Upper Urinary Tract & Kidney Infection: Symptoms, Causes, Treatment

Introduction

Upper urinary tract infections (UTIs) are a serious type of infection that affects the kidneys and ureters, the tubes responsible for carrying urine from the kidneys to the bladder. While less common than lower urinary tract infections, which involve the bladder and urethra, upper UTIs tend to be more severe and require prompt medical attention. If left untreated, upper UTIs can lead to significant health risks, including kidney damage and sepsis. This article provides a comprehensive overview of upper urinary tract infections, covering risk factors, symptoms, diagnostic tests, treatment options, and home care strategies. Understanding these aspects can help patients manage their health and seek timely care to prevent complications.

Definition of Upper Urinary Tract Infection

An upper urinary tract infection affects the kidneys and ureters. This article will explore the risk factors, symptoms, diagnostic tests, medications, procedures, and home care strategies that can help manage the condition.

Description of Upper Urinary Tract Infection

Also known as pyelonephritis, an upper urinary tract infection occurs when bacteria travel from the bladder to the kidneys. The kidneys filter waste from the blood and produce urine, so an infection in this area can lead to more severe symptoms and complications than a lower UTI. Typically, the infection begins in the lower urinary tract, but if left untreated, it can ascend to the kidneys, causing inflammation and infection.

Upper UTIs can progress rapidly, leading to symptoms such as high fever, chills, back or side pain (flank pain), nausea, and vomiting. In severe cases, the infection may spread to the bloodstream, resulting in a life-threatening condition known as sepsis. Early diagnosis and treatment are essential to prevent complications.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), upper UTIs are less common than lower UTIs but still affect millions of people each year. Women are more likely to develop UTIs than men, with the risk increasing with age. Approximately 1 in 30 women will experience an upper UTI in their lifetime, while men are less frequently affected.

Risk Factors for Developing Upper Urinary Tract Infection

Lifestyle Risk Factors

Certain lifestyle choices can increase the risk of developing an upper urinary tract infection. One of the most common risk factors is inadequate hydration. Not drinking enough water can lead to concentrated urine, which creates an environment where bacteria can thrive and travel up the urinary tract. Sexual activity, particularly in women, can also increase the risk of UTIs, as bacteria from the genital area can be introduced into the urethra. Additionally, using spermicides or diaphragms for birth control can disrupt the natural bacterial balance in the urinary tract, making infections more likely.

Poor hygiene practices can also contribute to the development of UTIs. Wiping from back to front after using the bathroom can introduce bacteria from the rectal area into the urethra, increasing the risk of infection. Holding in urine for extended periods allows bacteria to multiply in the bladder, raising the likelihood of the infection spreading to the kidneys.

Medical Risk Factors

Several medical conditions can predispose individuals to upper urinary tract infections. A history of recurrent lower UTIs is one of the most common risk factors. If lower UTIs are not effectively treated, they can ascend to the kidneys, leading to an upper UTI. People with diabetes are also at higher risk due to changes in immune function and the presence of glucose in the urine, which can promote bacterial growth.

Other medical risk factors include urinary tract obstructions, such as kidney stones or an enlarged prostate, which can block urine flow and create an environment where bacteria can thrive. Individuals with weakened immune systems, such as those undergoing chemotherapy or living with HIV, are also more susceptible to infections, including upper UTIs. Additionally, people who use catheters to drain urine are at increased risk of developing infections due to the introduction of bacteria into the urinary tract.

Genetic and Age-Related Risk Factors

Genetics can also play a role in the likelihood of developing upper urinary tract infections. Some individuals may have a genetic predisposition to urinary tract abnormalities, such as vesicoureteral reflux (VUR), a condition where urine flows backward from the bladder into the kidneys, increasing the risk of recurrent UTIs and kidney infections.

Age is another significant factor. As people age, the risk of developing upper UTIs increases. In older adults, changes in the urinary tract, such as decreased bladder control and incomplete emptying of the bladder, can contribute to infections. Postmenopausal women are particularly at risk due to hormonal changes that affect the urinary tract’s ability to fight off infections. Men over 50 are also at increased risk due to the potential for prostate enlargement, which can obstruct urine flow and lead to infections.

