Xp pyelonephritis what. Pyelonephritis: what is it, what is dangerous, symptoms and treatment of pyelonephritis. Principles of treatment of the disease

Pyelonephritis is an inflammation of the kidneys that occurs in acute or chronic form. The disease is quite widespread and very dangerous to health. Symptoms of pyelonephritis include pain in the lumbar region, fever, severe general condition and chills. Occurs most often after hypothermia.

It can be primary, that is, it develops in healthy kidneys, or secondary, when the disease occurs against the background of already existing kidney diseases (glomerulonephritis, etc.). There are also acute and chronic pyelonephritis. Symptoms and treatment will directly depend on the form of the disease.

It is the most common kidney disease in all age groups. More often they suffer from young and middle-aged women - 6 times more often than men. In children, after diseases of the respiratory system (,) takes second place.

Causes of pyelonephritis

Why does pyelonephritis develop, and what is it? The main cause of pyelonephritis is infection. Infection refers to bacteria such as E. coli, Proteus, Klebsiella, Staphylococcus and others. However, when these microbes enter the urinary system, the disease does not always develop.

In order for pyelonephritis to appear, contributing factors are also needed. These include:

1. Violation of the normal flow of urine (urine reflux from the bladder to the kidney, "neurogenic bladder", prostate adenoma);
2. Violation of the blood supply to the kidney (deposition of plaques in the vessels, vasospasm with, diabetic angiopathy, local cooling);
3. Immune suppression (treatment with steroid hormones (prednisolone), cytostatics, immunodeficiency as a result);
4. Pollution of the urethra (non-compliance with personal hygiene, with incontinence of feces, urine, during sexual intercourse);
5. Other factors (decrease in secretion of mucus in the urinary system, weakening of local immunity, impaired blood supply to the mucous membranes, urolithiasis, oncology, other diseases of this system and, in general, any chronic diseases, reduced fluid intake, abnormal anatomical structure of the kidneys).

Once in the kidney, microbes colonize the pelvicalyceal system, then the tubules, and from them - the interstitial tissue, causing inflammation in all these structures. Therefore, you should not put off the question of how to treat pyelonephritis, otherwise severe complications are possible.

Symptoms of pyelonephritis

In acute pyelonephritis, the symptoms are pronounced - it starts with chills, when measuring body temperature, the thermometer shows over 38 degrees. After a while, aching pain in the lower back appears, the lower back "pulls", and the pain is quite intense.

The patient is disturbed by the frequent urge to urinate, very painful and indicating accession and. Symptoms of pyelonephritis may have general or local manifestations. General signs are:

• High intermittent fever;
• Severe chills;
• Sweating, dehydration and thirst;
• Intoxication of the body occurs, as a result of which the head hurts, fatigue increases;
• Dyspeptic symptoms (nausea, no appetite, stomach ache, diarrhea appears).

Local signs of pyelonephritis:

1. Pain in the lumbar region, on the affected side. The nature of the pain is dull, but constant, aggravated by palpation or movement;
2. The muscles of the abdominal wall may be tense, especially on the affected side.

Sometimes the disease begins with acute cystitis - rapid and, pain in the bladder area, terminal hematuria (appearance of blood at the end of urination). In addition, general weakness, weakness, muscle and headache, lack of appetite, nausea, and vomiting are possible.

If these symptoms of pyelonephritis appear, you should consult a doctor as soon as possible. In the absence of competent therapy, the disease can turn into a chronic form, which is much more difficult to cure.

Complications

• acute or chronic renal failure;
• various suppurative diseases of the kidneys (kidney carbuncle, kidney abscess, etc.);

Treatment of pyelonephritis

In primary acute pyelonephritis, in most cases, the treatment is conservative, the patient must be hospitalized in a hospital.

The main therapeutic measure is the impact on the causative agent of the disease with antibiotics and chemical antibacterial drugs in accordance with the data of the antibiogram, detoxification and immunity-enhancing therapy in the presence of immunodeficiency.

In acute pyelonephritis, treatment should begin with the most effective antibiotics and chemical antibacterial drugs, to which the microflora of the urine is sensitive, in order to eliminate the inflammatory process in the kidney as quickly as possible, preventing it from turning into a purulent-destructive form. In secondary acute pyelonephritis, treatment should begin with the restoration of urine massage from the kidney, which is fundamental.

Treatment of the chronic form is fundamentally the same as the acute form, but longer and more laborious. In chronic pyelonephritis, treatment should include the following main measures:

1. Elimination of the causes that caused the violation of the passage of urine or renal circulation, especially venous;
2. The appointment of antibacterial agents or chemotherapy drugs, taking into account the data of the antibiogram;
3. Increasing the 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 prostate adenoma, stones from the kidneys and urinary tract, nephropexy with, plastic of the urethra or ureteropelvic 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 a sufficiently restored urine massage, the use of antibacterial drugs usually does not give a long-term remission of the disease.

