Signs and treatment of pyelonephritis in women. Pyelonephritis - symptoms and treatment Causes of pyelonephritis in women
Pyelonephritis is one of the most common urological diseases of an infectious nature that affects the calyx-pelvic system and renal parenchyma. This rather dangerous pathology, in the absence of timely competent treatment, can lead to a violation of the excretory and filtering functions of the organ.
What kind of kidney disease is this, why it is so important to know the first symptoms and consult a doctor in time, as well as how the treatment of various forms of pyelonephritis begins, we will consider further in the article.
What is pyelonephritis
Pyelonephritis is an inflammatory kidney disease characterized by damage to the parenchyma of the kidney, calyces, and renal pelvis.
In most cases, pyelonephritis is caused by a spread of infections from the bladder. The bacteria enter the body from the skin around the urethra. Then they rise from the urethra to bladder and then go to the kidneys, where pyelonephritis develops.
Pyelonephritis can be an independent disease, but more often complicates the course various diseases (urolithiasis, prostate adenomas, diseases of the female genital organs, tumors genitourinary system,) or occurs as a postoperative complication.
Classification
Pyelonephritis of the kidneys is classified:
- Due to development - primary (acute, or non-obstructive) and secondary (chronic, or obstructive). The first form is a consequence of infections and viruses in other organs, and the second is an abnormality of the kidneys.
- At the location of the inflammation - bilateral and unilateral. In the first case, both kidneys are affected, in the second - only one, the disease can be left-sided or right-sided.
- In the form of inflammation of the kidney, it is serous, purulent and necrotic.
Allocate:
- Acute pyelonephritis is caused by the ingress of a large number of microorganisms into the kidneys, as well as when the protective properties of the body are weakened (weak immunity, transferred colds, overwork, stress, poor nutrition). The inflammatory process is pronounced. It is most often diagnosed in pregnant women, whose body is especially vulnerable.
- What is chronic pyelonephritis? This is the same inflammation of the kidneys, only characterized by a latent course. Due to changes in the urinary system, the outflow of urine is disturbed, as a result of which the infection reaches the kidneys ascending.
By flow phases:
- Active inflammation is characterized by symptoms: fever, pressure, pain in the abdomen and lower back, frequent urination, edema;
- Latent inflammation is characterized by the absence of any symptoms and, accordingly, the patient's complaints. However, in the analysis of urine pathologies are visible;
- Remission - there are no urine pathologies and symptoms.
Causes of occurrence
With pyelonephritis, as we have already indicated, the kidneys are affected, and mainly the effect of bacteria leads to this result. Microorganisms, being in the renal pelvis or in it by the most urinogenic or hematogenous way, settle in the interstitial tissue of the kidney, as well as in the tissue of the renal sinus.
The disease can occur at any age. More often pyelonephritis develops:
- in children under the age of 7 years (the likelihood of pyelonephritis increases due to the peculiarities of anatomical development);
- in young women aged 18-30 years (the occurrence of pyelonephritis is associated with the onset of sexual activity, pregnancy and childbirth);
- in older men (with obstruction urinary tract due to the development of prostate adenoma).
Any organic or functional reason that prevents the normal flow of urine increases the likelihood of developing the disease. Often, pyelonephritis appears in patients with urolithiasis.
Most often, the cause of the development of urinary tract inflammation is:
- coli bacteria (Escherichia coli), or enterococcus.
- Less likely to provoke non-specific inflammatory process may other gram-negative bacteria.
- Often, patients are found to have combined or multi-resistant forms of infection (the latter are the result of uncontrolled and unsystematic antibacterial treatment).
Routes of infection:
- Ascending (from the rectum or foci chronic inflammationlocated in the urogenital organs);
- Hematogenous (realized through the blood). In this situation, any distant focus outside the urinary tract can be the source of infection.
For the occurrence of pyelonephritis, the penetration of microflora into the kidney is not enough. For this, in addition, predisposing factors are necessary, among which the main ones are:
- violation of the outflow of urine from the kidney;
- disorders of blood and lymph circulation in the organ.
However, it is believed that in some cases, highly pathogenic microorganisms can cause acute pyelonephritis in intact kidneys in the absence of any predisposing causes.
Factors that will help bacteria develop in paired organs:
- Lack of vitamins;
- Reduced immunity;
- Chronic stress and overwork;
- Weakness;
- Kidney disease or genetic predisposition to the rapid defeat of paired organs.
Symptoms of pyelonephritis in adults
Pyelonephritis symptoms can vary depending on the person's age and may include the following:
- Malaise;
- Fever and / or chills, especially in the case of acute pyelonephritis;
- Nausea and vomiting;
- Pain in the side under the lower ribs, in the back, radiating to the iliac fossa and suprapubic region;
- Confusion of consciousness;
- Frequent, painful urination
- Blood in the urine (hematuria)
- Cloudy urine with a pungent odor.
Pyelonephritis is often accompanied by dysuric disorders, manifested in the form of frequent or painful urination, urine separation in small portions, and the prevalence of nocturnal urine output over daytime.
Symptoms of the acute form of kidney pyelonephritis
In this form, pyelonephritis occurs in combination with symptoms such as:
- high fever, chills. Patients have increased sweating.
- The kidney from the side of the lesion hurts.
- On the 3-5th day of the manifestation of the disease, palpation can determine that the affected kidney is in an enlarged state, in addition, it is still painful.
- Also, by the third day, pus is found in the urine (which is indicated medical term pyuria).
- The appearance of chills and fever is accompanied by headache, joint pain.
- In parallel with these symptoms, there is an increase pain in the lumbar region, basically this pain still manifests itself on the side from which the kidney is affected.
Signs of chronic pyelonephritis
The symptoms of the chronic form of kidney disease are very conditional and the course has no pronounced signs. Often, the inflammatory process in everyday life is perceived as a respiratory infection:
- muscle weakness and headache;
- febrile temperature.
However, in addition to these characteristic signs of the disease, the patient has frequent urination, with the appearance of an unpleasant odor of urine. In the lumbar region, a person feels a constant aching pain, a desire to urinate often.
Late common symptoms of chronic pyelonephritis are:
- dryness of the oral mucosa (initially slight and inconsistent)
- discomfort in the adrenal region
- heartburn
- belching
- psychological passivity
- puffiness of the face
- pallor of the skin.
All this can serve as manifestations of chronic renal failure and are characteristic of bilateral kidney damage, the release of up to 2-3 liters of urine per day or more.
Complications
Serious complications of pyelonephritis include:
- renal failure;
- paranephritis;
- and bacterial shock;
- carbuncle of the kidney.
Any of these diseases has serious consequences for the body.
All of the above symptoms and signs urological disease must have an adequate medical assessment. You should not endure and hope that everything will turn out by itself, as well as engage in self-treatment without a preliminary examination of a medical worker.
