ACUTE & CHRONIC PYELONEPHRITIS

ACUTE & CHRONIC PYELONEPHRITIS

• Pyelonephritis refers to infection and inflammation of the renal pelvis and parenchyma.

• It is categorized as Acute or Chronic based on the duration and pattern.

• It is termed non-specific because it is not caused by specific organisms like tuberculosis or schistosomiasis.

AETIOPATHOGENESIS

MODERN VIEW

• Most common route of infection is ascending infection from the lower urinary tract.

• Organisms: Escherichia coli (most common), Proteus, Klebsiella, Enterococcus.

• Predisposing factors:

  • Vesicoureteral reflux

  • Urinary tract obstruction (stones, stricture, BPH)

  • Pregnancy

  • Diabetes mellitus

  • Catheterization or instrumentation

• In acute pyelonephritis, bacteria reach the kidney via ascending route or hematogenous spread, causing intense inflammatory response.

• In chronic pyelonephritis, repeated infection or persistent infection causes scarring, deformation of calyces, and gradual loss of kidney function.

AYURVEDIC CORRELATION

• Pyelonephritis can be compared with:

  • Mutrakrichchhra – Difficulty and pain in urination

  • Mutraghata – Obstructed or suppressed urination

  • Ashmari – Stone formation causing obstruction and infection

स्निग्धोष्णाभिष्यन्दिभोजनात् स्वप्नसुखाति सेवनात् ।
मन्दाग्नेः कृच्छ्रतो मूत्रं मुत्रकृच्छ्रमुदाहृतम् ॥
— Sushruta Samhita, Uttara Tantra 58/10

• The above verse explains how improper dietary habits and suppression of natural urges contribute to Mutrakrichchhra, which may evolve into infections like pyelonephritis.

CLASSIFICATION

MODERN CLASSIFICATION

• Acute Pyelonephritis

  • Simple (uncomplicated)

  • Complicated (with obstruction, abscess, or sepsis)

• Chronic Pyelonephritis

  • With obstructive uropathy

  • With vesicoureteric reflux

  • Reflux nephropathy

AYURVEDIC CLASSIFICATION (BASED ON DOSHA INVOLVEMENT)

• Vataja Mutrakrichchhra – Painful, scanty urination

• Pittaja Mutrakrichchhra – Burning micturition with yellowish urine

• Kaphaja Mutrakrichchhra – Sticky, cloudy urine with heaviness

• Sannipataja – Mixed features

• Ashmarijanya Mutrakrichchhra – Caused due to urinary stones

CLINICAL FEATURES

ACUTE PYELONEPHRITIS

• High-grade fever with chills

• Flank pain (costovertebral angle tenderness)

• Nausea and vomiting

• Dysuria, frequency, urgency

• Hematuria or pyuria

CHRONIC PYELONEPHRITIS

• History of recurrent UTI

• Dull flank pain

• Polyuria and nocturia (due to tubular damage)

• Hypertension in later stages

• Progressive renal failure (in advanced cases)

INVESTIGATIONS

• Urine analysis: Pyuria, bacteriuria, hematuria

• Urine culture: Growth of causative organisms

• Blood tests: Leukocytosis, raised ESR, CRP

• Ultrasound: Swollen kidneys (acute), contracted kidneys with scarring (chronic)

• DMSA Scan: Renal scarring

• IVU (Intravenous Urogram): Blunted calyces and clubbing in chronic cases

MANAGEMENT

MODERN MANAGEMENT

Acute Pyelonephritis:

• Hospitalization if severe or complicated

• Empirical broad-spectrum antibiotics: e.g., Ceftriaxone, Piperacillin-Tazobactam

• Analgesics and antipyretics

• Adequate hydration

• Drainage of abscess if present

Chronic Pyelonephritis:

• Treat underlying cause (e.g., VUR correction, stone removal)

• Long-term low-dose antibiotics to prevent recurrence

• Monitor renal function regularly

• Control of hypertension

• Renal replacement therapy in end-stage cases

AYURVEDIC MANAGEMENT

• Based on the type of Mutrakrichchhra or Mutraghata, Dosha predominance and Srotorodha

SHODHANA THERAPY

• Virechana – In Pittaja involvement
  “पित्तकृच्छ्रे विरेचने हितम्”
  – Chakradatta Mutrakrichchhra Chikitsa

• Basti karma – Useful in chronic conditions with Vata dominance

SHAMANA CHIKITSA

• Gokshuradi Guggulu

• Punarnavadi Kashaya

• Varunadi Kashaya

• Chandraprabha Vati

• Trinapanchamoola Kwatha – Diuretic and anti-inflammatory

स्वेदनं वमनं चैव विरेचं बस्तिकं तथा ।
विधिं चानुशयेणैव सन्धारितमपि क्रमे ॥
— Ashtanga Hridaya Chikitsa Sthana 32/2

• This verse implies that Snehana, Swedana, Vamana, Virechana, and Basti can be employed as per condition and Dosha involvement.

PATHYA-APATHYA

• Pathya:

  • Light, easily digestible food

  • Barley, green gram, old rice, boiled water

  • Coconut water, sugarcane juice, coriander water

• Apathya:

  • Spicy, oily, heavy food

  • Suppression of natural urges

  • Day sleeping and excessive exertion

PROGNOSIS

• Acute pyelonephritis responds well with appropriate antibiotics.

• Chronic pyelonephritis may lead to renal scarring and irreversible damage if untreated.

• Early detection and correction of underlying causes are key in preventing progression.