Kidney Infection (Pyelonephritis) in Pregnancy – Signs, Causes & Treatment

While issues in kidney function are generally common at any age, kidney infections in pregnancy are much more commonly seen in women, especially when pregnant. With so many changes happening in the body, along with the hormonal ones, keeping track of discomforts can be confusing. The Cleveland Clinic suggests that most of the kidney infections during pregnancy stem from urinary tract infections (UTIs), which move from the bladder to the kidneys to cause infections of the kidney or pyelonephritis (1). But by being aware of critical signs and symptoms, you can protect yourself from serious pregnancy complications that could jeopardise your and your fetus’ health.

What Is Pyelonephritis?

In simple terms, Pyelonephritis is the infection of the kidney. The infection is usually bacterial. Pyelonephritis can be of two types – acute and subacute, or chronic. Acute pyelonephritis is the sudden, severe inflammation of the kidneys and is most common in pregnant women. According to the NIH, pyelonephritis typically arises as a complication of an ascending urinary tract infection (UTI), which moves from the bladder upwards to the kidney. However, the infection can also be transmitted through the bloodstream (2).

Causes of Kidney Infection During Pregnancy

Pyelonephritis occurs when an E.coli infection occurs, leading to the inflammation of the kidney and pelvis. The infection could occur due to:

1. Enlargement of the Kidney

During pregnancy, progesterone is released in high volumes, causing the smooth muscles to relax and the uterus to dilate in order to accommodate the growing foetus and placenta. This retards the flow of urine, and in some cases, it stagnates and backs up into the kidney. The kidney then enlarges and allows the bacteria to multiply and cause an infection.

2. UTI

With the uterus pressing down on the ureter and bladder, the pregnant woman is more susceptible to infections of the urinary tract or UTIs. These infections can then travel up the ureter and infect the kidney. The most common bacterium responsible for UTIs is E. coli (Escherichia coli), which is typically present in the vaginal and rectal area. Other bacteria can also lead to UTIs, such as group B streptococcus, as well as the sexually transmitted infections gonorrhoea and chlamydia (3).

Signs and Symptoms of Kidney Infection During Pregnancy

The signs of pyelonephritis are usually manifest a few days after the infection occurs. The symptoms depend on whether you have acute or subacute pyelonephritis.

1. Acute Pyelonephritis (2)

• Severe pain in the abdomen and pelvic regions
• Loss of appetite
• A headache
• High fever
• Tenderness of the kidney
• Bloody or cloudy urine
• Vomiting and nausea

2. Subacute Pyelonephritis

• Mild abdominal pain
• Pain in the lower back
• Fluctuations in body temperature
• Vomiting
• Infrequent chills
• Frequent urination

Diagnosis and Tests of Kidney Infection While Pregnant

The diagnosis of acute pyelonephritis will be made after your doctor takes your full medical history. Some of the methods used for diagnosis that your doctor will recommend include (4):

1. Urine Tests

Upon a physical exam, if your doctor suspects any problems with the kidneys, then she will ask you to get a urine test done. The test will show any signs of infection that you may have.

2. Imaging Tests

Imaging tests will be recommended to find if there are any obstructions in the urinary tract that is causing the stagnation and backing up of urine. These tests can determine the presence of cysts or tumours.

3. Blood Test

Your doctor might ask you to get a blood test in order to determine the extent of the infection. Once this is determined, your doctor will be able to develop the ideal treatment plan.

Complications Associated With Pyelonephritis in Pregnancy

Acute pyelonephritis during pregnancy must be given the right medical attention as soon as possible. If it is left untreated, then the following complications might occur:

• One of the first things that could happen if pyelonephritis is left untreated is the scarring of the kidney, which could lead to high blood pressure and kidney failure.
• With the kidney not functioning at an optimum level, there are increased chances of blood poisoning. The bacteria infecting the kidneys could enter the bloodstream in this condition and cause blood poisoning.
• The infection could also enter the amniotic sac and fluid, causing an infection. This could lead to the rupturing of the sac and preterm delivery.
• Preterm delivery will result in complications for the baby’s health, including low birth weight (5).
• In some cases, when pyelonephritis is accompanied by a high fever, there could be a miscarriage.

How Is Kidney Infection Treated During Pregnancy?

Treatment for pyelonephritis in pregnancy varies with the cause and severity.

If you are diagnosed with acute pyelonephritis during pregnancy, then you will be admitted to the hospital, where the first round of treatment is IV antibiotics. If you do not respond to this treatment, then you will be given stronger antibiotics in order to kill the infection.

However, if the infection is caused by an obstruction such as kidney stones, the treatment will aim to ease the pressure on the kidneys.

