Signs of kidney infection when pregnant

Pyelonephritis: kidney infection in pregnancy | Pregnancy, Worries and discomforts articles & support

It can cause premature births and hospitalisation during pregnancy so it’s definitely worth knowing about a type of urinary tract infection called pyelonephritis

Urinary tract infections (UTIs) are more common during pregnancy. This is mostly because there are a whole load of changes going on around there at this time.

Pyelonephritis is one of the most serious types of UTIs and one of the ones most likely to get you admitted to hospital. As well as affecting the upper urinary tract, pyelonephritis affects the kidneys (Goumi et al, 2015).

Pyelonephritis usually happens if you’ve had cystitis (a lower urinary tract infection) and the bacteria then travels up into the kidneys (Goumi et al, 2015; NHS Choices, 2018).

Pyelonephritis symptoms

Symptoms of pyelonephritis usually start within a few hours (NHS Choices, 2018). Some of the symptoms in pregnancy are:

• fever
• pain and discomfort on back or side
• nausea
• vomiting
• pain in your side
• painful, frequent or an urgent need to wee.

(Goumi et al, 2015; NHS Choices, 2018).

Pyelonephritis causes

E.coli bacteria is the usual cause of pyelonephritis. This bacteria causes pyelonephritis by travelling up to the bladder, causing cystitis, then continuing up into the kidneys. Both of which are the last things you need when you’re pregnant.

E. coli normally live in the bowel where they cause no harm. But they can be transferred into the vagina during sex or when you wipe after you go to the toilet (NHS Choices, 2018). And that’s when you have a problem.

Pyelonephritis is more common in women as their urethras are shorter, so it’s easier for bacteria to reach the kidneys. It’s also more likely in younger women who are sexually active as frequent sex increases the chances of a kidney infection (NHS Choices, 2018).

The best way to avoid pyelonephritis is to:

• drink plenty of fluids
• go to the loo as soon as you need it
• go to the loo after sex
• wipe from front to back after going to the loo
• wash down below every day, and if possible before having sex
• treat any constipation as this can increase your risk of pyelonephritis.

(NHS Choices, 2018)

When to see your GP

Pregnancy isn’t a time to be taking health risks so see your GP if:

• you feel feverish
• you have pain in your back, tummy or down below that won’t go away
• your symptoms haven’t improved after a few days
• you have blood in your wee.

(NHS Choices, 2018).

Pyelonephritis diagnosis

When they’re diagnosing pyelonephritis, your GP will ask:

• if you have had a kidney infection before
• what symptoms you’ve been having
• for a urine sample.

(NHS Choices, 2018)

Will this UTI affect my baby?

If you have pyelonephritis in pregnancy, you are more likely to have your baby prematurely or to have a low birthweight baby (Goumi et al, 2015).

You’re also more likely to have complications in your kidneys (NICE, 2013). The risks are higher if you don’t have any symptoms (Goumi et al, 2015).

Pyelonephritis treatment and antibiotics in pregnancy

Pyelonephritis needs quick treatment with antibiotics to stop it from damaging the kidney or spreading to the bloodstream (NHS Choices, 2018).

If you’re pregnant and have pyelonephritis, you’ll more than likely be admitted to hospital so doctors can take regular urine and blood samples. Your doctor can speak to you about which antibiotics are safe in pregnancy and you’ll probably be given them intravenously (NICE, 2013).

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

References

Goumi H, Goto Y, Laopaiboon M, Usui R, Mori R. (2015) Routine blood cultures in the management of pyelonepthritis in pregnancy for improving outcomes. Cochrane Database Systematic Review. (2):CD009216 Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009216.pub2/full [Accessed 1st February 2018]

NHS Choices. (2018) Kidney infection. Available from: https://www.nhs.uk/conditions/kidney-infection/ [Accessed 1st February 2018]

NICE (The National Institute for Health and Care Excellence). (2013) Clinical Knowledge Summaries. Pyelonephritis – acute. Available from: https://cks.nice.org.uk/pyelonephritis-acute#!scenario [Accessed 1st February 2018]

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Infections in Pregnancy: Acute Pyelonephritis

What is acute pyelonephritis?