Diagnostics
Diagnosis of inflammation of the pelvis and renal parenchyma, as usual, begins with a general examination after collecting the patient's complaints. Instrumental and laboratory studies are becoming mandatory, which give a complete picture of what is happening.
Laboratory methods include:
- General clinical analysis of urine: when sowing urinary sediment on a glass slide, an increase in the number of leukocytes and bacteria in the field of view is detected. Urine should normally be acidic, with infectious pathology, it becomes alkaline;
- General clinical blood test: all signs of an inflammatory process appear in the peripheral blood, the erythrocyte sedimentation rate increases and the number of leukocytes in the field of view increases significantly.
Laboratory indicators:
- in the blood test, an increase with a shift in the formula to the left, accelerated ESR is determined;
- the urine is cloudy with mucus and flakes, sometimes has an unpleasant odor. A small amount of protein, a significant number of leukocytes and single erythrocytes are found in it.
- true bacteriuria is determined in urine cultures - the number of microbial bodies in a milliliter of urine is\u003e 100 thousand.
- the test according to Nechiporenko reveals the predominance of leukocytes in the middle portion of urine over erythrocytes.
- in a chronic process, changes in biochemical analyzes are observed: an increase in creatinine and urea.
Among the instrumental research methods are prescribed:
- Ultrasound of the kidneys and abdominal cavity;
- computed tomography or X-ray to detect changes in the structure of the affected kidney.
Treatment of kidney pyelonephritis
Kidney pyelonephritis should be treated in a comprehensive manner, including medication and physiotherapy. Complete treatment for kidney disease contributes to the speedy recovery of the patient from infectious pathology.
Medication
The goal of drug treatment is not only aimed at elimination of infectious agents and relief of symptomatic signs, but also on the restoration of vital functions of the body while the disease progressed pyelonephritis.
Preparations:
- Antibiotics. With an exacerbation, you cannot do without them, but it is optimal if a doctor prescribes them, it is even better if at the same time he explains how to collect and where to donate urine for culture for microflora and sensitivity to antibiotics. Most often used in outpatient practice:
- protected penicillins (Augmentin),
- 2nd generation cephalosporins (Ceftibuten, Cefuroxime),
- fluoroquinolones (Ciprofloxacin, Norfloxacin, Ofloxacin)
- nitrofurans (Furadonin, Furamag), as well as Palin, Biseptol and Nitroxoline.
- Diuretic drugs: prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), with acute pyelonephritis. Furosemide 1 tablet once a week.
- Immunomodulators: increase the reactivity of the body in case of illness, and to prevent exacerbation of chronic pyelonephritis.
- Timalin, intramuscularly 10-20 mg once a day, 5 days;
- T-activin, intramuscularly, 100 mcg 1 time per day, 5 days;
- Multivitamins (Duovit, 1 tablet once a day), Ginseng tincture - 30 drops 3 times a day, are also used to increase immunity.
- Non-steroidal anti-inflammatory drugs (Voltaren), have anti-inflammatory effects. Voltaren inside, 0.25 g 3 times a day, after meals.
Treatment of chronic pyelonephritis is carried out according to the same principles as the therapy of an acute process, but differs in greater duration and laboriousness. Therapy for chronic pyelonephritis includes the following therapeutic measures:
- elimination of the reasons that led to the obstruction of the outflow of urine or caused violations of the renal circulation;
- antibiotic therapy (treatment is prescribed taking into account the sensitivity of microorganisms);
- normalization of general immunity.
The goal of treatment during an exacerbation is to achieve complete clinical and laboratory remission. Sometimes even 6 weeks of antibiotic treatment does not give the desired result. In these cases, a scheme is practiced when, for six months, an antibacterial drug is prescribed every month for 10 days (each time - different, but taking into account the spectrum of sensitivity), and the rest of the time - diuretic herbs.
Surgery
Surgical intervention is prescribed if, during conservative treatment, the patient's condition remains severe or worsens. As a rule, surgical correction is performed when purulent (apostemotic) pyelonephritis, abscess or kidney carbuncle are detected.
During the operation, the surgeon restores the lumen of the ureter, excises inflammatory tissues and establishes drainages for the outflow of purulent fluid. If the parenchyma of the kidney is significantly destroyed, an operation is performed - nephrectomy.
Diet and nutrition
The goal pursued by the diet for pyelonephritis is
- sparing kidney function, creating optimal conditions for their work,
- normalization of metabolism not only in the kidneys, but also in other internal organs,
- lowering blood pressure,
- reduction of edema,
- maximum excretion of salts, nitrogenous substances and toxins from the body.
According to the table of treatment tables according to Pevzner, the diet for pyelonephritis corresponds to table number 7.
General characteristics of the treatment table No. 7 - this is a slight restriction of proteins, while fats and carbohydrates correspond to physiological norms. In addition, the diet should be fortified.
Products that need to be limited or, if possible, excluded for the period of treatment:
- broths and soups on meat, fish rich broth - we are talking about the so-called "first" broths;
- first courses from legumes;
- salted and smoked fish;
- any fatty varieties of river and sea fish;
- caviar of any fish;
- seafood;
- fatty meats;
- lard and interior fat;
- bread with added salt;
- any flour products with the addition of salt;
- mushrooms of any kind and prepared in any way;
- strong tea and coffee;
- chocolate;
- confectionery (pastries and cakes);
- sorrel and spinach;
- radish and radish;
- onion and garlic;
- sausages and sausages - boiled, smoked, fried and baked;
- any smoked products;
- spicy and fatty cheeses;
- canned meat and fish;
- marinades and pickles;
- high fat sour cream.
Allowed food items:
- Low-fat varieties of meat, poultry and fish. Despite the fact that fried foods are acceptable, it is advised to boil and steam, simmer and bake without salt and spices.
- Drinks are advised to drink more green tea, various fruit drinks, compotes, herbal teas and decoctions.
- Low-fat soups, preferably on a vegetarian vegetable basis.
- The most preferred vegetables for this diet are pumpkin, potatoes, squash.
- Cereals should be avoided, but buckwheat and oatmeal are acceptable and useful for this disease.
- Bread is advised to be eaten without adding salt, fresh is not recommended right away. It is advised to make toasts out of bread, dry it in the oven. Pancakes and pancakes are also allowed.
- With pyelonephritis, dairy products are allowed if they are low-fat or low-fat.
- Fruits can be eaten in any quantity, they are useful in the inflammatory process of the kidneys.
Compliance with a diet for pyelonephritis facilitates the work of kidney patients and reduces the load on all organs of the urinary system.
Folk remedies
Before using folk remedies for pyelonephritis, be sure to consult with your doctor, because there may be individual contraindications for use.
- 10 grams of harvest (prepared from lingonberry leaves, coltsfoot, strawberries, cornflower flowers, veronica grass, nettle and flax seeds) pour boiling water (0.5 liters) and place in a thermos for 9 hours. You need to consume 1/2 cup at least 3 times a day.
