Obstructive and unstructive pyelonephritis: causes, symptoms. What is chronic unstructive pyelonephritis obtultational pyelonephritis

In this diagnosis, each component - both "sharp", and "obstructive", and actually "pyelonephritis" - needs detailed explanation and accurate understanding. We are talking about the inflammation of the kidneys (jade) with preferably defeat of the system of cups and pyelonephritis, from Greek. Pyelos - Lohan), as well as the main functional fabric (parenchyma). When driving a pathogenic causative agent flashes and rapidly developing infectious inflammatory process (acute), prerequisite and condition of which is difficult, obstacle (obstruction) on the way of urine outflows.

It should be noted that from all known renal pathology, it is pyelonephritis that are in the first place in the frequency of occurrence. Women are hurt much more often than men (three to six times - depending on age category), and only in elderly and elder groups the incidence is somewhat compared. In this case, the obstructive version (it is also called secondary, in relation to the obstruction of the upper departments of the urinary tract as a primary factor) is 80-85% of all pyelonephritis.

In other words, this problem Indeed, as they say, know in the face.

2. Causes

The inflammatory process in a cup-lowering system, nephronous parenchyma (nephron - a single filtering cell of the kidney), and an interstitial, intermediate (loose connective) tissue can be due to almost any pathogenic and conditionally pathogenic microorganism, for example, an intestinal wand. In the absolute majority of cases, these are bacterial forms.

There are two main ways of infection penetration.

In the presence of a chronic infectious inflammatory hearth in other body systems, the causative agent can be entered into the kidney with a blood flow - such a mechanism of infection is called hematogenic. The primary focus can be located both in adjacent organs (prostate gland or ovary, urinary bubble, etc.) and quite far from the urogenital system (for example, in bronchi or oral cavity).

The urinogenic path implies the presence of cystitis - inflammation in the bladder. With reverse cast of urine from the bubble in the ureter (reflux), the pathogen is asked by the upward path to the ureter in the kidney. This path of infection is more frequent than hematogenous.

The cause of obstructive violations of urine evacuation may become migrating renal stones (in this version, symptoms develops most acutely), the pressure from the rising tumor, the rebirth of the tissue of the walls itself, - stenosis, i.e. gradual replacement of a more dense, rigid and volumetric connective tissue.

3. Symptomatics, diagnostics

In the clinic of pyelonephritis, several stages are distinguished, - from the initial serous, which can last 6-30 hours, and to heavy, dangerous complications: in the absence of fast specialized assistance, purulent processes will quickly progress - it can be formed and then break through the abscess, the retroperitoneal phlegmon and t. P. It should be noted that obstructive, secondary pyelonephritis compared to primary is characterized by a much stronger tendency to suppuration.

Symptomatics, by definition, grow sharply and already in the first hours is distinguished by significant severity. Often after a very painful renal colic, the temperature (up to 40 degrees and above) sharply increases with strong chills, dyspepsy (nausea, vomiting), muscle, bone and articular pains; Then, after hyperhydroposis (reinforced sweating), the temperature can quickly decrease to a normal or subfebrile level with a simultaneous improvement in the overall condition and dullness of pain syndrome, which is the most cunning manifestation of acute pyelonephritis, since there is no improvement in reality. If at this stage is not to eliminate the reasons for the impairment of urine outflow and do not accept antiseptic measures, the symptoms return with the new force. With the addition of purulent processes, intoxication and dehydration (dehydration) are quickly aggravated, fever begins, rapidly worsens general state, the features of the face are sharpened.

In some cases (as a rule, at an initially weakened contingent of patients), symptomatics can be erased or atypical, which further complicates the diagnosis of acute obstructive pyelonephritis.

The setting of the right diagnosis requires not only the study of complaints and anamnesis, but also a compulsory careful external inspection (skin, language, pressure measurement and heart rate, palpation and percussion in the search for diagnostically significant reflex reactions). Urgent laboratory blood tests and urine are prescribed. To clarify the nature of obstruction, the state of urinary structures and related bodies, as well as for differentiation of symptomatic states, it is often necessary to apply visualizing research methods (ultrasound, CT or MSCT, MRI).

