Pyelitis is also known as pyelonephritis, is derived from the Greek word “pyelum“, which means renal pelvis, “nephros” means kidney, and “itis” means inflammation.
Pyelitis is an ascending urinary tract infection that has reached the kidney. It usually occurs due to bacterial infection of the bladder.
Pyelitis or pyelonephritis is more common in females than in males. Acute pyelonephritis develops in 20-30% of pregnant females. Females in the age group of 15-35 are most commonly affected.
Acute pyelonephritis is a potentially life-threatening infection often leading to renal scarring.
Bacteria are the main infecting organism, but even viruses can cause the infection.
Pyelitis Pathophysiology
Bacteria reach the kidney from the lower urinary tract in all age groups or via the bloodstream.
A pathogen contaminates the periurethral. Bacteria colonize in the urethra and then migrate to the bladder.
The bacteria invade the bladder using adhesion leading to an inflammatory response in the bladder, and also, there is fibrinogen accumulation.
Bacterial toxins and proteases damage the epithelial cells. Then the bacteria ascend into the kidney and colonize there, leading to tissue damage in the kidney.
Pyelitis Types
Acute pyelonephritis:
It is the sudden development of kidney inflammation. It can be severe in the elderly and immunocompromised like those who have cancer, AIDS, etc.
The kidney is swollen and shows yellow raised abscesses.
On detailed microscopic examination, it is observed that tubules are destructed, but renal blood vessels show resistance to infection hence is saved.
Chronic pyelonephritis:
Chronic kidney infection results in repeated attacks of inflammation and scarring.
This can be of two types:
Chronic Obstructive Pyelonephritis: There is an obstruction to the outflow of urine at various levels making the kidney prone to infection.
Reflux Pyelonephritis: in this condition, there is reflux of urine from the bladder into one or both of the ureters during urination and is one of the major causes of chronic pyelonephritis.
Xanthogranulomatous pyelonephritis:
It is a form of chronic pyelonephritis in which there is granulomatous abscess formation with severe kidney destruction.
Pyelitis Causes
There are some primary causes of Pylitis –
Escherichia coli is responsible for almost 80% of pyelonephritis.
Staphylococcus
Proteus, klebsiella, enterococcus.
Kidney stones provide a place for bacteria to grow and evade the body’s defense mechanism.
Occasional or persistent backflow of urine leading to urinary tract infection.
Vesicoureteral reflux is also one of the causes where urine flows back from the bladder into the ureters or kidney pelvis.
Kidney stones
Obstructive uropathy
Bacteria from the bloodstream.
It can also be a hospital-acquired infection.
Pyelitis Symptoms
During acute episodes
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Acute onset of pain or is said to be costovertebral angle pain is most common on the affected side of the kidney.
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Fever with chills
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Lumbar tenderness
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Dysuria (pain during urination)
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Frequency in urination
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Urine examination shows excess in bacteria with pus cells.
Chronic
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Flank pain (pain in the sides of the abdomen)
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Abdomen pain with lumbar tenderness
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Blood in the urine (hematuria)
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Pus in urine
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Hypertension
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Frequency of urination
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Fever
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Weight loss
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Tiredness
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Decreased appetite with nausea and vomiting.
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Signs of infection.
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Urine examination reveals bacteria.
Xanthogranulomatous
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Urosepsis
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Anemia
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Painful renal mass
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Kidney stones
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Loss of function of the affected kidney
In Children
In children who are two years or younger usually present with
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Failure to thrive
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Feeding difficulty
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Fever
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Vomiting
In Elderly
Apart from the typical manifestation
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Fever
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Mental status change
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Generalized deterioration
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Decompensation in another organ system.
Pyelitis Complications
Some of the complications, which has been seen are as follows –
Recurrence of pyelonephritis
Sepsis
Papillary necrosis
Perinephric abscess
Acute renal failure
Chronic renal failure
Septic shock syndrome/acute respiratory distress syndrome.
