When do I need an antibiotic?

If kidney pain occurs acutely, one wonders from when an antibiotic should be taken. This should always be decided individually with the treating physician, because depending upon kind of the cause one falls back to the suitable means. An inflammation of the renal pelvis, for example, should be treated with antibiotics at an early stage to prevent chronicity, which can be accompanied by recurring inflammation including kidney pain, further on by shrinking kidneys or by renal insufficiency in the final stage.

In the first third of pregnancy, inflammation of the renal pelvis is more frequent and can cause kidney pain. To protect the mother and the unborn child, the therapy should be carried out under medical supervision directly with a broad-spectrum antibiotic (i.e. an antibiotic that is effective against as many germs as possible) such as amoxicillin. In 10% of pregnant women, screening tests detect bacteria in the urine that do not cause any symptoms.These pregnant women should also be treated in any case, as there is always the risk of complications for mother and child.

It is important to choose the right antibiotic, as some antibiotics such as fluoroquinolones or cotrimoxazole are contraindicated during pregnancy. If urinary stones are the cause of the pain, no antibiotic is necessary if the stone is removed without complications. If, however, there has been a long-term accumulation of urine, a more precise search for an infection should be conducted.

Specific treatment

In addition to general therapeutic procedures, specific therapeutic procedures are of course also important for the symptom of kidney pain, depending on the treatment of the cause. In the case of inflammation of the renal pelvis, bed rest, fluid intake, antipyretic medication and antibiotics to combat the bacterial pathogens are prescribed to relieve the kidney pain. Acute kidney pain is first treated with butylscopolamine (Buscopan®) and analgesics (analgesics).

If the stone does not dislodge on its own, which often happens with small stones, the stone is dissolved in the next period of time, depending on its composition, by alkalization of the urine (raising the urine pH value by means of medication and a special diet) or by shock waves or laser (lithotripsy). Alternatively, a stone can be removed with the aid of a sling which is pushed through the urethra towards the kidney on a catheter. A last – rarely necessary – option for stone elimination and thus for the elimination of kidney pain is surgery.

Depending on the severity of the kidney injury, such trauma accompanied by kidney pain is treated either conservatively with observation or, in severe cases, surgically. Kidney cancer is operated, whereby the kidneys are removed partially or completely and adjacent lymph nodes are removed. Depending on the stage of the cancer, chemotherapy, immunotherapy or hormone therapy may be added.

Narrowing of the kidneys causing pain is only treated if it significantly impedes the flow of urine. In these cases, the affected area is corrected surgically. If irreversible kidney damage has already occurred, the affected organs are removed completely (nephrectomy).

Milder forms of reflux are treated with antibiotics and checked regularly. More severe forms of reflux are operated by reconnecting the ureter to the bladder. This clinical picture is either treated with catheter dilatation (PTA = percutaneous transluminal angioplasty) or surgically.

In PTA, the occluded blood vessels are dilated to restore blood flow. The surgical therapy consists of scraping out the occluded vessel. In the case of massive vascular changes, it is possible to install a vascular prosthesis or a bypass in order to construct a bypass circuit around the changed vessel and thus eliminate the kidney pain.