Acute pyelonephritis is a bacterial infection of the kidneys that affects up to 2 percent of pregnant women. In most cases, the infection first develops in the lower urinary tract. If it’s not diagnosed and treated properly, the infection may spread from the urethra and genital area to the bladder and then to one or both kidneys.

Pregnant women are more likely to develop pyelonephritis than women who aren’t pregnant. This is due to physiological changes during pregnancy that can interfere with the flow of urine.

Normally, the ureters drain urine from the kidney into the bladder and out of the body through the urethra. During pregnancy, the high concentration of the hormone progesterone can inhibit contraction of these drainage ducts. Also, as the uterus becomes enlarged during pregnancy, it can compress the ureters.

These changes can lead to problems with proper drainage of urine from the kidneys, causing the urine to remain stagnant. As a result, bacteria in the bladder may migrate to the kidneys rather than being flushed out of the system. This causes an infection. The bacteria Escherichia coli (E. coli) is the usual cause. Other bacteria, like Klebsiella pneumoniae, the Proteus species, and Staphylococcus, can also cause kidney infections.

What are the symptoms of pyelonephritis?

Typically, the first symptoms of pyelonephritis are a high fever, chills, and pain on both sides of the lower back.

In some cases, this infection causes nausea and vomiting. Urinary symptoms are also common, including:

• urinary frequency, or the need to urinate often
• urinary urgency, or the need to urinate immediately
• dysuria, or painful urination
• hematuria, or blood in the urine

What are the complications of pyelonephritis?

Proper treatment of pyelonephritis may prevent serious problems. If untreated, it can lead to a bacterial infection in the bloodstream called sepsis. This can then spread to other parts of the body and cause serious conditions requiring emergency treatment.

Untreated pyelonephritis can also result in acute respiratory distress as fluid accumulates in the lungs.

Pyelonephritis during pregnancy is a leading cause of preterm labor, which puts the baby at high risk for serious complications and even death.

How is pyelonephritis diagnosed?

A urine test can help your doctor determine whether your symptoms are the result of a kidney infection. The presence of white blood cells and bacteria in urine, which can be viewed under a microscope, are both signs of infection. Your doctor can make a definitive diagnosis by taking bacterial cultures of your urine.

How should pyelonephritis be treated?

As a general rule, if you develop pyelonephritis during pregnancy, you’ll be hospitalized for treatment. You’ll be given intravenous antibiotics, probably cephalosporin drugs such as cefazolin (Ancef) or ceftriaxone (Rocephin).

If your symptoms don’t improve, it may be that the bacteria causing the infection are resistant to the antibiotic you’re taking. If your doctor suspects that the antibiotic isn’t able to kill the bacteria, they may add a very strong antibiotic called gentamicin (Garamycin) to your treatment.

Blockage within the urinary tract is the other main cause of treatment failure. It’s typically caused by a kidney stone or physical compression of the ureter by the growing uterus during pregnancy. Urinary tract obstruction is best diagnosed through an X-ray or an ultrasound of your kidneys.

Once your condition begins to improve, you may be allowed to leave the hospital. You’ll be given oral antibiotics for 7 to 10 days. Your doctor will choose your medication based on its effectiveness, toxicity, and cost. Drugs such as trimethoprim-sulfamethoxazole (Septra, Bactrim) or nitrofurantoin (Macrobid) are often prescribed.

Recurrent infections later in pregnancy aren’t uncommon. The most cost-effective way to lower your risk of recurrence is to take a daily dose of an antibiotic, such as sulfisoxazole (Gantrisin) or nitrofurantoin monohydrate macrocrystals (Macrobid), as a preventive measure. Remember that drug dosages may vary. Your doctor will prescribe what’s right for you.

If you’re taking preventive medication, you should also have your urine screened for bacteria each time you see your doctor. As well, be sure to tell your doctor if any symptoms return. If the symptoms return or if a urine test shows the presence of bacteria or white blood cells, your doctor may recommend another urine culture to determine if treatment is necessary.