Antibiotics and chemical antibacterial drugs should be prescribed taking into account the sensitivity of the patient's urine microflora to antibacterial drugs. To obtain antibiogram data, antibacterial drugs with a wide spectrum of action are prescribed. Treatment for chronic pyelonephritis is systematic and long-term (at least 1 year). The initial continuous course of antibiotic 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. In the presence of chronic renal failure, the appointment of nephrotoxic antibacterial drugs should be carried out under constant monitoring of their pharmacokinetics (concentration in the blood of urine). With a decrease in the indicators of humoral and cellular immunity, various drugs are used to increase immunity.

After the patient reaches the stage of remission of the disease, antibiotic treatment should be continued in intermittent courses. The timing of interruptions 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 onset of symptoms of the latent phase of the inflammatory process.

Antibiotics

Medicines are selected individually, taking into account the sensitivity of the microflora to them. The most commonly prescribed antibiotics for pyelonephritis are:

• penicillins with clavulanic acid;
• 2nd and 3rd generation cephalosporins;
• fluoroquinolones.

Aminoglycosides are undesirable because of their nephrotoxic effects.

How to treat pyelonephritis with folk remedies

Home treatment of pyelonephritis with folk remedies must necessarily be accompanied by bed rest and a healthy diet, consisting mainly of plant foods in raw, boiled or steam form.

1. During the period of exacerbation, such a collection helps. Mix equally taken white birch leaves, St. John's wort and knotweed grass, calendula flowers, fennel fruits (dill). Pour in a thermos 300 ml of boiling water 1 tbsp. l. collection, insist 1-1.5 hours, strain. Drink warm infusion in 3-4 doses 20 minutes before meals. The course is 3-5 weeks.
2. Outside of an exacerbation of the disease, use a different collection: knotweed herb - 3 parts; herb yasnotki (deaf nettle) and grass (straw) oats, leaves of sage officinalis and round-leaved wintergreen, rose hips and licorice roots - 2 parts each. Take 2 tbsp. l. collection, pour 0.5 l of boiling water in a thermos, leave for 2 hours and strain. Drink a third cup 4 times a day 15-20 minutes before meals. The course is 4-5 weeks, then a break for 7-10 days and repeat. In total - up to 5 courses (until stable results are obtained).

Diet

With inflammation of the kidneys, it is important to observe bed rest and a strict diet. Drink enough fluids to stop dehydration, which is especially important for pregnant women and people over 65.

With inflammatory processes in the kidneys, it is allowed: lean meat and fish, stale bread, vegetarian soups, vegetables, cereals, soft-boiled eggs, dairy products, sunflower oil. In small quantities, you can use onions, garlic, dill and parsley (dried), horseradish, fruits and berries, fruit and vegetable juices. Forbidden: meat and fish broths, smoked meats. You also need to reduce the consumption of spices and sweets.

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Chronic pyelonephritis is an inflammatory disease that primarily affects the pyelocaliceal system of the kidneys. It can develop at any age, in men and women, it can be both an independent disease and a complication of other diseases or developmental anomalies.

According to statistics, up to 20% of the population suffer from this disease, but experts believe that in fact its prevalence is even higher.

What clinical symptoms are typical for chronic pyelonephritis?

In chronic pyelonephritis, the inflammatory process is localized in the region of the calyces and pelvis of the kidneys.

• Lower back pain is often non-intense, aching, usually asymmetrical. It is noticed that often the pain does not appear on the affected side, but on the opposite side. There may be a feeling of discomfort, heaviness in the lower back, especially when walking or standing for a long time. Patients complain that the lower back is cold, tend to dress warmer. Severe or cramping pains are rather typical of urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.
• Temperature rise, not higher than 38 C, usually in the evening, for no apparent reason.
• especially at night.
• Increase in blood pressure. During remission, this may be the only symptom.
• Deterioration of health, weakness and weakness, more pronounced in the morning, decreased mood, headaches.
• Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.

Laboratory signs of chronic pyelonephritis

• Decreased hemoglobin in the general blood test.
• A three-time study of urine tests reveals an increased number of leukocytes (normally - no more than 4-6 in the field of view); bacteriuria more than 50-100 thousand microbial bodies in 1 ml; red blood cells (especially with urolithiasis,); sometimes - protein, but not more than 1 g / l, and there are no cylinders at all.
• In the Zimnitsky sample, the specific gravity often decreases (in no portion does it exceed 1018).
• In the biochemical analysis of blood, the total protein is within the normal range, albumin may slightly decrease, and when signs of renal failure appear, creatinine and urea increase.

