PYELONEPHRITIS IN PREGNANCY

There is increased chance of urinary tract infection in females as compared to males due to:

1) Short urethra. (4cms)

2) Close proximity of the external Urethral meatus to the areas (vulva and lower third of vagina) contaminated heavily with bacteria.

3) Catheterization.

4) Sexual intercourse.

INCIDENCE: - The overall incidence of pyelonephritis in pregnancy is between 1-3percent.

ETIOLOGY: - 1) It is more common in primigravidae than multiparae.

2) Previous history of urinary tract infection increases the chances by 50percent.

3) Presence of asymptomatic bacteriuria increases the chances by 25 percent.

4) Abnormalities in the renal tract is found in about 25 percent.

5)Stasis- due to compression of the ureters (mainly the right) by gravid uterus.

PATHOGENESIS: - Predisposing factors:- Dilatation of the ureters and renal pelves and stasis of the urine in the bladder and ureters are the normal physiological changes during pregnancy.

The organisms responsible are: - E.coli (70 percent) klebsiella pneumoniae(10 percent), enterobacter, proteus, pseudomonas, and staphylococcus aureus group. About 10 percent of women develop bacteremia following acute pyelonephritis. 70-80 percent of pyelonephritis occurs on right side, 10-15 percent on the left side and only few are bilateral.

ACUTE PYELONEPHRITIS: -

CLINICAL FEATURES: - the onset is acute and usually appears beyond the 16th week. The involvement is Bilateral but if unilateral, it is more frequent on the right side. Clinical features are mainly due to endotoxemia. The chemical mediators (cytokines) released are: IL1, TNF and endogenous pyrogen.

IMPORTANT FEATURES ARE:-

Aching pain over the loins, often radiating to the groin and costovertebral angle tenderness, dysuria, haematuria.

Fever (spiky 40-degree C) with chills and rigor followed by hypothermia (35-degree C), Anorexia, nausea, vomiting, and myalgias, Respiratory distress and pulmonary oedema (ARDS) due to endotoxin induced alveolar injury.

INVESTIGATIONS: - apart from the routine ones, serum levels of creatinine, electrolytes and culture study of urine and blood should be done.

HOMOEOPATHIC MEDICINES FOR PYELONEPHRITIS IN PREGNANCY: -

1) Belladonna: It is an ideal Homoeopathic remedy for treating inflammation of the kidneys accompanied by piercing or burning pain in the lumbar region of kidney. The pain reappears repeatedly with increased intensity each time.

2) Cantharis :- This homoeopathic cure is used in cases of nephritis. There is strong urging to urinate with cutting pains, that are felt before urine passes, as well as during and after.

3) Sarsaparilla:- this remedy is useful in cystitis and often helps when symptoms are unclear, or if other remedies have not been effective. Frequent urging is felt, with burning pain at the conclusion of urination.

4) Nux vomica : irritable bladder with a constant need to urinate, passing only small amounts, suggests a need for this remedy. Burning or cramping pain may be felt in the bladder area, with an Itching sensation in urethra while the urine passes.

5) Apis Mel:- This remedy is Indicated when the person frequently needs to urinate, but only small quantities are passed. Stinging and burning sensation are felt and the person may also experience soreness in abdomen.