4. Treatment

Suspicion or confirmed presence of acute obstructive pyelonephritis is a direct and unequivocal testimony for hospitalization. The priority therapeutic task is as quickly as possible restoration of normal urine evacuation. To this end, depending on the specific situation, catheterization, punctuation or full-scale surgical intervention. The longer period of time between the first symptoms and appealing for help, the worse the forecast: above the likelihood of severe, life-focused purulent-inflammatory burden of the clinical picture, which will require a complex, long operation.

In any case, it will be necessary individually (taking into account the set of factors) complex medical therapycomprising antibiotics, anti-inflammatory agents, measures for disintellation. There is also a long (up to year) monitoring of renal functions and compliance with a number of preventive restrictions in the lifestyle, diet, etc.

Obstructive pyelonephritis is the inflammation of the renal pelletium (pylitis) and fabric (nephritis), arising against the background of the impairment of urine outflow due to the obstruction of the urinary system organs. The main reason is urinary tract infections. Bacterial invasion prevents urine outflow and increases the likelihood of kidney stones. Violation affects one or two kidneys. Due to the anatomical features of a woman, the problem occurs much more often than a man. In the article we will analyze what it is - obstructive pyelonephritis. IN international Classification Diseases of the 10th revision (ICD-10) Pathology is denoted by code N11.1.

Acute obstructive pyelonephritis - infectious damage to the organs of the urinary system, which occurs due to the blockade of urine outflows by stone or foreign body. The diagnosis of chronic disease is made on the basis of visualization methods - ultrasonic research (Ultrasound) and computed tomography (CT).

Bubble-ureteral reflux (abbreviation: PMR) is a congenital condition associated with the insufficiency of the ureter valve and occurring in chronic unstructive pyelonephritis. PMR is present in 25-35% of people with symptomatic infections of urinary tract and kidney scars. The diagnosis of PMR is often established on the basis of radiographic data obtained during the evaluation of recurrent infectious pathology.

The unstructive acute pyelonephritis is the inflammatory process of renal tissue and pelvis, which is not due to the obstacle to the outflow of urine. The main reason is congenital anomalies for the development of the urinary system.

Causes and pathogenesis

The cause of obstructive kidney inflammation is usually urinary tract infections and renal disease. Even the constant use of catheters often leads to a recurrent cell and chronic pyelonephritis.

Bacteria from bladder Rise through the ureters in the kidneys with acute pellet. This leads to the formation of scars as a result of constantly emerging inflammatory processes.

It's important to know! Renal abscesses - Magni clusters, which are surrounded by a connective tissue capsule; Most patients suffer from severe fever, chill and kidney pain. Urination can be painful, and urine is purulent and bloody.

Factors affecting the development of pyelonephritis:

• paul patient and his or her sexual activity;
• pregnancy;
• chronic malnutrition (hypovitaminosis A, C, D and B);
• hereditary predisposition;
• viral and bacterial infections;
• neurogenic urinary bladder dysfunction.

Chronic pyelonephritis Related to progressive scarring of renal tissue, which can lead to the terminal stage of body failure. In some cases, the scars can be formed by intrauterine in patients with kidney dysplasia. Sometimes normal growth can lead to the spontaneous disappearance of PMR and pyelonephritis at the age of 7.

More about symptoms

Acute obstructive and unstructive pyelonephritis causes nonspecific signs: from pain to completely asymptomatic manifestation. Sometimes a fever occurs, which lasts no more than 2-3 days.

Clinical symptoms:

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

In rare cases, hematuria, dizuriy or anorya is observed. Weak patients (diabetics, HIV-infected) develop sepsis - system infection.

Forms and types of disease

By clinical flow Latent, hypertensive, asymptomatic and anemic pyelonephritis. Ethiology distinguishes primary and secondary forms of the disease. There is also a classification of morphology and the path of penetration of invasion.