Treatment of pyelonephritis

Elimination of the pathogen. For this, antibiotics and uroseptics are used. The main requirements for drugs: minimal nephrotoxicity and maximum effectiveness against the most typical infectious agents: E. coli, Proteus, Klebsiella, Staphylococcus, Pseudomonas aeruginosa, etc.

It is optimal to conduct a urine culture before the start of treatment with the determination of sensitivity to antibiotics - then the choice will become more accurate. Most often assigned

• penicillins (amoxicillin, carbenicillin, azlocillin) - with minimal nephrotoxicity, they have a wide spectrum of action;
• cephalosporins of the 2nd and 3rd generations are not inferior to the first ones in terms of effectiveness, however, the main part of the drugs is intended for injection, therefore they are used more often in the hospital, and in outpatient practice, suprax and cedex are most often used;
• fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin) - effective against most pathogens of urinary tract infections, non-toxic, but they are forbidden to use in pediatric practice, pregnant and lactating. One of the side effects is photosensitivity, so during the reception it is recommended to refuse to visit the solarium or go to the beach;
• sulfanilamide preparations (in particular biseptol) were so often used in our country at the end of the 20th century to treat literally any infections that now most bacteria are insensitive to them, so it should be used if the culture confirmed the sensitivity of the microorganism;
• nitrofurans (furadonin, furamag) are still very effective in pyelonephritis. However, sometimes side effects - nausea, bitterness in the mouth, even vomiting - force patients to refuse treatment with them;
• hydroxyquinolines (5-Noc, nitroxoline) - usually well tolerated, but sensitivity to these drugs, unfortunately, has also decreased recently.

The duration of treatment for chronic pyelonephritis is at least 14 days, and if complaints and changes in urine tests persist, it can last up to a month. It is advisable to change drugs once every 10 days, repeating urine cultures and taking into account their results when choosing the next medicine.

Detoxification

If there is no high pressure and pronounced edema, it is recommended to increase the amount of fluid you drink up to 3 liters per day. You can drink water, juices, fruit drinks, and at high temperature and symptoms of intoxication - rehydron or citroglucosolan.

Phytotherapy

The most effective herbal remedy for chronic pyelonephritis is the bearberry leaf.

These folk remedies for the treatment of pyelonephritis are effective as an adjunct to antibiotic therapy, but do not replace it, and should not be used during an exacerbation. Herbal preparations should be taken for a long time, monthly courses after the completion of antibacterial treatment or during remission, for prevention. It is optimal to do this 2-3 times a year, in the autumn-spring period. Undoubtedly, herbal medicine should be abandoned if there is a tendency to allergic reactions, especially hay fever.
Fee examples:

• Bearberry (leaf) - 3 parts, cornflower (flowers), licorice (root) - 1 part each. Brew in the ratio of 1 tablespoon per cup of boiling water, leave for 30 minutes, drink a tablespoon 3 times a day.
• Birch leaf, corn stigmas, horsetail 1 part each, rose hips 2 parts. Pour a tablespoon of the collection with 2 cups of boiling water, leave for half an hour, drink half a cup 3-4 times a day.

Means that improve renal blood flow:

• antiplatelet agents (trental, chimes);
• drugs that improve venous outflow (escusan, troxevasin) are prescribed in courses of 10 to 20 days.

Spa treatment

It makes sense, as the healing effect of mineral water is quickly lost when bottled. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

Almost every third elderly person has changes characteristic of chronic pyelonephritis. At the same time, the disease is diagnosed much more often in women, starting from childhood and adolescence, and ending with the menopause period.

It should be understood that chronic pyelonephritis rarely gives severe symptoms characteristic of kidney disease. Therefore, the diagnosis is difficult, but the consequences are quite serious.

Chronic pyelonephritis: what is it?

Pyelonephritis means inflammation of the renal pelvis. And, if acute inflammation cannot be overlooked - a high temperature rises, severe back pain occurs, pronounced changes in the urine are recorded - then chronic pyelonephritis most often develops gradually.

In this case, structural changes occur in the renal tubules and pelvis, which are aggravated over time. Only in a third of cases, chronic pyelonephritis is due to improperly treated acute inflammation. The diagnosis of chronic pyelonephritis is made when there are characteristic changes in the urine and symptoms for more than 3 months.

The cause of inflammation is a nonspecific pathogenic microflora: proteus, staphylococci and streptococci, E. coli, etc. Often, several types of microbes are sown at once. Pathogenic microflora has a unique chance of survival: it has developed resistance to antibiotics, is difficult to identify under microscopic examination, can go unnoticed for a long time and is activated only after a provoking effect.