Pyelonephritis and pregnancy: causes and treatment

Consultation with a specialist:

Types of pyelonephritis during pregnancy

Gestational pyelonephritis is classified according to different criteria:

• By pathogenesis: primary and secondary. Pyelonephritis is considered primary if the inflammatory process initially develops in a healthy kidney. Secondary pyelonephritis occurs against the background of anomalies in the development of the kidney and urinary tract, urodynamic disorders. nine0003

• Downstream: acute and chronic. Acute inflammation has a pronounced symptomatology, and is more often diagnosed in primiparas. Chronic is formed gradually, and is observed with repeated gestations.

• By period: exacerbation, partial remission and remission. For exacerbation, active symptoms are characteristic, for partial remission - a gradual fading of symptoms, for remission - the absence of clinical and laboratory signs of pyelonephritis. nine0003

• According to the preservation of kidney function: without impaired renal function, with impaired renal function and chronic renal failure.

• By the number of affected kidneys: unilateral (more often the right kidney is affected) and bilateral.

Depending on the nature of pathological changes, acute pyelonephritis has several stages of development: nine0003

• serous inflammation;

• purulent inflammation;

• apostematous pyelonephritis - a purulent-inflammatory process with the formation of multiple small pustules in the medulla of the organ;

• kidney carbuncle - purulent-necrotic process;

• nine0006 kidney abscess - the formation of a purulent focus, delimited by a pseudocapsule, in the cortical and medulla of the kidney.

The acute form has two outcomes - complete recovery or chronic inflammation. The outcome of chronic pyelonephritis is structural and functional changes in the renal tissue of varying degrees.

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Causes of pyelonephritis during pregnancy

During the gestation period, pyelonephritis is found even in healthy women with normal function and structure of the kidneys. The reason for this is the presence of any purulent-inflammatory process in the body. Conditionally pathogenic microorganisms enter the kidney with blood or urine from the underlying organs, initiate inflammatory changes in the kidney tissue.

The most common causative agent of pyelonephritis in pregnant and non-pregnant women is a bacterium of the Enterobacteriaceae family (E. coli). Saprophytic Staphylococcus aureus, Klebsiella, Candida, Chlamydia, Streptococcus, Proteus, Mycoplasma and viruses are sown less frequently. nine0003

Risk factors for the development of gestational pyelonephritis:

• Inflammatory diseases of the female genital organs. Infection of the kidney occurs with vulvitis (external inflammation of the genital organs), colpitis (inflammation in the vagina), bacterial vaginosis. Pathogens from the foci of infection by the hematogenous route enter the kidney tissue.

• Asymptomatic bacteriuria. In the urine of patients, a monoinfection is sown, while there are no clinical symptoms. Since urine is a favorable environment for the reproduction of opportunistic microflora, under conditions of stagnation and reverse reflux of urine, saprophytic microorganisms are activated, and pyelonephritis develops. The presence of a history of urological pathologies contributes to the more rapid development of latent chronic bacteriuria. nine0003

• urodynamic changes. In pregnant women, against the background of an increase in the level of progesterone, the pelvicalyceal system expands, hypotension of the bladder develops (impaired urine outflow). At the late stage of pregnancy, the situation is aggravated by the relaxation of the urethral sphincter, accelerated glomerular filtration, squeezing of the urinary organs by the growing uterus.

The likelihood of inflammation of the kidney tissue increases in the presence of urolithiasis, congenital malformations of the urinary system, kidney stones, diabetes mellitus. nine0003

Symptoms of pyelonephritis during pregnancy

Clinical manifestations of pyelonephritis in different gestational periods has typical features. In the first trimester, a constant symptom is a sharp, intense pain in the lumbar region. The pain spreads to the groin, genitals, lower abdomen.

Help! Usually, in primigravida, the first signs of pyelonephritis occur at 4-6 weeks, with repeated gestation - at 6-8 weeks. nine0094