Clinical Manifestations of Upper Urinary Tract Infection

Fever

Fever is one of the most common symptoms of an upper urinary tract infection, occurring in 80-90% of cases. It is the body’s natural response to infection, as it attempts to fight off invading bacteria. In upper UTIs, the infection has typically spread to the kidneys, triggering a systemic immune response that raises body temperature, often accompanied by sweating and chills. Fever is more likely in the early stages of an upper UTI and may persist until the infection is treated.

Chills

Chills, often accompanying fever, occur in about 60-70% of patients with an upper UTI. Chills are the body’s way of generating heat to raise its temperature in response to infection. When the kidneys are infected, the body releases chemicals called pyrogens, which act on the brain to increase body temperature. As a result, patients may experience shivering or shaking, even if they feel warm. Chills are typically more pronounced in the early stages of the infection and may subside as the fever decreases.

Flank Pain

Flank pain, occurring in 70-80% of upper UTI cases, refers to discomfort or pain in the lower back or sides, near the kidneys. This pain is caused by inflammation and swelling of the kidney tissues due to the infection. The kidneys are located on either side of the spine, just below the ribcage, and when infected, they can become tender and painful. Flank pain is often described as a dull, aching sensation but can also be sharp and severe. The pain may worsen with movement or deep breathing.

Nausea

Nausea is common in upper UTI patients, occurring in about 50-60% of cases. The infection in the kidneys can irritate the gastrointestinal system, leading to nausea. Additionally, the body’s immune response to the infection can trigger the release of chemicals that affect the digestive system. This symptom is more common in severe cases and may be accompanied by vomiting.

Vomiting

Vomiting occurs in approximately 30-40% of patients with an upper UTI. Like nausea, vomiting results from the body’s response to the infection and irritation of the gastrointestinal system. In some cases, vomiting may be triggered by severe pain or discomfort, particularly in patients experiencing significant flank pain. Vomiting can lead to dehydration, complicating the infection, so it is important for patients to stay hydrated and seek medical attention if vomiting persists.

Dysuria

Dysuria, or painful urination, occurs in about 40-50% of upper UTI cases. While more commonly associated with lower urinary tract infections, dysuria can also occur when the infection spreads to the kidneys. It is caused by inflammation and irritation of the urinary tract, making urination uncomfortable or painful. Patients may describe a burning sensation when urinating, and this symptom may be more pronounced in the early stages of the infection.

Urgency

Urgency, or the sudden and strong need to urinate, occurs in about 30-40% of upper UTI patients. This symptom is caused by irritation and inflammation of the bladder and urinary tract, making the body feel like it needs to empty the bladder more frequently. Even though the infection is in the upper urinary tract, the entire urinary system can be affected, leading to symptoms like urgency. Patients may feel the need to urinate frequently, even if little urine is produced.

Frequency

Frequency, or the need to urinate more often than usual, is another common symptom of upper UTI, occurring in about 40-50% of cases. Like urgency, frequency is caused by irritation and inflammation of the urinary tract. Patients may find themselves needing to urinate multiple times throughout the day and night, even if they produce only small amounts of urine. This symptom can be particularly bothersome and may disrupt daily activities and sleep.

Hematuria

Hematuria, or blood in the urine, occurs in about 10-20% of upper UTI cases. This symptom is caused by inflammation and damage to the tissues of the urinary tract, leading to small amounts of blood leaking into the urine. Hematuria may be visible to the naked eye (gross hematuria) or only detectable under a microscope (microscopic hematuria). While hematuria can be alarming, it is usually a sign of irritation and inflammation rather than a serious complication. However, it is important to seek medical attention if blood in the urine is present.

Malaise

Malaise, or a general feeling of discomfort and fatigue, is a common symptom of upper UTI, occurring in about 60-70% of cases. This symptom results from the body’s immune response to the infection, causing patients to feel tired, weak, and unwell. Malaise is often accompanied by other symptoms like fever, chills, and nausea, and it can persist until the infection is treated. Patients may find it difficult to carry out their usual activities and may need to rest more than usual.

