Acute non-obstructive pyelonephritis on the right. Chronic reflux pyelonephritis

29.07.2020

Pyelonephritis is the spread of inflammatory processes in the kidney tissue.

During pyelonephritis, this process is disrupted, which leads to the retention of excess fluid and toxic products in the body.

The disease itself is caused by infectious agents of the species staphylococcus, streptococcus, Escherichia coli, Proteus or enterococcus. Pyeloenephritis can occur in both acute and chronic forms, which can be in a dormant state for a long time and be activated by various external factors, be it pregnancy or a sudden change in climate.

Features of the course of the disease in humans depend on the following factors:

age;
a history of other pathologies of the genitourinary system;
chronic diseases of other organs and systems;
genetic predisposition.

The child's body is a vulnerable target for various kinds of bacterial infections. Most often, children suffer from pyelonephritis between the ages of six and sixteen years. Pathology is usually preceded by a viral disease, a sharp change in climate or hypothermia. Children suffer from an acute form of non-obstructive pyelonephritis, since they are not characterized by the formation of kidney stones.

The main clinical symptoms accompanying pyelonephritis in children:

violation of appetite and refusal to eat;
a sharply negative attitude towards trying to touch the lower back;
frequent urination;
complaints of dry mouth;
increased body temperature;
restlessness, behavior change;
tearfulness and irritability.

Inflammation of the kidneys can have the most negative consequences for babies. Due to an insufficiently well-formed system of metabolic processes in the body, the excretion of pathogenic substances and microbes in the urine is impaired. Intoxication in a child occurs much faster than in an adult: the development of acute symptoms occurs within a few hours from the moment the pathogen begins to multiply in the kidney tissue.

Causes

Most diseases of the excretory system are primarily associated with difficulties in the habitual excretion of urine from the body, as well as pyelonephritis.

Inflammatory processes in the genitourinary system can narrow the permeability of urine, resulting in scarring, as well as signs of pyelonephritis.
The presence of urolithiasis leads to various pain syndromes and obstructions.
Congenital pathologies that relate to the excretory system, intrauterine pathologies.
Weakened immunity due to chronic diseases, as well as after a serious illness, a lack of vitamins.
Infectious diseases.
The psycho-emotional state of a person is also important, constant stress, overwork lead to depletion of the body.

Identifying the main root causes of the disease is one of the first tasks of a doctor, only after that one can choose the optimal treatment.

Normally, the pelvic cavity is sterile - there are no microorganisms in it. The absence of microbes in the kidneys favors the reproduction of any bacteria here, since there is no antagonism inherent in microorganisms (as in the intestines, for example). Even conditionally pathogenic microflora entering the pelvis can lead to bacterial inflammation of the mucous membrane. The more dangerous is the introduction of pathogenic microorganisms into the renal cavity.

There are three possible routes for microorganisms to enter the pelvis:

retrograde from the underlying organs of the genitourinary system with reflux (reverse movement) of urine;
along the lymphatic vessels from the large intestine (with inflammation of the intestinal wall and other diseases);
through the blood with massive septic foci localized in other organs (joints, upper respiratory tract).

However, bacteria that have invaded the pelvis, even certainly pathogenic, do not always cause inflammation of the mucous membrane. With normal dynamics of urine outflow and active local immunity, a small number of bacteria have little chances to stay here and start reproducing. The likelihood of inflammation increases many times during stagnation of urine, when fluid drainage is impaired due to insufficient patency of the urinary ducts. What, in turn, can worsen the dynamics of urination? Usually, the reasons for this phenomenon are the following factors:

congenital anatomical abnormalities of the urinary system;
organic disorders of the ureters (narrowing) due to inflammation of the bladder or prostate;
obstruction of the entrance to the urinary duct by calculus with urolithiasis.

Congenital malformations of the anatomical structures responsible for urinary diversion lead to obstructive pyelonephritis already in childhood, often early (preschool period). Such conditions begin acutely and involve surgical interventions to restore the normal lumen of the ureters.

Two other factors (obstruction by a kidney stone or constriction (narrowing) of the duct due to its inflammation) are predominantly inherent in adult patients. Also, in adult patients, a violation of the outflow of urine can occur when the kidney is prolapsed, the ducts are compressed by tumors.

Like non-obstructive pyelonephritis, the disease is characterized by problems with urination, and obstruction occurs when:

congenital pathologies of the urinary tract - narrowness of the lumen of the ureter, deformation of the muscle layer of the walls;
calculi in the calyx-pelvis system, which block the lumen of the ureters and disrupt the outflow of urine;
inflammatory processes that provoked non-obstructive chronic pyelonephritis, as a result of which adhesions and narrowing of the lumen were formed;

These reasons provoke problems with urination, as a result of which urine ceases to be excreted normally and stagnates in the kidneys.

The provoking factors for pyelonephritis are diabetes mellitus, hypothermia, prolonged use of antibacterial drugs, and chronic infections in the body.

The causative agents of the disease are constantly present around a person and even in the body. For them to multiply, and inflammation occurs, the body must weaken and lose immunity.

Pathogens enter the kidney in the following ways:

The development of the disease is facilitated by violations of the outflow of urine from the kidney, reflux - the return of urine from the bladder. With a poor outflow, the pathogenic flora multiplies rapidly in the urine.

One of the provocateurs of pyelonephritis is urolithiasis, in which the parenchyma is damaged by stones and the flow of urine is disturbed.

The source of pyelonephritis is most often an infection caused by microorganisms. A decrease in the lumen of the ureter leads to serious consequences. The main causes and principles of treatment of obstructive pyelonephritis are well known. Both men and women suffer from such a violation of the urinary system. There are many reasons that provoke the development of pathology with urinary tract obstruction.

These include:

System anomalies;
Chronic urolithiasis;
Exacerbation of diseases during pregnancy;
Adenoma or prostate cancer in men;
Diabetes mellitus type 1 or 2;
Gout;
Severe hypothermia of the kidneys;
Long-term use of antibiotics;
Prolonged infectious diseases of other organ systems.

The inflammatory process in the kidneys is caused by bacteria, due to which various forms of pathology develop. The disease can develop when there are already lesions of the renal tissue, this condition is called secondary pyelonephritis.

In medical practice, the following types of inflammatory process are distinguished, which depends on the degree of changes:

Obstructive pyelonephritis is diagnosed when the outflow of urine is obstructed from the kidney canals.
Non-obstructive pyelonephritis - nothing interferes with the outflow of urine, the patency process is not disturbed.

The acute form has certain symptoms, the obstruction of the renal canals begins.
The chronic form is a long period during which relapses are possible, as well as the development of various kinds of pathologies.

The disease has various forms, as well as pathogens, which are sometimes difficult to diagnose. If there are warning signs, you should consult a doctor who will send you for a special diagnostic examination.

Obstructive pyelonephritis is much more common and can have various types and forms.

Doctors classify cases of obstructive pyelonephritis into two large groups:

acute obstructive pyelonephritis - occurs with primary obstruction of the urinary tract, the symptoms of the process are acute, proceeds rapidly, treatment requires urgent help;
chronic type of pathology - occurs after untreated acute pyelonephritis, the disease proceeds with characteristic periods of exacerbation and remission.

In addition to this division, classification according to the localization of the lesion in the kidneys, left-sided or right-sided pyelonephritis.

Pyelonephritis is classified after analyzes by the type of pathogen that caused it. This is necessary to determine an effective antibiotic.

Primary pyelonephritis develops when a healthy organ is infected. Secondary - caused by a pathology of the urinary organs, such as urolithiasis, ureteral stricture, or others. With an obstructive form, there are problems with the outflow of urine.

Inflammation can be serous (70% of cases) with thickening of the parenchyma or purulent with isolated foci.

Acute form

The acute form leads to a sharp rise in temperature with pain in the lumbar region, changes in the analyzes. There are signs of intoxication - nausea, headache, fever.

Chronic course

The chronic form of the disease occurs with untreated acute pyelonephritis. Pathogenic pathogens can be in a latent state, activating at an opportunity.

The most dangerous is bilateral pyelonephritis with damage to both kidneys. Untimely treatment leads to renal failure.

Inflammatory kidney disease is classified into several types. There are types of non-obstructive pyelonephritis. It is acute and chronic, and can also be associated with a reflex. Non-obstructive chronic pyelonephritis associated with reflux affects the structures surrounding the organ.

There are two main forms of obstructive pyelonephritis: acute and chronic.

In the development of acute or chronic obstructive pyelonephritis, the degree of obstruction plays an important role:

Relative obstruction. The outflow of urine is partially disturbed;
Absolute obstruction. The outflow is completely stopped;
Increasing obstruction. Gradual, progressive development of the obstacle.

Common types of obstruction are associated with the underlying cause. These include:

Stones;
Tumors;
Structural anomalies;
BPH;
Foreign bodies.

Acute and chronic pyelonephritis in children

In childhood, renal pathology is associated with congenital anatomical abnormalities: improper location of the bladder, ureter, kidneys. Subsequently, the child has problems with the outflow of urine, when it ends up in the kidney, bacteria are activated there.

Some babies have underdeveloped kidneys. What does it mean? The child grows, but the organ does not, and its function is disrupted. Rarely, pyelonephritis in children is provoked by altered intestinal flora - dysbiosis. Sometimes inflammation in the kidneys is a consequence of flu, tonsillitis, cystatitis.

As medical practice shows, doctors immediately notice problems in a child. Parents should pay attention to the following symptoms:

The temperature rises sharply to 40 degrees. At the same time, the child does not cough, his throat is not sore.
The kid is weak, refuses to eat.
The child is drinking but not going to the toilet, or you start to notice an increased urge to urinate.
The kid often wakes up at night.
The urine smells bad.
During urination, the child begins to scream, grunt, whimper.
The urine became suspiciously dark.
Stool problems, frequent regurgitation.

Parents, watch your children carefully!

Acute and chronic pyelonephritis in men

There are a lot of factors leading to the development of this renal pathology in the female. Most often it is cystitis. A woman may be predisposed to various pathologies of the genitals, genitourinary system. In some, pyelonephritis is provoked by anatomical features: the urethra is short, subsequently pathogenic microorganisms penetrate into the organ and an infection develops.

The causative agents of various forms of pyelonephritis in the female are pathogenic microorganisms. Most often, the disease is provoked by E. coli, as well as:

A woman, like no one else, is susceptible to various factors leading to pyelonephritis. Please note that most often the fair half is sick:

After hypothermia.
With sexually transmitted diseases.
After suffering nervous stress.
With weakened immunity, if uncontrollably takes antibacterial drugs.
In case of violation of urinary outflow.
After a strong fatigue.
With diabetes.
In case of problems with blood circulation in the kidneys, as well as in the case of impaired lymphatic outflow in the genitourinary system.

It is worth noting that female pyelonephritis can be accompanied by other pathologies. Before prescribing a course of therapy for a woman, the urologist must find out the cause of the disease.

What symptoms are typical for a woman?

The symptoms of the disease can be different. It all depends on how difficult the pathology is and in what form. Typically, a woman complains about:

Intolerable back pain.
Cramping abdominal pain.
High temperature.
Weakness, impossible to work normally.
Headaches.
Irritability, apathy.
Swelling of the limbs, face.

When the disease subsides a little, the woman feels better, only high blood pressure and weakness remain. And sometimes a woman suffers from general intoxication of the body - high temperature (39 - 40 degrees), frequent urination, burning sensation and pain in the urethra.

How dangerous is pyelonephritis for women?

If the disease is started, everything will end with a kidney abscess. In this case, a purulent inflammatory process is observed, while the symptoms are aggravated, a febrile condition is possible, and acute sensations in the lower back and abdomen. With an abscess, the level of leukocytes rises sharply. Apostematous nephritis and renal carbuncle are no less dangerous for a woman. The disease is extremely difficult, requires urgent surgery, otherwise everything will end in the death of the patient.

Pathology develops in the case of an impaired outflow of urine. This condition is provoked by:

Severe prostatitis.
Sand and kidney stones.
Adenoma of the prostate.

The listed pathologies are the primary causes of pyelonephritis. But there are other factors leading to the disease. For example, most often these are various disorders in the body that cause stagnation of urine, and bacteria begin to actively multiply in it, which gradually end up in the kidney tissue. Most often men suffer from pyelonephritis after 50 years. Their disease is associated with metabolic failure, diabetes mellitus.

What symptoms are typical for men?

Burning, pain in the urethra.
Urination becomes more frequent.
Urinary incontinence.
Aching, paroxysmal lower back pain.
Reduced performance, weakness.
High blood pressure.
Intoxication with symptoms such as muscle aches, fever, nausea and vomiting.