Once you are discharged from the hospital, you will need to continue to take oral antibiotics for ten days. There will be around a 23% chance of recurrence during and post-pregnancy, so you will be monitored regularly.

What Should Be the Outlook After Treatment?

Pyelonephritis needs to be monitored after treatment too. Here is the post-treatment care and monitoring you will need:

1. Screening

After you have been treated for pyelonephritis, your doctor will continue to screen you for any possible recurrence of the infection during your regular prenatal routine check-ups. This will include checking on the health of the baby as well as urine tests.

2. After Delivery

Even after delivery, you will have to be screened for the occurrence of the infection of the kidney. While the uterus will no longer be applying pressure on the urinary tract and the hormones will have settled down to normal levels, there is still a possibility that you will continue to have issues with the kidney depending upon the extent of the initial infection and how soon it was treated.

3. For the Baby

If the pyelonephritis is not treated in a timely manner, the infection could affect the amniotic sac, leading to preterm delivery. In such a case, the health of the baby will have to be closely monitored in the initial months in order to ensure that all systems, including the immune system, are fully developed with no lasting ill effects.

Home Remedies to Cure Kidney Infection During Pregnancy

While you do need medical attention to take care of the infection, there are certain home remedies that you can try.

The following remedies are to be used only after discussing with your doctor, as each remedy has its own properties and mechanism and places of action.

• Drinking cranberry juice will make the urine more acidic and help flush out and kill the harmful bacteria.
• Yoghurt is not only an excellent source of antioxidants but also hosts a wide array of beneficial bacteria that can kill and inhibit the growth of the harmful bacteria causing the infection.
• You must incorporate foods that are rich in Vitamin C into your diet. This includes citrus fruits, potatoes, and strawberries.
• Juice a bunch of parsley and have it every morning to help flush out the bacteria.
• Marshmallow roots are known to be a good diuretic and will help cleanse the kidneys.
• If you are prone to UTIs, you must consume some apple cider vinegar every day, as it neutralises infections and restores the body’s pH levels. Please note: Only pasteurised apple cider vinegar must be taken during pregnancy.
• Another great diuretic is garlic.
• Echinacea reduces the swelling of the urethra and will make urinating less painful.
• Celery seeds are well known for their antibacterial and antifungal properties.

Prevention of Kidney Infection in Pregnancy

There are many steps you can take in order to avoid a kidney infection during pregnancy. Some of them include (6):

• Keeping yourself well hydrated by drinking 8-10 glasses of water every day. This will ensure that your kidneys work at the optimum level.
• Practising good hygiene, especially around the genital area – clean and dry.
• With the opening of the urethra so close to the anus, it is important to clean the area well.
• Use soaps and other products that are mild and hypoallergenic.
• If you do have an infection, then avoid coffee and alcohol.
• Avoid high sugar items as they encourage bacterial growth.

When to See a Doctor?

It is advised to visit a doctor if you experience any of the following kidney infection symptoms, such as:

• Fever and chills
• Painful urination
• Abdominal pain
• Blood in the urine

FAQs

1. What if I get UTI (urinary tract infection) in pregnancy and have no symptoms?

If you have had UTIs in the past, then you must tell your doctor about it. She will recommend that you get frequent urine tests in order to screen for UTIs during your pregnancy.

2. Which factors increase the risk of urinary tract infection while pregnant?

Some risk factors include a history of UTI infection, diabetes, and being overweight.

3. How long will it take for medicines to work?

After you are given antibiotics for the infection, you should start to notice signs of relief within three days. However, it is of utmost importance that you continue and complete the entire course of antibiotics in order to fully kill off the infection.

4. What are some early warning signs of kidney infections in pregnancy?

Pain while urinating, fever, flank pain, nausea, and frequent visits to the loo are some early signs indicating issues in the kidney or the urinary tract.

Delay in the treatment of kidney infection during pregnancy can risk damaging the urinary system and jeopardise the health of the fetus, increasing the risk of premature birth and low birth weight. Thus, timely diagnosis and treatment is essential.

Also Read:

TORCH Infection
Viral Infections in Pregnancy
Yeast Infection during Pregnancy
Chikungunya Infection while Pregnant

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Sources References

1. Cleveland Clinic – Kidney Infection (Pyelonephritis)

2. NIH – Acute Pyelonephritis

3. Nationwide Children’s – Urinary Tract and Kidney Infections in Pregnancy

4. American Kidney Fund – Kidney infection (Pyelonephritis) symptoms, treatment and prevention

5. Mayo Clinic – Kidney infection

6. Tommy’s – Painful urination in pregnancy