The factors that activate the inflammatory process in the kidneys in women include:

• Congenital pathology - bladder diverticula, vesicoureteral reflux, urethrocele;
• Acquired diseases of the urinary system - cystitis / urethritis, nephrolithiasis, nephroptosis and, in fact, untreated acute pyelonephritis;
• Gynecological pathology - non-specific vulvovaginitis (thrush, bacterial vaginosis, reproduction in the vagina of Escherichia coli, etc.), sexual infections (gonorrhea, trichomoniasis);
• Intimate sphere of a woman - the beginning of sexual contacts, active sex life, pregnancy and childbirth;
• Concomitant diseases - diabetes mellitus, chronic pathology of the gastrointestinal tract, obesity;
• Immunodeficiency - frequent diseases of angina, influenza, bronchitis, otitis media, sinusitis, not excluding HIV;
• Elementary hypothermia - habit of washing feet in cold water, inappropriate clothing in cold weather, etc.

Important! Recent studies have shown the dependence of the development of chronic pyelonephritis with an inadequate immune response. Sensitization to one's own tissues activates an autoimmune attack on one's own kidney cells.

Stages of chronic pyelonephritis

With chronic inflammation, a gradual degeneration of the renal tissues occurs. Depending on the nature of structural changes, four stages of chronic pyelonephritis are distinguished:

1. I - atrophy of the tubular mucosa and the formation of infiltrates in the interstitial tissue of the kidneys;
2. II - sclerotic foci form in the tubules and interstitial tissue, and the renal glomeruli become empty;
3. III - large-scale atrophic and sclerotic changes, large foci of connective tissue are formed, renal glomeruli practically do not function;
4. IV - the death of most of the glomeruli, almost all of the renal tissue is replaced by connective tissue.

The larger the irreversible changes, the more severe the symptoms of kidney failure.

Chronic pyelonephritis is characterized by an undulating course. Periods of deterioration are replaced by remission and give the patient a false sense of complete recovery. However, most often chronic inflammation proceeds erased, without bright exacerbations.

Symptoms of chronic pyelonephritis in women with a latent course of the disease are lethargy, headache, fatigue, loss of appetite, periodic temperature rises to 37.2-37.5ºС. In comparison with acute inflammation, in chronic pyelonephritis the pain is not very pronounced - a weak symptom of Pasternatsky (pain when tapping in the lumbar region).

Changes in the urine are also not informative: a small amount of protein and leukocytes is often associated with cystitis or eating salty foods. The same explains the periodic increase in the number of urination, a slight increase in pressure and anemia. The appearance of the patient also changes: dark circles under the eyes clearly appear on the pale skin of the face (especially in the morning), the face is puffy, hands and feet often swell.

Exacerbation of the chronic form

With recurrent pyelonephritis against the background of poor symptoms - malaise, slight hyperthermia, mild back pain, increased urination (especially at night) - suddenly, after a provocative effect, a picture of acute pyelonephritis develops. High temperature up to 40.0-42ºС, severe intoxication, severe lumbar pain of a pulling or pulsating nature are accompanied by vivid changes in the urine - proteinuria (protein in the urine), leukocyturia, bacteriuria and rarely hematuria.

Progressive replacement of the renal tissue with connective tissue leads to a decrease in kidney function, up to the development of renal failure. Toxins and decay products enter the bloodstream and poison the entire body.

In this case, the further development of chronic pyelonephritis can proceed according to the following scenarios:

• Urinary syndrome - signs of urination disorders come to the fore in the symptomatic picture. Frequent nightly trips to the toilet are associated with the inability of the kidneys to concentrate urine. Sometimes when emptying the bladder, pain occurs. The patient complains of heaviness and frequent pain in the lower back, swelling.
• The hypertensive form of the disease - severe arterial hypertension is difficult to respond to traditional therapy with antihypertensive drugs. Often patients complain of shortness of breath, heart pain, dizziness and insomnia, hypertensive crises are not uncommon.
• Anemic syndrome - a violation of the functionality of the kidneys leads to the rapid destruction of red blood cells in the blood. With hypochromic anemia due to kidney damage, blood pressure does not reach high levels, urination is scanty or periodically increases.
• Azotemic variant of the course - the absence of painful symptoms leads to the fact that the disease is diagnosed only with the development of chronic renal failure. Laboratory tests that detect signs of uremia help confirm the diagnosis.