It should be noted that symptoms in men depend on the type of bacteria that affects the kidneys. Before treating a disease, doctors must determine the causative agent of pyelonephritis.

We draw your attention to the fact that the chronic form of pyelonephritis is initially invisible, while the man's urinary system function is inhibited. When the disease subsides, there are no symptoms at all, only sometimes the pressure rises.

Is it possible to prevent pyelonephritis in men?

First of all, it is necessary to timely treat diseases of the genitourinary system - prostate adenoma, prostatitis, urolithiasis. Elderly men should not forget to go to the urologist, it is important to dress warmly, to take care of their shoes in winter so that their feet do not freeze. Quite often, men repair their car by lying on cold ground.

Pyelonephritis during pregnancy

Many pregnant women cannot understand why they were not bothered by the kidneys before, and during this crucial period serious problems appeared. Gynecologists explain everything:

Hormonal disruptions in a pregnant woman. We draw your attention, by the 10th week, hormones begin to affect the function of the ureter, its tone is noticeably reduced. This condition is dangerous because infection progresses during pregnancy, stagnation occurs in the kidneys.
Dilation of the veins and uterus of the ovaries leads to stretching of the kidney, compression of the urinary tract.
The placenta actively produces estrogens, they create a favorable flora for the development of E. coli.

What are the symptoms of the expectant mother?

A pregnant woman should urgently go to the doctor if she has:

Shows temperature above 37 degrees on the thermometer.
Severe headache with chills worries.
The urine becomes cloudy.
There is pain during urination and in the lumbar region.
Nausea appears first, followed by vomiting.

We note that both forms are dangerous for a pregnant woman. In the case of acute pyelonephritis, a woman suffers from severe intoxication, this negatively affects the baby. The expectant mother's temperature rises, severe pain worries, leading to the tone of the uterus. If measures are not taken in a timely manner, the woman and the child may die.

Chronic pyelonephritis is no less dangerous for the expectant mother. The inflammation proceeds sluggishly, it can periodically worsen. Even with minor pain, a woman quickly gets tired and feels bad. Remember! Any inflammation negatively affects the intrauterine development of the child, so you need to be extremely careful.

Signs of pyelonephritis

It should be noted that this disease is typical for people of different ages. Most often it is diagnosed:

In small children with anatomical abnormalities.
In girls, women under 30 years of age who are just beginning to have sex or have undergone childbirth.
In older men who have prostate adenoma.

What determines the symptoms of pyelonephritis? First of all, on age, gender, as well as the form of the disease.

The main symptoms include:

Unbearable pain in the lumbar region. As a rule, it is aching, localized on one side, because most often one kidney is affected. Sometimes the pain can come from the opposite side, despite the inflammation of the other kidney.
Heaviness in the lower back, the appearance of a feeling of discomfort. The unpleasant sensations intensify during sports, physical activity, and also during brisk walking.
Feeling of coldness in the lumbar region. The patient is cold even in the heat.
Pain throughout the abdomen - this symptom is most typical for children.
Urination becomes more frequent, the patient has to frequent the toilet.
The temperature rises sharply in the evening to 39 degrees, although there are no other symptoms.
Blood pressure rises.
In the morning, a person suffers from weakness, reduced performance, weakness.
Severe headache worries.
The person suffers from increased irritability, apathy.
The face and limbs swell a little.

When the disease subsides, the general symptoms disappear, but the person suffers from high blood pressure and weakness. Symptoms of acute pyelonephritis are practically the same, only more pronounced and may be accompanied by general intoxication of the body, back pain, discomfort and burning sensation in the urethra. In the case of acute bilateral pyelonephritis, signs of renal failure appear. How can it all end?

Paranephritis (ulcers in the kidneys).
Kidney abscess.
Kidney carbuncles.
Necrosis of the papillae of the kidneys.

In all these situations, surgical intervention is indispensable.

Symptoms

All forms of the disease in the primary stages have similar symptoms, but over time, the symptoms worsen and become pronounced. Acute obstructive pyelonephritis is almost always manifested by renal colic. This condition is expressed by acute pain. This situation is associated with obstruction of the renal canals.

In addition to the acute form, the following symptoms are also distinguished:

back pain;
increased body temperature;
heavy sweating, fever;
heart palpitations;
vomiting, feeling unwell;
severe headaches.

Such signs are more characteristic of the acute stages of the disease; during the development of the pathology, pain in the muscles and lower back is possible. But it is worth considering the increase in symptoms, so a relapse can happen at any time.

Symptoms of the disease, only in the acute form, are pronounced, otherwise general malaise, weakness, aching pain in the muscles are possible.

Inflammatory pathology, one of the causes of which is a violation of the outflow of urine, first appears acutely, but under unfavorable conditions and not restored dynamics of urine diversion, it often turns into a chronic form with the occurrence of frequent relapses. Just like non-obstructive chronic pyelonephritis, the obstructive form of the disease during exacerbation manifests itself in the same symptoms as acute inflammation of the mucous membrane of the calyx-pelvic anatomical complex.

During the period of remission, chronic pyelonephritis practically does not manifest itself in any way, although a sluggish inflammation of the mucous membrane can occur during this period. The exacerbation of the disease, which can be triggered by a weakening of local immunity (hypothermia, stress), a sharp deterioration in urodynamics or the repeated introduction of infectious agents into the pelvic cavity, is manifested by the following symptoms:

severe, intolerable pain in the lower back from the inflamed kidney, often radiating to the lower abdomen, anterior femoral region, external organs of the genital area;
rise in body temperature to 39-40 degrees;
intoxication caused by the reabsorption of nitrogenous substances from insufficiently diverted urine on the one hand and released toxins due to the vital activity of bacteria on the other;
significant problems with urination - the physiological process is accompanied by a burning sensation and cutting.

The obstructive form of renal inflammation begins with pain, the intensity of which is constantly increasing and reaches a peak about a day after its onset. Intoxication and temperature appear on the second day and reach a maximum by 3-4 days of illness. This nature of the course of acute obstructive inflammation is explained by the overflow of the renal cavities with non-diverted urine, as a result of which the excretory organ expands.

The stretching membrane of the kidney irritates the pain receptors located here, which leads to the appearance of severe pain, the intensity of which directly depends on the degree of stretching of the organ. Pain syndrome with obstruction of the urinary ducts is difficult to relieve with antispasmodics and analgesics, even with their parenteral administration, which also suggests that the cause of pain is the stretching of the kidney by accumulated urine.

With renal colic, patients' temperature rises to 39-40˚С. The attack torments patients, they develop headaches, dry mouth, weakness, vomiting and nausea.

Feels chills, fever, and other signs of poor health. Blood pressure decreases, cold sweat appears.

This indicates the development of a formidable complication - bacteriostatic shock, which leads to acute renal failure, and in the absence of immediate qualified assistance, this condition is fatal.

The strength of the sensations increases with time, the work of the heart worsens, patients suffer from squeezing or tingling sensations behind the sternum.

The beginning pain becomes unbearable in a short time, and the condition is noticeably aggravated. Therefore, at the first signs of renal colic, immediately consult a doctor.

Urologists distinguish different signs of an acute form of pyelonephritis.

Common symptoms include:

Fever.
Chills.
Excessive sweating.
Thirst and dehydration.
Intoxication of the body - increased fatigue, headache, general malaise.
Dyspeptic symptoms - the appearance of diarrhea, decreased appetite, stomach ache, there may be vomiting.

Local symptoms include:

Low back pain, which is localized in the side of the affected kidney. It is dull, persistent, and may increase during movement, as well as touching.
Pasternatsky's symptom is positive - severe pain with slight tapping of the lower back.
Abdominal muscle tension.

Please note that when the infection affects the kidney, severe inflammation develops. Subsequently, an embolus, a blood clot becomes infected, a heart attack develops, accompanied by severe suppuration.

Often, before acute pyelonephritis, acute cystitis develops, accompanied by painful and frequent urination. Depending on the symptomatology, obstructive and non-obstructive acute pyelonephritis are distinguished.

Features of non-obstructive pyelonephritis

First, dysuria occurs, after 2 days the temperature rises, pain in the affected kidney worries, the patient shivers. After that, the person sweats a lot, his body temperature drops sharply, and during urination there is a feeling of discomfort.

Features of obstructive pyelonephritis

Most often, this type of disease appears in the case of large stones in the ureter, as well as with severe inflammation in the lymph nodes, genital cancer. First, there is a growing pain in the lower back, then the temperature rises, chills worried. Obstructive pyelonephritis is dangerous because it can develop:

Purulent process.
Urosepsis.
Pyonephrosis.
Toxic hepatitis.
Bacteriotoxic shock.
Paranephritis.

To prevent serious complications, it is necessary to consult with a urologist in a timely manner.

The main clinical signs include:

Aching pain in the lower back. Most often, unpleasant sensations are localized on the opposite side.
Feels heaviness in the lower back. The patient becomes worse if he stands for a long time, walks a lot.
The patient dresses warmly because he is very cold.
Disturbed by severe, cramping low back pain. In children, the kidney is located low, so they still have abdominal pains.
The temperature rises to 38 degrees. Most often in the evening.
Urination increases at night.
Blood pressure rises.
In the morning, one feels weakness, the state of health sharply worsens, the patient suffers from a headache, a bad mood.
Swelling of the face, hands, legs, feet.

We should also pay attention to non-laboratory symptoms:

Decreases hemoglobin.
Leukocytes increase in urine analysis.
Bacteriuria.
An increase in erythrocytes, especially if the cause of the disease is nephroptosis, urolithiasis.
A biochemical blood test shows a decrease in albumin. In the case of the development of renal failure, creatinine and urea are increased.

Do you have these symptoms? Do not delay the examination and therapy.

There are several types of non-obstructive pyelonephritis, it can be acute and chronic

Symptoms of chronic non-obstructive pyelonephritis occur periodically and are expressed:

Aching pain in the kidney area;
Increased body temperature;
Changes in the properties of urine;
Swelling;
Increased blood pressure.

It is important that a proper diet can help with pyelonephritis. With a certain diet, the disease may not even remind of itself.

Acute non-obstructive pyelonephritis is characterized by the following symptoms:

An increase in body temperature up to 39 degrees;
Chills;
Sweating;
Dehydration;
Severe headaches;
Pain in the lumbar region;
Frequent urge to urinate;
Often cramps when urinating.

Severe pain in the kidneys and during urination characterize an acute inflammatory process in the urinary system of the body.

The development of the obstructive process of the disease is slow, accompanied by damage to individual renal structures. Pathology clearly manifests itself if the tissues already have severe damage. It is important to recognize the symptoms and receive treatment in the early stages of the disease.

Chronic obstructive pyelonephritis manifests itself in periods of remission and exacerbation with the following symptom complex:

Renal colic;
Pain in the lumbar region, often more pronounced on one side;
Persistent temperature rise;
Intoxication;
Puffiness;
Dark circles under the eyes;
Unpleasant smell of sweat and from the mouth;
Sleep disturbance;
Constant feeling of thirst;
Decreased appetite;
Nausea;
Failure of the heart rate;
Weakness;
Losing weight without changing the diet;
Painful sensations when urinating.

Diagnosis of obstructive pyelonephritis

The urologist deals with general diagnostic examinations, as well as prescriptions and therapy. The first thing to do is to visit a doctor, during the examination he will make a preliminary diagnosis, which can be further confirmed or refuted.

The following research methods are also used:

general blood analysis;
general urine analysis;
biochemical laboratory blood test;
x-ray, computed tomography.

With the help of a comprehensive diagnosis, a diagnosis is made, and the root cause of the disease is determined. Based on the data obtained, optimal therapy is prescribed, which includes various principles of treatment, taking into account all individual characteristics. Accurate diagnostic results are the basis for any diagnosis. Therefore, it is important to properly follow all the doctor's prescriptions.

Diagnostics of pyelonephritis is a number of laboratory, instrumental techniques that are able to accurately determine the true condition of the patient.

The definition of a disease begins with the collection of anamnestic data and an assessment of subjective data from the patient's complaints. Already on the basis of a patient survey, preliminary conclusions can be drawn about the nature of the pathology. The primary conclusions are confirmed during laboratory tests and instrumental studies of the affected organ. In the laboratory conditions are carried out:

a general blood test, during which signs of inflammation are determined (increased ESR, leukocytosis);
biochemical blood test - an increase in the content of C-reactive protein and fibrinogen in the physiological fluid also indicates an active inflammatory process;
microscopy of urine determines a large number of leukocytes in the field of view, bacteria that caused the inflammatory process can be identified;
in order to determine the sensitivity of microbes to antibacterial drugs, sowing of microorganisms is done, followed by microbiological examination.

