Kidney Reinfection and Urachus Diverticulum: Understanding a Hidden Connection

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During early development in the womb, there is a natural connection between the bladder and the navel. Normally, this connection closes before birth. However, if it remains open, it can form a condition known as a urachus diverticulum. This rare congenital anomaly can allow urine to flow back and become trapped, creating a breeding ground for bacteria. As a result, it may lead to repeated urinary tract infections and, over time, serious complications like kidney infections or even kidney failure. Fortunately, the diverticulum can be surgically removed to prevent such outcomes.

What Is a Urachus Diverticulum?

During fetal development, there is a normal, temporary connection between the bladder and the umbilicus (navel) called the urachus. This structure typically closes and becomes a fibrous cord before birth.

However, in some individuals, this connection fails to close completely, resulting in a urachus diverticulum—a pouch-like remnant attached to the top of the bladder. This anatomical defect may go unnoticed for years until it becomes a source of urinary stasis (urine pooling), leading to bacterial growth and subsequent infections.

Over time, repeated infections and backward flow of urine (reflux) can cause the bacteria to travel up the urinary tract, potentially resulting in kidney inflammation or even kidney failure if not diagnosed and treated.

Symptoms and Detection: Recognizing the Warning Signs

Signs of Infection and Kidney Involvement

One of the key clinical signs that doctors look for during a physical exam is tenderness over the kidneys, which can be assessed in two ways:

  • Kidney Percussion Test (Kidney palpitation):

    • The physician taps the area around the kidneys (usually located about 3–4 finger-widths above the pelvic bone).

    • If this elicits pain, it may indicate inflammation of the kidney or renal pelvis, commonly due to pyelonephritis.

  • Kidney Palpation Test (Renal palpation findings):

    • The doctor presses gently on the kidney area to detect tenderness or swelling.

    • Pain upon palpation may also suggest infection, stone formation, or inflammation.

While these tests are not definitive on their own, they provide important clues when interpreted alongside other symptoms and diagnostic tools.

What Bacteria Are Involved?

In cases where the urachus becomes infected or allows urine to stagnate, several bacteria may be present, especially in the navel or bladder region.

Symptoms:
  • Umbilical discharge: White or yellowish pus, sometimes with a foul odor.
  • Abdominal pain: Often localized to the lower abdomen or around the umbilicus.
  • Fever: A sign of infection.
  • Other potential symptoms: Redness or swelling around the umbilicus, palpable mass in the lower abdomen, urinary symptoms (like dysuria or frequency)

These typically include:

    1. Escherichia coli (E. coli) – the most common cause of UTIs.
    2. Other enteric (gut) bacteria, which may travel up from the lower urinary tract.
    3. Staphylococcus aureus – often found on the skin but can enter through breaks or connections like a urachus.
    4. Enterococci are most commonly responsible for such infections.
    5. Less commonly, pathogens such as staphylococci, yeasts can also be involved. 

Causes of Kidney Pain or Tenderness

Beyond infections from a urachus diverticulum, other common causes of kidney pain include:

  • Pyelonephritis: Bacterial infection of the kidney and renal pelvis.

  • Kidney Stones: Can cause sharp, severe pain when they move or block urine flow.

  • Glomerulonephritis: Inflammation of the kidney’s filtering units, sometimes linked to autoimmune or post-infectious causes.

  • Cysts, Tumors, or Dehydration: These conditions can also trigger pain, discomfort, or even damage to kidney tissues.

When to Seek Medical Help

You should see a doctor immediately if you experience:

  • Persistent or severe kidney or lower back pain

  • Fever or chills

  • Nausea or vomiting

  • Changes in urination (e.g., color, odor, pain, or frequency)

These could be signs of a serious kidney infection or complications due to an undiagnosed structural abnormality such as a urachus diverticulum.

Diagnosis and Management

Diagnosis usually involves a combination of:

What is the best imaging for an urachal cyst?

The primary imaging modality for urachal cysts is ultrasound revealing a cystic mass in the midline anteriorly between the bladder dome and umbilicus. CT or MRI may be subsequently employed to help reach a definite diagnosis.

  • Physical examination (kidney percussion and palpation tests)

  • Urine and blood tests to detect infection or kidney dysfunction

  • CT Imaging with Contrast: A minimally invasive diagnostic technique involves the use of two contrast agents:
    A minimally invasive diagnostic technique involves the use of two contrast agents: Xenetix 300 (90 mL), administered intravenously, and Telebrix Gastro (500 mL), taken orally.
    Additionally, a small amount of Telebrix Gastro can be instilled directly into the umbilicus using a needleless syringe while the patient is standing, approximately 10 minutes before CT imaging. This combined approach enhances visualization of the urachal tract, helps detect potential pockets or abdominal leakage, and aids in identifying anatomical anomalies such as a urachal diverticulum.

In some cases, surgical removal of the urachus diverticulum may be necessary to prevent recurrent infections and protect kidney function.

Conclusion

Although rare, a urachus diverticulum is a potentially serious condition that can lead to repeated kidney infections and long-term kidney damage. Early recognition and treatment are essential. If you're experiencing frequent UTIs or unexplained kidney symptoms, consider discussing the possibility of a urachus-related problem with your healthcare provider. Timely diagnosis can be the key to preventing chronic kidney complications.

Reference: 

Infected Urachal Sinus in an Adult
https://pmc.ncbi.nlm.nih.gov/articles/PMC8281809/

Management of an Infected Vesicourachal Diverticulum in a 42-Year-Old Woman
https://pmc.ncbi.nlm.nih.gov/articles/PMC7421747/#:~:text=The%20initial%20management%20of%20infected%20urachal%20anomalies,as%20the%20treatment%20of%20choice%20%5B2%2C%205%5D.

Research:

Kidneys  https://www.kenhub.com/en/library/anatomy/kidneys

© 2025-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

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