Bacteremia
Respiratory insufficiency
Renal dysfunction
Anemia
Pyelitis Risk Factors
Elderly aged individuals
People with diabetes are at risk.
Pregnant females are prone to infection.
Those with a weak immune system, e.g., AIDS, Cancer.
H/O cystitis, renal papillary necrosis, kidney stones, vesicoureteric reflux, or obstructive uropathy.
Damage to the nerves of the bladder causes a lack of sensation in the bladder and lower abdomen.
The patient would not experience any symptoms or pain, and thus he would be unaware that the infection has progressed to the kidney.
Pyelitis Diagnosis
When the physician examines the patient, they find tenderness in the lumbar region.
Urine examination reveals: increase in WBC, RBC, an increase in nitrites due to gram-negative bacteria’s and a rise in leukocyte esterase, which is due to pyuria.
Urine culture reveals the bacteria present in the urine.
Blood culture -shows the presence of infection/bacteria,
Intravenous pyelogram or CT scan of abdomen reveals enlarged kidneys with the poor flow of dye through kidneys.
Pyelitis Management
Tips for prevention
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Ensure to drink 6-8 glasses of water per day to maintain bladder hygiene.
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Personal hygiene has to be maintained. One must clean the genital area from front to back.
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Women should avoid sitting for a long time in wet clothes.
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Do not postpone the urge to urinate.
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Always empty the bladder while urinating.
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Urinating immediately after sexual intercourse may help in eliminating the bacteria.
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Crane berry juice prevents a certain type of bacteria from attaching to the bladder wall.
Conventional Line Of Treatment
The treatment is aimed at controlling the infection. Acute symptoms usually resolve within 48-72 hrs after the treatment.
In elderly patients, there is always a risk of permanent kidney damage and high mortality; hence immediate treatment is essential.
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Intravenous antibiotics are given to control the infection.
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Vigorous oral or IV fluids are given
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Antipyretic for fever
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Analgesics/ anti-inflammatory for pain
Emergency surgery is indicated if
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Fever or blood culture results persistently longer for more than 48 hrs.
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A patient who is deteriorating
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The patient appears toxic for longer than 72 hrs.
Pyelitis Homeopathic Medicines
Homeopathy aims at decreasing the frequency of infection and helping the patient get better by stimulating the patient to own the immune system.
This is achieved by a complete history and general health consideration, and even family history and history of illness are all taken into considerations.
Severe structural abnormalities take time to be cured. When at the physiological level, the disease is excellently cured by homeopathy without any side effects.
1.COPAIVA OFFICINALIS: For Pyelitis with retention of urine with pain in bladder, anus, and rectum
Symptoms:
The patient experiences burning pressure, and they have painful urination, which is dropped by drop.
Swelling is noticed at the opening of the urethra. The urethra seems to be wide open.
Urine is retained with pain in the bladder, anus, and rectum.
The patient has a constant desire to urinate.
Urine is greenish, turbid in color, and has a peculiar pungent odor that smells like violets.
Dosage and potency:
30C, 200C potency with frequent repetition till improvement can be administered.
2.CUPRUM ARS: For Pyelitis with loss of kidney function
Symptoms:
The kidney functions are affected, leading to uremia.
Urine has a garlicky odor.
Urine has high specific gravity with increased acetones and diacetic acid.
Dosage and potency:
Low potency will only work as there is pathological dysfunction. Higher potencies will lead to aggravation.
3.MERC COR: For Pyelitis with the destruction of secreting portions of the kidney
Symptoms:
In the affections of the kidney, we can observe the following symptoms.
There is intense burning in the urethra. Urine is hot, scanty, burning, or suppressed with bloody or greenish discharge.
Urine is also albuminous with severe tenesmus of the bladder, making the patient inclined to urinate constantly.
There is stabbing pain extending from the urethra to the bladder. And then there is profuse perspiration after urination.