Treatment Options for Upper Urinary Tract Infection

Medications for Upper Urinary Tract Infection

Ciprofloxacin

Definition: Ciprofloxacin is a fluoroquinolone antibiotic used to treat bacterial infections, including upper urinary tract infections (UTIs) and kidney infections.

How and When It’s Used: Ciprofloxacin is often prescribed for severe upper urinary tract infections, especially when other antibiotics are ineffective. It works by inhibiting bacterial DNA replication, preventing bacterial growth. It is particularly useful for infections caused by antibiotic-resistant bacteria.

Expected Outcomes: Patients typically notice improvement within 2 to 3 days, but completing the full course is crucial to prevent recurrence or resistance.

Nitrofurantoin

Definition: Nitrofurantoin is an antibiotic that targets bacterial infections in the urinary tract by damaging bacterial DNA.

How and When It’s Used: Nitrofurantoin is generally used for uncomplicated lower UTIs but may be prescribed for upper urinary tract infections if the bacteria are susceptible. It is often a first-line treatment for mild infections.

Expected Outcomes: Symptoms typically improve within a few days, but completing the full course (usually 5 to 7 days) is necessary to ensure the infection is fully cleared.

Trimethoprim-sulfamethoxazole

Definition: This combination antibiotic inhibits bacterial growth through two mechanisms, making it highly effective against a range of bacteria.

How and When It’s Used: Trimethoprim-sulfamethoxazole is commonly used for both lower and upper urinary tract infections. It is often prescribed when the infection is caused by bacteria sensitive to this combination. It is a first-line treatment for uncomplicated infections but may also be used for more severe cases.

Expected Outcomes: Patients typically experience symptom relief within 2 to 3 days, but the full course (usually 7 to 10 days) should be completed.

Amoxicillin

Definition: Amoxicillin is a penicillin-type antibiotic that works by disrupting the bacterial cell wall, causing bacterial death.

How and When It’s Used: Amoxicillin is often used for upper urinary tract infections caused by bacteria sensitive to penicillin. It is more commonly prescribed for mild to moderate infections, especially in pregnant women and children.

Expected Outcomes: Symptom relief typically occurs within a few days, but completing the full course (usually 7 to 10 days) is necessary to prevent recurrence.

Fosfomycin

Definition: Fosfomycin is a broad-spectrum antibiotic that inhibits bacterial cell wall synthesis.

How and When It’s Used: Fosfomycin is often used for uncomplicated lower UTIs but may be prescribed for upper urinary tract infections if the bacteria are susceptible. It is typically given as a single-dose treatment, making it convenient for patients.

Expected Outcomes: Patients can expect symptom relief within 2 to 3 days after taking the single dose, but follow-up may be needed to ensure the infection is fully cleared.

Levofloxacin

Definition: Levofloxacin is a fluoroquinolone antibiotic that works by inhibiting bacterial DNA replication.

How and When It’s Used: Levofloxacin is often used for more severe or complicated upper urinary tract infections, especially when other antibiotics have failed or the bacteria are resistant. It is typically reserved for cases where first-line treatments are not effective.

Expected Outcomes: Patients usually see improvement within 2 to 3 days, but the full course (usually 7 to 14 days) is necessary to prevent recurrence or resistance.

Ceftriaxone

Definition: Ceftriaxone is a broad-spectrum cephalosporin antibiotic often administered via injection or intravenously (IV) to treat severe bacterial infections.

How and When It’s Used: Ceftriaxone is typically used in hospital settings for severe upper urinary tract infections or when oral antibiotics are ineffective. It is often given as an initial treatment before switching to oral antibiotics once the infection is under control.

Expected Outcomes: Patients usually experience rapid improvement within 24 to 48 hours, but completing the full course (usually 7 to 14 days) is necessary to ensure the infection is fully treated.

Gentamicin

Definition: Gentamicin is an aminoglycoside antibiotic that works by inhibiting bacterial protein synthesis, leading to bacterial death.

