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Kidneys under siege

The kidney is a little-understood organ, but productive steps can prevent it from getting infected.

By Celine Blancas-Evidente, M.D.

JUNE 2012 

According to the Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults, updated in 2004 by the Philippine Task Force on UTI, urinary tract infection continues to be among the top five reasons for consultations in health facilities nationwide.

Mechanics of the urinary tract

Kidney infection or pyelonephritis occurs when bacteria travels from the bladder into one or both kidneys, which is easily treatable but can get worse and cause kidney damage. This is different from cystitis, a common infection of the bladder which causes painful urination.

The Task Force on UTI says the classic syndrome of acute uncomplicated pyelonephritis, or upper urinary tract infection, is characterized by fever, chills, flank pain, nausea and vomiting, with or without signs of lower urinary tract infection. Urine may also be cloudy or smell bad. Urinalysis will reveal pus cells and high bacteria counts on urine culture.

When the kidney infection becomes complicated, hospital admission may be necessary. Indications include: inability to tolerate oral hydration or medications; severe illness with high fever or severe pain; or the presence of complicating conditions. Untreated infections can damage the kidneys, leading to chronic kidney disease, kidney failure, severe blood infection or sepsis, or other changes such as an increase in blood pressure. In pregnant women, recurrent kidney infections can result in a smaller baby.

Women at risk

Milagros Lorenzo, M.D., an OB-GYN from Capitol Medical Center in Quezon City, says kidney infections can affect anyone at any age but are more common in women, due to their shorter urethra compared to males. Sexually active and pregnant women are also susceptible to getting a kidney infection. Dr. Lorenzo says in the latter case, the pressure applied by the enlarging uterus causes slow transit of the urine. UTI in women is also related to hormonal changes, making it a common occurrence before a period or in pregnancy. Older, menopausal women may also be at risk because of thinner and drier tissues of the urinary tract.

Prevention or treatment

Dr. Lorenzo says kidney infections may be prevented with proper hydration. Drinking plenty of water can help flush out and remove bacteria during urination. The doctor says holding back urination should be avoided and women should urinate frequently. Proper hygiene should be observed by wiping carefully from front to back after urinating or after a bowel movement. Panty liners, if used, should be regularly changed. Use mild feminine products and avoid soaps, tight pants or underwear that can irritate the genital area or urethra.

Antibiotics are the answer to bacterial infections. The duration of treatment can last up to 14 days depending on the antibiotic. Some medications may be given for seven to 10 days. A pain reliever may be needed for the fever or discomfort. These should be taken under the supervision of your doctor.

Some studies show that coconut water or cranberry juice can help with the treatment but these should not replace antibiotics. Research shows that the antioxidant component of cranberries can relieve symptoms, but there are no recommendations regarding how frequently or in what quantity they should be consumed. The validity of these home remedies as treatment is still controversial owing to lack of significant data, but they may be considered an alternative or preventive measure.

For more on pyelonephritis and how to prevent it, get a copy of the June issue of HealthToday magazine from newsstands and bookstores.

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