The most informative diagnostic instrumental methods are ultrasound of the kidneys, fluoroscopy with a contrast agent, computed tomography, during which the reasons for the violation of the outflow of urine (a stone in the ureter, a tumor compressing the duct, etc.) are determined. Also, these methods make it possible to determine the degree of urine stagnation and organ stretching, the state of the functional renal layer.

To make a diagnosis, the patient consults a nephrologist or urologist. At the very beginning, doctors interview the patient, are interested in the time of the onset of symptoms, the nature and duration of the pain attack.

In the future, the patient is referred to instrumental diagnostic methods that confirm or deny the initial diagnosis.

For this, the following tests are prescribed:

a general and biochemical blood test (the erythrocyte sedimentation rate, the number of leukocytes, the amount of fibrinogen and C-reactive protein are noted);
general urine analysis - the emphasis is on the content of leukocytes, which signals an inflammatory process in the kidneys;
urine analysis according to Zimnitsky;
bacterial culture of urine to determine the presence of bacteria and sensitivity to antibacterial drugs;
ultrasound diagnostics of the kidneys - visually sees the cause of obstruction: lumen, stricture;
x-ray with contrast agent - informative diagnostic methods;
retrograde cystourethrography - helps to determine non-obstructive chronic pyelonephritis associated with urine reflux;
magnetic resonance imaging and computed tomography - see the extrarenal causes that caused the pathology, tumors that compress the ureter and make it impossible for the normal flow of urine from the kidneys.

Diagnosis of acute non-obstructive kidney inflammation is usually straightforward. The symptoms of this disease are known. Abnormal blood and urine test results. Multiple white blood cells usually appear as a sign of an inflammatory process.

The diagnosis of obstructive urinary tract disease includes:

A detailed blood test;
Analysis of the composition of urine;
Blood chemistry;
Bacterial urine culture.

To determine a more accurate location of the obstruction focus, the intensity of the lesion, the state of the ureters, the following procedures are performed:

Ultrasound procedure;
X-ray (no contrast or contrast urography);
CT and MRI.

Urine analysis for pyelonephritis

To find out about the state of the body, as well as to assess the work of the kidneys, the doctor must prescribe a general urine test, which includes a study according to Nechiporenko and according to Zimnitsky. The last analysis needs to be collected all day, and according to Nechiporenko, urine is collected early in the morning.

How do I prepare for the analysis?

In order for the study to show a true result, it is important to adhere to these valuable recommendations:

Before the analysis, do not eat fruits, vegetables that affect the color of urine.
Don't take diuretics.
It is forbidden to donate urine during menstruation.
Remember to wash your hands before collecting the test..

With the help of a urine test, the doctor quickly diagnoses the disease. The analysis shows the level of leukocytes, the number of bacteria, the pH level. Let's understand the main indicators:

Erythrocytes (BLd)... When the rate rises, this indicates a serious renal pathology.
Bilirubin (Bil)... The appearance of bilirubin is the first signal of damage to liver cells; a serious inflammatory process with toxic effects develops in the body.
Urea (Uro) should not be elevated.
Ketones (KET)... The norm is the absence of KET. If substances appear in the urine, diabetes mellitus may be suspected.
Protein (PRO)should not be in urine.It appears when the kidney tissue is damaged, the development of an infectious disease.
Nitrite (NIT)... The norm is 0 nitrites, their appearance indicates a bacterial infection.
Glucose (GLU)... The presence of this indicator in the blood indicates diabetes, the development of thyrotoxicosis, pheochromacytoma.
Acidity (pH) an important indicator to which special attention is paid.
Density (S.G) ranges from 1.012 to 1.33 g / l. If the indicator is increased, then you have pyelonephritis. When the rate drops, kidney failure can be suspected.
Leukocytes are always a sign of an inflammatory process. The higher they are, the worse. A high rate is a signal of pyelonephritis, kidney stones.

The urologist pays attention to all of the above indicators. The color of urine is also taken into account, it may indicate a specific causative agent of the disease. It is worth noting that indicators often deviate from the norm due to age and other chronic diseases.

Methods for the treatment of obstructive inflammation of the renal cavities

restoration of primary functions;
the use of antibacterial agents;
treatment of the main symptoms;
surgical intervention as recommended by a doctor.

Each treatment is an integrated approach that will quickly remove pain and reduce overall symptoms. The first thing to do during therapy is to correct the normal flow of urine. By making this process easier, the patient will immediately feel much better. Drug treatment includes drugs that have a wide range of effects.

Surgical intervention is also one of the directions in the treatment of a pathological condition. It is assigned in case the situation is too neglected or when none of the methods gives a result. With the help of surgical intervention, the usual outflow of urine can be established.

Pyelonephritis is a diagnosis that often worries people. This disease concerns the excretory system, has vivid symptoms, as well as features in treatment.

Therapeutic measures for pyelonephritis caused by a violation of the normal outflow of urine are carried out only in a hospital setting - in the urological or surgical department. Therapeutic tactics involves the following effects:

conservative or surgical methods of restoring urinary outflow;
antibiotic therapy;
relief of the most severe symptoms accompanying the disease.

The main task of doctors is to restore the dynamics of urine diversion. Without the success of this event, the appointment of antibacterial agents does not bring a therapeutic effect. Even partial restoration of urinary outflow significantly eases the condition (pain decreases, temperature and degree of intoxication decrease).

Conservatively restore urine diversion by intravenous administration of strong antispasmodics (Baralgin, Platifillin). If relaxation of the ureter wall does not lead to positive dynamics within 2 days, surgical methods are used. Now, operations to restore the patency of the ureters are performed using minimally invasive methods (endoscopy, laparoscopy), which greatly improves the prognosis and shortens the rehabilitation period.

With obstructive pyelonephritis, medical care solves two problems:

They remove a bacterial infection, which will help achieve remission in pathology.
Restore the normal outflow of urine and eliminate those factors that interfered with the course.

To solve the first problem, the patient takes antibacterial drugs. Doctors prescribe to those patients who have acute non-obstructive pyelonephritis, but are also relevant for patients with obstruction.

In case of attacks, the patient is hospitalized, and the drugs are prescribed intravenously or intramuscularly in order to quickly stop the infection.

Antibacterial drugs for obstructive pyelonephritis are cephalosporins of the second and third generation, the penicillin group, fluoroquinolones.

The principle when choosing a drug for treating a patient is the sensitivity of the isolated pathogenic microflora to it as a result of urine analysis.

In addition to antibacterial drugs, pain relievers, anti-inflammatory drugs, uroseptics, medicines are prescribed to normalize body temperature.

When eliminating the cause of obstruction, they often resort to surgical intervention. This is due to the fact that congenital or acquired pathologies of the urinary tract cannot be eliminated by conservative methods.

Therefore, the only correct decision for the patient is to eliminate the cause promptly. In the presence of stones, lithotripsy is performed, and with narrowing of the ureter - plastic of the walls, elimination of the area with adhesions.

In the case of a serious condition of the patient, a nephrostomy is applied for urgent removal of urine from the body, and a catheterization of the bladder is performed. This will help eliminate swelling, relieve intrarenal pressure.

Prevention of obstructive pyelonephritis consists in the timely treatment of urological pathologies, elimination of foci of infection in the body. Upon detection of the first signs of pathology, a doctor's consultation is required.

With complications of the disease, renal failure can develop - the inability of the kidneys to cleanse the blood of toxins and metabolic products.

Loss of organ functions occurs in 5% of patients with poor-quality and untimely treatment.

Bacteriotoxic shock occurs when decay products from the kidneys pass into the blood. In the absence of a normal urine output, these substances remain in the body, poisoning it. This threatens the death of the patient.

If purulent contents enter the bloodstream, sepsis may develop - a common infectious lesion of the body transmitted through the blood.

According to some reports, Pope John Paul II died of sepsis caused by a kidney infection.

Taking medications

At the first symptoms, you should contact a urologist or nephrologist. If the examination confirms renal pathology, it is urgent to get rid of the main causative agent of the disease. You will have to drink uroseptics, antibiotics. What is the requirement for medicinal products? They should be minimally nephrotoxic, while effectively destroying pathogenic flora: staphylococcus, Pseudomonas aeruginosa, Proteus, E. coli, Klebsiella.

Detoxification of the body

To reduce high blood pressure, get rid of increased puffiness, you need to drink only clean water. It is allowed to use fruit drinks, juices. Do you have a high fever? Have symptoms of intoxication? Consume Citroglucosolan, Rehydron.

Phytotherapy

We draw your attention to the fact that really folk methods are effective, but in the event of an exacerbation of the pathology, one cannot experiment. It is best to use herbal remedies as a complementary treatment to antibiotics.

As a rule, herbal teas are drunk for a long time, and also for prophylactic purposes after the main treatment. It is best to do this in the fall and spring when the disease is worsening.

Prohibited! You can not take herbal preparations for hay fever.

We draw your attention to the following useful fees:

Recipe 1. Licorice (tablespoon) bearberry (3 tablespoons) the same amount of cornflower flowers. All herbs need to be poured with boiling water (200 ml). Wait half an hour, the medicine should be well infused.
Recipe 2. Prepare a tablespoon of birch leaves, corn stigmas, horsetail, wild rose. Then pour the mixture into boiling water (600 ml). Drink the medicine 500 ml at a time in the morning and evening.

Health resort treatment

Of no small importance for patients is a visit to a sanatorium, where they provide useful mineral water. The resorts in Obukhovo, Truskavets, Karlovy Vary, etc. have proven themselves well. Which balneological resort to choose? It all depends on where you live, as well as your finances.

It is necessary to treat chronic pyelonephritis in a complex manner. The choice of treatment will depend on the stage, form and severity of the pathology. The decisive importance will be the data on the degree of disturbance of the process of urine outflow and the state of the second kidney.

The asymptomatic development of obstructive pyelonephritis often leads to untimely seeking of qualified medical help.

In the acute stage of the disease, the patient must necessarily be hospitalized. Often, treatment of acute non-obstructive and acute complicated obstructive pyelonephritis is carried out with antibiotics and drugs that restore urine flow.

Sometimes a drainage tube is installed. In case of severe dysfunction, one cannot do without an apparatus that will maintain a normal blood composition. Non-steroidal anti-inflammatory drugs, analgesics, antispasmodic medications help to relieve symptoms. After antibiotic therapy, probiotics are prescribed, to maintain immunity and restore the body after an illness - vitamin and mineral complexes.

Appropriate treatment of obstructive pyelonephritis and rehabilitation therapy are carried out only under the supervision of a specialist. Treatment is prescribed by a doctor. As a radical method of treatment, surgery is used to improve the patency of the ureters.

During the recovery period and for the prevention of the disease, physiotherapy and immunostimulation are used to increase the body's defenses.

You can get rid of the inflammatory process in the kidneys with timely examination and treatment, as well as adherence to an appropriate diet and a healthy lifestyle.

Antibiotics for pyelonephritis

Have you checked for sensitivity? The doctor will select antibiotics for treatment:

Penicillin (Azlocillin, Amoxicillin, Carbenicillin). This group has minimal nephrotoxicity, while helping to destroy various types of bacteria.
Cephalosporins (Cedex, Suprax) of the second and third generation is used as an injection, therefore, they are most often prescribed in stationary conditions.
Fluoroquinolones (Norfloxacin, Ofloxacin, Levofloxacin) are used in urology. Despite the fact that antibiotics are not toxic, they are prohibited from use on children, during lactation and pregnancy. They have such a side effect as photosensitivity. Do not sunbathe in the sun after taking medications.
Sulfanilamide antibiotics (Biseptol) are used to treat infections of a different nature. But there is a problem: most of the bacteria are insensitive to this type of drug.
Nitrofurans (Furamag, Furadonin) is an effective remedy for the treatment of pyelonephritis, but they have many side effects: bitterness in the mouth worries, begins to feel sick, after which vomiting appears.
Oxyquinolines (5-NOC). As a rule, the patient tolerates the drug well, but it is not always effective.

How much antibiotics should you drink?

Be sure to take two weeks of therapy. If complaints persist for a long time, urine changes, then you need to take antibiotics for another month. Do not treat yourself. Antibiotics can only be prescribed by the attending physician.