- Pumpkin juice is especially in demand, which has a strong anti-inflammatory effect during and pyelonephritis. From a vegetable, you can cook yourself a medicinal porridge for breakfast or steam it, as well as in the oven.
- Corn silk - hairs of ripe corn - as a diuretic for high blood pressure... In addition, the plant has an antispasmodic effect that will eliminate pain in the inflammatory process in the kidneys and in other parts of the body, but if blood clots form too often in the patient's blood, then corn stigmas will have to be abandoned.
- Dry and grind the plant.
- Pour 1 dessert spoon of hairs with 1 glass of boiling water.
- They languish for 20 minutes.
- Insist 40 minutes.
- Take 2 tbsp. broth every 3 hours.
- Collection of kidney pyelonephritis: 50 g each - horsetail, wild strawberries (berries) and rose hips; 30 g each - nettle (leaves), plantain, lingonberry and bearberry; 20 g each - hops, juniper and birch leaves. The whole medicinal composition mix and fill with 500 ml of water. Bring the entire therapeutic mass to a boil. After that, strain and use 0.5 cups 3 times a day.
Prevention
- visit a urologist (once every 3-4 months);
- timely treat urological and gynecological diseases;
- consume a large amount of fluid to normalize the outflow of urine;
- avoid hypothermia;
- live a healthy life;
- adhere to a balanced diet;
- do not abuse protein foods;
- for men - to monitor the state of the urinary system, especially if in the past there were previous urological ailments;
- if there is a urge to urinate, do not delay the process;
- observe the rules of personal hygiene.
Pyelonephritis of the kidneys is a serious disease that must be treated when the first signs appear so that there are no complications. Be sure to get diagnosed by a nephrologist or urologist, 1-2 times a year.
This is all about kidney pyelonephritis (acute, chronic): what are the main symptoms and signs of the disease in men and women, especially the treatment. Be healthy!
Is a nonspecific infection of the kidney caused by various bacteria. The acute form of the disease is manifested by an increase in temperature, symptoms of intoxication and pain in the lumbar region. Chronic pyelonephritis may be asymptomatic or be accompanied by weakness, impaired appetite, increased urination, and mild back pain. The diagnosis is made based on the results of laboratory tests (general and biochemical urine tests, bacterial culture), urography and ultrasound of the kidneys. Treatment - antibiotic therapy, immunostimulants.
General information
Pyelonephritis is a widespread pathology. Patients suffering from acute and chronic pyelonephritismake up about 2/3 of all urological patients. The disease can be acute or chronic, affecting one or both kidneys. Diagnosis and treatment is carried out by a specialist in the field of clinical urology and nephrology. In the absence of timely therapy, pyelonephritis can lead to such severe complications as renal failure, carbuncle or kidney abscess, sepsis and bacterial shock.
Causes of pyelonephritis
The disease can occur at any age. More often pyelonephritis develops:
- In children under the age of 7 years (the likelihood of pyelonephritis increases due to the peculiarities of anatomical development.
- In young women aged 18-30 years (the occurrence of pyelonephritis is associated with the onset of sexual activity, pregnancy and childbirth).
- In older men (with obstruction of the urinary tract due to the development of prostate adenoma).
Any organic or functional reasons that interfere with the normal outflow of urine increase the likelihood of developing pathology. Often, pyelonephritis appears in patients with urolithiasis. Adverse factors contributing to the onset of pyelonephritis include diabetes mellitus, immune disorders, chronic inflammatory diseases and frequent hypothermia. In some cases (usually in women) pyelonephritis develops after acute cystitis.
The asymptomatic course is often the reason for the untimely diagnosis of chronic pyelonephritis. Patients begin treatment when kidney function is already impaired. Since the pathology very often occurs in patients suffering from urolithiasis, such patients need special therapy even in the absence of pyelonephritis symptoms.
Symptoms of pyelonephritis
Acute pyelonephritis
The acute process is characterized by a sudden onset with a sharp rise in temperature to 39-40 ° C. Hyperthermia is accompanied by profuse sweating, loss of appetite, severe weakness, headache, and sometimes nausea and vomiting. Dull pains in the lumbar region of varying intensity, often one-sided, appear simultaneously with an increase in temperature. Physical examination reveals soreness during tapping in the lumbar region (positive Pasternatsky symptom).
The uncomplicated form of acute pyelonephritis does not cause urinary disturbances. The urine becomes cloudy or reddish. A laboratory study of urine reveals bacteriuria, minor proteinuria and microhematuria. The general blood test is characterized by leukocytosis and increased ESR... In about 30% of cases in biochemical analysis blood, an increase in nitrogenous wastes is noted.
Chronic pyelonephritis
Chronic pyelonephritis often becomes the outcome of an untreated acute form. Development of a primary chronic process is possible. Sometimes pathology is discovered by chance when examining urine. Patients complain of weakness, decreased appetite, headaches and frequent urination. Some patients have dull aching pains in the lumbar region, worse in cold, damp weather. Symptoms indicating an exacerbation coincide with the clinical picture of an acute process.
Complications
Bilateral acute pyelonephritis can cause acute renal failure. The most formidable complications include sepsis and bacterial shock. In some cases, the acute form of the disease is complicated by paranephritis. Perhaps the development of apostenomatous pyelonephritis (the formation of multiple small pustules on the surface of the kidney and in its cortex), a kidney carbuncle (often arises from the fusion of pustules, is characterized by the presence of purulent-inflammatory, necrotic and ischemic processes) kidney abscess (melting of the renal parenchyma) and papillary necrosis ...
If treatment is not carried out, the terminal stage of a purulent-destructive acute process begins. Pyonephrosis develops, in which the kidney is completely exposed to purulent fusion and is a focus consisting of cavities filled with urine, pus and tissue decay products. With the progression of chronic bilateral pyelonephritis, renal function is gradually impaired, which leads to a decrease in the specific gravity of urine, arterial hypertension and the development of chronic renal failure.
Diagnostics
The diagnosis is usually not difficult for the urologist due to the presence of pronounced clinical symptoms... A history of chronic diseases or recent acute purulent processes is often noted. The clinical picture is formed by a characteristic combination of severe hyperthermia with back pain (usually one-sided), painful urination and changes in urine. The urine is cloudy or reddish and has a pronounced offensive odor. As part of diagnostic activities, the following are performed:
- Laboratory research... Laboratory confirmation of the diagnosis is the detection of bacteria and small amounts of protein in the urine. To determine the pathogen, urine culture is performed. The presence of acute inflammation is evidenced by leukocytosis and an increase in ESR in the general blood test. Using special test kits, the microflora that caused the inflammation is identified. The concentration ability of the kidneys is assessed using the Zimnitsky test.