Potential complications

Fine treatment can be aggravated by the flow of pyelonephritis and lead to arterial hypertension or renal failure. It is important at an early stage to start therapy to prevent possible irreversible damage to organs.

Complications of chronic pyelonephritis:

It's important to know! Acute renal failure - the most severe complication of obstructive (calculous) pyelonephritis, which is capable of leading the patient to death in a short time. In the event of any of the above symptoms, you need to seek the advice of a qualified medical specialist, since it will help to avoid irreversible tissue changes.

Methods for identifying pathology

Initially, a physical examination is carried out and an anamnesis (illness history) is collected. Characteristic renal scars are often present in patients during the initial examination, new can be formed in 3-5% of patients. The development of scars is back connected with the rate of destination antibacterial therapy narrow spectrum of action. The presence of new scars often indicates the occurrence of systemic infections.

It's important to know! In the army during chronic pyelonephritis do not take.

Laboratory diagnostics

Urine laboratory tests are able to reveal the piura. It is recommended to carry out a bacteriological analysis of urine, which helps to detect gram-negative pathogenic pathogens - intestinal wand and proteins. The negative result of the microorganism survey does not exclude the diagnosis of chronic pyelonephritis. If Albuminuria is present, it indicates complications. The concentration of creatinine and uric acid in blood serum is rising.

Histology of kidney shows focal glomerosclerosis with a developed reflux nephropathy. Pregnant woman I. little child Supplementary surveys may be needed to eliminate secondary complications.

Instrumental examination

The urogram helps to establish with high pyelonephritis, because it reveals the dilatation of the renal cup and the scars. Sometimes the expansion of the ureter and reducing the value of the kidneys are also found.

X-ray examination with the help of succifer (hemeta) is more sensitive than intravenous pyroid, because it helps to identify the kidney scars. The diagnostic procedure is appointed by many pediatric specialists, because it is easily performed and able to detect pathology.

Computed tomography is a selection procedure in the diagnosis of obstructive pyelonephritis. Ultrasonographic images of kidneys can show concrections, but ultrasound is not a sensitive method for detecting reflux nephropathy.

Paths of treatment and forecast for patients

Patients prescribe medical therapy with antibiotics. It is recommended to continue treatment until sexual maturity and to completely disappear the reflux disease. Rule in these cases is spontaneous remission; The operation of such people is not needed. Birmingham Reflux research data has proven that conservative and operational methods for treating PMR are equally effective.

Indications for surgical intervention:

• neglect of the conservative treatment regime;
• sepsis;
• renal ureter reflux.

Surgery is recommended for all children over 12 months with sclerosis fabric changes and urine back. Patients aged 1-4 years with right-sided PMR and without borders can be held antibioticophylaxis.

Kidney damage can be reduced by limiting the dietary protein. Reduced arterial pressure medicinal preparations Helps slow down the development of renal failure; Calcium channel blockers (BKK) and angiotensin receptor antagonists are especially useful in hypertension.

Cephalosporin and penicillin antibiotics of the first generation in urology are the preparations of choice due to high efficiency against gram-negative microbes. Babies use predominantly a number of penicillins. wide spectrum actions. In patients aged six months, therapy can be changed to imidazolidinedion in the form of sodium salt. Teens and adults can be treated by co-trimoxazole.

It is forbidden to change the already appointed antibiotic therapy to prevent the development of resistance. Research in Birmingham clearly showed that drug-surgical methods equally effectively prevent kidney damage from obstructive pyelonephritis. Most children with a chronic form of inflammation spontaneously get rid of the PMR. Approximately 2% there are renal failure, while 5-6% are long complications, including hypertension. If consequences are developing due to improper treatment, you need to consult a doctor.

It's important to know! Hypertension contributes to the accelerated loss of kidney function in people with chronic pyelonephritis. Reflux nephropathy is the most common cause of improving blood pressure in children and occurs in 10-20% of cases.