If pyelonephritis is not treated - the consequences

Inflammation in the kidney develops very quickly. With an untimely start of treatment, the hope of being cured by alternative methods and ignoring the intake of antibiotics, the following complications may develop:

transfer of infection to the second kidney;
necrosis of the renal papillae - the spread of inflammation to other parts of the organ;
transition to the emphysematous form;
the release of inflammation outside the kidney - paranephritis;
carbuncle of the kidney - small purulent foci, connected by a common membrane;
bacteriotoxic shock - poisoning of the body as a result of a large number of toxins in the blood and not excreted by the kidneys.

The functional part of the organ loses its capabilities, a scar remains at the site of the infection focus. Working cells are replaced by connective tissue.

This leads to disruption of the functioning of the organ. With damage to both kidneys, the body loses its ability to filter and remove decay products, and renal failure develops.

For women

In women, pyelonephritis often develops as a result of inflammation in the genitals. This happens with an active sex life and lack of proper hygiene.

The disease is provoked by thrush, chlamydia, vulvar inflammation. These pathologies even have common symptoms - the localization of pain and problems with urination.

Therefore, you cannot treat these diseases on your own, guided by the advice of friends and the Internet. A timely visit to a doctor will help diagnose pyelonephritis in time.

During pregnancy, the initial manifestations of pyelonephritis can be mistaken for toxicosis. Women show signs of intoxication:

nausea and vomiting;
dizziness, weakness;
pain in the lumbar region;
loss of appetite.

In the early stages, pyelonephritis threatens with miscarriage. Pregnant women need to control the temperature in the presence of such symptoms. Its increase may indicate the onset of an inflammatory process in the kidneys.

With the rapid progression of the disease and the purulent nature of inflammation, especially with damage to both kidneys, intrauterine infection, fetal hypoxia and stillbirth are possible.

Menace to men

Untimely treatment of prostatitis is especially dangerous for men. An enlarged prostate gland deforms the ureter, disrupting the normal flow of urine.

Its stagnation develops, which leads to an increase in the risk of infection.

Men’s tendency to eat meat, smoke and drink increases the risk of developing kidney stones and inflammation.

Risks to Children

When examining children with pyelonephritis, inflammatory processes in other organs are almost always found, which are of a protracted nature. These are sinusitis, tonsillitis, caries.

In children, the purulent form of the disease and the transition of inflammation to a chronic one are especially dangerous.

For fear of dysbiosis and allergic reactions, parents sometimes do not take a full course of antibiotics and supportive therapy.

This threatens with incomplete suppression of the infectious focus, the transition of the disease into a recurrent form.

After suffering pyelonephritis, children for 3 years are registered with a pediatrician or nephrologist with test control. Sports are prohibited for a year.

Pyelonephritis affects several leading functions of the body at once: even with a mild course, the disease has some negative consequences that will need to be treated.

Timely access to a nephrologist and hospitalization for a course of therapy will help minimize the risk of comorbidities.

Acute pyelonephritis has a sudden onset: it may be preceded by recent hypothermia or a previous infectious disease. Unfortunately, the acute process does not pass without leaving a trace for the body: it can cause multiple changes in the renal tissue and neighboring organs, which may manifest themselves in the distant future.

The main consequences of acute pathology:

Formation of abscesses. Due to the transition of purulent-inflammatory changes to the kidney capsule and surrounding tissues, a cavity delimited by the capsule can form in the retroperitoneal space, inside which there is pus. Kidney abscesses are removed in the Department of Purulent Surgery.
Formation of phlegmon of the retroperitoneal space. With the breakthrough of an abscess and the further spread of pus, the development of melting of the surrounding tissues is possible. Phlegmon is a diffuse accumulation of pus in tissues, which can affect several areas of the abdominal cavity and retroperitoneal space at once.
Acute renal failure. When there is a massive death of kidney cells, the body becomes unable to excrete waste products in the urine. If you do not provide first aid for this pathology in time, the patient will end up on lifelong hemodialysis.
Uremic coma is end-stage renal disease. Due to the accumulation of toxins in the body, paralysis of the central and peripheral nervous systems occurs, as well as oppression of consciousness and reflex activity.

Chronic pyelonephritis occurs against the background of inadequate therapy for an acute inflammatory process. It is characterized by a wave-like course, in which exacerbation processes are replaced by remission. The more often an exacerbation of the disease occurs, the more severe it has. Chronic pyelonephritis can last for many years, gradually destroying kidney tissue.

The consequences of a long course of the disease:

Sclerosis of the renal vessels and nerves. The connective tissue, gradually growing, causes compression of the neurovascular bundles, which enhances ischemic processes in the affected organ and can cause its premature wrinkling.
Inflammatory process in the renal pedicle. Gradually, microorganisms move from the area of \u200b\u200bthe renal tissue to the area of \u200b\u200bthe renal pedicle, which includes the ureter, blood and lymphatic vessels, and nerves.
Necrotic changes in the renal capsule. With a long-term process of inflammation, a capsule is involved in it: it covers the surface of the kidney from all sides and, with an increase in the size of the organ, it can get tears, which then begin to necrotize.

The most important thing in the treatment of pyelonephritis is to prevent the transition of an acute disease to a chronic one. It is necessary to consult a specialist in a timely manner and avoid heavy physical exertion, work in hazardous industries, hypothermia and stress. While maintaining your immunity normally, you can not be afraid of complications.

Pyelonephritis is dangerous not only for its primary manifestations, but also for possible complications that may accompany the inflammatory process. In severe cases, the risk of their occurrence increases threefold. The main complications caused by pyelonephritis traditionally include urolithiasis, cyst formation, chronic renal failure, and a shriveled kidney.

There are many factors that affect the possibility of secondary pathological processes in the altered kidney:

secondary and primary immunodeficiency;
reduced resistance to the action of environmental factors;
genetic predisposition to the formation of pathologies of the urogenital tract;
anomalies in the development of the genitourinary system;
recently transferred infectious diseases;
the presence of oncology;
recent chemotherapy.

Urolithiasis disease

Stone formation is a pathological process that can occur both directly in the calyx-pelvic system of the kidney, and in the underlying structures. Pyelonephritis and urolithiasis have a direct connection with each other. Due to the inflammatory and destructive changes in the kidney parenchyma, favorable conditions for the formation of calculi develop.

frequent hypothermia;
eating too salty, fried and fatty foods;
taking some antibiotics;
hereditary disposition to diseases of the urogenital tract.

The size of stones can range from a few millimeters to ten centimeters or more in diameter. The clinical picture is characterized by the appearance of renal colic - this is an acute, unbearable pain in the lower back, which forces the patient to take a forced position. It is not possible to stop the attack on its own. Colic is caused by a spasm of smooth muscles, which occurs in response to an irritating factor - a stone.

Treatment is carried out in several ways at once: stones can be removed using ultrasonic crushing, removed through the bladder, or eliminated by laparoscopic surgery. Conservative therapy provides for various physiotherapy procedures, taking medications that prevent further stone formation, as well as adherence to diet and physical activity.

The formation of a shriveled kidney is one of the most unfavorable outcomes of the terminal stage of pyelonephritis. The pathological inflammatory process ends with a stage of scarring, in which the functioning renal nephrons are replaced by connective tissue. It cannot perform the basic functions of the glomeruli - filtration and reabsorption. The kidney itself is significantly reduced in size, which can be detected by physical or instrumental examination.

Treatment and prevention

The preventive measures that prevent the violation of the outflow of urine is the timely recognition and elimination of the causes leading to blockage of the ureters, therefore, the prevention of obstructive inflammation can be considered adequate treatment of such diseases:

urolithiasis disease;
prostatitis and prostate adenoma;
tumors of the genitourinary organs and adjacent anatomical structures.

It is more difficult to identify congenital anomalies in the development of the urinary ducts, especially if they only partially disturb urodynamics. As a rule, such pathological changes in the normal anatomy of the ureters are detected after the occurrence of obstructive pyelonephritis, which in the overwhelming majority of cases occurs in childhood.

Recovery Predictions

Timely initiation of treatment guarantees recovery. Usually, improvement after starting antibiotics is observed after 2-3 days.

In the future, dispensary observation and preventive maintenance courses of antibiotics for 6 months are shown. For 2 years, control tests and doctor's visits are needed. Only then can we consider that complete recovery has come.

Diet for pyelonephritis

Nutrition is also important in the treatment of kidney disease. The diet should contain foods that are well absorbed. Also, the menu needs to include vitamins, trace elements. How many calories are allowed for pyelonephritis? The daily menu should consist of 3200 kcal per day.

Prohibited foods

Hot seasonings, spices.
Canned food.
Rich meat broth.
Coffee.
Alcohol.

Melons - melons, watermelons, zucchini, pumpkin.
Vegetables.
Juices.
Fruit.
Compotes.
Products containing protein - kefir, yogurt, milk, egg white.
Lean meat - veal, beef, chicken.
Lean fish.

For the first, it is imperative to use only a vegetarian dish.
With an exacerbation of the disease, you must not forget to drink (2 liters). This way, the infection will not linger in the kidneys, and you will also prevent the appearance of stones. Are you swollen? The amount of water must be reduced.
Only steam food.
It is allowed to salt food quite a bit. Are you suffering from high blood pressure? Reduce the amount of salt to 3 grams.
If pyelonephritis has worsened, you will have to forget about fatty meat and other animal fats. You can add butter (15 grams) to the diet, as well as vegetable fats.
The liquid must be drunk in small sips. Drinking a lot of water at once will damage your kidneys.
Gradually, the diet needs to be expanded. At first, small amounts of garlic, onions, and other spices are allowed. But coffee, alcohol, carbonated drinks are prohibited.
Follow your drinking regimen. Cranberry juice is especially valuable. Take a glass of fruit drink, add methionine (0.5 grams). With the help of fruit drink, you can improve the production of hippuric acid in the liver, which is one of the best bacteriostatic agents.
Drink herbal anti-inflammatory, diuretic tea. We recommend changing the herbal failure every 2 weeks. Use blueberry leaves, licorice root, white willow bark, nettle, St. John's wort, birch leaves.

Special meals

Pyelonephritis anemia. Renal disease is often accompanied by anemia. Eat foods containing cobalt, iron: pomegranate, strawberries, apples.
Uremic syndrome. Eat foods that reduce intoxication, get rid of slagging: sorbents, herbal decoctions, a large amount of fiber - vegetables, fruits. It is worth reducing the amount of protein (consume no more than 25 grams).
Allergy pyelonephritis... Please note that an allergic reaction often leads to severe inflammation in the kidneys. Therefore, it is so important to cross all allergens from your menu.
glomerulonephritis... During an exacerbation of the disease, it is necessary to reduce the amount of water, abandon salt.

How important is diet?

With healthy nutrition, you can:

Facilitate renal function.
Reduce the load on the urinary organs.
Facilitate the course of the disease.
Recover faster.
Remove excess water from the body. So you will not only perfectly flush the urinary tract, but also quickly get rid of edema.
Normalize water and electrolyte balance, pressure, prevent complications.
Improve the body's work, enrich it with vitamins.
Strengthen immunity.
Get rid of pathogenic microflora.

What happens if you don't follow a diet?

Do you continue to use unhealthy foods? Everything can end with urolithiasis, paranephritis, abscess, carbuncles, bacteriotoxic shock, renal failure, sepsis.

Pyelonephritis menu

Monday

In the morning, consume barley fresh cucumber chicory drink.
Dine on a lean borscht. For the second, you can eat boiled potatoes, lean fish, drink weak tea.
Dine on boiled beets with rice porridge.

We have breakfast with buckwheat porridge with fresh tomatoes, drink compote.
We have lunch with lean soup, wheat porridge with boiled beef, and tea.
We have dinner with oatmeal with berries

For breakfast: semolina porridge with vegetable salad and chicory drink.
For lunch: vegetarian borscht, boiled tuna potatoes. You need to drink jelly.
Dinner: barley porridge juice.

We have breakfast with cottage cheese with the addition of berries.
We have lunch with lean soup, milk porridge, drinking compote is best.
We dine with meat pudding, wash down with jelly.

We have breakfast with buckwheat with fresh vegetables and tea.
For lunch: vegetarian wheat porridge soup with boiled beef rosehip broth.
For dinner: steamed omelet with stewed vegetables.

We have breakfast with barley with cauliflower tea.
We dine with borsch, rice porridge with apples, boiled fish compote.
We have supper with cottage cheese, we drink juice.

Sunday

For breakfast: pearl barley with tomatoes, a drink with chicory and milk.
For lunch: light soup boiled potatoes steam meatballs rosehip broth.
Dinner: oatmeal with fruit.