- Radiation diagnostics... In the course of a survey urography, an increase in the volume of one kidney is revealed. Excretory urography indicates a sharp limitation of the mobility of the kidney during orthopedic testing. With apostematous pyelonephritis, there is a decrease in the excretory function on the side of the lesion (the shadow of the urinary tract appears with a delay or is absent). With a carbuncle or abscess on the excretory urogram, bulging of the kidney contour, compression and deformation of the cups and pelvis is determined. Diagnosis of structural changes kidney tissue with pyelonephritis, it is performed using ultrasound of the kidneys. To exclude urolithiasis and anatomical abnormalities, CT of the kidneys is performed.
Pyelonephritis treatment
Treatment of acute pyelonephritis
An uncomplicated acute process is treated conservatively in a hospital setting. Antibacterial therapy is in progress. Medicines are selected taking into account the sensitivity of bacteria found in the urine. In order to eliminate inflammation as quickly as possible, preventing the transition of pyelonephritis to a purulent-destructive form, treatment begins with the most effective drug.
Detoxification therapy, immunity correction is carried out. In case of fever, a diet with a low protein content is prescribed, after normalization of the temperature, the patient is transferred to a good diet with increased content liquids. At the first stage of treatment of secondary acute pyelonephritis, obstacles that impede the normal outflow of urine should be eliminated: as a rule, for this, a ureteral catheter-stent is installed. Prescribing antibacterial drugs for impaired urine passage does not give the desired effect and can lead to the development of serious complications.
Chronic pyelonephritis treatment
It is carried out according to the same principles as the therapy of the acute process, but differs in greater duration and laboriousness. The therapeutic program provides for the elimination of the causes that led to the obstruction of the outflow of urine or caused disorders of the renal circulation, antibiotic therapy and the normalization of general immunity.
If there are obstructions, it is necessary to restore the normal passage of urine. Restoration of the outflow of urine is performed promptly (nephropexy with nephroptosis, removal of stones from the kidneys and urinary tract, removal of prostate adenoma, etc.). The elimination of obstacles that interfere with the passage of urine, in many cases, allows you to achieve a stable long-term remission. Antibacterial drugs are prescribed taking into account the antibiogram data. Before determining the sensitivity of microorganisms, therapy with broad-spectrum antibacterial drugs is carried out.
Patients with chronic pyelonephritis require long-term systematic therapy for at least a year. Treatment begins with a continuous course of antibiotic therapy lasting 6-8 weeks. This technique allows you to eliminate the purulent process in the kidney without the development of complications and the formation of scar tissue. If renal function is impaired, constant monitoring of the pharmacokinetics of nephrotoxic antibacterial drugs is required. For the correction of immunity, if necessary, use immunostimulants and immunomodulators. After achieving remission, intermittent courses of antibiotic therapy are prescribed.
During the period of remission, patients are shown sanatorium treatment (Jermuk, Zheleznovodsk, Truskavets, etc.). It should be remembered about the obligatory continuity of therapy. The antibacterial treatment started in the hospital must be continued on an outpatient basis. The treatment regimen prescribed by the doctor of the sanatorium should include the intake of antibacterial drugs recommended by the doctor who constantly monitors the patient. Phytotherapy is used as an additional method of treatment.
Pyelonephritis is an acute or chronic kidney disease that develops as a result of exposure of the kidney to certain causes (factors) that lead to inflammation of one of its structures, called the calyx-pelvic system (the structure of the kidney in which urine is accumulated and excreted) and adjacent to this structure, tissue (parenchyma), with subsequent impairment of the function of the affected kidney.
The definition of "Pyelonephritis" comes from the Greek words ( pyelos - translated as, pelvis, and nephros-bud). Inflammation of the kidney structures occurs in turn or simultaneously, it depends on the cause of the developed pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 39 ° C, nausea, vomiting, urination disorder), when it correct treatment after 10-20 days, the patient recovers completely.
Chronic pyelonephritis is characterized by exacerbations (most often in the cold season), and remissions (abatement of symptoms). Its symptoms are mild, most often, it develops as a complication of acute pyelonephritis. Chronic pyelonephritis is often associated with any other disease of the urinary system (chronic cystitis, urolithiasis, anomalies of the urinary system, prostate adenoma, and others).
Women, especially young and middle-aged, get sick more often than males, approximately in a 6: 1 ratio, this is due to the anatomical features of the genitals, the onset of sexual activity, and pregnancy. Men are more likely to develop pyelonephritis at an older age, this is most often associated with the presence of prostate adenoma. Children also get sick, more often of an early age (up to 5-7 years), compared with children of an older age, this is due to the low resistance of the body to various infections.
Kidney anatomy
The kidney is an organ of the urinary system that participates in the elimination of excess water from the blood and products secreted by the tissues of the body that are formed as a result of metabolism (urea, creatinine, drugs, toxic substances, and others). The kidneys excrete urine from the body, further along the urinary tract (ureters, bladder, urethra), it is excreted into the environment.The kidney is a paired organ, bean-shaped, dark brown in color, located in the lumbar region, on the sides of the spine.
The mass of one kidney is 120 - 200 g. The tissue of each of the kidneys consists of a medulla (in the form of pyramids) located in the center, and a cortical substance located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are surrounded by funnel-shaped formations (small renal cups, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal cups (on average 2-4 in one kidney). In the future, the large renal cups pass into one large renal pelvis (a cavity in the kidney, funnel-shaped), which, in turn, passes into the next organ of the urinary system, which is called the ureter. From the ureter, urine enters the bladder (the reservoir for collecting urine), and from there through the urethra to the outside.
Inflammatory processes in the calyx and pelvis of the kidney are called pyelonephritis.
Causes and risk factors in the development of pyelonephritis
| Features of the urinary tract | |
| Rthey develop as a result of exposure of the fetus during pregnancy to unfavorable factors (smoking, alcohol, drugs) or hereditary factors (hereditary nephropathies, resulting from a mutation of a gene responsible for the development of the urinary system). Congenital anomalies that lead to the development of pyelonephritis include the following malformations: narrowing of the ureter, an underdeveloped kidney (small size), a lowered kidney (located in the pelvic region). The presence of at least one of the above defects leads to stagnation of urine in the renal pelvis, and a violation of its excretion into the ureter, this is a favorable environment for the development of infection and further inflammation of the structures where urine has accumulated. |
| In women, compared to men, the urethra is shorter and larger in diameter, so sexually transmitted infections easily enter the urinary tract, rising to the level of the kidney, causing inflammation. |
| Hormonal changes in the body during pregnancy | |
| The pregnancy hormone, progesterone, has the ability to reduce the muscle tone of the genitourinary system, this ability has, positive effect (prevention of miscarriages), and a negative effect (impaired urine flow). The development of pyelonephritis during pregnancy is the disturbed outflow of urine (a favorable environment for the reproduction of infection), which develops as a result of hormonal changes, and compression by the enlarged (during pregnancy) uterus of the ureter. | |
| Reduced immunity | |
The task of the immune system is to eliminate all substances and microorganisms foreign to our body, as a result of a decrease in the body's resistance to infections, pyelonephritis can develop.
|
|
| Chronic diseases of the genitourinary system | |
| lead to a violation of the excretion of urine and its stagnation; |
| (inflammation of the bladder), in case of ineffective treatment or its absence, the infection spreads up the urinary tract (to the kidney), and its further inflammation. |
| Infections such as chlamydia, trichomoniasis, when penetrating through the urethra, enter the urinary system, including the kidney. |
| Chronic amygdalitis, bronchitis, intestinal infections, furunculosis and other infectious diseases are a risk factor for the development of pyelonephritis . In the presence of a chronic focus of infection, its causative agent (staphylococcus, E.coli, Pseudomonas aeruginosa, candida and others) with blood flow can enter the kidneys. |
Symptoms of pyelonephritis
- burning and pain during urination, due to the inflammatory process in the urinary tract;
- need to urinate more often than usual in small portions;
- beer-colored urine (dark and cloudy), is the result of the presence of a large number of bacteria in the urine,
- unpleasant smell of urine,
- often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).