Recommendations on the diet depend on the main cause of pyelonephritis. Fast and complete treatment of cystitis and other infections helps prevent renal inflammation. Therapy of bubble-ureteral reflux or obstructive uralopathy also prevents the development of the disease. In some cases, recurrent cystitis, the use of antibiotics helps to eliminate Wrostsis.

Most cases of pyelonephritis are underway without complications. Sometimes treatment can be long and aggressive. The goal is to avoid sepsis and renal failure. Children and adults need to make an optimal amount of fluid, as well as vitamin supplements. Dehydration increases the likelihood of recurrence in the next 2 years.

If fever arises, chills, dizziness and night sweating - it is necessary to consult with the attending physician. With symptoms of exacerbation of pyelonephritis, you need to contact the doctor to prevent complications. Initially started therapy increases the chances of the patient's complete recovery.

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The emergence of recurrence of pyelonephritis of chronic form

- This is a non-specific inflammatory defeat of kidney parenchyma. For pathology, a high fever with chills and sweating, headache, Malgia, Arthralgia, general malaise, lower back pain, changes in the urine in the type of leukocyturia and pyuria. Diagnostics include microscopic and bacteriological examination of urine, kidney ultrasound; If necessary, carrying out excretory urography, radioisotope studies, tomography. Diet is assigned, abundant drink, antibiotics, nitrofurans, antispasmodics. With obstructive pyelonephritis, the installation of the ureter catheter-stent or puncture nephrostomy is shown; With purulent-destructive processes - the decapsulation of the kidney or nephrectomy.

MKB-10

N10 Acute tubula interstal nephritis

General

Acute pyelonephritis It is the most frequent disease kidneys in modern urology. Pathology often occurs in childhoodWhen the burdens load is very intense, and their morpho-functional development has not yet been completed. Girls suffer 10 times more often than boys. At the age of 40, women are dominated among patients, in older age group There is a prevalence of male patients. Perhaps the defeat of one or both kidneys.

The reasons

Acute pyelonephritis develops with endogenous or exogenous penetration of pathogenic microorganisms in the kidney. Typically, pathology is caused by an intestinal wand (in 50% of cases), protemat, a blue rod, less often - staphylococci or streptococci. For primary process The infection can be in a hematogenic kidney from primary foci of inflammation in the urinary organs (with adnexite, cystitis, prostatitis, etc.) or from remote organs. Less often infection occurs on the ascending mechanism, along the wall or lumen of the ureter (with bubble-ureteral reflux).

The secondary acute pyelonephritis is associated with a violation of the passage of urine against the background of the stricture of the ureter, the obstruction of the ureter of stone, strictures and valves of urethra, prostate adenoma, prostate cancer, phimosis, neurogenic bladder. Predisposing moments to the development of this form of the disease serve supercooling, dehydration, hypovitaminosis, overwork, respiratory infections, pregnancy, diabetes.

Pathogenesis

Inflammation is associated not only with microbial invasion, but also by the ingress of the contents of the pelvis in an interstitial tissue, which is due to the reverse current of the urine, that is, the Forenaya Reflux. The kidneys are full, slightly increased. The mucous membrane of the renal pelvis of the edema is inflamed, ulcerated; In Lohanks there may be inflammatory exudate. In the following in the brain and cortex, the kidney layer can be formed by numerous uluses or abscesses; Sometimes a purulent-destructive melting of renal parenchyma is observed. The stages of acute pyelonephritis correspond to the morphological changes occurring in the kidney.

The initial phase of serous inflammation is characterized by an increase in the kidney increasing and tension, an edema of the ololyopochnye fiber, perivascular infiltration of interstitial tissue. With a timely appropriate treatment, this stage is subjected to reverse development; Otherwise, it goes into the stage of purulent-destructive inflammation. In the Stage purulent inflammation The phases of the apostleatous pyelonephritis, the carbuncule and the kidney abscesses are isolated. Apostatient (rotored) pyelonephritis proceeds with the formation of multiple small guns of 1-2 mm in the cortical layer.

