Pyelonephritis Symptoms, Pathogenesis, Ayurvedic Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Pyelonephritis is inflammation of the kidney. It is typically due to a bacterial infection, most commonly Escherichia coli. Acute pyelonephritis is a sudden and severe kidney infection. Pyelonephritis can be life-threatening. When repeated or persistent attacks occur, the condition is called chronic pyelonephritis.

Causes

Bowel organisms that enter the urinary tract – E. coli (70–80%) and Enterococcus faecalis. Coliform bacteria and enterococci, as well as other organisms (Pseudomonas aeruginosa and various species of Klebsiella).
Lower urinary tract infections, mainly cystitis and prostatitis.

Read – Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment

Risk Factors

Structural abnormalities in the urinary tract
Vesicoureteral reflux (urine from the bladder flowing back into the ureter)
Kidney stones
Urinary tract catheterization
Ureteral stents or drainage procedures (e.g., nephrostomy)
Pregnancy
Neurogenic bladder 
Prostate disease in men
Diabetes mellitus
immunocompromised states
Change in sexual partner within the last year
Spermicide use
Positive family history 

Pathology

The infection usually starts in the lower urinary tract as a urinary tract infection (UTI). Bacteria enter the body through the urethra and begin to multiply and spread up to the bladder. From there, the bacteria travel through the ureters to the kidneys.

Read – Urinary Obstruction: Causes, Types, Symptoms, Ayurvedic Treatment

Symptoms

Fever greater than 102°F (38.9°C)
Pain in the abdomen, back, side, or groin
Painful or burning urination
Cloudy urine
Pus or blood in the urine
Urgent or frequent urination
Fishy-smelling urine

Other symptoms –
Shaking or chills
Nausea
Vomiting
General aching or ill feeling
Fatigue
Moist skin
Mental confusion
Read more about – Pyelonephritis – Symptoms, Risk factors, Diagnosing factors

Treatment

Antibiotics
Hospital admission
Surgery
Surgery may be required to remove any obstructions or to correct any structural problems in the kidneys. Surgery may also be necessary to drain an abscess that doesn’t respond to antibiotics.
In cases of severe infection, a nephrectomy may be necessary.
Read – Effects Of Constant Holding Urine: Ayurvedic Treatment

Pyelonephritis In Ayurveda

Probable Ayurvedic correlation

Vrikka Vidradhi – is a term which describes various types of abscesses. Antarvidradhi is a classification of abscesses which describes 10 seats of abscesses formed inside the body. One among them is Vrikka Vidradhi i.e. abscess or pus formed in the kidney. This condition can be correlated to pyelonephritis or peri-nephric abscess. Parshva sankocha i.e. squeezing pain in the flanks i.e. region of kidneys has been said as the chief complaint of vrikka vidradhi.

Read – Vidradhi: Causes, Pathogenesis, Types, Treatment, Medicines

Mutrakrichra – especially vataja (pain, frequency, chills, aches, fatigue, confusion,), pittaja (inflammation, fever, formation of pus, bleeding through urine, foul smell in urine, burning sensation, fishy odor of urine) and kaphaja (cloudy and foul urine, nausea, vomiting, discharges) types of the disease shall be considered. When symptoms are intense, worse and long standing, and chronic pyelonephritis, when most symptoms are present, they shall be considered as sannipataja mutrakrichra.

Samprapti – Pathogenesis

Dosha – vata, pitta, kapha, sannipata
Dushya – rakta, mamsa, meda, asthi
Srotas involved – Mutravaha mainly (raktavaha, mamsavaha, medovaha)
Srotodushti Lakshana – Sanga (obstruction), vimargagamana (movement in abnormal route)
Roga Marga – Abhyantara Roga Marga (since kidneys are visceral organs) and Madhyama Roga Marga (kidneys being related to urinary bladder which is a marma or vital organ)
Sadhya Asadhyata – Sukhasadhya / Krichrasadhya (curable to curable with difficulty) depending on the intensity of the disease

Read – Cystitis In Ayurveda – Symptoms, Causes, Treatment

Chikitsa – treatment principles

Krimi Chikitsa – i.e. the treatment of worms / bacteria / microorganisms shall be started as a first hand approach since the source of this disease is infection of the kidney leading to inflammation. This shall be a short-term treatment. Following this, the other treatments according to predominance of doshas, dosha symptoms or systems involved shall be adopted. The other treatments shall be done simultaneously with krimi chikitsa.