- Pasternatsky's symptom is positive - with a light strike with the edge of the palm on the lumbar region, pain appears.
- Edema, formed in the chronic form of pyelonephritis, in advanced cases (no treatment), often appear on the face (under the eyes), legs, or other parts of the body. Edema appears in the morning, soft pasty consistency, symmetrical (on the left and right sides of the body of the same size).
Diagnostics of the pyelonephritis
General urine analysis - indicates abnormalities in the composition of urine, but does not confirm the diagnosis of pyelonephritis, since any of the abnormalities may be present in other kidney diseases.Correct urine collection:in the morning, the toilet of the external genital organs is performed, only after that the morning, first portion of urine is collected in a clean, dry dish (a special plastic cup with a lid). Collected urine can be stored for no more than 1.5-2 hours.
Indicators of the general analysis of urine with pyelonephritis:
- A high level of leukocytes (normal in men 0-3 leukocytes in the field of view, in women up to 0-6);
- Bacteria in urine\u003e 100,000 per ml; the excreted urine is normal, should be sterile, but when it is collected, it is often not respected hygienic conditions, therefore, bacteria up to 100,000 are allowed;
- Density of urine
- Ph urine - alkaline (normally acidic);
- The presence of protein, glucose (normally they are absent).
Urine analysis according to Nechiporenko:
- Leukocytes are increased (normally up to 2000 / ml);
- Erythrocytes are increased (normally up to 1000 / ml);
- The presence of cylinders (normally they are absent).
Kidney ultrasound: is the most reliable method for determining the presence of pyelonephritis. Determines the different sizes of the kidneys, a decrease in the size of the affected kidney, deformation of the calyx-pelvic system, the identification of a stone or tumor, if any.
Excretory urography, is also a reliable method for detecting pyelonephritis, but in comparison with ultrasound, the urinary tract (ureter, bladder) can be visualized, and in the presence of a blockage (stone, tumor), its level can be determined.
CT scan, is the method of choice, using this method it is possible to assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)
Pyelonephritis treatment
Drug treatment of pyelonephritis
- Antibiotics, are prescribed for pyelonephritis, according to the results of bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.
Antibiotics and antiseptics in the treatment of pyelonephritis:
- Penicillins(Amoxicillin, Augmentin). Amoxicillin inside, 0.5 g 3 times a day;
- Cephalosporins (Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
- Aminoglycosides (Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg / kg 2 times a day;
- Tetracyclines (Doxycycline, orally 0.1 g 2 times a day);
- Levomycetin group (Chloramphenicol, inside 0.5 g 4 times a day).
- Sulfonamides (Urosulfan, orally 1 g 4 times a day);
- Nitrofurans (Furagin, inside 0.2 g 3 times a day);
- Quinolones(Nitroxoline, 0.1 g orally 4 times a day).
- Diuretic drugs: are prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and are not prescribed for acute pyelonephritis. Furosemide 1 tablet once a week.
- Immunomodulators: increase the reactivity of the body in case of illness, and to prevent exacerbation of chronic pyelonephritis.
- Timalin,intramuscularly 10-20 mg once a day, 5 days;
- T-activin,intramuscularly, 100 mcg 1 time per day, 5 days;
- Multivitamins , (Duovit,1 tablet once a day), ginseng tincture -30 drops 3 times a day, also used to increase immunity.
- Non-steroidal anti-inflammatory drugs (Voltaren),have anti-inflammatory effects. Voltaren inside, 0.25 g 3 times a day, after meals.
- To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantil,0.025 g 3 times a day.
Herbal medicine for pyelonephritis
Herbal medicine for pyelonephritis is used as an adjunct to drug treatment, or to prevent exacerbation in chronic pyelonephritis, and is best used under the supervision of a physician.Cranberry juice, has antimicrobial effect, drink 1 glass 3 times a day.
Bearberry broth, has antimicrobial effect, take 2 tablespoons 5 times a day.
Boil 200 g of oats in one liter of milk, drink ¼ cup 3 times a day.
Kidney collection number 1: A decoction of the mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.
Collection number 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, lingonberry. Finely chop all these herbs, pour 2 tablespoons with water and boil for 20 minutes, take half a glass 4 times a day.
Pelonephritis is an infection of the renal pelvis or parenchyma that is usually caused by bacteria.
The kidneys filter the blood to produce urine. Two tubes called ureters transport urine from the kidney to pyelonephritis.php. From the bladder, urine is excreted from the body through the urethra (urethra).
In most cases, pyelonephritis is caused by a spread of infections from the bladder. The bacteria enter the body from the skin around the urethra. Then they rise from the urethra into the bladder and then enter the kidneys, where pyelonephritis develops.
Sometimes, bacteria escape from the bladder and urethra by traveling the ureters from one or both kidneys. As a result kidney infection called pyelonephritis.
Pyelonephritis can be acute or chronic.
Acute uncomplicated pyelonephritis is a sudden onset of kidney inflammation and is usually associated with ascending infectionwhen bacteria enter the body from the skin around the urethra and then rise from the urethra to the bladder and further to the kidneys. In uncomplicated cases, the causative agent of the disease is usually Escherichia coli (75%).
Chronic (long-term) pyelonephritis is a rare condition, usually caused by birth defects in the kidneys and usually leads to progressive damage and scarring of the kidneys. This can eventually lead to kidney failure. As a rule, chronic pyelonephritis is found in childhood.
But also chronic pyelonephritis can develop as a result of untreated acute pyelonephritis, when it was possible to remove acute inflammation, but it was not possible to completely destroy all pathogens in the kidney, nor to restore the normal outflow of urine from the kidney. It is usually asymptomatic and is often found on urinalysis or ultrasound.
Severe variants of pyelonephritis occur with complicating factors, such as: a structural defect, or diabetes.
Causes and risk factors for pyelonephritis
Most often, the bacteria that cause pyelonephritis are the same as those that cause common urinary tract infections. Stool bacteria such as E. coli and Klebsiella are the most common.
Common reasons:
Urinary tract infections.