In the case of merging of the guns, a local joining focus can be formed - kidney carbuncoon, having inclinations to progressive abscess. Carbuncules are of size from 0.3 to 2 cm, can be solid or multiple. With purulent melting of parenchyma, kidney abscess is formed. The danger of the kidney abscess is the possibility of emptying the reels of the waste into the paranefral tissue with the development of purulent paranefrites or the retroperitoneal phlegmon.

With a favorable outcome, infiltrative foci is gradually absorbed, replacing the connective tissue, which is accompanied by the formation of scar tension on the kidney surface. The scars first have dark red, then a white and gray color and a wedge-shaped form, on the cut breathing to the lochank.

Classification

Acute pyelonephritis can be primary (unstructive) and secondary (obstructive). The primary version of the disease proceeds against the background of normal urine outflow from the kidneys; The secondary is associated with a violation of the undergoing urinary tract due to their external compression or obstruction. By the nature of inflammatory changes, pathology can carry serous or purulent-destructive character (pyelonephritis of the aposthoretous, abscess or kings carbuncoon).

Symptoms of acute pyelonephritis

The flow is characterized by local symptoms and signs of a pronounced common infectious process, which differ depending on the stage and form of the disease. Serous pyelonephritis proceeds more calmly; In purulent inflammation, pronounced clinical manifestations. With an acute unstructive process prevail general symptoms infections; With obstructive - local symptoms.

The clinic of acute unstructive pyelonephritis develops lightning (from several hours to one day). There is ailment, weakness, stunning olar with a significant increase in temperature to 39-40 ° C, abundant sweating. Significantly worsens well-being headaches, tachycardia, arthralga, myalgia, nausea, constipation or diarrhea, meteorism.

From local symptoms, there is a painful pain, propagating along the ureter in the thigh area, sometimes in the stomach and back. By nature, pain can be constant stupid or intense. Urination, as a rule, is not violated; Daily diuresis decreases due to the abundant loss of fluid from then. Patients may pay attention to urine turbidity and its unusual smell.

The secondary pyelonephritis caused by the urinary tract obstruction is usually manifest with renal colic. On high painful attack Fever arises with chills, headache, vomiting, thirst. After an abundant sweating, the temperature is critically reduced to subnormal or normal numbersthat is accompanied by some improvement in well-being. However, if the urinary tract obstruction factor is not liquidated in the coming hours, then the attack of colic and temperature rise will repeat again.

Purulent forms of pathology proceed with a resistant pain in the lower back, hectic type fever, chills, sharp voltage of the muscles of the abdominal wall and lumbar region. Against the background of severe intoxication, the confusion and nonsense may be marked.

Diagnostics

In the process of recognizing acute pyelonephritis, data of physical examination is important. When palpation of the lumbar region and hypochondrium estimates the size of the kidney, consistency, surface structure, mobility, soreness. The kidney is usually increased, the muscles of the lower back and the abdomen are intense, the tendering of the palm edge along the XII edge - painfully, the symptom of Pasternatsky is positive. Men need a rectal inspection of prostate and palpation of the scrotum, in women - vaginal research. Differential diagnosis It is carried out with appendicitis, cholecystitis, cholangitis, adexitis.

• Laboratory diagnostics. In the urine there is a total bacteriuria, a slight proteinuria, leukocyturia, with secondary defeat - red blood cell. Bacterial sowing urine allows you to decide on the type of pathogen and its sensitivity to antimicrobial drugs. Blood indicators are characterized by anemia, leukocytosis, increased SEE, toxic grit neutrophils.
• Ultrasound kidneys. Used not only in diagnosis, but also for dynamic control of the treatment process. The value of these echoscopy is the possibility of visualizing destructive foci in the parenchyma, state of paranefral fiber, identifying the cause of the obstruction of the upper urinary tract.
• X-ray techniques. With a survey urography, an increase in the size of the kidneys, blowing the contour with an abscess or carbuncule, the fuzziness of the outlines of the paranefral fiber is not paid. With the help of excretory urography, the restriction of kidney mobility is determined during breathing, which is characteristic sign acute inflammatory process. The exact detection of destructive foci, the reasons and level of obstruction in acute purulent pyelonephritis is possible with the help of kidnase CT.