Differences between chronic pyelonephritis and acute inflammation

Acute and chronic pyelonephritis differ at all levels, from the nature of structural changes to the symptoms and treatment of women. In order to accurately diagnose the disease, it is necessary to know the signs characteristic of chronic pyelonephritis:

1. Both kidneys are more often affected;
2. Chronic inflammation leads to irreversible changes in the kidney tissue;
3. The beginning is gradual, extended in time;
4. The asymptomatic course can last for years;
5. The absence of pronounced symptoms, in the foreground - intoxication of the body (headache, weakness, etc.);
6. In the period of remission or in the latent course, the urinalysis changed slightly: the protein in the general analysis is not more than 1 g / l, the Zimnitsky test reveals a decrease in beats. Weights less than 1018;
7. Hypotensive and antianemic drugs are not very effective;
8. Taking traditional antibiotics only reduces inflammation;
9. The gradual decline in renal function leads to renal failure.

Often, chronic pyelonephritis is diagnosed only with instrumental examination. When visualizing (ultrasound, pyelography, CT) of the kidney, the doctor discovers a diverse picture: active and fading foci of inflammation, connective tissue inclusions, deformity of the renal pelvis. In the initial stages, the kidney is enlarged and looks lumpy due to infiltration.

In the future, the affected organ shrinks, large inclusions of connective tissue protrude above its surface. In acute pyelonephritis, instrumental diagnostics will show the same type of inflammation.

Possible complications: what is the danger of chronic pyelonephritis?

The absence of pronounced symptoms in chronic pyelonephritis is the reason for the late visit of women to the doctor. Antibiotics that are effective in treating acute pyelonephritis will only slightly reduce inflammation in the chronic form of the disease. This is due to the high resistance of microflora to conventional antibacterial agents. Without adequate therapy, the chronic form of pyelonephritis leads to the development of chronic renal failure: a little slower with a latent course and faster with frequent exacerbations.

Possible consequences:

• pyonephrosis - purulent fusion of renal tissue;
• paranephritis - a purulent process extends to the perirenal tissue;
• necrotic papillitis - necrosis of the renal papillae - a severe condition accompanied by renal colic;
• wrinkling of the kidney, "wandering" kidney;
• acute renal failure;
• stroke by hemorrhagic or ischemic type;
• progressive heart failure;
• urosepsis.

All these conditions pose a serious threat to a woman's life. It is possible to prevent their development only with complex therapy.

Illness during pregnancy

The double load on the kidneys of a pregnant woman leads to inflammation. At the same time, the impact of impaired renal function in a future mother can lead to miscarriage, fading of pregnancy, the formation of developmental anomalies in the fetus, premature birth and stillbirth. Doctors distinguish three degrees of risk associated with pyelonephritis:

• I - pyelonephritis first appeared during pregnancy, the course of the disease without complications;
• II - chronic pyelonephritis was diagnosed before pregnancy;
• III - chronic pyelonephritis, occurring with anemia, hypertension.

An exacerbation of the disease can occur 2-3 times during the gestation period. At the same time, every time a woman is hospitalized without fail. I-II degree of risk allows you to carry a pregnancy. A pregnant woman’s card is marked with “chronic pyelonephritis”, a woman more often than the usual schedule (depending on the gestational age) takes tests and undergoes an ultrasound scan. Even with the slightest deviation, the expectant mother is registered for inpatient treatment.

III degree of risk - a direct indication for termination of pregnancy.

Struck photo, photo

Only an integrated approach to the treatment of chronic pyelonephritis will prevent the progression of the pathological process and avoid renal failure. How to treat chronic pyelonephritis:

• Gentle regimen and diet

First of all, provoking moments (colds, hypothermia) should be avoided. Food must be complete. Coffee, alcohol, carbonated drinks, spicy and salty dishes, fish / meat broths, marinades (contain vinegar) are excluded. The diet is based on vegetables, dairy products and boiled meat / fish dishes.

Not recommended citrus fruits: Vit. C irritates the kidneys. During exacerbations and pronounced changes in the analyzes, salt is completely excluded. In the absence of hypertension and edema, it is recommended to drink up to 3 liters of water in order to reduce intoxication.

• Antibiotic therapy

To select an effective drug, it is necessary to do a urine culture (it is better during an exacerbation, the pathogen may not be detected during remission) and conduct tests for sensitivity to antibiotics. Taking into account the results of the analysis, the most effective drugs are prescribed: Ciprofloxacin, Levofloxacin, Cefepime, Cefotaxime, Amoxicillin, Nefigramon, Urosulfan. Nitroxoline (5-NOC) is well tolerated, but not very effective, often prescribed for pregnant women.

Furadonin, furazolidone, Furamag have a pronounced toxic effect and are poorly tolerated. Palin, effective in renal inflammation, is contraindicated in pregnancy. Treatment of chronic pyelonephritis lasts at least 1 year. Antibacterial courses continue for 6-8 weeks. and are periodically repeated.

• Symptomatic therapy

In hypertensive syndrome, antihypertensive drugs are prescribed (enalapril and other ACE inhibitors, as well as combined drugs with hypothiazide), and antispasmodics that enhance their effect (No-shpa). If anemia is detected, Ferroplex, Ferrovit forte and other iron-containing tablets are prescribed.