Principles of nutrition for acute pyelonephritis

For the first two days, you need to adhere to a fruit-sugar diet, drink at least 2 liters of water. Then include melons in the diet. On days 3-4, you need to adhere to a dairy-plant diet.

Features of nutrition for chronic pyelonephritis

The therapeutic diet includes the intake of boiled, stewed and baked vegetables. It is very useful to include milk in your diet, it has a diuretic effect. It is important that the menu contains fermented milk products, a low-fat type of meat.

Diet for pregnant women

We draw your attention to the fact that many medications are absolutely contraindicated for the treatment of kidneys, therefore it is so important to follow the diet. A pregnant woman needs to be deleted from her menu: fried, spicy, fatty, salty. Diversify your diet with vegetables, fruits. Remember to drink as much as possible. We recommend including prunes and beets in the menu.

Note! Useful recipes

Pumpkin soup

Prepare 300 grams of potatoes, pumpkin, onions, carrots. Cut everything into small pieces. Boil 2 liters of water, then add vegetables. When done, grind the soup in a blender.

Vegetable cutlets

Take cauliflower (700 grams) milk (500 ml) semolina (tablespoon) butter (tablespoon) some bread crumbs. The cabbage is chopped, mixed with milk, then semolina and an egg are added. After that, you need to form the cutlets and stew.

Rice and apple casserole

Prepare 3 apples rice (2 cups) butter (2 tablespoons) sugar (half a cup) sour cream (200 grams). First, boil the rice, add butter and an egg to it. After that, you need to peel the apples, add sugar, a little cinnamon to them. Grease the pan with butter, add some rice, add apples, top with the rest of the rice. Cook everything in the oven for about half an hour.

If you believe the reviews, without a diet, drug treatment is not effective. Therefore, it is so important to adhere to basic nutritional principles for kidney disease.

To summarize, pyelonephritis is one of the most serious and common kidney diseases that you shouldn't mess with. Are you often concerned about low back pain? Having trouble urinating? Are you worried about the burning sensation? Have previously had kidney problems? Go to a urologist urgently, have a urine, blood test, and do not delay treatment.

Obstructive pyelonephritis (ICD code 10 - N11.1) is a serious infectious kidney disease, provoked by impaired urine flow. This factor mainly distinguishes it from the non-obstructive course of the disease (ICD code 10 - N11.0).

These two types of disease have characteristic differences.

Sign	Obstructive pyelonephritis	Non-obstructive pyelonephritis
Impaired urine outflow	there is	Not
Formation of stones in the kidney	Often. Sometimes the disease itself is due to the formation of stones.	Seldom. Possibly in case of prolonged latent course of the disease
The nature of the fever	A sharp rise in temperature to critical values. Poorly or not at all confused with antipyretic drugs	A slow rise in temperature to critical values \u200b\u200bwith episodes of lowering without taking antipyretics
Pain sensations	Renal colic, very severe sharp pains	Pressing or dull aching pain in the lower back, radiating to the abdomen
Formation of purulent infiltrates	A common complication of the course of the disease	Almost never occurs
Etiology	The disease is secondary. The main reason lies either in congenital anomalies in the structure of the urinary tract, or in the long course of a chronic inflammatory process or urolithiasis	The disease is primary in nature, occurs when pathogenic microorganisms enter the tissue and mucous membranes of the kidneys.
Surgical intervention	Required often. Defects that disturb the outflow of urine, stones are eliminated in an operative way. Sometimes a nephrostomy is needed to preserve kidney function	No surgery required

Both obstructive and non-obstructive pyelonephritis can occur with ascending (from the bladder and urethra) and descending (with blood flow) infection of kidney tissue with pathogens, but with the first type of disease it is characterized by severe congestion and destruction of renal tissue.

Stages

Stages of development of non-obstructive pyelonephritis:

Acute infectious inflammatory process, characterized by fever, pain syndrome.
A chronic process that may be asymptomatic. At this stage, changes occur in the renal calyx-pelvic system, scarring and hardening of tissues is possible, after which we will talk about obstructive pyelonephritis.

The stages of obstructive pyelonephritis are distinguished according to the degree of kidney damage:

The inflammatory process proceeds evenly throughout the kidney, its swelling is observed.
Stagnant inflammatory foci aggravate the obstruction process, abscesses, carbuncles are formed, pathological changes occur in the calyx-pelvis system, kidney wrinkling, and necrotic processes.

Diagnostic methods

To make the correct diagnosis in both cases, the patient must pass a clinical blood test and a general urine test, and undergo an ultrasound examination of the kidneys. If ultrasound and laboratory tests show the presence of an obstructive-stagnant process, the patient may be prescribed CT or contrast urography and cystography to determine the location of the urinary outflow disorder and its cause.

Therapy

Treatment of non-obstructive pyelonephritis is carried out exclusively with medication. The patient is prescribed an antibiotic to which the pathogens that caused the inflammation are sensitive. To alleviate the condition during treatment and further prophylaxis, the patient must follow a diet and drinking regimen.

If an obstructive process is detected, antibiotic therapy is prescribed to begin with to eliminate acute inflammation. Then the patient is selected uroseptics or bacteriostatic drugs to prevent relapse. The doctor determines the location and nature of the obstruction and then decides on the need for surgical intervention. For example, obstructive pyelonephritis, which occurs during pregnancy, simply requires drug support before delivery, calculi from the kidneys can be removed by hardware, but congenital anomalies require surgery to eliminate them.

Possible complications

The main danger in non-obstructive pyelonephritis is its transition into a chronic asymptomatic process with scarring of the renal tissues or into obstructive pyelonephritis.

Serious complications in the obstructive course of the disease are:

Development of reflux nephropathy and secondary kidney wrinkling.
The emergence of focal purulent processes (abscess, carbuncle, tissue necrosis).
Sepsis and bacteriotoxic shock.
Development of acute renal failure and organ loss.

Forecast

The sooner the disease is diagnosed, the more favorable the prognosis. With non-obstructive pyelonephritis, a complete cure can be achieved a maximum of two weeks after the start of therapy. Obstructive pyelonephritis requires a more serious diagnosis and careful treatment of the main cause of the difficulty in the functioning of the kidney. Thanks to modern minimally invasive technologies for operations on the kidneys and ureters, the patient will also soon fully recover.

Pyelonephritis is a non-specific inflammatory kidney disease. There are two main forms of it: obstructive and non-obstructive. An ailment occurs against the background of other disorders, for example, with urolithiasis or bacterial infection. Obstructive pyelonephritis is characterized by a deterioration in the outflow of urine through the urinary tract. In the chronic course of the pathology, the functioning of the kidney is severely impaired, the risk of renal failure is high.

Obstructive pyelonephritis

Inflammation of the renal structures rarely develops on its own, more often it is a "background" condition that occurs with bacterial infections in the excretory system, urolithiasis, impaired protein metabolism and other pathologies. In non-obstructive pyelonephritis, the normal outflow of urine from the renal pelvis and ureters is preserved, and in the obstructive form, it is impaired.

Obstructive pyelonephritis develops slowly, affecting individual renal structures, so the disease is difficult to recognize immediately.

Impaired urine flow occurs when inflammation of the kidney tissue is so severe that it causes a narrowing or spasm of the ureters.

It is important to understand that inflammation of the renal structures is not always caused by infectious diseases. For example, non-obstructive chronic pyelonephritis associated with reflux is formed due to pathologies in the development of the excretory system, and the course of chronic obstructive pyelonephritis is one of the complications of urolithiasis.

Forms of obstructive pyelonephritis

There are two main forms of obstructive pyelonephritis: acute and chronic. The first is characterized by the rapid development of obstruction - obstruction of the urinary tract against the background of acute infectious inflammation or under the influence of other factors.

The chronic form differs from the acute one in that it combines periods of recurrence of the inflammatory process with remission, during which the patient's excretory system begins to function normally.

Causes of obstructive pyelonephritis

There are many reasons provoking the development of pyelonephritis with urinary tract obstruction:

congenital or acquired as a result of trauma or previous diseases, anomalies of the urinary system;
advanced urolithiasis, when large deposits are formed that can clog the renal tubules;
exacerbation of pathologies of the excretory system during pregnancy, when the load on the kidneys and ureters increases;
adenoma or prostate cancer in men;
severe hypothermia of the kidneys, followed by the addition of a bacterial infection or the death of organ tissues;
type 1 or type 2 diabetes mellitus;
gout;
long-term use of antibiotics;
protracted infectious diseases of other organ systems.

The exact cause of this ailment should be established by a nephrologist after hardware diagnostics and laboratory tests. It is important to prescribe the correct therapy.

Obstructive pyelonephritis symptoms

Symptoms of obstruction with inflammation of the kidneys do not appear immediately, the disease gives itself out at the moment when the tissues are already severely damaged. The patient is tormented by the following symptom complex:

renal colic;
pain in the lumbar region (sometimes the patient clearly feels discomfort on one side);
persistent with chills;
intoxication of the body, which is manifested by puffiness, dark circles localized under the eyes, yellowing or reddening of the sclera, unpleasant odor of sweat and from the mouth;
frequent headaches, sleep disturbances (insomnia or constant sleepiness);
constant feeling of thirst;
decreased appetite, nausea;
disruptions in heart rate, decreased endurance with physical activity;
weakness;
losing weight without changing the diet;
painful sensations when urinating in the lumbar region.

Individual symptoms associated with the patient's initial physical health prior to the development of obstructive pyelonephritis may occur. The appearance of signs of the disease is influenced by concomitant pathologies of the kidneys and other organs.

Acute obstructive pyelonephritis is more pronounced than the chronic or non-acute form. The patient experiences severe back pain, the temperature rises to 40 degrees, due to severe intoxication, vomiting, upset stool and loss of consciousness, sweating are possible. Urination is very difficult. Most often, this type of inflammatory process is associated with kidney damage with a severe infection of a bacterial or viral nature.

Diagnosis of obstructive pyelonephritis

The diagnosis of obstructive pyelonephritis should be started at the appearance of its first signs in order to minimize the negative effects for the patient. This pathology is dangerous for its complications. The most important laboratory tests are:

a detailed blood test (counting immune and other blood cells) to confirm the inflammatory process in the body;
analysis of the composition of urine;
blood biochemistry;
bacterial culture of urine (allows you to detect the causative agent of the infection if it has become the cause of pyelonephritis, and also to track the presence of antibiotic resistance in this pathogen).

Instrumental methods will help to more accurately determine the location of the focus of obstructive pyelonephritis, the intensity of the lesion, the state of the ureters. These include the following procedures:

Ultrasound of the pelvic organs;
x-ray examination of the kidneys (without contrast or contrast urography);
CT and MRI.

The complex of these procedures will help the doctor to accurately diagnose, determine the location of the inflammation focus, find the cause of the pathology and choose the treatment. It is important to remember that you cannot try to get rid of this disease on your own - you can only aggravate the situation. No herbs or products will help eliminate, for example, an infection, and a blurred clinical picture will interfere with a correct diagnosis.

Treatment of obstructive pyelonephritis

Obstructive pyelonephritis is a reason for hospitalization of the patient. Often, treatment requires a course of antibacterial drugs, medications that restore the outflow of urine. Sometimes it is necessary to install a drainage tube; in severe cases, you cannot do without a device that maintains a normal blood composition if the functioning of the kidneys is severely impaired.

In addition to drugs that fight the cause of the disease, the therapeutic complex includes drugs that relieve symptoms - it gives the patient a lot of discomfort. These drugs include non-steroidal anti-inflammatory drugs, analgesics, antispasmodics, prebiotics in case of taking antibiotics, as well as vitamin and mineral complexes.

In addition to medical and apparatus therapy, it is important to give the patient complete rest. Bed rest and refusal from heavy physical activity are required. you also need to adjust, give preference to light food, completely eliminate any drinks containing sugar and caffeine, reduce salt, fat and protein intake.

The development of obstructive pyelonephritis may be asymptomatic. This disease slowly affects the kidneys, disrupting their function and the flow of urine through the ureters. The causes of pyelonephritis are varied, therefore, before the appointment of therapy, the patient should be examined. The earlier the therapy begins, the less the likelihood of complications, so you should not self-medicate, it is better to immediately consult a doctor.

Obstructive secondary pyelonephritis, as well as non-obstructive pyelonephritis, can develop in childhood and in adults. What is it and how to treat it? Obstructive pyelonephritis is an infectious kidney disease that occurs as a result of impaired urine flow. A type of inflammation of the kidney tissue is non-obstructive pyelonephritis. With non-obstructive pyelonephritis, the normal outflow of urine from the renal pelvis and ureters remains. This disease is very common and well studied.

