ROLLIN’ INTO PYELONEPHRITIS Enough to cause us to slam on the brakes!!

Urinary tract infections or UTIs. Most of us have been plagued with these obnoxious occurrences because we are using a urinary catheter on a frequent basis putting us at risk for urinary infections. But what happens when the usual, routine UTI leads to more? Precisely that happened to a friend…..leading me to discuss PYELONEPHRITIS.

Let me start at the beginning……a friend, who happens to be SCI, sent out a post to other SCI friends. It went like this…….

“I had spasms in my right side all night, like wake me up spasms.... I woke up feeling like I'd been hit by a truck and was wet. I could barely transfer to cath, but managed. Temp 100.4. Assumed it was because I'd been snug in my covers. J Exhausted getting ready but went and limited all exposure (unintelligent season for me as well, apparently, I haven't had my flu shot) Got home, temp of 100.7. Assuming bladder infection. Laid down, achy with strong pain in my neck and head (probably dysreflexia). Urine specimen to my doctor. No nitrites, but blood. Temp 102.4. I took Excedrin Migraine to help pain and fever. Teeth chattering and side still spasms. Temp 102.8.”

The next day….. “I actually feel good right now, I think that pain was AD, but my pressure is super low now, so we fixed that. No stomach issues. This is all weird. I'm hoping it'll be quick for me. I'm still thinking UTI.”

Day 3….. “I'm being admitted to the hospital now for a severe kidney infection. This is a new one for me! I guess I should update! Got to see my CT this morning and my right kidney is about 3 times the size of my left! And it's showing banding? Anyone know what that means? Anyway, my doctor here said that if the CT looked this terrible after a Rocephine shot and Levaquin, he can't imagine how bad it would have been otherwise. Eeeeek! So, I'm here until at least Mon when the culture comes back. Anyone had a kidney infection without a bladder infection first? Seems weird!”

So how does a routine UTI turn nasty? What are the signs and symptoms to be on the look for? After this incident, I felt some education to the SCI population was in order. I know, as a nurse, who is also SCI, I needed a refresher too.

What is Pyelonephritis? Great definition from WebMD……Most urinary tract infections (UTIs) involves only the bladder and urethra (the lower urinary system). Pyelonephritis results when a UTI progresses to involve the upper urinary system (the kidneys and ureters). The kidneys filter the blood to produce urine. Two tubes called the ureters carry urine from the kidneys down to the bladder. Urine travels from the bladder out of the body through the urethra. Most cases of pyelonephritis are complications of common bladder infections. Bacteria enter the body from the skin around the urethra. They then travel up the urethra to the bladder. Sometimes, bacteria escape the bladder and urethra, traveling up the ureters to one or both kidneys.

This explains the pain in her right side and the pain contributed to spasms, a common occurrence to us with SCI. Spasms are the “special” method to notify us paralyzed individuals that something is amiss. Spasms sometime take some detective work to determine the cause but an increase in spasms almost always means something is not right with our bodies. Sometimes it’s our first symptom but fever accompanied spasms this time alerting her to something is definitely wrong.

Symptoms of Pyelonephritis:

Symptoms of pyelonephritis are similar to UTI but when the bacteria travels to the kidneys further symptoms become apparent:

• Nausea and/or vomiting

• Fever

• Malaise

• Back and/or flank pain

• Confusion (not an evident symptom in this situation)

• Blood in the urine

• Cloudy or foul smelling urine

One of the most concerning symptoms for people with SCI is Autonomic Dysreflexia (AD) that was occurring. AD associated with the above symptoms is a cause to find your nearest ED. Which did occur and she was hospitalized over the weekend with IV antibiotics until the urine culture was completed. Urine cultures can take up to 72 hours.

Treatment of pyelonephritis:

Sometimes hospitalization is not required but in this case it was. Oral antibiotics may be ordered but to ensure antibiotics are reaching the kidneys, IV antibiotics may be needed. Also, rest and IV fluids aid in recuperation. Because of nausea and/or vomiting, oral medication may not always perform as required. So rest, relax, and bring on the IV meds. Antibiotics are usually a 7 – 10 day course although hospitalization may not be needed for that long. Routinely a few days of IV meds may be all that is necessary and then home with oral antibiotics but that is entirely up to your health care provider.

Prevention:

Prevention of Pyelonephritis is the same as the “usual” attempt to prevent UTIs. You can do everything right and it still happens. Forcing fluids, particularly water, to flush the system, avoiding sugary fluids and sodas, and utilizing an arsenal of cranberries, D-Mannose, and Vitamin C would be helpful also. But sometimes, no matter what you do, UTIs and a progression to pyelonephritis still may occur, as in my friend’s story. Like I said earlier, rest, relax, and bring on the antibiotics as needed. Kick that bad boy to the curb.

Let’s all remain healthy and UTI-free.

It’s all good.

Patty Kunze, RNC, BSN

The Rollin RN

References:

Kidney infections: Symptoms and treatments. Obtained December 9, 2015 from http://www.webmd.com/a-to-z-guides/kidney-infections-symptoms-and-treatments.