Vidradhi Chikitsa – line of treatment of treating abscesses can be followed to treat pyelonephritis. Though vrikka vidradi has been independently described, the general line of treatment of vidradi vis-à-vis abscess shall be followed in treating pyelonephritis. This condition shall also be treated on the lines of treating pittaja and raktaja (caused by vitiated blood) vidradi. This is because suppuration / formation of pus are possible only by the involvement of vitiated pitta and rakta.

Mutrakrichra line of treatment – especially vataja, pittaja kaphaja or sannipataja mutrakrichra treatment shall be adopted depending on the causative dosha.

Read – Ayurvedic Home Remedy For Urine Infection And Painful Urination

Other considerations for treatment –

Shotha Chikitsa – Line of treating swellings and inflammation

Pitta shamana and Rakta Prasadana – blood tissue and pitta have a close relationship of residence and resident. Kidneys are formed from the combination of the best essence of blood and fat tissues. Kidneys have a rich blood supply. If high pitta is circulating in the blood, it can cause inflammation of the kidneys and cause pyelonephritis. Therefore measures to mitigate pitta and calm the blood should be considered.

Mutravaha sroto dushti chikitsa – treatment principles for contamination of channels carrying urine

Jwara Chikitsa – line of treatment of fever

Other treatment strategies based on the cause / risk factor directly related to symptoms of pyelonephritis –

Vesicoureteral reflux –
– treatment to combat apana vata
– unctuous purgation in the form of medicated oils like Gandharvahastadi Taila or Nimbamritadi Eranda Taila
– changing the course of retrograde movement of vata by implementing udavarta treatment and vatanulomana (helping vata to move in its normal downward direction) by administering medicines like Gandharvahastadi Kashayam, Dhanwantaram Gulika, Vayu Gulika etc.
– decoction enemas – Dashamula Kashaya or Erandamuladi Kashayam, the same decoctions prepared in milk (ksheera vasti) shall also be given (to combat associated pitta vitiation)
– oil enemas / fat enemas – Tiktaka Ghrita or Guggulutiktaka Ghrita is useful

Kidney stones – treatment of mutra ashmari
Neurogenic bladder (e.g., due to spinal cord damage, spina bifida or multiple sclerosis) – treating vitiated vata with unctuous purgation, effective enemas, external therapies like abhyanga, swedana, murdni taila, taila dhara / pizhichil etc.
Prostate disease (e.g., benign prostatic hyperplasia) in men – treatment principles of ashtila (enlarged prostate), mutraghata (obstruction to urination), shotha (swelling) and granthi (cystic swelling)
Diabetes mellitus – line of treating diabetes mellitus
Immunocompromised states – Panchakarma treatments according to the predominance of dosha / doshas followed by Rasayana (immune-modulator / anti-ageing / rejuvenation therapies)

Role of Panchakarma

Virechana and Basti are the best therapies to treat pyelonephritis and they shall be conditionally administered as and when needed, as explained above.

Upakarmas, Useful medicines and herbs

The same external therapies, medicines, dietetic inclusions as applicable for treating urethritis can also be used to treat pyelonephritis.

In addition –
Patoladi Kashayam
Punarnavadi Kashayam
Nimbadi Kwatham
Varanadi Kwatham
Dashamula Haritaki
Guggulutiktakam Kwatham
Guggulutiktakam Ghritam
Varanadi Ghritam
Triphala Guggulu
Madhusnuhi Rasayana
Gandhaka Rasayana

Dietetic inclusions and herbs

Garlic
Horse gram
Red variety of drumstick
Bitter gourd
Boerhavia diffusa
Plumbago zeylanica
Honey
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