Introduction 

Definition of kidney infections 

A kidney infection is commonly known as a type of urinary tract infection (UTI). It can start in the bladder or in the tube that carries urine from the body. The infection can travel to one or both kidneys. This type of infection is also called pyelonephritis.

Pyelonephritis is a bacterial infection associated with the kidney and renal pelvis. It is usually caused by the ascension of bacteria from the lower urinary tract, primarily E. coli.¹

There are different types of UTIs, and each type requires a different treatment procedure and management. Therefore, it is important to identify them correctly.

Importance of managing pain and discomfort

Managing pain and discomfort in UTIs is crucial as these symptoms can severely affect the patient’s quality of life.

The pain and systemic symptoms can lead to significant distress, affect day-to-day activities, and cause emotional and physical exhaustion.

• If not treated properly, serious complications can occur, such as chronic kidney disease, sepsis, renal abscesses, and, in severe cases, can be life-threatening. Immediate and effective management of symptoms and appropriate therapy are essential to prevent these adverse outcomes

By addressing both the infection and related symptoms, healthcare providers can help ensure better patient outcomes and prevent the progression of the disease from getting worse.

Symptoms of kidney infections

Common symptoms

Symptoms of kidney infections may include:

• Fever
• Chills
• Nausea and vomiting
• Back, side or groyne pain

Children may have other symptoms such as:

• Smelly urine
• Blood in their urine
• Being sick and/or not feeding well
• Wetting in the bed

 A child younger than 2 may only have a high temperature without any other noticeable symptoms.

Severity and variation

The severity and presentation of symptoms in kidney infections can vary widely.

• Mild to severe pain levels: Pain intensity can range from mild discomfort to severe, excruciating pain. The intensity of the pain often correlates with the extent of the infection and the individual’s overall health

Chronic vs. acute symptoms

• Acute Kidney Infections: These infections present suddenly with severe symptoms, needing immediate medical intervention
• Chronic Kidney Infections: These develop gradually, often leading to persistent but less intense symptoms. Chronic infections can cause long-term kidney problems if not treated properly²

Chronic kidney disease (CKD) and acute kidney injury (AKI) are closely related, with CKD increasing the risk of AKI, and AKI potentially leading to CKD if not managed appropriately.²

Medical management of pain

Pharmacological treatments

The treatment of kidney infections, or pyelonephritis, normally requires antibiotics to eliminate the causative bacteria. Common antibiotics involve cephalosporins (e.g., cefotaxime, ceftriaxone), fluoroquinolones (e.g., ciprofloxacin, levofloxacin) and beta-lactamase inhibitors (e.g., amoxicillin-clavulanate).³

Duration and dosage 

The duration of antibiotic treatment for pyelonephritis generally ranges between 7 to 14 days, depending on how serious the infection is and the patient’s response to treatment. Dosage is regulated based on the specific antibiotic and patient factors.

Pain relievers

• To help alleviate pain and reduce inflammation associated with kidney infections, Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often used. However, they must be used with caution in patients with kidney disease due to potential nephrotoxic effects. Short-term use at the lowest effective dose is normally recommended
• Acetaminophen, also known as paracetamol, is commonly recommended for pain relief too as it is safe for the kidneys when the appropriate dose is used. It can help with mild to moderate pain and reduce fever³

Prescription pain medications

When stronger medications are needed

In situations where over-the-counter relievers are insufficient, stronger prescription pain medications may be necessary. These involve opioids like oxycodone, tramadol, and hydromorphone. These medications are normally reserved for severe pain due to the risk of side effects and the potential for addiction.

Possible side effects and precautions

Side effects involve constipation, sedation, respiratory depression, and the potential for dependency. That’s why careful monitoring and dosage adjustments are crucial, particularly in patients with impaired kidney function, to avoid accumulation and toxicity.