- 75% of pyelonephritis cases are caused by E. coli.
- 10% to 15% are caused by other gram-negative bacteria: Klebsiella, Proteus, Enterobacter, Pseudomonas, Serratia Citrobacter.
- 5-10% gram-positive bacteria such as Enterococcus and Staphylococcus aureus.
- Fungal bacteria, especially Candida SPP, develop in immunocompromised and diabetic patients.
- Salmonella, leptospira, mycoplasma, chlamydia.
Cumulative or contributing factors:
Diseases or conditions that cause stagnation of urine in the urinary tract, facilitating the multiplication of pathogens in the urinary tract and, as a result, the ascension of infection.
- Diseases that weaken the immune system, contributing to the multiplication of microorganisms in the urinary tract and the ascension of infection.
- The presence of devices (catheters, urine bags, Foley catheter) in the urinary tract that promote the multiplication of microorganisms in the urinary tract and the ascension of infection.
Conditions that obstruct or reduce the normal flow of urine are more likely to lead to pyelonephritis. When urine flow is slowed down or obstructed, bacteria can easily enter the ureters. Some of the reasons that prevent normal urine flow include:
Benign prostatic hypertrophy,.
- Abnormal development urinary tract.
Cancers associated with the renal tract, such as renal cell carcinoma, bladder cancer, tumors of the ureters, cancers originating outside the renal tract, such as bowel cancer, prostate cancer.
- Radiation therapy or surgical injury ureters
Neurological disorders, for example.
- Polycystic kidney disease.
- Neurogenic bladder after injury or neurological disorderssuch as diabetic neuropathy.
Immunity disorders:
- HIV.
- Myeloproliferative diseases.
- Diabetes.
- Organ transplant
-
Other reasons:
Age. Acute pyelonephritis is more common in
- Paul. Women get pyelonephritis more often than men because women have a much shorter urethra than men, which is one of the reasons women are more vulnerable to urinary tract infections. Women are more likely to develop pyelonephritis when they are pregnant. Pyelonephritis and other forms of urinary tract infection increase the risk of premature birth. Acute pyelonephritis is more common in sexually active women.
- Genetics. Vesicoureteral reflux is hereditary and is observed in 10% of first-degree relatives of the victim. Polycystic kidney disease also has an autosomal dominant inheritance.
- Socio-economic status.
Symptoms of pyelonephritis
Pyelonephritis symptoms can vary depending on the person's age and may include the following:
Malaise
- Fever and / or chills, especially in the case of acute pyelonephritis
- Nausea and vomiting
- Pain in the side under the lower ribs, in the back, radiating to the iliac fossa and suprapubic region.
- Confusion of consciousness.
- Frequent, painful urination.
- Blood in urine (hematuria)
- Cloudy urine with a pungent odor
- Children under 2 years of age may have only high fever without urinary tract symptoms.
- Elderly people may not have any symptoms related to the urinary tract. They may show confusion, incoherent speech, or hallucinations.
- Chronic pyelonephritis, as a rule, is asymptomatic, but can constantly bother the patient with dull aching pains in the loins, especially in damp cold weather.
Diagnostics of the pyelonephritis
The diagnosis of acute pyelonephritis is usually straightforward and includes:
- Physical examination (general appearance, temperature, heart rate,) and palpation of the abdomen;
- Urine culture, to determine the specific type of bacteria that caused the development of pyelonephritis;
- Blood culture if pyelonephritis has spread to the blood;
- Blood test. Creatinine is an important indicator. It is a byproduct of normal muscle breakdown. Creatinine is filtered through the kidneys and excreted in the urine. The ability of the kidneys to process creatinine is called creatinine clearance, which allows us to estimate the glomerular filtration rate - the rate of blood flow through the kidneys, or, more simply, the degree of blood purification. The normal level of creatinine in the blood is from 71-106 μmol / L in adult men and from 36-90 μmol / L in adult women.
- Analysis of urine. Microscopic analysis of urine will almost always show signs of infection. The presence of white blood cells and bacteria in the urine indicates an infection
- ultrasound. Ultrasound examination can help identify abscesses, stones and causes of urinary retention, birth defects of the urinary tract;
- Computed tomography (CT). Usually, CT is not necessary, but if the ultrasound fails to see the full picture, CT may be advisable;
- Gynecological examination. Typically, in women, the symptoms of pyelonephritis are similar to those of certain sexually transmitted diseases, so a pelvic examination may be recommended.
Pyelonephritis treatment
Antibiotics are commonly used to treat pyelonephritis. In most cases, treatment for uncomplicated pyelonephritis usually lasts 10 to 14 days. They can be administered orally or intravenously, depending on clinical condition the patient. As a rule, they are used orally, and their choice will depend on the specific situation: laboratory research to bacteria that caused the disease, the presence of allergies, pregnancy, etc. The following antibiotics are commonly used: penicillin, trimethoprim, sulfamethoxazole (Bactrim), ciprofloxacin, cefotaxime, cefaclor, cefuroxime, cephalexin, ceftazidime, or levofloxacin.
In the treatment of pyelonephritis in pregnant women, a group of broad-spectrum antibiotics is prescribed - nitrofurans. These include furagin and furadonin. As a prophylactic agent, drugs containing nalidixic acid are used.
With exacerbations of chronic pyelonephritis, a drug is prescribed - nitroxoline.
Below is a table of antibiotic sensitivity of the main causative agents of pyelonephritis:
| The causative agent of pyelonephritis | Sensitivity to drugs (uroantiseptics) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Patients with complicated pyelonephritis, concomitant diabetes, calculi, known renal damage, known renal anatomical abnormalities, and pregnancy should hospital treatment
When high temperature, chills, severe nausea and vomiting, there is a great chance of dehydration. In this case, hospital treatment and intravenous antibiotics may also be required. Fever and chills can also be signs that a kidney infection has spread into the bloodstream.
In rare cases, pyelonephritis can progress to form a focus of infection - an abscess. Abscesses that are difficult or impossible to cure with antibiotics must be drained. This is most commonly done with a tube inserted through the skin on the back into a kidney abscess. This procedure is called a nephrostomy.
Along with antibacterial therapy, treatment with herbs that have anti-inflammatory and diuretic effects is indicated. Herbal medicine is successfully used in the treatment of chronic pyelonephritis.
Medicinal plants used for chronic pyelonephritis:
- Altay
- Lingonberry
- Elderberry black
- Elecampane
- St. John's wort
- Corn silk
- Nettle
- Angelica root
- Birch leaves
- Wheatgrass
- Kidney tea
- Horsetail
- Chamomile
- Rowan
- Bearberry
- Cornflower flowers
- Cranberry
- Strawberry leaves
Complications of pyelonephritis
Acute infection from the renal pelvis or parenchyma
- Formation of an abscess
- Scarring in the kidneys
- Renal failure
- Chronic renal failure
- Hypertension
- Sepsis, shock, and hypotension can occur in severe cases
- Rarely can lead to acute papillary necrosis or, if obstructed, can progress to chronic pyelonephritis
- Children with chronic pyelonephritis have apathy, convulsions, bloating, irritability, weight loss, enuresis, diarrhea, vulvar itching.