Treatment of acute pyelonephritis

The patient's hospitalization is carried out; Treatment is carried out under the control of the doctor-urologist. Therapeutic tactics in the unstructive and obstructive acute pyelonephritis, serous and purulent-destructive form differ. Common events include the appointment of bed regime, abundant drinking (up to 2-2.5 liters per day), a fruit-dairy diet, an easy-to-carry protein food.

With a primary version of inflammation, pathogenetic therapy is immediately beginning, the basis of which is antibiotics, active with respect to the gram-negative flora, is cephalosporins, aminoglycosides, fluoroquinolones. When choosing an antimicrobial drug, the results of the antibioticogram are also taken into account. Additionally, NSAIDs, nitrofurans, immunocormers, disintellation therapy are prescribed.

When revealing obstruction, the priority measure is decompression - the restoration of urodynamics in the affected kidney. For this purpose, the catheterization of the lochanks with a urine catheter or catheter-wall is undertaken, in some cases - puncture imposition of percutaneous nephrosty.

In the presence of purulent-destructive foci, they resort to the decapsulation of the kidneys and the imposition of nephrostomas, with the help of which reducing intravenous pressure is achieved. When the formed urns are found, their autopsy is made. In the case of total damage to the renal parenchyma and the impossibility of organ-powder tactics is carried out nephrectomy.

Prediction and prevention

Timely adequate therapy allows you to achieve cure of acute pyelonephritis in most patients within 2-3 weeks. In a third of cases, the transition to a chronic form (chronic pyelonephritis) is noted, followed by the sclerosis of the kidney and the development of nephrogogenic arterial hypertension. Among complications may occur paranephritis, retroperitonitis, workpox, renal failure, bacteriotoxic shock, interstitial pneumonia, meningitis. Heavy septic complications worsen the forecast and are often caused by death.

Prevention is the Sanation of Foci chronic inflammationwhich can serve as sources of potential hematogenous drift of causative agents; elimination of the causes of possible urinary tract obstruction; compliance with the hygiene of the urinary organs to prevent the ascending distribution of infection; Compliance with the conditions of aseptics and antiseptics during urological manipulations.

Pyelonephritis is a non-specific infectious inflammatory process in the kidney flowing with a preferably lesion of interstitial tissue. In childhood, this is one of the most common diseases occupying second after pathology. respiratory tract.

For the development of pyelonephritis, you need a combination of at least two main factors: invasion bacterial infection In the kidney and obstacles to the outflow of urine.

The penetration of the causative agent in the kidney is possible in three ways: hematogenic, lymphogenic and urinogenic. The hematogenous path of infection is usually observed in patients with chronic infectious diseases, most often the respiratory tract and ENT organs. Lymphogenic infection occurs due to extensive lymphatic kidney bonds with a colon. Under the Urinogenic path, infection comes from the lower urinary tract as a result of a retrograde cast of non-sterile urine with bubble-ureteral reflux.In the genesis of pyelonephritis, the leading role is played by the gram-negative (intestinal chopstick, protein, cakes, enterococci, enterobacteria, klebseyella, etc.) and anaerobic flora, although the coking flora, including conditionally pathogen, can also cause a disease. The role of mushrooms of the genus Candida in the genesis of pyelonephritis should be noted.

Pyelonephritis is a cyclic disease. In its development, separate stages can be traced: acute and chronic, but they usually speak acute and chronic pyelonephritis. Acute pyelonephritis is divided into serous and purulent (apostlesis, kidney carbuncoon and last stage purulent inflammation - pionephrosis). Chronic pyelonephritis can be both unstructive and obstructive, characterized recurrent or latent flow. Both forms of pyelonephritis have an active stage, the reverse development period, or partial clinical and laboratory remission, and complete clinical and laboratory remission. In this case, the kidney functions can be stored or impaired up to CPN.

