing without consequences. The treatment allows the radical elimination of any bacteria present in the urine, by taking cycles of specific antibiotics, which also take a preventive value against the causes and the recurrence of the infection. Sometimes, it is necessary to resort to surgery such as urethroscopy (an operative method generally used for the treatment of stones, stenoses, small urothelial neoformations) or nephrectomy (partial or total removal of the kidney).

Acute pyelonephritis is a localized inflammation, which affects the mucosa of the renal pelvis (or renal pelvis) and the kidney; it is often caused by the spread of an infection supported by pathogens belonging to the intestinal bacterial flora, which can reach the kidney through three ways: ascending from the bladder (the most common), blood and lymphatic from the lymph.

There are several are the conditions and mechanisms that can make them susceptible to pyelonephritis. Indicative symptoms of acute inflammation are high fever, chills, lumbar pain, dysuria and renal involvement in physical examination. Infection in the kidney causes an inflammatory process of a suppurative nature, with the formation of small abscesses distributed in the affected organ.

Pyelonephritis has a benign evolution: if the proper treatment is used, the symptoms tend to regress in about two weeks. In the case of concurrent urinary abnormalities, the infection may prove to be particularly resistant to treatment and sometimes there may be an evolution in the chronic form of the disease.

Pyelonephritis can affect subjects of any gender and age, but there is a greater incidence in women and children, for the following reasons. Women: they have a shorter urethra than men and, during pregnancy, the uterus can compress the excretory ways even more. Other factors, which make the female sex more exposed, may be hormonal changes and urethral traumas during sexual intercourse. Children: present the phenomenon of bladder-ureteral reflux more frequently.

Causes and risk factors of the pyelonephritis UTI

The cause of acute pyelonephritis is often to be found in a urinary tract infection, which can be ascertained and diagnosed by performing a urine culture.

The presence of bacteria in the urine (they are sterile, in general, in the healthy subject) in a significantly high number, makes evident the presence of an infection, which can be concretized precisely in the onset of pyelonephritis. Most cases of pyelonephritis are due to intestinal microorganisms entering the urinary tract, such as Escherichia coli (in 70-80% of cases) and Enterococcus faecalis. Nosocomial infections (contracted in hospital) may be due to coliform bacteria and enterococci, as well as to other less common organisms (eg Pseudomonas aeruginosa and various Klebsiella species).

Most cases of pyelonephritis begin as infections of the lower urinary tract, especially cystitis and prostatitis. Escherichia coli can invade the ‘umbrella’ cells of the bladder (defined as each of them covers more cells of the intermediate layer) to form intracellular bacterial communities, which can mature in biofilms (complex aggregation of microorganisms characterized by the secretion of an anchor matrix); the latter are resistant to antibiotic therapy and immune system responses, so much so as to represent a possible explanation for recurrent infections of the urinary tract, including pyelonephritis.

Causes and risk factors of the pyelonephritis UTISeveral factors predispose to pyelonephritis:

1. Anatomical-functional alterations, which can cause urinary flow obstruction or facilitate the entry into the bladder of pathogens;

  • structural defects of the urinary tract, such as some congenital malformations;
  • shorter urethra in women: promotes colonization of the urinary tract by micro-organisms of intestinal origin, for their access to the vaginal vestibule. In the same way, sexual relations facilitate the entry into the urethra of pathogens in women;
  • tumors, strictures, kidney stones, prostatic hypertrophy;
  • neurological damage of the bladder and of the sphincters (spina bifida, multiple sclerosis).
  • incomplete bladder emptying. The bladder-ureteral reflux (reflux of urine from the bladder to the ureter and sometimes to the renal parenchyma) and the incomplete emptying of the bladder favor an ascending infection reaching the kidney.

2. Catheterization. During insertion of a catheter, bacteria can be transported into the bladder via the endoluminal route or through contact with the external surface. Ureteral stents (small tube inserted into the ureter to prevent or resolve obstruction of urine flow from the kidney) or drainage procedures (for example: nephrostomy) may also increase the risk of pyelonephritis.

3. Predisposing diseases of various kinds: metabolic diseases (Diabetes Mellitus, hyperuricemia), immunosuppression, neurological diseases, etc.

4. Pregnancy is a condition that makes susceptible to acute pyelonephritis due to the increased production of estrogen (dilatation of ureters, pelvis and bladder) and for the enlargement of the uterus (compression on ureters and bladder with stagnation of urine).

Complications

With timely antibiotic therapy, most cases of acute pyelonephritis resolve without complications. However, adequate therapy can be aggressive or prolonged. After finishing antibiotic treatment, a urine test should always be performed for pregnant women and diabetic patients or those with spinal paralysis, to ensure that the pathogens are no longer present.

