The best treatments for pyelonephritis in adults
As a rule, patients with pyelonephritis are in no hurry to see a doctor at the first symptoms, but in vain. While the inflammation has not spread to the entire kidney, pyelonephritis is successfully treated with antibiotics, but if the disease is advanced, surgery may be necessary.

Pyelonephritis is the most common infectious and inflammatory disease of the kidneys. With uncomplicated pyelonephritis, medical treatment is sufficient, however, in severe forms of the disease, including pyelonephritis in pregnant women, surgery may sometimes be required. Together with an expert, we will analyze the main methods of treating pyelonephritis and find out in which cases this or that method of therapy is prescribed.

1. Antibiotics for pyelonephritis in adults

The main treatment for pyelonephritis is antibiotic therapy. It is antibiotics that allow you to get rid of the cause of pyelonephritis – a bacterial infection.

When choosing antibiotics, doctors usually give preference to those drugs to which the causative agent is sensitive. The most commonly prescribed broad-spectrum antibiotics are:

  • fluoroquinolones (levofloxacin, ciprofloxacin, etc.);
  • cephalosporins III-IV generations (ceftriaxone, cefotaxime, etc.);
  • carbapenems (imipenem and meropenem, thienam)1.

2. Immunostimulants for pyelonephritis in adults

Recently, doctors are increasingly prescribing immunostimulants for the treatment of pyelonephritis. At the same time, it is important to understand that the immune system is a rather complex mechanism, and it is not worth interfering with its work once again. 

Therapy with immunomodulators is not the standard of care. And although the modern pharmaceutical market is replete with drugs of this group, most of them do not have any evidence base. Moreover, the vast majority of such “fashionable” medicines generally belong to homeopathy.

Immunostimulants may be useful in the treatment of immunosuppressed patients when self-immunity is not sufficient, such as after chemotherapy or HIV infection. However, these are special cases, so the decision to prescribe immunostimulants should only be made by a specialist.

3. Diet for pyelonephritis

With pyelonephritis, it is recommended to adhere to a therapeutic diet table number 7. Its essence: less proteins and a minimum of salt.

A strict diet is required in the first days of the disease. In the future, you just need to adhere to the principles of a healthy diet, excluding certain foods.

One canLean meats, poultry, fish. Vegetable soups. Low fat dairy products. Buckwheat, oatmeal. Carrots, zucchini, pumpkin, potatoes. Watermelons, melons. Fruits (not sour). Crackers from fresh bread. Mineral alkaline water. Rosehip decoction. Dried fruit compote, berry fruit drinks. Weak tea. diluted juices.  
Must notSmoked and salted fish. Conservation. Fatty varieties of meat, fish and dairy products. Spicy and sour vegetables: radish, sorrel, onion, spinach, capsicum. Strong tea, coffee, sweets and chocolate. Alcohol. Rich broths. Mushrooms. Legumes. Cabbage. Sausages.
RestrictCheeses. Eggs (1 pc. per day). Sour cream, cream. Salt (up to 3 g per day).

If you ignore the diet, the risk of recurrence of the disease increases. Especially dangerous is the recurrence of urolithiasis, which is often accompanied by obstructive pyelonephritis. And obstructive pyelonephritis, in turn, can be complicated by the development of renal failure or even sepsis.

4. Spa treatment and balneotherapy

Patients are referred to sanatorium-and-spa treatment in order to consolidate the effect of the main therapy. You can come to climatotherapeutic and balneological resorts only after the acute stage of the disease has passed.

Spa treatment should include balneotherapy (treatment with mineral waters and healing mud), diet therapy, climatotherapy, exercise therapy. In this case, it is better to choose cool resorts with a mild climate. It is also not recommended to swim in the sea for a long time, so as not to cause hypothermia and exacerbate the process. You can only be in the open sun in the morning.

Mineral waters for pyelonephritis are prescribed with a low content of minerals. This will help to establish blood flow inside the organs, normalize urination. Also, from balneological procedures, the doctor can advise mineral and iodine-bromine baths and mud applications.

The mode of physiotherapy exercises is necessarily chosen sparing. Strength exercises are contraindicated, but breathing exercises, on the contrary, are recommended.

5. Phytotherapy for pyelonephritis

By itself, the appointment of herbal remedies, as well as immunostimulants, will not cure pyelonephritis, especially in an acute form. Phytotherapy can only be an auxiliary component of treatment, since usually herbal medicines do not have serious side effects and can be prescribed for a long period – for example, to prevent the recurrence of an infection. Again, only drugs with proven efficacy should be chosen.

6. Surgery for pyelonephritis in adults

Unfortunately, in the treatment of pyelonephritis, there are situations when drug therapy is not enough. First of all, these are inflammatory processes in the kidneys with impaired outflow of urine from them – for example, due to a stone or tumor of the ureter.