Pyelonephritis prognosis
A single episode of uncomplicated pyelonephritis rarely causes kidney damage in healthy adults. However, repeated episodes of pyelonephritis can lead to chronic (long-term) kidney disease in children with diabetes mellitus, as well as adults who have structural abnormalities of the urinary tract or nerve diseases that impair bladder function.
Pyelonephritis can become chronic if the infection cannot be cleared due to kidney stones or other abnormalities in the urinary system.
Most patients with uncomplicated pyelonephritis find that their symptoms begin to improve after one to two days of antibiotic treatment. However, even after symptoms improve, antibiotics are usually prescribed for a 10 to 14 day course.
- Drink several glasses of water every day. Water helps to flush bacteria out of the urinary tract and inhibits their growth. It also helps prevent the formation of kidney stones, which can increase your risk of developing pyelonephritis.
- To prevent the spread of intestinal and skin bacteria from the rectum to the urinary tract, women should always wipe with toilet paper after bowel movement or urination from front to back.
- Reducing the spread of bacteria during sex. A woman should urinate after intercourse to flush bacteria out of her bladder.
- Practice safe sex, avoid frequent changes of sexual partners.
- Timely heal any inflammatory diseases, regardless of their severity.
- Regularly improve the body's defenses and immunity. Accept multivitamin complexes, lead an active, healthy lifestyle.
- Keep your legs, lower back and kidney area warm, do not sit on cold surfaces.
- In case of structural problems with the urinary system, such as blockage of the ureters by a stone, or developmental abnormalities, consider surgery to restore normal urinary function and prevent future episodes of pyelonephritis.
This is a disease of the calyx-pelvis system and the renal parenchyma of an inflammatory nature, which, under unfavorable conditions, is caused by a number of microorganisms.
Acute and chronic forms are the most frequent illnesses upper urinary tract.
Most often, one kidney is affected by the disease. But a two-way process is also rare.
Causes of pyelonephritis
A person of any age can get sick, but more often they get sick:
- children under 7 years of age, in whom the disease is associated with anatomical developmental features;
- girls and women 18-30 years old, in whom the appearance of pyelonephritis is associated with the onset of sexual activity, with pregnancy or childbirth;
- elderly men with prostate adenoma.
In addition to the above, one of the most frequent reasons is an urolithiasis diseaseand frequent bouts of renal colic.
Also promotes development pyelonephritisfactors such as a decrease in the general immunity of the body, diabetes mellitus, chronic inflammatory diseases.
Frequent hypothermia, lack of control over the state of the kidneys (according to the general analysis of urine, if necessary, according to the analysis of blood) can lead to a deterioration in renal function due to severe inflammation. Especially often, the disease occurs in the presence of salts or kidney stones (with urolithiasis of the kidneys), therefore, if salts or stones are found on ultrasound, even with an asymptomatic course, special treatment is required. Sometimes (more often in women) the disease begins with acute cystitis.
If you experience suspicious symptoms, be sure to see your doctor - only he can study your medical history, make the correct diagnosis and prescribe an effective treatment and diet. If pyelonephritis worsens, call an ambulance immediately.
Symptoms of acute pyelonephritis
Acute pyelonephritis often begins suddenly, the temperature rises sharply to 39-40 ° C, weakness appears, headache , profuse sweating, possible nausea and vomiting.
Simultaneously with the temperature, lower back pain appears, as a rule, on one side. The pains are dull in nature, but their intensity may be different.
Urination in uncomplicated form pyelonephritis not broken. In the early days, urine contains pus, erythrocytes, protein, and a large number of bacteria.
Beating in the lumbar region causes pain, and after it blood is found in the urine - the so-called positive Pasternatsky symptom.
With bilateral acute pyelonephritis, which is rare, signs of renal failure appear.
Even judging by the listed symptoms, it is not difficult to diagnose pyelonephritis, since patient complaints are quite typical.
With the help of urine analysis, bacteria, an increase in the number of leukocytes and protein are detected. Special test systems allow you to identify bacteria that cause inflammation in the urinary tract.
An important role in the diagnosis is played by a history of indications of a recent acute purulent process or the presence of chronic diseases. A combination of fever with frequent and painful urination, pain in the lumbar region and changes in urine is characteristic.
The plain X-ray shows an increase in one of the kidneys in volume, with excretory urography - a sharp restriction of the mobility of the affected kidney during breathing, the absence or later appearance of the shadow of the urinary tract on the side of the lesion. Compression of the calyx and pelvis, amputation of one or more calyces indicate the presence of a carbuncle.
Chronic pyelonephritis
Chronic pyelonephritis, as a rule, is the result of an untreated acute pyelonephritis, when it was possible to remove acute inflammation, but it was not possible to completely destroy all pathogens in the kidney, nor to restore the normal outflow of urine from the kidney.
Progression of bilateral pyelonephritis leads to kidney failure. In addition, chronic pyelonephritis worsens from time to time, and then the patient has all the signs of an acute process.
The vital activity of the body of a pregnant woman is aimed at creating and ensuring optimal conditions for the development of the fetus. During pregnancy, the restructuring of the activity of a woman's body affects almost all organs and systems. In particular, specific changes in kidney function occur in pregnant women, which, together with other pathological factors, can lead to the development of one or another kidney disease.
One of the most common kidney diseases in pregnant women is pyelonephritis... It can be observed during pregnancy, childbirth and after childbirth, i.e. at all stages of the gestational period, it is advisable to use the term "gestational pyelonephritis".
Clinically gestational pyelonephritisproceeds in an acute or chronic form.
For acute purulent gestational pyelonephritis in pregnant women, the following symptoms are characteristic:
- tremendous chills with high fever, severe headache, muscle aches;
- nausea, sometimes vomiting;
- increased breathing and heart rate;
- sweating and the subsequent decrease in temperature down to normal numbers.
Between chills it is noted lethargy , weakness. Disturbed by severe soreness in the lumbar region, corresponding to the side of the lesion, radiating to upper part abdomen, groin, perineum, thigh. Increased pain is characteristic at night, in the position of the patient on the back or on the side opposite to the diseased kidney, as well as when coughing, taking a deep breath.
Chronic gestational pyelonephritisdull pain in the lumbar region is inherent, aggravated by movement and physical exertion, headache , general weakness and fatigue.
There is an asymptomatic course.
The development of pyelonephritis during pregnancy is facilitated by a violation of the urodynamics of the urogenital tract, which may be associated not only with mechanical causes, but also, according to the results of recent studies, with the effect of female sex hormones (estrogens, progesterone, etc.).