The most susceptible to diseases are people with weakened immunity.

There are several types of non-obstructive pyelonephritis, it can be acute and chronic

Symptoms of chronic non-obstructive pyelonephritis occur periodically and are expressed:

Aching pain in the kidney area;
Increased body temperature;
Changes in the properties of urine;
Swelling;
Increased blood pressure.

It is important that a proper diet can help with pyelonephritis. With a certain diet, the disease may not even remind of itself.

Acute non-obstructive pyelonephritis is characterized by the following symptoms:

An increase in body temperature up to 39 degrees;
Chills;
Sweating;
Dehydration;
Severe headaches;
Pain in the lumbar region;
Frequent urge to urinate;
Often cramps when urinating.

Severe pain in the kidneys and during urination characterize an acute inflammatory process in the urinary system of the body.

Chronic obstructive pyelonephritis manifests itself in periods of remission and exacerbation with the following symptom complex:

Renal colic;
Pain in the lumbar region, often more pronounced on one side;
Persistent temperature rise;
Intoxication;
Puffiness;
Dark circles under the eyes;
Unpleasant smell of sweat and from the mouth;
Sleep disturbance;
Constant feeling of thirst;
Decreased appetite;
Nausea;
Failure of the heart rate;
Weakness;
Losing weight without changing the diet;
Painful sensations when urinating.

Acute obstructive pyelonephritis is manifested by the occurrence of severe pain syndrome. In such a situation, you must immediately seek medical help.

System anomalies;
Chronic urolithiasis;
Exacerbation of diseases during pregnancy;
Adenoma or prostate cancer in men;
Diabetes mellitus type 1 or 2;
Gout;
Severe hypothermia of the kidneys;
Long-term use of antibiotics;
Prolonged infectious diseases of other organ systems.

The exact causes of the obstructive process are established by a nephrologist.

There are two main forms of obstructive pyelonephritis: acute and chronic.

In the development of acute or chronic obstructive pyelonephritis, the degree of obstruction plays an important role:

Relative obstruction. The outflow of urine is partially disturbed;
Absolute obstruction. The outflow is completely stopped;
Increasing obstruction. Gradual, progressive development of the obstacle.

Common types of obstruction are associated with the underlying cause. These include:

Stones;
Tumors;
Structural anomalies;
BPH;
Foreign bodies.

Diagnosis of acute non-obstructive kidney inflammation is usually straightforward. The symptoms of this disease are known. Abnormal blood and urine test results. Multiple white blood cells usually appear as a sign of an inflammatory process.

The diagnosis of obstructive urinary tract disease includes:

A detailed blood test;
Analysis of the composition of urine;
Blood chemistry;
Bacterial urine culture.

To determine a more accurate location of the obstruction focus, the intensity of the lesion, the state of the ureters, the following procedures are performed:

Ultrasound procedure;
X-ray (no contrast or contrast urography);
CT and MRI.

The results of the examination will guide the doctor towards the correct diagnosis.

The asymptomatic development of obstructive pyelonephritis often leads to untimely seeking of qualified medical help.

Sometimes a drainage tube is installed. In case of severe dysfunction, one cannot do without an apparatus that will maintain a normal blood composition. Non-steroidal anti-inflammatory drugs, analgesics, antispasmodic medications help to relieve symptoms. After antibiotic therapy, probiotics are prescribed, to maintain immunity and restore the body after an illness - vitamin and mineral complexes.

It is important to provide the patient with complete rest. Necessarily - bed rest and refusal of heavy physical activity. When adjusting the diet, you need to give preference to light food, exclude sugar, caffeine, reduce the intake of salt, fat and protein.

In most cases, the method of traditional medicine - herbal treatment is excellent for the treatment of renal pathology.

During the recovery period and for the prevention of the disease, physiotherapy and immunostimulation are used to increase the body's defenses.

You can get rid of the inflammatory process in the kidneys with timely examination and treatment, as well as adherence to an appropriate diet and a healthy lifestyle.

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Non-obstructive pyelonephritis is a type of inflammation of the kidney tissue, a very common and well-studied disease.

It proceeds with characteristic symptoms and in most cases is of a secondary nature (acts as a complication). It has several forms of flow.

With improperly selected therapy or untimely treatment, pyelonephritis can cause renal failure or septic shock.

There are several types of pyelonephritis, since this disease is inflammatory in nature, it proceeds according to several "scenarios" and in most cases with a normal outflow of urine.

Non-obstructive pyelonephritis is a type of disease in which diuresis is not disturbed, that is, the ureters are not blocked by calculi or pathogenic bacteria. There are no ischemic changes in the organs. The blood flow to the kidneys is not disturbed.

If urine accumulates in the pelvis and cups, diuresis is impaired, tissue inflammation is actively flourishing, then such pyelonephritis is called obstructive.

As a rule, the disease is secondary, that is, it occurs against the background of infection with pathogens. Among urologists and nephrologists, there is an opinion that primary pyelonephritis does not exist.

Inflammation of the kidneys can be a consequence of a reduced immune status, but in fact there are not so many reasons for the occurrence of the disease.

A feature of non-obstructive pyelonephritis is considered to be its rapid development, bright symptoms and rapid progress. The disease affects both women and men, and can be diagnosed in a child. The disease does not have a certain age range, but more often they suffer from it:

children aged 6-7 years;
pregnant women;
elderly people;
people with diabetes or HIV infection.

In order for the inflammatory process to begin to actively progress, it is enough for bacteria to enter the human body, with the flow of blood or lymph. They get to the kidney tissue, causing pathological processes in it.

But the disease can develop in a different "scenario", provided that the organs of the small pelvis or the reproductive system are affected. In this case, bacteria in an ascending or descending line can enter the kidneys and cause inflammation.

Given the widespread occurrence of pyelonephritis, then its diagnosis does not cause problems. According to statistics, 2/3 of patients in nephrology are patients with kidney inflammation of various etiologies.

Nominally, there are only 2 main reasons that can lead to the development of the disease:

damage by bacteria;
decreased activity of the immune system.

If we talk about the defeat of pathogens, then it occurs by hematogenous (through the blood) or urogenic pathway.

Bacteria enter the kidney, causing inflammation, while not disrupting the outflow of urine. It leaves freely, but the person has characteristic signs of a disease of the urinary system.

The following pathogenic microorganisms can lead to the development of pyelonephritis:

proteus;
escherichia coli;
staphylococcus;
klebsiella;
blue purulent stick.

And also inflammation can develop against the background of a long course in the body of the following diseases:

All of the above conditions lead to a decrease in the activity of the immune system; diseases of an autoimmune nature can also be included in the list.

At risk are pregnant women, children and the elderly, due to a decrease in immunity caused by the natural state of the body.

There are several types of non-obstructive pyelonephritis, it can be acute and chronic, and also have a direct connection with the reflex.

This type of disease has one feature - not only the tissues of the kidney itself are involved in the inflammatory process. The disease affects the structures surrounding the organ. Up to the parenchyma, extensive inflammation leads to a significant deterioration in the patient's condition and increases the likelihood of complications.

With this type of course of the disease, the symptoms are pronounced. Pyelonephritis is diagnosed in a patient for the first time, proceeds against the background of a significant increase in body temperature, an increase in the general intoxication of the body. The inflammation progresses rapidly, but with the right treatment, the symptoms easily subside.

It proceeds with structural changes in the tissues of the kidneys, it is considered a pathology. This type of disease is due to frequent relapses. Despite the fact that the chronic type of the course of the inflammatory process does not have pronounced symptoms.

This type of pyelonephritis can cause kidney failure and other complications. Since it is asymptomatic for a long period of time.

If we evaluate the clinical picture, then it consists of the following pathological signs:

weakness;
increased body temperature;
the appearance of frequent urination;
severe intoxication of the body;
discoloration and odor of urine;
pain in the lumbar spine.

These symptoms are considered common, they occur most often in non-obstructive pyelonephritis.

But it is possible to divide the signs and according to the stages of the course, which will allow to classify the disease and differentiate it.

At the initial stage, a person's body temperature rises. If we are talking about acute pyelonephritis, then the indicator reaches 40 degrees. If the disease is chronic, then the increase in body temperature is insignificant.

There is a strong weakness, intoxication of the body. Chills may disturb, and after them a short decrease in body temperature.

At the second stage of development, the inflammatory process begins to actively progress. Strong pain appears in the kidney area (on one or both sides). The patient's condition gradually worsens, the concentration of protein and erythrocytes in the urine increases, the level of leukocytes and ESR in the blood increases.

At the 3rd stage of development, the condition worsens significantly, complications may occur (carbuncle, abscess, sepsis).

Against the background of the constant progress of the infectious disease, the patient's general condition worsens, memory lapses, impaired perception of consciousness may occur.

There are several factors that can lead to the development of pyelonephritis:

the presence of an infectious focus in the body (a chronic inflammatory disease);
a significant decrease in the activity of the immune system (occurs against the background of pregnancy, systemic diseases, reduced immune status);
anatomical features of the structure of the body and anomalies in the development of the organs of the urinary system.

The risk group can include people with various diseases, ranging from diabetes mellitus and ending with tuberculosis and HIV infection. Pyelonephritis often affects children (between the ages of 5–7 years) and pregnant women (due to the high load on the kidneys).

A nephrologist is involved in the treatment of the disease, if there is no such specialist, then you can contact a urologist.

Specific procedures will help diagnose the disease:

CT and MRI are rarely performed, most often it is enough to do an ultrasound scan, detect structural changes in the structure of organs, or conduct extensive urography. At the same time, the state of the patient's blood and urine is assessed, the presence of pathogenic microorganisms in biological fluids indicates an infectious process.

Preference is given to drug treatment; surgical interventions are rarely resorted to, since the outflow of urine in non-obstructive pyelonephritis is not disturbed. Surgery is required only if complications develop.

It means taking drugs with an antibacterial spectrum of action. Antibiotics will help stop inflammation.

It is possible to strengthen antibacterial therapy with vitamins and herbal anti-inflammatory drugs. But the therapy is selected on an individual basis.

If the outflow of urine is not disturbed, then the disease does not require surgical treatment. Surgical manipulations are carried out only with the development of complications (carbuncle, abscess).

In the acute type of the course of the disease, it is ineffective. For chronic pyelonephritis, herbs that speed up kidney function can be used.

These plants are easy to prepare and take daily. The ingredients are mixed in equal proportions (total weight 35 gr.). The mixture is poured with 1 liter of boiled water, and put in a water bath for 15 minutes, then filtered, cooled and drunk 3 glasses a day.

If there is no ICD, then you can drink cranberry and lingonberry juice with honey, 200 ml daily in the morning, diluting the drink with a spoon of honey.

If we talk about the acute type of the course of the disease, then its main complication is considered to be the transition of pyelonephritis to a chronic form. Against this background, there are structural changes in the tissues.

With a long and uncompensated course, the disease can also cause:

renal failure;
carbuncle or kidney abscess;
sepsis of blood of a bacteriological nature.

These are the most common complications that pyelonephritis can lead to, but the disease often leads to damage to nearby organs and tissues. The inflammation spreads to the liver, intestines, stomach. This significantly worsens the general condition of the body and leads to the appearance of additional symptoms.

With timely treatment, well-chosen treatment, the prognosis is favorable. In the event of complications, the likelihood of surgical procedures increases.

timely treat bacterial and infectious diseases;
in case of a chronic type of course, contact a nephrologist once every 12 months;
in case of unpleasant symptoms, consult a doctor;
strengthen the immune system with appropriate medications.

When the first signs appear, it is worthwhile to urgently consult a doctor and get tested. This will help avoid serious complications and stop the development of the inflammatory process.

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Reflux, or backflow of fluid, aggravates the course of the disease and is the cause of intoxication. This type of ailment is typical for elderly patients. This article reports on the features of the course of chronic pyelonephritis with reflux and how to treat it.

Obstructive inflammation is called an organ inflammation, in which an obstacle has formed in the path of urine outflow. In this case, renal colic occurs, characterized by acute pain and, in some situations, requiring surgical intervention.

In case of non-obstructive inflammation, the outflow of excreta occurs freely, however, there are options for the development of the pathological process, complicated by the backflow of urine into the kidneys.

Obstructive kidney inflammation.

The disease affects very elderly people, mainly women 75 ... 79, as well as men 70 ... 74 years old. According to statistics, deaths are recorded in 23.84 and 42.55% of the number of women and men, respectively.

