Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
With chronic pyelonephritis, pyelo- means pelvis, and -neph- refers to the kidney, so in this case it’s the renal pelvis, which is the funnel-like structure of the kidney that drains urine into the ureter, and -itis means inflammation. This inflammation is usually caused by bacterial infection of the kidney, which is called acute pyelonephritis.
Now a urinary tract infection, or UTI, is any infection of the urinary tract, which includes the upper portion of the tract—the kidneys and the ureters, and the lower portion of the tract—the bladder and urethra.
Now, an episode of acute pyelonephritis often clears up without much complication. Certain people, though, are predisposed to having recurring bouts of acute pyelonephritis, which eventually leads to chronic pyelonephritis and permanent scarring of the renal tissue.
The most common risk factor for recurrent acute pyelonephritis and therefore chronic pyelonephritis, is vesicoureteral reflux, or VUR, which is where urine is allowed to move backward up the urinary tract, which can happen if the vesicoureteral orifice fails.
The vesicoureteral orifice is the one-way valve that allows urine to flow from each ureter into the bladder, but not in the reverse direction.
VUR can be the result of a primary congenital defect or it can be caused by bladder outlet obstruction, which increases pressure in the bladder and distorts the valve.
That being said, chronic obstruction is its own independent risk factor for chronic pyelonephritis.
Obstructions in the urinary tract causes urinary stasis, meaning it tends to cause urine to stand still, which makes it easier for bacteria to adhere to and colonize the tissue, making lower UTIs more likely and therefore upper UTIs more likely.
Bilateral obstruction increases pressure in the bladder and therefore affects both kidneys, causes include congenital malformations, like posterior urethral valve, which obstructs the flow of urine through the urethra, as well as benign prostatic hyperplasia in men, which is an enlarged prostate, and cervical carcinoma in women, both of which can compress the urethra shut.