Pyelonephritis, chronic:

Pyelonephritis, chronic: 

The phrase 'chronic pyelonephritis' (CP) is not really one diagnosis. It is meant to mean the long-term damage done by recurrent urine infection to the drainage system of the kidney. But it has come to be a 'fallback diagnosis', i.e. when doctors are not sure of the cause of kidney failure, and the kidney has scars on its surface, they call it CP.

Causes and Risk Factors

The urinary tract consists of the kidneys, a pair of ureters that lead to the urinary bladder, and the urethra that leads urine to the urinary outlet. Any obstruction in this tract can cause stagnation and retrograde of urine which is toxic for the body tissues.

Sometimes, the cause of CP is unclear, but the two main mechanisms of CP development are:

• An obstruction in the urinary tract: such as stones or other organs that enlarge and obstruct the passageway of urine.
• Reflux nephropathy (because of an obstruction or a urinary tract anomaly): is a disease of the kidney caused by the reflux of urine in the urinary tract and back to the kidney.

Symptoms 

CP is asymptomatic in its early stages. The usual symptoms are similar to that of kidney infection or chronic kidney disease, like:

• Burning sensation while peeing
• Difficulty in peeing
• Flank pain (on one side of the affected kidney) or back and abdominal pain
• Needing to urinate during the night
• History of recurrent UTIs since childhood
• Ankle swelling
• Tiredness, fatigue
• Itching

Children with CP may report these symptoms, too:

• Fever
• Nausea
• Lethargy
• Failure to thrive
• High blood pressure
• Tenderness on the sides
• If CP has progressed to late stages, the patient will experience renal insufficiency and hypertension.

Diagnosis

Blood creatinine may be raised if it has led to chronic kidney disease. Urine tests may show infection and low to moderate levels of protein. Other tests include;

• kidney ultrasound or IVP (intravenous pyelogram - a special x-ray) showing scarring,
• nuclear medicine scan,
• computed tomography (CT),
• micturating cystourethrogram (MCU). This will usually not be necessary.