Opioids like oxycodone and hydromorphone are preferred over others, such as morphine, which has more adverse effects in patients with kidney disease. Additionally, non-opioid analgesics such as gabapentinoids and serotonin-norepinephrine reuptake inhibitors (SNRIs) might be considered for neuropathic pain management, with the right adjustments based on kidney function.³

Non-pharmacological and complementary management

Home remedies and lifestyle changes

 Hydration

• Sufficient fluid intake is crucial for flushing out bacteria from the urinary tract. Cranberry juice has long been used for its potential to inhibit bacterial adhesion to urinary tract walls
• Various types of fluids can contribute to hydration, including water, herbal teas, and clear broths⁴

Heat therapy

• Using heat can provide relief from discomfort related to UTIs. Heating pads or warm baths can alleviate symptoms such as pain and inflammation⁴

Dietary adjustments

Foods to avoid

Certain foods may aggravate UTI symptoms and should be avoided. Incorporating a balanced diet rich in vitamins and minerals helps overall immune function.

Foods that may help reduce symptoms

While specific foods can negatively impact UTIs, consuming a diet high in antioxidants and nutrients can promote urinary tract health.

 Rest and activity modification

• Rest is important as it allows the body to focus on fighting off the infection and aids in the healing process
• Engaging in low-impact activities is encouraged as it promotes circulation and may alleviate discomfort without worsening symptoms⁵

Herbal remedies

• Cranberry: Cranberry products, including juice and tablets, are widely used to help prevent UTIs. Studies have shown that cranberry extracts can improve urine pH and prevent UTI symptoms such as pyuria, bacteriuria, and dysuria⁶
• Parsley: Parsley is traditionally used as a diuretic, which can help flush UTI-causing bacteria out of the urinary tract⁷

Acupuncture and massage

Role in pain relief

Acupuncture helps to maintain pain and overall improves well-being by stimulating specific points in the body. It can be effective in reducing chronic pain and inflammation related to kidney infections.⁸

Massage therapy can help relieve muscle tension and promote relaxation, which helps with pain levels and reduces stress. However, specific studies on massage therapy for kidney infections are limited and are normally recommended as a complementary therapy.⁹

Precautions and considerations

Both acupuncture and massage should be done by qualified practitioners to avoid any adverse effects. Patients with severe infections or other underlying conditions should consult their healthcare provider before starting these therapies.

Monitoring and follow-up

Recognising signs of complications

Worsening symptoms

Patients should be educated about the signs and symptoms associated with chronic kidney disease (CKD), such as shortness of breath, increasing fatigue, and changes in urinary habits. Recognising these symptoms early can help with timely intervention and management.

Signs of spreading infection

Patients with CKD have a higher risk of infections, especially UTIs and sepsis. It is of vital importance to educate patients about signs of infection spreading like high fever, severe abdominal pain, and altered mental status. A suspicious infection should prompt immediate medical attention.

Regular medical check-ups

Importance of follow-up appointments

Regular follow-up appointments are important to monitor kidney function and overall health. These appointments enable the early detection of any complications or changes in disease progression.¹⁰

Monitoring kidney function and overall health

During follow-up appointments, the healthcare provider will monitor different parameters, including serum creatinine level, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, blood pressure and electrolytes. These assessments help track disease progression and evaluate treatment effectiveness.¹¹

Prevention of future infections

Prophylactic antibiotics

When they are recommended

Prophylactic antibiotics may be recommended for individuals at high risk of recurrent urinary tract infections (UTIs), such as those with a history of frequent infections or structural abnormalities of the urinary tract.¹² Additionally, individuals undergoing invasive urological procedures or those with specific medical conditions, such as immunocompromised states, may benefit from prophylactic antibiotics.¹²

Benefits and risks

Prophylactic antibiotics can help reduce the risk of future infections by suppressing bacterial growth in the urinary tract. However, their use should be carefully considered due to the potential for antibiotic resistance, adverse effects, and disruption of the natural microbiota.¹²

Lifestyle modifications

Hygiene practices

Proper hygiene practices, such as maintaining genital hygiene, wiping from front to back after urination or bowel movements, and avoiding the use of irritating products in the genital area, can help reduce the risk of UTIs by minimising bacterial contamination.¹³

Summary

• Kidney infections, or pyelonephritis, are serious bacterial infections that require prompt and comprehensive management
• Recognising symptoms early, combining medical treatments like antibiotics with non-medical approaches such as hydration and dietary adjustments, and creating personalised treatment plans are crucial for optimal outcomes
• Encouraging patients to seek timely medical care, adhere to prescribed treatments, and make necessary lifestyle changes is essential
• By taking a holistic approach and involving patients in their care, healthcare providers can improve outcomes and prevent complications associated with kidney infections