Dosage and potency:
30C potency with frequent repetition as per the state of the patient.
4.TEREBINTHINIAE OLEUM: For Pyelitis following any acute disease
Symptoms:
It is an excellent remedy for inflammation of kidneys with dark, passive, fetid bleeding.
The bladder base is blocked or irritated, leading to severe pain and a strong desire to urinate. This condition is accompanied by bloody urine.
The urine is scanty, suppressed with an odor of violets.
Even the urethra is inflamed with painful erections.
With inflammation of the kidney, there is a constant inclination to evacuate the bowels.
Dosage and potency:
30C potency 3-4 pills thrice or four times a day till improvement.
5.TRITICUM REPENS: For Pyelitis due to Chronic cystitis
Symptoms:
it is an excellent remedy for excessive irritability of the bladder with pain during urination.
The patient has frequent, difficult, and painful urination.
The patient has chronic cystitis with irritability.
The urine dribbles on its own with a constant desire to urinate.
The urine is dense and irritates the mucous surface.
Dosage and potency
Mother tincture drops to be added to a glass of water and reduced to half a glass and taken in 4 doses in a day.
6.UVA URSI: For Pyelitis with bloody urine
Symptoms:
it is indicated in chronic bladder irritation with pain and cramps
The patient has frequent urging with severe spasms of the bladder with burning and tearing pain.
Urine contains blood, pus, mucus with clots in large quantity.
Sometimes the patient passes urine unknowingly, which is green in color.
The patient has severe pain during urination and burning after the passage of slimy urine.
In severe cases, the patient experiences breathlessness, nausea, vomiting, and small and irregular pulse with blueness in the eyes and face(cyanosis).
Dosage and potency:
In Pyelitis, trituration of leaves, if given the desired results, is achieved faster.
Mother tincture 5-30 drops in a glass of water twice or thrice a day.
7.CHIMAPHILLA: For Pyelitis with scanty urine loaded with ropy and mucopurulent sediment
Symptoms:
It is indicated in acute inflammation of the urinary tract.
It is indicated in plethoric young women who complain of pain during urination and females who have large breasts.
The patient has to urge to urinate.
Urine is turbid, offensive, and contains ropy mucopurulent sediments and even bloody mucus.
There is severe burning and scalding during urination and straining after urination.
They have to strain before the flow comes.
The patient has a fluttering sensation in the kidney region with scanty urine.
The patient cannot urinate without standing feet wide apart, and the body has to be inclined forward.
The patient complains of severe cramps in the bladder, which worsens sitting and better by walking.
The complaints worsen in damp weather and from sitting on the cold stone pavement.
Dosage and potency:
Mother tincture 5-10 drops in half glass of water twice or thrice a day as per the patient’s state can be administered.
8.JUNIPERUS COMMUNIS: For Chronic Pyelitis with suppression of urine and dropsy
Symptoms:
It is indicated in older adults with poor digestion and scanty urine.
The patient feels weight in the kidney region.
The urine is scanty, bloody, painful, and violet in odor.
There is an excess blood flow to the kidney region.
Even cough is accompanied by scanty and loaded urine.
Dosage and potency:
Mother tincture up to 10 drops in half glass of water twice or thrice a day till improvement.
9.KALIBICHROMICUM: For pyelonephritis with scanty albuminous urine
Symptoms:
It is indicated in the subacute stage rather than the acute violent stage.
It is indicated in people who are fat, fair, and fleshy with a light complexion. Their face has a blotchy red appearance.
There is congestion in the kidney indicated in nephritis with scanty albuminous and casts in urine.
It is indicated in Pyelitis, where urine is mixed with epithelial cells, mucus, pus, or blood cells.
The patient experiences severe burning in the urethra with ropy mucus in urine.
They have a feeling that after urination, a drop is remaining, which One cannot expel.
The patient passes bloody urine with severe back pain.