In such cases, it is urgent to surgically restore the normal outflow of urine from the kidney, otherwise bacterial toxins can enter the bloodstream and cause septic shock. And this is a direct threat to life.

Also, surgical intervention is necessary in cases of development of purulent pyelonephritis – when, against the background of aggressive microbial flora or a decrease in local immunity (for example, due to impaired blood supply to the kidney or decompensated diabetes mellitus), purulent fusion of areas of the renal tissue develops. In this case, they resort either to the installation of drainage into the purulent cavity, or to open operations and even the removal of the kidney in case of a massive purulent lesion.

Additional therapies

Depending on the situation and clinical manifestations of pyelonephritis, the doctor may prescribe:

  • antipyretic drugs at high temperature;
  • low molecular weight heparins to improve blood flow in small vessels and prevent the formation of blood clots;
  • drugs to protect the gastric mucosa and restore intestinal microflora.

If a severe form of pyelonephritis has brought a patient to intensive care, he will need support from the cardiovascular system, a blood filtration system from toxins, etc.

Also, we must not forget that the infection can enter the kidneys not only by the ascending (with urine) route, but also by the hematogenous (through the blood) route. The kidneys tirelessly filter our blood, so if there is a distant purulent focus in the body (for example, a sore throat or untreated caries), the infection can enter the kidneys with the bloodstream2. Therefore, therapy will be required that neutralizes the source of infection.

Prevention of pyelonephritis in adults at home

For the prevention of pyelonephritis, it is important to avoid hypothermia – especially in the lumbar region. Do not swim in cold waters, dress warmly in the cold season.

In addition, for the prevention of pyelonephritis it is important:

  • women regularly undergo examination by a gynecologist;
  • timely treat cystitis and diseases of the genitourinary system;
  • observe the rules of personal hygiene;
  • observe the drinking regime;
  • do not self-medicate.

Popular questions and answers

We asked you to answer popular questions regarding the treatment of pyelonephritis Candidate of Medical Sciences, urologist Sergey Belomyttsev.

What is the difference between the treatment of pyelonephritis in men and women?

– Due to anatomical differences (short and wide female urethra), acute uncomplicated pyelonephritis is predominantly a “female” disease. Its cause is an ascending urinary infection. According to statistics, pyelonephritis in women occurs 2-5 times more often than in men.

Pyelonephritis in a man is almost always accompanied by the presence of complicating factors: urolithiasis, poor urination against the background of prostate adenoma, etc. Therefore, the treatment of pyelonephritis in men is approached as a deliberately complicated form: with the search for a predisposing factor and the appointment of more “serious” antibiotic therapy regimens.

Why does pyelonephritis occur in adults?

– The main reason for the development of pyelonephritis is a bacterial infection in combination with a disturbed outflow of urine. It starts from the lower urinary tract, rises up the urethra, reaches the bladder, and from there it enters the kidneys through the ureters.

There are various factors that contribute to the development and maintenance of inflammation in the kidneys:

• various congenital anomalies, leading to a slowdown in the outflow of urine or a backflow of urine from the bladder into the kidney (vesicoureteral reflux);

• the presence of kidney stones (bacteria often arrange their colonies on them and it becomes very difficult to fight them);

• poor emptying of the bladder and a large amount of residual urine in the bladder3.

A significant factor in the development of acute pyelonephritis is the presence of drainage in the genitourinary system (stents, nephrostomy, cystostomy, catheters, etc.). Elimination of these factors is the key to success in the treatment of pyelonephritis3.

Is it possible to cure pyelonephritis in adults forever?

– Yes, you certainly may. In the case of the correct appointment of therapy, its full course (and not interrupting it as soon as it became easier, which patients often do), as well as the elimination of inflammatory factors, there is every chance of leaving pyelonephritis in terrible memories. Do not neglect the follow-up examination after treatment.

Unfortunately, it is not always possible to achieve the above, so chronic pyelonephritis and its recurrent forms are far from uncommon.

 What is useful for the kidneys in pyelonephritis?

– The most useful thing is to strictly follow the doctor’s prescriptions. It is necessary to consume a sufficient amount of liquid (preferably plain filtered water) – at least 2 liters per day, if the patient has no contraindications to this. It should be abandoned for the duration of treatment from spicy, salty and fried foods, and you should not eat large amounts of protein foods. And, of course, do not allow hypothermia of the kidneys. 

Sources of:

  1. Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genital organs. Federal clinical guidelines. https://www.mediasphera.ru/issues/terapevticheskij-arkhiv/2016/4/downloads/ru/540040-366020150417
  2. Moscow Urological Practice. D.Yu. Pushkar. M .: OOO “ID” ABV-Press “, 2019.-816s. https://niioz.ru/upload/iblock/752/75207b882f291340c0a49d3169250069.pdf
  3. Clinical guidelines of the European Association of Urology, 2020. https://radiology.by/wp/wp-content/uploads/2020/01/UZD-EAU-Urologiya-2017.pdf

Leave a Reply