How and When It’s Used: Gentamicin is often used for severe or complicated upper urinary tract infections, particularly when the infection is caused by bacteria resistant to other antibiotics. It is usually administered intravenously in a hospital setting.

Expected Outcomes: Patients typically see improvement within 24 to 48 hours, but completing the full course (usually 7 to 14 days) is necessary to prevent recurrence.

Ampicillin

Definition: Ampicillin is a penicillin-type antibiotic that works by disrupting the bacterial cell wall, causing bacterial death.

How and When It’s Used: Ampicillin is often used for upper urinary tract infections caused by bacteria sensitive to penicillin. It is more commonly prescribed for mild to moderate infections, especially in pregnant women and children.

Expected Outcomes: Symptom relief typically occurs within a few days, but completing the full course (usually 7 to 10 days) is necessary to prevent recurrence.

Meropenem

Definition: Meropenem is a broad-spectrum carbapenem antibiotic used to treat severe bacterial infections, including complicated upper urinary tract infections.

How and When It’s Used: Meropenem is typically reserved for cases where the infection is caused by multidrug-resistant bacteria. It is usually administered intravenously in a hospital setting and is often used when other antibiotics have failed.

Expected Outcomes: Patients usually experience rapid improvement within 24 to 48 hours, but completing the full course (usually 7 to 14 days) is necessary to ensure the infection is fully treated.

Improving Upper Urinary Tract Infection and Seeking Medical Help

In addition to prescribed medications, several home remedies can help alleviate symptoms and support recovery from an upper urinary tract infection:

1. Drink plenty of water: Staying hydrated helps flush bacteria out of the urinary tract.
2. Consume cranberry juice: Cranberry juice may help prevent bacteria from adhering to the bladder wall.
3. Avoid irritants like caffeine and alcohol: These substances can irritate the bladder and worsen symptoms.
4. Practice good hygiene: Proper hygiene can help prevent the spread of bacteria to the urinary tract.
5. Urinating after intercourse: This can help flush out bacteria that may have entered the urethra during sexual activity.
6. Take probiotics: Probiotics can help maintain a healthy balance of bacteria in the body.
7. Eat garlic: Garlic has natural antibacterial properties that may help fight infections.
8. Increase vitamin C intake: Vitamin C can help boost the immune system and make the urine more acidic, which may inhibit bacterial growth.
9. Use heat therapy: Applying a heating pad to the lower abdomen can help relieve pain and discomfort.
10. Wear loose-fitting clothing: Tight clothing can trap moisture and create an environment where bacteria thrive.

If symptoms persist or worsen despite these remedies, it is important to seek medical help. Telemedicine offers a convenient way to consult with a healthcare provider from the comfort of your home. Our primary care telemedicine practice can provide timely diagnosis, prescribe appropriate medications, and offer guidance on managing your symptoms.

Living with Upper Urinary Tract Infection: Tips for Better Quality of Life

Living with an upper urinary tract infection can be uncomfortable, but there are steps you can take to improve your quality of life:

1. Follow your treatment plan: Always complete the full course of antibiotics, even if you start feeling better.
2. Stay hydrated: Drinking plenty of water helps flush out bacteria and supports recovery.
3. Monitor your symptoms: Keep track of any changes in your symptoms and report them to your healthcare provider.
4. Practice good hygiene: Proper hygiene can help prevent future infections.
5. Rest: Give your body time to heal by getting plenty of rest.
6. Manage pain: Over-the-counter pain relievers and heat therapy can help alleviate discomfort.

By following these tips and working closely with your healthcare provider, you can manage your symptoms and reduce the risk of future infections.

Conclusion

Upper urinary tract infections are serious bacterial infections that require prompt treatment to prevent complications. Early diagnosis and appropriate treatment, including antibiotics and supportive care, are essential for a full recovery. If you suspect you have an upper UTI, don’t wait—seek medical help right away. Our telemedicine practice offers convenient, accessible care from the comfort of your home. Contact us today to schedule a consultation and get the care you need to feel better.

James Kingsley

Learn More