It is also necessary to compensate for the lack of folic acid, vit. A and E, B12. Vit. C is allowed to be taken outside the exacerbation period.

To improve blood circulation in the kidneys, the nephrologist prescribes antiplatelet agents (Kurantil, Parsadil, Trental). With severe symptoms of intoxication, intravenous infusions of Regidron, Glucosolan are prescribed. In the presence of edema, diuretics are prescribed at the same time (Lasix, Veroshpiron). Uremia and severe renal failure require hemodialysis. With complete kidney failure, a nephrectomy is performed.

• Physiotherapy

Drug treatment of a sluggish current chronic process in the kidneys is enhanced by physiotherapeutic procedures. Electrophoresis, UHF, modulated (SMT-therapy) and galvanic currents are especially effective. Outside the period of exacerbation, sanatorium treatment is recommended. Sodium chloride baths, mineral water and other physiotherapy significantly improve the condition of patients.

With a latent course of chronic pyelonephritis and complex treatment of the disease, women do not lose their quality of life. Frequent exacerbations leading to kidney failure lead to disability and pose a serious threat to life.

- an infectious and inflammatory disease of the kidneys, with predominant localization in the tubulointerstitial zone.

Urologists often encounter this pathology, since the incidence is 19 cases per 1000 people. Women are affected 1.5 times more often than men.

Table of contents:

Classification of chronic pyelonephritis

Primary chronic pyelonephritis is distinguished, for its development, the root cause is considered to be damage to the microbial flora. There are no obstructions to the outflow of urine.

Secondary chronic pyelonephritis develops against the background of diseases leading to impaired urodynamics:

• anomalies in the development of the structure of the organs of the genitourinary system;
• nephrourolithiasis;
• narrowing of the ureter;
• refluxes;
• retroperitoneal sclerosis;
• neurogenic disorders of the bladder according to the hypotonic type;
• sclerosis of the neck of the bladder;
• prostatic hyperplasia and sclerotic changes;
• malignant and benign formations.

Pyelonephritis is unilateral and bilateral.

During chronic pyelonephritis, the following phases are distinguished:

• active;
• latent;
• remission;
• clinical recovery.

Symptoms and signs of chronic pyelonephritis

Complaints in chronic pyelonephritis are present during the period of exacerbation. The patient complains of dull. Dysuric disorders are uncommon but may be present. Common symptoms include the following:

• weakness, apathy;
• decrease in working capacity;
• heaviness in the lower back;
• causeless increase in temperature to 37 - 37.2 degrees.

If the process is complicated by accession, then there are signs of loss of the functional ability of the kidneys.

There are no manifestations in the latent phase or in the remission phase, and when making a diagnosis, laboratory data are taken into account.

The following are considered predisposing factors for the development of chronic pyelonephritis:

• immunodeficiency states;
• in severe form;
• infectious diseases;
• gestation;
• diseases of the urogenital tract in history;
• foci of chronic infection (, etc.);
• operations on the organs of the urinary system.

Physical examination reveals pain on palpation of the kidney/kidneys, a positive symptom of tapping in the lumbar region. With a long-term process, there may be polyuria (an increase in the daily amount of urine).

In secondary chronic pyelonephritis, an increase in blood pressure is often noted against the background of kidney anomalies.

Laboratory and instrumental examination methods

You can use decoctions of diuretic and anti-inflammatory herbs:

Sanatorium - resort treatment in Pyatigorsk, Truskavets, Essentuki, Zheleznovodsk is possible only during the period of remission.

If a patient has chronic pyelonephritis accompanied by an increase in blood pressure, then salt is limited to 5-6 g / day. Liquids can be drunk up to 1000 ml.

With nephrogenic hypertension supported by chronic pyelonephritis, ACE inhibitors are prescribed, since an increase in pressure is associated with an increase in renin in the blood.

In case of intolerance due to side effects, angiotensin II receptor antagonists are used.

Tactics of managing patients with exacerbation of chronic pyelonephritis with some concomitant pathology

If the patient has diabetes mellitus as a concomitant disease, then aminopenicillins and ciprofloxacins are used.

For patients with chronic renal failure, drugs with a hepatic or dual route of excretion are selected:

• Pefloxacin;
• Ceftriaxone;
• Cefoperazone.

A competent choice of antibacterial drugs ensures the safety of use and simplifies the selection of dosage.

Patients with CRF are not prescribed aminoglycosides and glycopeptides, due to their nephrotoxicity.

In patients and people suffering from drug addiction, the causative agent of pyelonephritis may be uncharacteristic. Preference is given to fluoroquinolones (levofloxacin), aminoglycosides and cephalosporins, since they are not metabolized in the body and are excreted by the kidneys.