Acute pyelonephritis is characterized by a sudden beginning, hectic hectares of body temperature, increasing intoxication and excicosis. Older kids can complain about pain in the lumbar region, small children are clearly painted and shown on the navel. With a laboratory survey, the urinary syndrome is revealed: leukocyteuria, moderate proteinuria, bacteriuria.

Chronic pyelonephritis is distinguished by the sharpening of a clinical picture. In part, the process takes a chronic course without prior sharp start. Basic signs - chronic intoxication, delay in the injection of body weight, pallor skin Pokrov, fast fatiguability. Children with the indicated clinical picture, given the possible serious outcomes of pyelonephritis (secondary kidney wriggling with the development of CPR and arterial hypertension), it is necessary to perform urine tests. The risk group also should also include patients with a long subfebilitation after respiratory and other infectious diseases (scarletins, measles, epidemic parotitis et al.), patients with a burdened family history (malformations of the urinary system, urolithiasis disease, arterial hypertension) And children with palpable tumor syndrome in the abdominal cavity.

It should be noted that the detection of leukocyturia does not allow you to immediately diagnose. Leukocyturia can be the result of vulvovaginitis, balanitis, infections of the lower urinary tract, etc. Only a combination with moderate proteinuria and bacteriuria testifies to pyelonephritis. However, putting a diagnosis of pyelonephritis, in no case cannot be limited only by the appointment of anti-inflammatory treatment. Without establishing the cause of the disease therapy will be ineffective and will only lead to risk of developing complications. It should be remembered that in 90% of cases the cause of pyelonephritis is a variety of obstructive uralopathy. Therefore, it is necessary to perform a research complex, starting with an ultrasound, radiological (intravenous urography and cystography) and endoscopic methods and ending with the functional methods of estimating urodynamics of the lower urinary tract, radioisotope studies and angiography.

Treatment

Treatment of obstructive pyelonephritis is only comprehensive. It includes the following activities:

Normalization of the passage of urine through reconstructive-plastic operations or conservative measures;

The appointment of adequate antibacterial therapy, taking into account the sensitivity of the sized urine microflora;

Antioxidant, immunomodulatory and membrane-stabilizing therapy;

Desensitizing treatment and vitamin therapy;

Spa treatment.

Dispensary observation

Dispensary observation is shown to all patients with obstructive pyelonephritis. Control urine tests; Sailing urine on sterility is carried out monthly, biochemical analyzes of blood and urine - 1 time in 6-12 months, measured hell. The highly informative and non-invasive method for assessing the state of urinary tract in the katamase - ultrasound in combination with dopplerography. This study is recommended to repeat every 3-6 months before the child's removal from the dispensary accounting. Controls radiological studies Perform as needed annually. An informative method for assessing the degree of preservation of kidney functions is radioisotope renegography.

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Obstructive pyelonephritis is an extremely dangerous infectious disease of the kidney, developing against the background of an acute violation of urine outflows in a cup-lowering system and rapid reproduction of bacterial microflora. This disease is quite common. Obstructive, as well as the unstructive pyelonephritis can develop in children, and in adults. People relaxed immunity are most susceptible to this disease.

The peak of morbidity usually falls on the spring and autumn when an increase in the number of cases of the development of IDV and influenza is observed. Against the background of these respiratory infections Human immunity is significantly reduced, therefore bacteria, which are always present on the mucous membranes of the genitourinary system, get the opportunity to multiply, becoming the cause of inflammatory kidney damage. There are many other factors that greatly contribute to this pathological state.

Many different factors contributing to the difficulty of urine outflow create conditions for the development of this infectious disease. Stagnation processes lead to an increase in the number of bacteria provoking inflammatory lesions of the tissues. Often pyelonephritis arises on the background congenital anomalies Development of kidneys and urinary tract. Usually, such pathologies begin to manifest themselves with inflammation in early childhood.

