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Urinary Infection

What is meant by the term Pyelonephritis ? The term Pyelonephritis refers to an infection in the kidney. This infection is due to infectious organisms, usually bacteria, fungi and occasionally viruses. These organisms can be grown from the urine.

There are two forms of pyelonephritis: Acute Pyelonephritis refers to an acute infection in kidneys which have no scars or any underlying abnormality which predisposes to urine infection. Acute Pyelonephritis does not give rise to scarred kidneys.

Chronic Pyelonephritis refers to an infection in kidneys which are coarsely scarred. The cause for such scarring is due to a combined effect of infection and the retrograde flow of urine up the kidney from the urinary bladder past damaged valves at the junction of the bladder and the ureter. This condition of retrograde flow of urine into the kidney from the bladder is known as vesico-ureteric reflux. Vesico, derived from the word Vesicle, refers to the bladder and reflux, the retrograde flow.

What is vesico-ureteric reflux?

Urine normally flows from the kidneys along the ureters and into the bladder. When the bladder contracts during the act of passing urine, valves which are present at the junction of the bladder and ureters also contract to prevent the urine from flowing backwards up to the ureters. At the same time the valve at the opening of the bladder called the urethral valve relaxes and urine passes out from the bladder to the urethra and the bladder empties itself. In some people, usually children, there is a congenital defect in the valves at the junction of the bladder and ureters so that during the act of passing urine, urine flows backwards into the kidneys. This condition predisposes to urine infection and it is a combined effect of this vesico-ureteric reflux and the infected urine which causes scarring of the kidneys. If the scars progress with time, the patient will develop kidney failure.

 

This reflux of urine will not show up on an intravenous pyelogram ( IVP X-ray ) but the presence of a particular pattern of scarring is a clue to the diagnosis. In order to demonstrate the presence of vesico- ureteric reflux, a cystogram or X-ray of the bladder is performed. This involves taking X-ray pictures during the act of passing urine to see if any urine goes backwards into the kidneys.

 

What is meant by Cystitis?

Cystitis refers to an infection of the urinary bladder. One of the clues to cystitis is the site of the pain or discomfort at the area just above the pubic bone where the bladder is situated. This is usually associated with passing of urine many times a day. The passage of urine may cause pain at the urethra and there may be blood in the urine too.

 

How does urine infection occur?

There are two routes of urine infection. Bacteria can enter the bloodstream and from there go to the kidneys to cause an infection in the kidney. The other more common route is by what is known as ascending infection. Here the bacteria comes from outside and enters the urethra and gets into the bladder. From the bladder the bacteria ascend the ureters and get into the kidneys to cause infection. If the infection localizes in the bladder then the patient has only a cystitis and if in the kidneys she has pyelonephritis.

 
 

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