Exclusion from the group of cephalosporins:

• Cefatoxime;
• Cefoperazone;
• Ceftriaxone.

Exacerbation of chronic pyelonephritis associated with resistant nosocomial bacterial strains is extremely rare. This may be a complication of medical procedures or a history of inadequate antibiotic intake.

In these cases, use Ceftazidime and Amikacin.

Cefazidime is prescribed as a single antibiotic, or in combination with Amikacin.

Carbapenems are considered reserve drugs (an exception is ertapenem).

Surgery

Indications for surgery are all violations of the outflow of urine.

If chronic pyelonephritis is complicated by the formation of apostemes or carbuncles of the kidney, an operation is performed in the amount of decapsulation, followed by the installation of a nephrostomy drainage.

In the most advanced cases, resort to nephrectomy.

Chronic pyelonephritis is quite common. With this pathology, nonspecific inflammatory processes occur, caused by various bacteria. As a result, the renal pelvis, calyces and parenchyma of the kidney suffer. Most often, inflammation occurs due to the activity of Escherichia coli or staphylococci. From this article, you will learn the answers to questions about what chronic pyelonephritis is, how, what are the signs of chronic pyelonephritis.

Symptoms of the disease

Very often, patients have an asymptomatic course of the disease. Inflammation may not make itself felt for many years, slowly affecting the kidneys before symptoms of chronic pyelonephritis begin to appear. Chronic pyelonephritis of the kidneys manifests itself with the help of symptoms only during the period of exacerbation.

If you have been diagnosed with chronic pyelonephritis, then the symptoms and treatment largely depend on how the disease manifests itself and in which place the disease is localized, as well as on the presence of other infectious pathogens.

During the period of exacerbation of chronic pyelonephritis, a picture of general inflammation is observed. Patients have an elevated body temperature, reaching up to 39 degrees. There are pain sensations in the lumbar region, and the localization of pain depends on which kidney is affected by the disease (often both suffer from chronic pyelonephritis, which causes pain on both sides of the lower back).

When pyelonephritis appears, patients often complain of feeling unwell, loss of appetite and headache. The presence of pyelonephritis can also be determined by the appearance of the patient: the face becomes slightly swollen, the eyelids may swell, the skin becomes pale and bags under the eyes are often observed.

When remission occurs (a period of illness during which there is a significant weakening of symptoms or their complete disappearance), it is quite difficult to determine the presence of chronic pyelonephritis in a patient by symptoms. Unlike the period of exacerbation, when the kidneys are affected, chronic pyelonephritis during the "calm" may not bother the patient at all, however, in some cases the following symptoms occur: rare and minor pain (pulling or aching pain) in the lumbar region, a slight increase in body temperature ( especially at bedtime), dry mouth and dark coating on the tongue, pale and dry skin, high blood pressure. If a patient suffers from chronic pyelonephritis for a long time without consulting a doctor, then he is often worried about excessive fatigue, loss of appetite and subsequent weight loss, causeless headaches. In some cases, intermittent nosebleeds are present. The advanced stages of the disease are characterized by bone pain, frequent urination, and excessive thirst.

If you find yourself with one or more of the above symptoms, you should immediately seek help from a highly qualified specialist in order to start treatment on time and prevent subsequent complications.

Causes of the disease

They lie in pathogens that penetrate the human excretory system - various microorganisms (E. coli, staphylococci, streptococci, enterococci and other microorganisms). After the pathogens enter the body for one reason or another, they proceed to the stage of reproduction. Often, before the disease begins, acute inflammation of the kidneys occurs.

The causes of chronic pyelonephritis can also be various kidney diseases not diagnosed in time. In children, the disease often appears after suffering influenza infections, tonsillitis, measles. This disease affects young girls who early began maintaining a regular sexual life. Patients suffering from diabetes mellitus, obesity and diseases of the gastrointestinal tract are also included in the risk group.

A particular factor contributing to the onset of the disease is a weakened immune system, which can occur due to hypothermia of the body, especially from hypothermia in the kidney area.

Stages of the disease

With such an ailment as chronic pyelonephritis, the stages are as follows:

Stage 1 - atrophy of the collecting ducts of the kidneys. Branches of segmental arteries decrease in number.

Stage 2 - there is a significant vasoconstriction, some glomeruli become empty.

Stage 3 is characterized by severe atrophy of the tubules, many renal glomeruli die.

Stage 4 is characterized by intense damage to the glomeruli, a decrease in size and drying of the kidney.

