Pregnancy is ridden with health issues. Yet a few problems like kidney infection need immediate attention. The changes in the anatomy of the urinary tract slow down the flow of urine during pregnancy. This triggers the bacterial infection in the lower urinary tract, gradually spreading into the bladder and then into one or both kidneys.

General cause of UTI is by bacteria from your skin, vagina,or rectum that enter your urethra and travel upstream. UTI can affect any part of your urinary tract which starts at the kidneys, where urine is made and continues through the tubes called ureters down to the bladder, where urine accumulates and ends with the urethra, a short tube that carries urine outside your body.

Causes, Symptoms and Treatment of Kidney Infection During Pregnancy

There are several common types of UTI:-

Bladder infection: ​Bacteria stop in your bladder and multiply there, causing inflammation and triggering those familiar symptoms of bladder infection. Cystitis is fairly common among sexually active women.

Pyelonephritis : ​Bacteria travel from bladder up through ureters to infect one or both A kidney infection called pyelonephritis is the most common serious medical complication of pregnancy. A kidney infection have serious consequences for your baby. Your risk of preterm labor and having a low birth weight baby is increased , and it has been linked to an increased risk of fetal or newborn mortality.

Asymptomatic bacteriuria: ​It is possibility of presence of bacteria in the urinary tract and have no symptoms called as asymptomatic bacteriuria.

Symptoms

Pyelonephritis is classified into ​acute pyelonephritis​ and ​subacute​​pyelonephritis, ​with each having varying symptoms.

Acute pyelonephritis:-

• Headache
• Loss of appetite
• Severe abdominal pain in women who are more than 16 weeks pregnant
• Fever with sudden increase in body temperature
• Concentrated urine with pus and debris
• Paling and vomiting
• Tenderness of the affected kidney

Subacute pyelonephritis:-

• Lower back pain
• Feeling unwell
• Mild abdominal pain
• Irregular fluctuations in the body temperature
• Vomiting
• Symptoms indicating pneumonia and pleurisy

It could be difficult to detect subacute pyelonephritis as the are slow and you might see them as just another discomfort during pregnancy. Be acute or subacute, a kidney infection cannot be ignored given the consequences that you would face.

Complications

• Glomerulosclerosis in general term known as kidney scarring that can further lead to high blood pressure and kidney failure.
• Blood poisoning also called septicaemia.
• Kidney infection causes ascent of bacteria into the amniotic sac and fluid can result in preterm delivery.
• Preterm labor can result in low birth weight baby
• Pyelonephritis with high fever is a severe cases of kidney infection that lead to miscarriage.

Causes

Kidney infection, also termed as Pyelonephritis, occurs when the infection spreads to the upper urinary tract. It leads to inflammation of the kidney tissues and renal pelvis.

The infection is usually caused by the bacteria Escherichia coli (E.Coli) that travel through the urethra to the bladder and then to the kidneys. The other bacteria that can cause urinary tract infection are Klebsiella pneumoniae or Staphylococcus. The infection occurs due to the changes in the urinary tract, such as kidney enlargement and compression of the ureters and bladder.

Hydronephrosis : also called kidney enlargement in which dilation of ureters is caused due to high concentration of progesterone hormone secreted during pregnancy , slowing down the flow of urine, leading to its accumulation in the bladder. It causes the kidneys to enlarge and gives time to the bacteria to multiply and trigger the infection.

Compression of the ureters and bladder: The growing uterus puts pressure on the ureters and the bladder, making it difficult for the urine to flow.

Also, the infections pass more easily into a woman’s body than into a man’s because of the shortness of her urethra, which is close to the anal opening. This leads to easy transfer of bacteria from the rectal matter at the anal opening to the urethra.

Diagnosis

Physical examination – Doctor may gently press the area around the kidneys to feel the tenderness and understand the extent pain in that part.

Laboratory tests:-

• Urine analysis to detect pus, bacteria, blood, white blood cells, and red blood cells in urine.
• Clean catch urine culture to detect type of bacteria.
• Blood test to determine level of infection.
• CT scan to check enlargement of kidneys or any blockage in urinary tract.
• Intravenous pyelogram (IVP) is an X-ray of the kidneys. In IVP a dye is injected into the veins. The dye detects any obstructions or abnormalities as it passes through the urinary tract and imparts the images on the X-ray.
• Biopsy to know through extent of infection.
• Ultrasound to check for any blockage.

Treatment

Fundamental treatment includes administration of intravenous antibiotics such as ceftriaxone or cefazolin.Your Doctor will monitor your temperature, blood pressure, urinating ability, pulse, and heart rate to determine any indications of preterm labor. If there is no improvement in your condition, then it could mean that infecting bacteria are resistant to the medicine then doctor may prescribe another antibiotic gentamicin.

After hospitalization, your doctor will prescribe oral antibiotic medicine such as nitrofurantoin (Macrobid) or trimethoprim-sulfamethoxazole (Septra, Bactrim) for ten days. However, use of trimethoprim-sulfamethoxazole is avoided during the first trimester of pregnancy. Once the treatment is complete, you will be put on low-dose antibiotics. Prescription of a daily dose of 1 gm of sulfisoxazole (Gantrisin) or 100mg of nitrofurantoin monohydrate macrocrystals (Macrobid) to prevent any risk of kidney infection again is given by the Doctor. During every prenatal visit, your doctor will recommend urine screening to check for the presence of any infection-causing bacteria or white blood cells in the urine.