In rare cases, permanent kidney damage may result when:

  • Recurrence of infection occurs in a transplanted kidney (particularly in the first three months of transplantation);
  • Repeated infections that occur during childhood.
  • Acute pyelonephritis may present in severe form in the elderly and in immunocompromised persons (eg patients with cancer or AIDS). Complications occur more frequently in patients with diabetes mellitus, chronic renal failure and sickle cell anemia.

kidney infectionIf left untreated, a kidney infection can lead to potentially serious complications, such as:

Relapse of the infection

Acute pyelonephritis can cause, in rare cases, acute renal failure in children, healthy adults and pregnant women. This secondary complication generally occurs in conjunction with other factors contributing to the onset (such as the presence of tumors, kidney stones, sepsis) and is characterized by slower recovery. Serious episodes of acute renal inflammation can cause permanent injury and induce chronic kidney disease.

Blood infection (sepsis)

The kidneys filter waste substances from the blood, which is distributed to the rest of the body through the bloodstream. If the patient has a kidney infection, the bacteria can spread to the blood that comes from the kidneys and enter the systemic circulation. The overall mortality from sepsis increases significantly in cases of chronic renal failure, acute renal dysfunction and age above 64 years. Elderly people, newborns and people with a weakened immune system are at a higher risk of having a septic shock, a critical state of acute circulatory failure, which is characterized by the drastic drop in blood pressure and a series of events progressively more serious.

Often, patients who have the conditions listed above, need hospitalization for constant monitoring.

Other complications can be:

  • Permanent renal damage: a renal disease can cause permanent damage and cause chronic renal failure;
  • Renal scars: these are scars left by acute pyelonephritis and originate more frequently in pediatric age; Fibrous areas replace the functioning parenchyma and may cause hypertension in adulthood.
  • Pregnancy complications: women who develop a renal infection during pregnancy may have a more complicated course with a significant risk of premature delivery.
  • Perirenal abscess (more common, in case of abnormal urinary tract). A renal or perirenal abscess is a localized collection of pus within or around the kidney (perirenal space) following a severe infection. The main risk factors for the onset of this rare complication are the deposits of kidney or ureteral minerals (calculi) and diabetes mellitus.
  • Emphysematous pyelonephritis: life-threatening condition, fortunately rare. This severe necrotizing form of acute pyelonephritis occurs with some species of bacteria that cause glucose fermentation, with accumulation of gas in the renal parenchyma. It occurs especially in obese or elderly patients with diabetes.
Prevention:
  • therapy, able to eradicate any acute infection that occurs acutely;
  • elimination of any obstruction to urine outflow (kidney stones, stenosis);
  • correction of bladder-ureteral reflux;
  • limitation of other predisposing factors.

In women with at least three symptomatic infections over the course of a year, a prophylactic treatment should be considered with an antibiotic to be taken orally: a low dosage can help eliminate the incidence of any relapsing infection. For children, the current orientation reserves antibiotic prophylaxis only for those who are at higher risk of complications (example: evidence of vesicoureteral reflux, recurrent infections or the appearance of renal scarring). Reducing the risk of pyelonephritis is possible, paying attention to some details:

Take care of daily hygiene, to avoid the entry of bacteria and to prevent the spread of bacteria from the perianal region to the vaginal vestibule and to the urethra. Avoid using products in the genital area, such as deodorant sprays or vaginal washings that may cause irritation.

Catheters: in the particular situation in which it is necessary to make use of these devices it is important that the necessary safety measures are respected, during regular replacement and manipulation. Furthermore, the area around the catheter should be monitored and cleaned frequently.

Kidney stones: In patients with kidney infections, such aggregations of mineral salts are often found. Examining a specific exam and visiting a urologist may allow more accurate assessment of the case and prevent any relapse infections.

Drink plenty of fluids, especially water and cranberry juice: it can help remove urinary tract bacteria, increasing the frequency of urination. Coffee and alcohol should be avoided as they can exacerbate the urgent need to urinate and promote dehydration.

Urinate frequently: avoid retaining urination when you feel the need to urinate; moreover, it is important to empty the bladder immediately after sexual intercourse, since this favors the removal of any bacteria that may have been introduced during sexual activity.

In people suffering from recurrent urinary tract infections, further investigation can identify an anatomic-functional anomaly. Occasionally, surgery is necessary in such patients to reduce the likelihood of recurrence. As for nutrition, there is no specific diet to follow. In cases of acute pyelonephritis, it is important to note that some symptoms, such as nausea and vomiting, create conditions of poor appetite and can contribute to dehydration or weakness, as it may be difficult to maintain adequate nutrition. The American blueberry juice has been studied as a prophylactic measure: many studies suggest the net benefit due to its ingestion.

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