Symptoms of the disease occur suddenly and are characterized by the symptoms of intoxication listed below:

Dysuria, with frequent painful urging.
Chills preceding pyretic hyperthermia - 40 °.
Pain in the lower back, frontal head.
Nausea.
Weakness.
Tachycardia.

Kidney inflammation with reverse urine reflux occurs for the following reasons:

Are common:

Diabetes.
Osteochondrosis.
Brain tumors.
Hypertension.
Atherosclerosis.
Chronic diseases - tonsillitis, cholecystitis, etc.
Side effects of medications.

Local:

Pathology of the prostate.
Abnormalities in the development of the kidneys.
Neoplasms.

When diagnosing, the patient's age is taken into account, a general analysis of urine, ultrasound, excretory urography with the introduction of a contrast indicator into the urinary reservoir is performed.

The disease affects the elderly

Treatment of non-obstructive chronic pyelonephritis associated with reflux begins with the elimination of the cause of the pathology. Analyze the possible side effects of medications used in the complex therapy of other diseases and cancel them. If an allergic etiology is established, corticosteroids are prescribed.

The rest of the techniques are similar to those in the treatment of traditional kidney inflammation:

Drinking large volumes of fluids.
The use of antimicrobial drugs, mainly nitrofurans.
Antispasmodics, anticoagulants.
When relieving exacerbations - herbal medicine.

Conclusion

A non-obstructive type of pyelonephritis with the occurrence of a backflow of urine is recorded, mainly in old people suffering from chronic diseases. When treating, it is necessary to take into account the possible side effects of drugs.

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Primary pyelonephritis is a nonspecific infection of the renal tissue with spread to the pelvis and calyx.

There are the following types of pathogens:

escherichia coli, Protea, Klebsiella, Enterococci - usually come from the lower parts of the genitourinary system;
staphylococcus aureus, Mycobacterium tuberculosis - are brought in with the blood stream;
adenoviruses, pathogenic fungi, herpes simplex virus are rare provocateurs of pyelonephritis.

In older women, pyelonephritis occurs due to gynecological problems or fecal incontinence, in older men - with prostate adenoma.

It is necessary to mention the risk factors for the development of pyelonephritis. These include the following circumstances:

elderly age;
female;
vesicoureteral reflux;
pregnancy;
diabetes;
immune deficiency diseases;
prolonged or incorrect finding of the catheter in the bladder cavity;
anomalies in the development of the genitourinary system, disrupting the normal formation and outflow of urine.

The kidneys are affected on one or both sides. Focal and polymorphic changes in the renal pelvic system are characteristic. The main classification of non-obstructive pyelonephritis is based on the etiology of infection and the severity of the inflammatory process.

Acute non-obstructive pyelonephritis is a sudden and rapidly developing inflammation of the kidney tissue.

The course of the disease is characterized by the following symptoms:

heat;
unilateral or bilateral lower back pain;
frequent urge to urinate;
cloudy urine due to an admixture of pus.

Severe intoxication is observed: thirst, profuse sweating, headache and muscle pain, chills, vomiting. Signs of dehydration are possible. The person refuses to eat and cannot sleep.

A chronic type of pyelonephritis develops after an acute form of the disease, sometimes carried over in childhood. Relapses can be triggered by any disease or negative factor. There is an increasing degradation of the renal-pelvic system with a gradual wrinkling of the kidneys.

The clinic is not demonstrative, there are no urination disorders. The following signs will help to suspect the presence of non-obstructive chronic pyelonephritis:

constant pain in the lower back of a pulling character;
unstable and slight rise in temperature;
poorly corrected arterial hypertension and combination with glomerulonephritis.

Depending on the ways in which microbes enter the organ, there are ascending and descending forms of pathology:

Ascending type of pyelonephritis - penetration of microbes from the ureters and bladder. The form is common in the elderly, pregnant and recently given birth women, often due to the return of urine. Also, urogenital infections are the cause of non-obstructive pyelonephritis. Unfortunately, the disease can also occur after medical intervention - surgery, cystoscopy.
Descending form of pyelonephritis - drift of infection with blood flow from the septic focus existing in the body or after its elimination. This phenomenon is often caused by boils, mastitis, tonsillitis, panaritium.

With ascending infection, the damage to the renal tissue occurs from the depths of the organ, with hematogenous penetration, the process begins from its surface.

Initially, the patient needs to see a GP. After passing the tests and suspicion of kidney disease, the doctor will give a referral for a consultation with a nephrologist. With the appearance of a combined lesion of the urinary tract, a urologist will help.

Non-obstructive pyelonephritis requires laboratory and instrumental examinations. With an acute type of disease, the following measures must be taken:

complete blood count - leukocytosis and an increase in ESR;
general urinalysis - the presence of leukocytes and bacteria in the urine (with hematogenous genesis, no);
bacteriological examination - identification of the pathogen and its susceptibility to antimicrobial agents.

In the chronic form of non-obstructive pyelonephritis, an admixture of pus, protein and blood is found in an insignificant amount in the general analysis of urine. Against the background of a long illness, the specific gravity of urine decreases. Outside of exacerbation of pyelonephritis in the blood, there are no sharp changes in general and biochemical parameters.

The more the kidney atrophies, the less laboratory disorders are expressed.

In the acute phase of pyelonephritis, pain in the lumbosacral region is aggravated by tapping in the projection of the organ with the edge of the doctor's palm (Pasternatsky's symptom). Palpation of the anterior abdominal wall reveals muscle tension from the side of the same name. In addition, a significant decrease in the amount of urine excreted is characteristic.

Special tests are carried out - samples of Addis-Kakovsky, Zimnitsky - to clarify the diagnosis. Instrumental methods of diagnosing non-obstructive pyelonephritis are required:

radiography;
excretory urography;
scanning;
angiography;
radioisotope survey;
biopsy.

In controversial cases, MRI of the urinary system or nuclear magnetic resonance is performed.

In older people, even an acute form of pyelonephritis is distinguished by erased kidney symptoms. Characterized by complaints of low temperature, aching back pain, lack of appetite. In blood and urine tests, the changes are insignificant. Therefore, the diagnosis of pyelonephritis in this category of patients is especially difficult.

With timely treatment, the acute form of pyelonephritis is cured without consequences. Therapy of the chronic type is aimed at preventing relapses and achieving a stable remission.

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Drug treatment of pyelonephritis includes drugs of various pharmacological groups. First of all, means are used that affect the cause of the disease - a pathogenic microorganism. For this, the following antimicrobial agents are prescribed:

Antibiotics - cephalosporins (Ceftriaxone), tetracyclines (Vidoccin), aminoglycosides (Gentamicin). The drugs are used depending on the sensitivity of the isolated microorganism. Read more about antibiotics for pyelonephritis →
Nitrofurans - Furadonin.
Sulfonamides - Bactrim Forte.

There is a rapid normalization of urine tests, but antibiotic therapy continues for a month with a change in medications from different groups.

As a symptomatic treatment of non-obstructive pyelonephritis, drugs of the following drug groups are used:

antispasmodics - No-shpa, Papaverine;
diuretics for urinary retention - Lasix;
detoxifying agents - Reopolyglyukin, Gemodez.

To speed up recovery, vitamins are prescribed (Milgamma, ascorbic acid). Patients must observe the drinking regime - consumption of at least 2.5 liters of clean water. In advanced chronic forms, the volume of water depends on the patient's condition and the results of the examination.

During the rehabilitation period, physiotherapy is indicated - diathermy of the lumbosacral region, electro- and phonophoresis using anti-inflammatory drugs and antispasmodics, application of paraffin and mud.

In a chronic type of pyelonephritis, antimicrobial therapy is used regularly throughout the year. Active vitamin therapy is recommended. In stationary conditions, according to indications, hemodialysis, blood or plasma transfusions are performed.

In case of persistent remission of chronic pyelonephritis, resort treatment is recommended in specialized sanatoriums - Zheleznovodsk, Essentuki.

If in acute pyelonephritis, conservative therapy measures are ineffective, the help of a surgeon is needed. The renal capsule is dissected and the kidney is drained to remove pus.

Operations for the chronic variety are carried out according to strict indications, more often part of the kidney is excised.

To prevent the acute form of pyelonephritis, the following simple measures are important:

exclusion of hypothermia;
destruction of any infectious focus in the body;
timely elimination of inflammation in the urinary tract;
a balanced diet enriched with vitamins and minerals.

The best prevention of pyelonephritis chronicity is timely treatment of the acute phase. To prevent relapses, they use heating pads, drink decoctions and infusions of diuretics, anti-inflammatory herbs, and vitamin supplements.

An annual examination by doctors of various profiles with the delivery of basic laboratory tests is required.

The danger of non-obstructive pyelonephritis is the likelihood of becoming chronic. This leads to the formation of chronic renal failure, fraught with death. Therefore, it is so important to timely contact a doctor and follow his recommendations.

List of sources:

Handbook of a practicing physician, ed. Denisova I.N., Ulumbekova E.G. Ed. "Medical Academic Book", 2000
Therapist's handbook, ed. Astapenko M.G. "Medicine", 2001

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Depending on the severity of the pathology, pyelonephritis can be obstructive and non-obstructive. Each of them has its own ways of manifestation in the body, treatment method and classification. The disease can be chronic, acute, as well as bilateral and unilateral.

Obstructive or non-obstructive pyelonephritis gets its name from the presence or absence of obstruction. They can be different, for example, urolithiasis, tumor, prostate adenoma, or abnormal structures of the genitourinary system.

Obstructive pyelonephritis is an inflammatory process in the kidneys that affects their individual areas. These are, most often, the renal pelvis and calyces. If they are under the influence of pathology, this will lead to difficulty in the outflow of urine through the urethra.

The disease, in general, does not arise on its own and is a complication of any infectious disease of the kidneys or ureters. Because of this, obstructive pyelonephritis is also called secondary. Infection is always caused by organisms of pathogenic microflora, they enter the organs through the urethra, and then - the bladder or blood.

An obstruction is any situation that means that the natural flow of urine is difficult. The most common is urolithiasis, individual anatomical features of the body and tumors.

Adenoma of the prostate is also one of the obstructions. In male patients, this is the most common problem. The urethra, that is, the urethra, passes through the tissues of the prostate, if it enlarges as a result of inflammation, the duct is compressed. Over time, this will lead to difficulty urinating, but if fluid constantly accumulates in the bladder, cystitis is more likely to develop.

Note! After a while, the infection will pass through the ureter into the kidney and provoke pyelonephritis. Therefore it is very important to diagnose the problem in a timely manner.

Neoplasms can create problems, not only being directly in the kidneys or ureter. If a tumor is found in the intestine, it can at least affect the obstruction of the channels. They will be compressed from the outside, which will also lead to inflammation.

With urolithiasis, calculi can form either in the calyx of the kidney or in the bladder. When they begin to move, they block the channels, which affects the normal flow of urine. The most common problem is always with a too large stone blocking the ureter. As a result, urine will accumulate in organ tissue and pelvis.

If the patient is infected with chronic or acute obstructive pyelonephritis, the degree of obstruction will play a fundamental role:

progressive obstruction will mean a gradual overlap of the canals. This is typical for malignant tumors or prostate adenoma;
acute obstructive pyelonephritis often develops due to absolute obstruction. In this case, the patient feels renal colic and pronounced fever, which threatens the development of hydronephrosis;
relative obstruction will mean that the outflow is partially obstructed.

This happens when the stone at the exit of the ureter does not completely block it. But if the calculus changes its position and blocks the canal, pyelonephritis can sharply worsen and go from chronic, with mild symptoms, to acute.

The development of pyelonephritis and its treatment are always associated with problems with urine outflow. This can be triggered by the following number of reasons:

ICD (urolithiasis). The resulting stones will eventually begin to come out of the kidney and block the canal. This will lead to complete obstruction followed by renal colic.
Lesions - inflammation of the kidneys, bladder and ureter.
Congenital pathologies of the genitourinary system.

With the development of the kidneys even at the embryonic level, there is a possibility of the manifestation of defects. These can be problems with the muscular layer of the walls of the organs or the absence of the lumen of the urethra. All this will provoke a violation of the natural flow of urine.

The obstructive form of the disease has a similar picture of symptoms with non-obstructive pyelonephritis. The difference will depend on the sequence of manifestations and the course of the disease.

Obstructive pyelonephritis symptoms:

Renal colic.
Elevated temperature up to 40 degrees.
Severe migraine.
Vomiting and nausea.
Body aches and weakness.
Dry mouth.
Heart rhythm problems.
Intense thirst.

