Pyelonephritis (Bacterial Infection of the Kidney) in Cats

My cat was urinating blood, and when I took her to the veterinarian she was diagnosed with something called “pyelonephritis”. This was explained to me as an infection in her kidneys. I would like more information about this disease.

pyelonephritis_in_catsUrinary tract infections are fairly uncommon in cats, although they generally involve the bladder and urethra (the tube that leads the urine out of the body) and are described as lower urinary tract infections.  Pyelonephritis is more accurately described as an upper urinary tract infection. The upper urinary tract consists of the kidneys and the ureters (the tubes that carry from the kidneys to the bladder).

There seems to be no specific age predisposition for pyelonephritis in cats, and there is no difference in frequency between females than males.

Many cats have no clinical signs when they have pyelonephritis, although they may have signs of lower urinary tract disease. The signs of lower urinary tract infection include:

  • Increased drinking and increased urination
  • Difficult/painful urination
  • Frequent urination of small volumes of urine
  • Inappropriate urination (particularly noticeable in cats that have previously been well house trained)
  • Slow, uncomfortable urination

Additional signs of upper urinary tract infection include fever and pain when the kidneys are palpated during the physical examination. Also, one or both kidneys may be abnormal in size.

 

What causes pyelonephritis?

Pyelonephritis is usually caused by a bacterial infection that moves up the urinary tract from the bladder to the kidneys. The bacteria most commonly implicated are Escherichia coli and Staphylococcus. Other bacteria that may be found include Proteus, Streptococcus, Klebsiella, Enterobacter, and Pseudomonas, which frequently infect the lower urinary tract and may move up into the upper urinary tract. Less commonly, bacteria that can live and grow in a low/no oxygen environment, as well as fungal organisms may cause pyelonephritis.

 

Are there risk factors for pyelonephritis?

There are several developmental conditions that increase the risk for pyelonephritis.

  • “Ectopic ureters” describes a condition in which the ureters do not attach to the bladder properly or may attach to reproductive organs instead of the bladder.   
  • “Vesicoureteral reflux” describes backflow of urine from the bladder back into the ureters.
  • “Renal dysplasia” describes abnormal development from birth of the kidneys

There are several medical and procedural conditions that increase the likelihood of urinary tract infection including:

  • Diabetes mellitus, causing glucose (sugar) in the urine, making the urine very attractive to bacteria
  • Administration of medications containing steroids
  • Kidney failure
  • Catheterization of the urethra
  • Urine retention
  • Bladder or kidney stones
  • Surgical removal of the penis with creation of a new opening into the urethra

 

How is pyelonephritis treated?

Cats with pyelonephritis are usually treated as outpatients unless they have bacteria circulating in their blood causing septicemia, or they have clinical signs of kidney failure. If cats with pyelonephritis also have kidney disease, part of their treatment will include a kidney support nutritional profile (e.g. Hill’s Prescription Diet k/d® Feline).

The specific treatment of pyelonephritis depends on the underlying cause.

Ectopic ureters are repositioned surgically to properly drain urine into the bladder. Blockage of the upper urinary tract by a urinary tract stone in a cat with bacterial infection/inflammation of the kidneys may rapidly progress to generalized disease and septicemia. This is a medical emergency and is most often treated with surgery.

Antibiotics to treat pyelonephritis are chosen based on testing the urine for bacteria and antibiotic sensitivity. The chosen antibiotic should kill bacteria, be present at appropriate levels in the blood and in the urine, and should not be toxic to the kidneys. Antibiotics are generally given for 4–6 weeks to treat pyelonephritis.

 

What kind of follow-up care can I expect for my cat?

Serial urinalyses and urine cultures are done during antibiotic treatment, generally 5–7 days into treatment and 1–4 weeks after antibiotic therapy concludes. Potential complications of pyelonephritis include kidney failure, recurrent kidney infections, and bacteria in the blood causing infection in other parts of the body such as the lining of the heart or the joints.

Overall, cats with sudden pyelonephritis do well and return to normal health unless they also have kidney stones, chronic kidney disease, urinary tract obstruction, or cancer in the urinary tract.

Cats with chronic or recurrent pyelonephritis may be difficult to cure, and their prognosis is more serious. If pyelonephritis is not identified and treated appropriately, permanent kidney damage and chronic kidney disease with kidney failure may result.

This client information sheet is based on material written by: Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CRPP

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