Chronic pyelonephritis

Chronic pyelonephritis is chronic bacterial infection of the kidney, mainly involving the renal interstitium, pelvis and calyces. Continuous or recurrent inflammation scars the interstitium, pelvis and calyces, causing renal atrophy and dysfunction. Patients may have only lumbar soreness and/or low fever without obvious dysuria, frequency or urgency; main features are nocturia and small amounts of leukocytes and protein; there is a long or recurrent UTI history, and uremia may appear late.

Common Symptoms

Decreased urine osmolality; increased phosphate excretion; low urine specific gravity; Bo Jianguo; lumbar soreness; urinary occult blood; lumbar pain with frequency; soreness of waist and knees; raised urine amylase; hyperuricuria; increased urine calcium

Causes

Common in women; some have childhood acute UTI that became asymptomatic bacteriuria and then chronic pyelonephritis. Recurrent UTI, bladder-ureteral reflux and gram-negative infection cause renal scarring; antibodies (mostly IgG, IgA) fix complement and damage the kidney. Persistent obstruction, malformation and low immunity let acute inflammation leave small scars. Autoimmunity may participate: Tamm-Horsfall protein shares antigenicity with E. coli, and antibodies continue to damage renal tissue after bacteria vanish. L-form bacteria (first found by Lister) survive in the hypertonic medulla, evade antibiotics, and cause relapse; about 20% of culture-negative chronic pyelonephritis have L-form bacteria.

Treatment

Medication, rehabilitation therapy

Prevention

1. Drink water and urinate often. 2. Keep the perineum clean. 3. Avoid urinary instruments; use asepsis. 4. Recurrent cases may take a nightly prophylactic antibiotic (co-trimoxazole, furadantin, amoxicillin or cefradine) for over a year; urinate and take a dose after intercourse.

Recommended Department

It is recommended to visit the nephrology department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.