List of consequences of the disease

The development of pyonephrosis is a consequence of chronic pyelonephritis. Complications after suffering pyelonephritis occur mainly in people after thirty years. The consequence may be the presence of acute renal failure, expressed by disturbances in the functioning of the kidneys, and sometimes even a complete loss of the functional ability of the organ, the presence of paranephritis (purulent inflammation), the presence of necrotic papillitis (most often this complication, during which renal colic, hematuria and others occur). serious disorders, women are susceptible), the presence of urosepsis (perhaps the most serious complication during which a kidney infection affects the entire body, which almost always ends in death).

Diagnostics

Diagnosing the disease is quite difficult. This is due to the fact that its manifestations can be varied, and it is often possible to proceed in a latent form. To diagnose chronic pyelonephritis, the specialist relies on the patient's complaints and on additional instrumental and laboratory studies. Diagnostics should be comprehensive.

A number of laboratory tests include: general urine and blood tests, prednisolone and pyrogenal tests (during the test, the patient is given a drug, and after a while a series of urine samples are taken for analysis), the Sternheimer-Malbin test to determine the quantitative content of cells, bacteriological examination of urine and a biochemical blood test, a test for the content of electrolytes in the blood and urine.

A number of instrumental studies include: x-ray, thanks to which it is possible to determine the size of the kidneys (with chronic pyelonephritis, the kidneys decrease); carrying out radioisotope renography, due to which the functional abilities of each kidney are determined separately; performing a kidney biopsy, which allows you to determine the extent to which the kidneys are affected; chromocystoscopy, which allows you to determine how well the excretory function of the kidneys works; performing an ultrasound examination of the kidneys.

It should also be noted that for an accurate diagnosis, it is often enough for a doctor to ask the patient in detail about his complaints.

At the same time, the exclusion of amyloidosis, chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis is of particular importance in the diagnosis, since these diseases are similar to chronic pyelonephritis in the general clinical picture.

Treatment of the disease

Can chronic pyelonephritis be cured? Chronic pyelonephritis - what is it? Your doctor can answer these questions for you. If you find yourself with chronic pyelonephritis, treatment is available using various methods. The process of treating the disease involves an individual approach to each patient. The main methods of treatment are a special diet and drug therapy. In case of exacerbation, the patient is recommended inpatient treatment under the supervision of a physician. The patient is prescribed a rest regimen in combination with a proper diet and taking special medications. The duration of bed rest, which provides treatment for chronic pyelonephritis, is determined based on the degree of the disease, as well as the quality of treatment.

For an important role is played by nutrition. Moreover, diet is a prerequisite for treatment.

It is necessary to draw up a proper diet, excluding the use of foods such as rich broths, fatty and spicy foods, various seasonings, as well as coffee and alcohol.

It is forbidden to eat food that irritates the urinary tract. For example, eating foods containing a significant amount of protein contributes to an increase in the acidity of the urine, which adversely affects the body suffering from the disease. Food containing oxalic and lactic acid is subject to a complete ban. The use of easily digestible carbohydrates (beans, peas, chickpeas and others) negatively affects the patient's body, since under the influence of such products a beneficial environment is created for the spread of microorganisms.

Also, the list of prohibited foods includes smoked foods, fatty dairy products, semi-finished products, mushrooms, pickled foods. The use of confectionery products should either be limited or completely eliminated from the diet.

The body of a person suffering from chronic pyelonephritis is beneficially affected by diets that normalize the patient's metabolism, normalize blood pressure and help reduce stress on the kidneys.

The diet should contain a minimum amount of protein foods. The consumption of carbohydrates and fats should correspond to the amount equal to the physiological norms of a person. It is also necessary to enrich the diet with foods containing vitamins necessary for the health of the body.

As a doctor, the doctor prescribes antibiotics to the patient - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin and other drugs that eliminate chronic infections. The drugs are prescribed to the patient for a long time - up to eight weeks. Before treating the disease and prescribing medications, the specialist needs to check the acidity of the patient's urine and only after that determine the medicine that corresponds to these indicators.

Treatment of chronic pyelonephritis will provide a visit to a sanatorium specializing in diseases of the excretory system.

Prevention

Cured pyelonephritis must be monitored to prevent recurrence of exacerbation. As a preventive measure, people suffering from this disease are advised to monitor their diet, limit salt intake, and drink kidney tea. As soon as the treatment of chronic pyelonephritis is completed, patients are registered in a dispensary to prevent the risk of a recurrence of the disease. The transferred disease dictates the need to maintain normal immunity, which is facilitated by maintaining a healthy lifestyle, fresh air, hardening, as well as moderate physical activity. It is also important to organize the right working environment for yourself, not to get a job at enterprises where people are subjected to hard physical labor, hypothermia and excessive nervous tension.

To prevent chronic pyelonephritis, it is necessary to ensure sufficient fluid intake, which guarantees a normal outflow of urine.