Dosage and potency:
30C, 200C potency will act best in these conditions, and repetition would depend upon the patient’s state.
10.OLEUM SANTALI: For Pyelitis with acute pain in the kidney region
Symptoms:
It is indicated in acute pain in the kidney region.
While passing urine, the patient has frequent burning and smarting swelling.
They have redness in the opening of the urethra.
Urine flow is slow, and the stream is small.
They have a sensation of the ball pressing against the urethra, which worsens on standing.
In chronic cystitis (infection of the bladder), there is always profuse, thick discharge.
Dosage and potency:
Mother tincture, 30C potency twice or thrice per day till improvement.
11.ARSENIC: For Pyelitis with paralyzed bladder
Symptoms:
The medicine acts excellently on nerves.
The patient is very restless and becomes weak from trivial causes.
In Pyelitis, urine is scanty, burning, and is passed involuntarily.
The patient has tremendous weakness in the abdomen after urination.
Older adults suffer from atony of the bladder where the muscle has lost its strength.
There is the retention of urine due to atony of the bladder.
The urine passed is black as if mixed with dung with tremendous pain.
Dosage and potency:
200C, 1M potency can be administered, and repetition should be done depending upon the patient’s state.
12.BENZOIC ACID: For Pyelitis with renal insufficiency
Symptoms:
Urine passed by the patient has a repulsive odor, changeable color, brown in appearance, and is acidic.
The patient experiences tremendous pain, which changes locality suddenly.
In aged men, urine is offensive. There is recurrent cystitis in patients, making them prone to Pyelitis.
Dosage and potency:
30C potency with frequent repetition can be administered to the patient.
13.CANTHARIS: For Pyelitis with bloody urine
Symptoms:
This is an excellent remedy for nephritis with bloody urine.
The patient has intolerable urging with tenesmus.
The patient experiences violent paroxysms of cutting pain and burning in the kidney region with painful urging to urinate.
The patient passes urine drop by drop and is bloody.
They have intolerable tenesmus and cutting pain before, during, and after urination.
The patient feels that urine scalds him, and there is a constant desire to urinate.
Urine appears jelly-like, shreddy, and membranous scales are looking like bran in water.
Dosage and potency:
30C potency 3-4 pills thrice a day till improvement.
14.BELLADONNA: For Pyelitis with acute urinary tract infection
Symptoms:
Belladonna is an excellent medicine for a disease that is violent and comes suddenly.
Urine is retained and, when passed appears turbid, and dark. It is scanty in quantity with a constant urge to pass urine.
Urine is loaded with phosphates.
The vesical region( internal region of the urinary bladder, which appears as a trigone) is very sensitive.
There is a continuous dropping of urine which is not in control of the patient. This condition is called incontinence.
Incontinence is noticed more on lying down when standing, at night while sleeping, and during the day.
There is the retention of urine with paralysis of the bladder especially seen after delivery in pregnant females.
The patient experiences profuse and frequent urination, which is fiery red due to blood in the urine.
The patient has a sensation as if worms were turning in the bladder without a desire to urinate.
Blood is passed in urine but without any underlying disease.
Dosage and potency:
30C, 200C, 1M potency can be administered. In acute conditions, it has to be repeated frequently till improvement is noticed.
15.HYDRANGEA ARBORESCENS: For Pyelitis due to renal calculus
Symptoms:
Hydrangea is an excellent remedy for renal colic with bloody urine and pain in the lumbar region.
The patient has severe burning in the urethra and frequent desire. They find it difficult to start urinating. There is a heavy deposit of mucus in the urine.
The patient experiences sharp pain in the loin region, especially the left side.
The patient is prone to gravel(stone) deposits and spasmodic stricture.
There is a profuse deposit of amorphous salts in the urine.
With all these complaints, the patient is extremely thirsty.
Dosage and potency:
Mother tincture 10-15 drops in half glass of water twice or thrice a day till improvement.