Urolithiasis also often predisposes to the development of pyelonephritis, and then obstruction. Kidney stones under certain circumstances can descend into the ureter, partially or completely blocking urine outflows. In men, pyelonephritis is often developing against the background of adenoma or prostate cancer. In women, a pregnancy may be a provocation for such a defeat of the kidneys, since an increase in the uterus contributes to a change in the position of this pair of this organ, and sometimes it becomes the reason for squeezing the ureters. In addition, there are factors that contribute to the emergence of chronic obstructive pyelonephritis, including:

• diabetes;
• thyroid diseases;
• long use of antibiotics;
• supercooling.

Create conditions for the development of such a kidney tissue damage can previously performed operations on urinary trait. In addition, the occurrence of obstructive pyelonephritis is capable of kidney injury. The decrease in immunity of any etiology can provoke the development of this pathological condition.

Symptoms

In most cases, this disease is sharply manifested. There is a rapid increase in body temperature to +40 ° C. The main feature of this violation is considered renal colic - acute pain in the lower back. Due to inflammatory damage to kidney tissues, urination problems are usually observed. Patients complain about chills and increased sweating. As a rule, rapidly growing total weakness. As the disease develops, the following symptoms may appear:

• severe thirst;
• vomiting;
• nausea;
• a feeling of dry blood;
• headache.

The intensity of the signs of this pathological state is usually increasing for 3-4 days. This is due to the fact that toxins are increasing in the body, which due to the violation of the kidneys cannot be removed with urine. To avoid the development of severe complications, it is necessary at the first symptoms to consult a doctor. If the treatment was not started in a timely manner, this disease passes into a chronic form for which the alternation of recurrence and remission periods is characterized. Such an outcome is considered extremely unfavorable, as in the future leads to renal failure.

Diagnostics

First of all, the patient's inspection is carried out, collection of history and evaluation of the available symptoms. Even this happens enough for the specialist to suspect the development of obstructive pyelonephritis. Usually, research is carried out to confirm the diagnosis as:

• general I. biochemical analysis blood and urine;
• bakposiev urine;
• urography;
• angiography;
• nephrocintigraphy;
• radiography.

Nephrologist independently decides which research is required for diagnosis. Self-medication can represent a serious health hazard. After carrying out comprehensive diagnostics The doctor may appoint required drugs To suppress the inflammatory process.

Treatment of obstructive pyelonephritis

In a sharp period required comprehensive therapyTo avoid the transition of the disease in chronic form. First of all, a diet is assigned - table number 7a. On a day, it is necessary to drink at least 2-2.5 liters of liquid. This will allow faster to eliminate the pathogenic microflora and suppress the inflammatory process. To relieve pain and improve local blood circulation, the doctor can recommend thermal procedures.

Among other things, directed drug therapy is required. In the first days of the course of the acute period of obstructive pyelonephritis, there is an extremely strong pain syndrome. To eliminate it, nephrologist can assign antispasmodics. To suppress the infection requires directional antibacterial therapy.

Usually, when obstructive pyelonephritis uses such drugs as:

• Benzylpenicillin;
• Oxacillin;
• Ampicillin;
• Ampicillin sodium salt;
• Streptomycin;
• Tetracycline;
• Metacycline;
• Morphocyclin;
• Tetraolean;
• Etietin;
• Gentamicin;
• Cephaloridine.

The course of antibacterial therapy should be at least 4 weeks. It should not interrupt it, as this may contribute to the transition of the disease in a chronic form. Such drugs are usually introduced intravenously or intramuscularly. In addition, preparations are prescribed to reduce body temperature. Vitamin complexes can also be appointed, which contribute to improving immunity. However, if conservative methods treatment does not allow a pronounced effect, can be shown operational intervention. Usually, similar therapy is required in the presence of stones and various anomalies of urinary tract.