Acute pyelonephritis referred to the bacterial infection of the kidneys, which might occur in 1-2% of pregnant women. The infection primarily occurs in the lower urinary tract. It is very important to diagnose the infection at an early stage. In case it is not detected in the primary stage, it spreads from the urethra and affects the entire bladder and genitals. It gradually affects both the kidneys and causes major threats to the pregnancy.

Pyelonephritis is more likely to develop in pregnant women than other women. The physiological changes that occur in pregnant women create obstacles in the normal flow of urine. The ureters pass the urine to the bladder from the kidney and ultimately it goes out of the system through the urethra.

At the time of pregnancy, high volume of progesterone hormone inhibits contraction of the urine drainage ducts. At the same time, the uterus increases in size during pregnancy and causes compression to the ureters. These physical changes in the urinary system create problems in the proper passage of urine from the kidneys. Thus, the urine becomes stagnant at a point, which creates bacterial development in the kidneys. Instead of being washed out, the stored urine causes this bacterial development that spreads to the kidney from the bladder. This results in the Escherichia coli (E. coli) infection. Other infectious bacteria like Staphylococcus, Klebsiella pneumoniae, and Proteus species develops in stored urine and affects the kidney functions.

Causes of Acute Pyelonephritis

Acute pyelonephritis can occur in pregnant women because of her previous records of repeated urinal tract infections. This is, in fact, a long-standing medical infection. This sometimes happens in early infancy as well. Some women face urinal infection at the beginning of their sex life. Repeated urinary tract infection in childhood leads to the production of renal scarring. This narrows the renal cortex of the kidney. The outer part of the kidney becomes abnormally narrow and thus creates an obstruction in the free passage of urine through the urinary tract.

Symptoms of Pyelonephritis

The primary symptoms of pyelonephritis are:

1. High fever

2. Pain in the lower back of the body

3. Severe chills or rigors

4. Nausea and vomiting

5. Frequent urinary pressure

6. Urgency to urinate immediately

7. Painful urination or dysuria

8. Blood in the urine or haematuria

The other symptoms of Acute Pyelonephritis are:

1. The pregnant woman is suddenly noticed to be seized with acute abdominal pain on her both sides. This happens mostly after 16 weeks of pregnancy.

2. The body temperature rises to almost 39.5°C. The infection is confined to the right kidney in half of the cases. In 34% cases, it affects both the kidneys. And in 16% cases, it affects the left kidney.

3. There are rapid changes in pulse rates due to the effect of such infection. It often remains 120/minute continuously for several days.

4. The woman tends to become pale in complexion. She suffers from repeated vomiting. The affected kidney becomes tender over the course of time.

5. In more severe cases, if the infection remains untreated, it can reduce production of the volume of urine. The urine contains pus and debris.

Complications of Pyelonephritis

The serious problems of pyelonephritis can be well treated with proper medication. However, the sepsis or the bacterial infection caused in the bloodstream needs to be taken care urgently. It can cause serious medical conditions if in case it gets spread to the other parts of the body.

In particular cases, untreated pyelonephritis causes acute respiratory distress to the pregnant women. This occurs due to the fluid accumulation in the lungs. Pyelonephritis also can lead to preterm labor and put the baby at high risk. It can even lead the preterm delivery of the baby. This can cause non-fatal complications in newborn babies and even death on dire occasions.

Diagnosis of Pyelonephritis

It’s very important to report to the doctor in case any abnormality is experienced in the urine passage. Sometimes the pregnant woman may experience itching in her genitals. It is utmost important to take a urine test to determine whether the symptoms are due to the occurrence of kidney infection or not. Presence of bacteria and WBC (White Blood Corpuscles) in the urine confirms kidney infection. Microscopic tests are done in this case to determine the presence of infection-causing bacteria.

Presence of white blood cells the urine confirms that the kidney is infected. If required, the doctor can further prescribe definitive diagnosis to culture the bacteria present in the urine.

Early diagnosis of Pyelonephritis is the key to the success of its treatment. When diagnosed at an early stage, the risk of the baby and the mother both are less. So it is advised to would-be-mothers to immediately seek medical help in case of any vaginal irritation.

Treatment of Pyelonephritis

It is not a regular practice to prescribe pain-killers to a pregnant woman. Doctors mostly advise them to take complete bed rest for pain relief. In case one of the kidneys is affected, the patient is advised to lie on the other side. The knees need to be flexed for proper abdominal relaxation.

Once the urine specimen is obtained for bacteriological examination, the patient is given 500 mg of antibiotics (ampicillin) at every 6 hours. The further course of action is proposed after the bacteriological report is available. The treatment might be continued with ampicillin or another appropriate drug is introduced. The patient’s condition is expected to be improving within 2 to 3 days of antibacterial drug dosage. The treatment should be continued for a minimum period of 3 days until the time the fever and all other symptoms are subsided. Regular urinary cultures are required to keep a track on the development of infections.

The doctor advises drinking more fluids during this time. It includes more water, fruit juices, vegetable soup, milk, and stew. This increases the flow of urine in the system. Thus, the micro-organisms are washed out from the urinary tract. Frequent urination also decreases chances of urine stagnancy in the system. Hence, infection build up is vastly reduced. Intravenous fluids are recommended in case of severe vomiting.

Drinking more water flushes out the accumulated infectious organisms from the urinary tract. This immediately reduces the irritation at the genitals. The antibiotics control the fever and chills.

Outlook after Treatment

It’s very important to treat persistent or recurrent pyelonephritis on time. Even after the treatment and recovery, the patient should be kept under medical observation. Regular urine checkup is a must for such women. An intravenous pyelogram is mostly prescribed to women if the presence of pus cells or other micro-organisms are found. This reduces the threat of kidney damage. In case any secretion of pus cells or bacilli is noticed to be continued intermittently, adequate treatment should be provided with antibiotics. Application of long-acting sulphonamides is done by doctors to cure the causes and effects of infections to the core.

In specific cases, the pregnant woman even suffers from a miscarriage or intrauterine fetal death due to untreated severe pyelonephritis accompanied by high fever. In cases of asymptomatic bacteriuria or less severe infection, birth defects or premature labor is noticed. Such infections always increase the risk of mortality. Effective treatment brilliantly prevents it from reoccurring.