The most obvious sign of the disease is renal colic, which is accompanied by severe pain with pyelonephritis in the lumbar region. Most patients position these pains as the most severe in their life. But they have an increasing character, it is very important here to call an ambulance in a timely manner to give an anesthetic injection.

Renal colic is distinguished by its intensity due to a violation of the outflow of urine. Stagnation expands the pelvis and "cups", then the organ tissue itself lends itself to changes. This edema will immediately provoke the expansion of the capsule. It is on it that nerve cells are located, which are responsible for the intensity of pain.

Advice! Sometimes the pain is so intense that even powerful pain relievers cannot help the patient. In such a situation, you should not give a large number of injections. If the stone is stuck, the only recourse is to remove it.

If a person suffers from acute chronic pyelonephritis, these symptoms are almost 100% likely to occur. But if the pathology proceeds in a chronic form, its signs will be very blurred, so people often do not suspect that they are already sick. In this case, it is recommended to pay attention to the following minor deviations:

increased sleepiness;
decreased performance;
weakness;
mild pain in the lumbar region;
loss of body weight.

Very often, such signs are attributed to a decrease in immunity. To avoid an exacerbation of the disease, it is desirable, as a preventive measure, to undergo an examination.

Symptoms of the development of non-obstructive pyelonephritis appear within 1 day. The first signs will resemble the manifestations of an infectious disease. Following them, the patient will feel the following:

Nausea and vomiting.
Tachycardia.
Headaches (most often in the forehead).
If pyelonephritis is bilateral, the person will feel pain on both sides in the lumbar region.
Violation of natural urination. The urges can be frequent and painful.
Chills, eventually flowing into increased sweating and a temporary decrease in body temperature.
General weakness.
High temperature up to 39 degrees.

The first thing that a sick person will feel is intoxication and high fever. These manifestations of non-obstructive pyelonephritis are often confused with ARVI. Further, a slight aching pain in the lower back gradually appears.

Diagnosis of obstructive and non-obstructive pyelonephritis is carried out only by a urologist. The first stage is to interview the patient and determine the complete picture of the development of pathology. These data will be enough to draw conclusions regarding the preliminary diagnosis.

Donating blood for biochemistry. If inflammatory processes occur in the body, an increase in the level will be noticed here.
Urine culture is necessary to draw up a general picture of the bacterial environment and susceptibility to antibacterial components of drugs.
Ultrasound examination - will allow you to see the changes that have occurred in the kidney, ureters and pelvis.
General urine analysis. With all pyelonephritis, multiple leukocytes will be seen. Sometimes it will be necessary to conduct a study of the liquid according to Zimnitsky, to determine the total number of cells. This type of disease always involves an increased amount of harmful organisms in the urine.
X-ray examination with the introduction of contrast. It is used before each type of treatment for non-obstructive pyelonephritis. The data obtained will make it possible to assess the degree of permeability of urine from the calyx-pelvic area.
Magnetic resonance imaging and computed tomography. These types of studies are used when there is a suspicion of the formation of tumors and the likelihood that they are compressing the ureter. It will also allow an assessment of the organ structure.

For the treatment to be as effective as possible, it must be carried out only in a specialized department of surgery or urology. Therapy is always carried out according to the following principles:

the release of the urethra and the restoration of the normal outflow of urine;
taking antibacterial drugs;
ridding the patient of the symptoms of the disease;
in especially difficult cases, surgical intervention is used.

The first thing to do when a patient is admitted to the hospital is to restore the natural outflow of urine. Sometimes this cannot be done fully. But if doctors can partially free or widen the canal, this will already affect the improvement of the patient's well-being. The temperature will drop almost immediately, and the intensity of the pain will be controlled. It is highly discouraged to take antibiotics without correcting drainage problems.

If the problem areas are in the organ itself or the ureter, doctors prescribe intravenous antispasmodics, for example, Baralgin. This will help partially widen the canal and restore urine flow.

All types and forms of pyelonephritis are necessarily accompanied by antibiotic therapy. To begin with, doctors use broad-spectrum drugs or use combination therapy, that is, 2-3 antibacterial agents at the same time. In order for the effect to manifest itself as quickly as possible, they are injected into a vein or intramuscularly.

If previously used medications do not help within the first 2 days, the funds must be replaced, as this will mean that bacteria can resist the active components of the drug. In order not to face such problems, patients, immediately after arriving at the hospital, are tested to determine the pathogen and its susceptibility to the drug. The course of therapy is 7-11 days.

The operation to eliminate the problem is always carried out only as a last resort. The reason for its appointment may be the inability to eliminate problems with urine outflow in the first 2 days, as well as the prevention of recurrence of such episodes.

At the moment, technical progress makes it possible to carry out operations without using a scalpel. For example, for urolithiasis, an endoscopic method can be used. This means that a special device will be introduced to the patient through the canal and the operation will be performed from the inside. If the obstruction is anatomical, a laparoscopic operation is performed that does not leave scars.

It is almost impossible to predict exactly how a person will be infected. But everyone can help to keep these risks to a minimum. To do this, it is recommended to adhere to the following rules:

Timely treatment of diseases that can be provocateurs of obstructive and non-obstructive pyelonephritis. Also included are diseases such as all forms of cystitis and prostatitis. These pathologies increase the risk of infection entering the kidneys through the ureter by several times.
Quite often, the causative agents are harmful bacteria that have entered the organ from foci such as teeth with caries, nasopharynx or tonsils. This means that initially it is necessary to pay attention to the health of all ENT organs. Pregnant women need to be especially careful. If there are any chronic infectious diseases in the body at the moment, the probability of infection is almost 100%.
Genital hygiene. School-age girls and women suffer from pyelonephritis 4 times more often than men. This is due to the fact that they have a short and wide urethra. This allows infections to travel easily into the bladder and then into the kidneys. To avoid infection, adult women need to follow the rules of hygiene after each intercourse.

Like all other types of pyelonephritis, the obstructive and non-obstructive form of the disease requires timely detection with subsequent treatment. If you ignore the pathology, over time it will move to a more complex stage, which may involve surgical intervention.

Obstructive pyelonephritis - inflammation of the renal pelvis (pyelitis) and tissue (nephritis), which occurs against the background of a violation of the outflow of urine due to obstruction of the urinary system. The main cause is urinary tract infections. Bacterial invasion inhibits urine flow and increases the likelihood of kidney stones. The disorder affects one or two kidneys. Due to the anatomical features, a woman has a problem much more often than a man. In the article, we will analyze what it is - obstructive pyelonephritis. In the international classification of diseases of the 10th revision (ICD-10), pathology is indicated by the code N11.1.

Acute obstructive pyelonephritis is an infectious lesion of the urinary system, which occurs due to blockage of the outflow of urine by a stone or foreign body. The diagnosis of a chronic disease is made on the basis of imaging methods - ultrasound (ultrasound) and computed tomography (CT).

Vesicoureteral reflux (abbreviation: VUR) is a congenital condition associated with ureteral valve insufficiency and occurs in chronic non-obstructive pyelonephritis. VUR is present in 25-35% of people with symptomatic urinary tract infections and renal scarring. The diagnosis of VUR is often made on the basis of radiographic findings obtained during the assessment of recurrent infectious pathology.

Non-obstructive acute pyelonephritis is an inflammatory process of the renal tissue and pelvis, which is not caused by an obstacle to the outflow of urine. The main reason is congenital malformations of the urinary system.

Causes and pathogenesis

Obstructive kidney inflammation is usually caused by urinary tract infections and kidney stones. Even the constant use of catheters often leads to recurrent cystitis and chronic pyelonephritis.

Bacteria from the bladder rise through the ureters to the kidneys in acute pyelitis. This leads to the formation of scars as a result of constantly occurring inflammatory processes.

It is important to know! Renal abscesses are accumulations of pus that are surrounded by a connective tissue capsule; most patients suffer from severe fever, chills, and pain in the kidney area. Urination may be painful and the urine is purulent and bloody.

Factors affecting the development of pyelonephritis:

the patient's gender and his or her sexual activity;
pregnancy;
chronic malnutrition (hypovitaminosis A, C, D and B);
hereditary predisposition;
viral and bacterial infections;
neurogenic dysfunction of the bladder.

Chronic pyelonephritis is associated with progressive scarring of the kidney tissue, which can lead to end-stage organ failure. In some cases, scars can form in utero in patients with renal dysplasia. Sometimes normal growth can lead to spontaneous disappearance of VUR and pyelonephritis at the age of 7 years.

More about symptoms

Acute obstructive and non-obstructive pyelonephritis causes nonspecific symptoms ranging from pain to completely asymptomatic manifestations. Sometimes there is a fever that lasts no more than 2-3 days.

Clinical symptoms:

pain in the side to the left or right;
chills;
body temperature above 40 degrees Celsius;
nausea and vomiting.

In rare cases, hematuria, dysuria, or anuria are observed. Weakened patients (diabetics, HIV-infected) develop sepsis - a systemic infection.

Forms and types of the disease

According to the clinical course, latent, hypertensive, asymptomatic and anemic pyelonephritis are distinguished. By etiology, there are primary and secondary forms of the disease. There is also a classification according to the morphology and path of invasion.

Potential complications

Late treatment can aggravate the course of pyelonephritis and lead to arterial hypertension or renal failure. It is important to start therapy at an early stage to prevent possible irreversible organ damage.

Complications of chronic pyelonephritis:

It is important to know! Acute renal failure is the most severe complication of obstructive (calculous) pyelonephritis, which can lead to the death of the patient in a short time. If you experience any of the above symptoms, you should seek the advice of a qualified medical professional, as he will help to avoid irreversible tissue changes.

Methods for detecting pathology

First, a physical examination is performed and a history (medical history) is taken. Typical renal scars are often present in patients during the initial examination, new ones may form in 3-5% of patients. Scar development is inversely related to the rate of administration of narrow-spectrum antibiotic therapy. New scars are often indicative of systemic infections.

It is important to know! The army with chronic pyelonephritis is not taken.

Laboratory diagnostics

Laboratory tests of urine can detect pyuria. It is recommended to conduct a bacteriological analysis of urine, which helps to detect gram-negative pathogens - Escherichia coli and Proteus. A negative result of a microorganism examination does not exclude the diagnosis of chronic pyelonephritis. If albuminuria is present, this indicates complications. The concentration of creatinine and uric acid in the blood serum increases.

Renal histology shows focal glomerulosclerosis with advanced reflux nephropathy. A pregnant woman and a young child may need additional tests to rule out secondary complications.

Instrumental examination

The urogram helps to establish with high accuracy pyelonephritis, as it detects renal calyx dilation and scars. Sometimes enlargement of the ureter and a decrease in the size of the kidneys are also found.

Succimer (hemet) X-rays are more sensitive than intravenous pyelography because they help identify renal scars. The diagnostic procedure is prescribed by many pediatric specialists because it is easy to perform and can detect pathology.

Computed tomography is the procedure of choice for the diagnosis of obstructive pyelonephritis. Ultrasonography of the kidney may show calculi, but ultrasound is not a sensitive method for detecting reflux nephropathy.

Treatment options and prognosis for patients

Patients are prescribed medical therapy with antibiotics. It is recommended to continue treatment until puberty or reflux disease completely disappears. The rule in these cases is spontaneous remission; operation of such people does not need to be treated. Data from the Birmingham Reflux study have shown that conservative and surgical treatments for VUR are equally effective.

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Causes

Acute form

Chronic course

Acute and chronic pyelonephritis in children

Acute and chronic pyelonephritis in men

Pyelonephritis during pregnancy

Signs of pyelonephritis

Symptoms

Diagnosis of obstructive pyelonephritis

Urine analysis for pyelonephritis

Methods for the treatment of obstructive inflammation of the renal cavities

Antibiotics for pyelonephritis

If pyelonephritis is not treated - the consequences

For women

Menace to men

Risks to Children

Urolithiasis disease

Treatment and prevention

Recovery Predictions

Diet for pyelonephritis

Stages

Diagnostic methods

Therapy

Possible complications

Forecast

Obstructive pyelonephritis

Forms of obstructive pyelonephritis

Causes of obstructive pyelonephritis

Obstructive pyelonephritis symptoms

Diagnosis of obstructive pyelonephritis

Treatment of obstructive pyelonephritis

Causes and pathogenesis

More about symptoms

Forms and types of the disease

Potential complications

Methods for detecting pathology

Laboratory diagnostics

Instrumental examination

Treatment options and prognosis for patients

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