It is noted that the most high level hormones are observed in the second half of pregnancy, at the same time the development of gestational pyelonephritis in pregnant women is characteristic. The effect of an increased hormonal background is directed to the renal calyx system, ureters and bladder, which leads to impaired urine outflow and reverse urine reflux and, as a consequence, to its stagnation in the pelvic calyx system, the reproduction of pathological microorganisms and the development of gestational pyelonephritis.
Analyzing the course of pregnancy and childbirth in women suffering pyelonephritis, it should be noted that acute gestational pyelonephritis, which first appeared during pregnancy, has a less pronounced adverse effect on the course of pregnancy.
With a long course of chronic pyelonephritismiscarriage is often observed, termination is most often observed at 16-24 weeks (6% of women), more often in such women and premature birth (25% of women). The main reason leading to the termination of pregnancy is severe forms of gestosis, which often develop in chronic pyelonephritis.
Currently acute gestational pyelonephritisdoes not serve as an indication for termination of pregnancy if there are no other obstetric indications. Some authors argue that termination of pregnancy against the background of an active process can aggravate the course of the inflammatory process up to the development of sepsis and septic uterine bleeding.
Acute gestational pyelonephritis, which arose during pregnancy, despite the acute course at the onset of the disease, with timely treatment, does not lead to the development of complications, which cannot be said about the course of chronic pyelonephritis.
This disease, even if it does not worsen during pregnancy, is more often complicated by nephropathy, premature birth or severe preeclampsia, which is an indication for termination of pregnancy. The methods used to terminate a pregnancy are different and depend on the duration of the pregnancy and the severity of the patient's condition.
In a full-term pregnancy, a woman with a gestational pyelonephritiscan give birth on their own, with the full use of painkillers. In the postpartum period, it is advisable to carry out a course of antibiotic treatment.
It should be noted that children born to women who have undergone an acute or chronic form of the disease often have signs of intrauterine infection, some die in the early postpartum period. Based on all of the above, it follows that pregnant women with acute or chronic gestational pyelonephritisneed special supervision and timely treatment.
Of great importance during pregnancy and the normal development of the fetus is the presence or absence of hypertension, as well as azotemia during chronic pyelonephritis... Depending on this, three degrees of risk are distinguished in pregnant women:
- degree of risk - uncomplicated pyelonephritis that occurs during pregnancy;
- degree of risk - chronic pyelonephritis that arose even before pregnancy;
- degree of risk - chronic pyelonephritis with hypertension or azotemia, pyelonephritis of a single kidney.
Gestational treatment pyelonephritis in pregnant women women must be carried out in a hospital setting, as it is possible to develop severe complications that threaten the life of the mother and child.
Pyelonephritis in children
Children of the first two years of life are most susceptible to the development of pyelonephritis. This is due to the structural features of the kidneys and urinary tract at this age: the pelvis are located inside the kidneys, the ureters are convoluted with a low tone, the neuromuscular apparatus at this age is not yet mature. At the same time, in young children, local immunity has not yet been finally formed and does not provide reliable protection.
Symptoms of pyelonephritis in newborns and young children are not specific and accompany many other diseases: fever , pallor and marbling of the skin, lethargy , lack of appetite, vomiting and regurgitation, diarrhea , a decrease in the rate of weight gain or even its reduction. Often the only symptom in children, especially 1 year of age, is only fever.
Therefore, in the case of a fever in a child without a cough, runny nose , red throat, it is recommended to take a urine test to exclude pyelonephritis and other infectious diseases of the urinary tract.
In older children, the symptoms of pyelonephritis are similar to those in adults.
Complications of pyelonephritis
Most frequent complications pyelonephritis is associated with the spread of the infection through the kidney and into surrounding tissues. So acute pyelonephritis can be complicated by paranephritis, the formation of pustules in the kidney (apostematous pyelonephritis), carbuncle or kidney abscess, necrosis of the renal papillae, which is an indication for surgery.
Pyonephrosis - is the terminal stage of purulent-destructive pyelonephritis... The pyonephrotic kidney is an organ that has undergone purulent fusion, consisting of separate cavities filled with pus, urine and tissue decay products.
A two-way process, affecting the excretory function of the kidneys, can lead to the development of renal failure.
Pyelonephritis treatment
The main therapeutic measure is the impact on the causative agent of the disease with antibiotics and chemical antibacterial drugs in accordance with the sensitivity of the found pathogen to them, detoxification therapy and therapy that increases immunity in the presence of immunodeficiency.
With acute pyelonephritis treatment should begin with the most effective antibiotics and chemical antibacterial drugs, to which the microflora of urine is sensitive, in order to quickly eliminate the inflammatory process in the kidney, preventing it from becoming a purulent-destructive form.
With secondary acute pyelonephritis treatment should begin with the restoration of the passage of urine from the kidney, which is fundamental.
Treatment of chronic pyelonephritis fundamentally the same as acute, but more lengthy and laborious.
With chronic pyelonephritistreatment should include the following main activities:
- elimination of the causes that caused the violation of the passage of urine or renal blood circulation, especially venous;
- the appointment of antibacterial agents or chemotherapy drugs taking into account antibiogram data;
- increased immune reactivity of the body.
Restoration of urine outflow is achieved primarily by the use of one or another type of surgical intervention (removal of adenoma of the prostate gland, stones from the kidneys and urinary tract, nephropexy in nephroptosis, plastic of the urethra or pelvic-ureteric segment, etc.). Often after these surgical interventions it is relatively easy to obtain a stable remission of the disease without long-term antibacterial treatment. Without sufficiently restored urine massage, the use of antibacterial drugs usually does not give long-term remission of the disease.
Antibiotics and chemical antibacterial drugs should be prescribed taking into account the sensitivity of the microflora of the patient's urine to antibacterial drugs. Before obtaining antibiogram data, antibacterial drugs are prescribed that have wide range actions. Treatment for chronic pyelonephritis systematic and long-term (at least 1 year). The initial continuous course of antibacterial treatment is 6-8 weeks, since during this time it is necessary to suppress the infectious agent in the kidney and resolve the purulent inflammatory process in it without complications in order to prevent the formation of scar connective tissue.
After the patient reaches the stage of remission of the disease, antibacterial treatment should be continued with intermittent courses. The timing of breaks in antibacterial treatment is set depending on the degree of kidney damage and the time of onset of the first signs of an exacerbation of the disease, i.e., the appearance of symptoms of the latent phase of the inflammatory process.
Sanatorium treatment of patients with chronic pyelo-jade carried out in Truskavets, Zheleznovodsk, Jermuk, Sairma, etc. It should be remembered that only strictly successive treatment of patients with chronic pyelonephritis in a hospital, a clinic and a resort gives nice results... In this regard, patients with chronic pyelonephritis in the latent phase of inflammation should continue antibacterial treatment in the conditions of the resort according to the scheme recommended by the attending physician, who is observing the patient for a long time.
In addition, one of the basic rules in the treatment of this disease is the regular intake of "renal" herbs.