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Acute pyelonephritis


Acute pyelonephritis Acute pyelonephritis is a disease characterized by an inflammatory process in the kidney with the involvement of the interstitial tissue of the organ and the renal pelvis. Pyelonephritis is one of the most common diseases in urology, which in the absence of adequate treatment often becomes chronic with the development of renal failure.

By the nature of the disease are distinguished:

  • unilateral;
  • bilateral pyelonephritis;
  • purulent;
  • serous.

Most often, pyelonephritis occurs in people older than 40 years, but there are cases when the disease was detected in children of school age. The course of pyelonephritis in children occurs in waves, often without marked clinical symptoms, which are aggravated by certain factors on the body.

Causes of pyelonephritis

The development of an acute inflammatory process in the kidneys is always due to the effect on the body of a pathological infectious pathogen. Urologists have proven that purulent forms of pyelonephritis can occur when there are foci of chronic infection in the body, no matter what localization. This means that even carious teeth can be a prerequisite for the development of an inflammatory process in the kidneys.

Acute pyelonephritis can develop as a complication after such diseases:

Most often the causative agent of acute inflammation of the kidneys are E. coli, staphylococcus, streptococcus, gonococcus, Pseudomonas aeruginosa, mycoplasma, candidal fungi, viruses.

The spread of an infectious process is possible in several ways: lymphogenous, hematogenous, ascending.

The hematogenous route of transmission can carry the pathological pathogen into the kidneys from any lesion in the body - inflammation of the gallbladder, carious teeth, chronic inflammation of the tonsils, and more. In infectious diseases, pathogenic microflora penetrates the kidneys in a descending way.

The ascending path of penetration of infectious pathogens (urogenic) is characteristic of the penetration of pathogenic microflora into the kidneys from the inflamed bladder, urethra and ureters. As a rule, the ascending transmission of infection is more characteristic of patients who have problems with the outflow of urine, as a result of stagnation, congenital anomalies of the urinary organs, the presence of sand and stones in the bladder.

Predisposing factors for the development of pyelonephritis

Predisposing factor for the development of acute pyelonephritis is a tendency to allergic reactions in humans. Other prerequisites for kidney inflammation are:

  • weak immune defense;
  • frequent viral and infectious diseases;
  • hypothermia (especially the lumbar region);
  • diabetes;
  • vitamin deficiency in the body;
  • pregnancy;
  • circulatory disorders;
  • injury to the lumbar region.

Symptoms of acute pyelonephritis

Most often, patients develop acute right-sided pyelonephritis. This is due to the anatomical features of the structure of the right kidney, which contributes to the occurrence of stagnation in it.

The clinical manifestations of acute inflammation of the renal tissue are largely dependent on the shape and course of the pathological process. The serous form of pyelonephritis is relatively not heavy. With a pronounced clinical picture pyelonephritis proceeds purulent form.

The following symptoms are characteristic of acute pyelonephritis:

  • the appearance of dull aching pain in the lumbar region;
  • a sharp increase in body temperature (up to 38.5-39.0);
  • dysuric phenomena (violation of urine outflow);
  • chills, fever;
  • growing weakness;
  • increased sweating;
  • tachycardia , shortness of breath, muscle and headaches.

With bilateral acute pyelonephritis, the painful sensations are of different intensity, sometimes the patient has a feeling that the entire back and abdomen hurts. With purulent pyelonephritis, the nature of pain resembles renal colic - the patient is restless, rushes about, and cannot find a comfortable posture.

Urination disorder is characterized by frequent urge to empty the bladder and the prevalence of nighttime diuresis over daytime. During palpation of the abdomen, the doctor notes the pain in the affected area. Often, in the first days of pyelonephritis, characteristic symptoms of peritoneal irritation are observed, therefore, early diagnosis with palpation is extremely difficult. In most cases, acute pyelonephritis is accompanied by the appearance of edema and an increase in blood pressure.

Laboratory diagnosis of acute pyelonephritis

In laboratory studies of blood tests reveal:

  • neutrophilic leukocytosis,
  • increased ESR,
  • minor proteinuria.

Detection of protein in the urine due to pyuria. For the acute form of pyelonephritis most typical is the appearance of pus in the urine, a large number of red blood cells. Such manifestations are especially pronounced with concomitant inflammation of the bladder.

Patients with the acute form of pyelonephritis must be prescribed a bacteriological examination of urine analysis. For this purpose, the urine is collected using catheterization, so that bacteria from the environment or external genital organs do not enter the tube. As a rule, 90% of patients reveal pathogenic bacterial flora during the study.

With prolonged pyelonephritis and the absence of adequate therapy, the patient's filtration capacity decreases in time with the renal glomeruli, as a result of which nitrogenous compounds begin to accumulate in the blood (the level of urea and acetone in the blood rises), uremia develops rapidly. In some cases, acute pyelonephritis can occur without a pronounced clinical picture, especially in children and pregnant women. In these cases, the disease is diagnosed using extensive laboratory studies.

Pyelonephritis with mild clinical symptoms is diagnosed by counting the number of leukocytes in the urine analysis, as well as during the bacteriological culture of urine on the nutrient medium.

A special and rare form of acute pyelonephritis is papillary necrosis - a kidney disease that occurs in elderly women with diabetes. This type of pyelonephritis is characterized by an acute onset: in patients, the body temperature rises sharply to 39.0-40.0 degrees, pronounced hematuria and pyuria are observed in the urine analysis, symptoms of intoxication and a septic condition quickly increase.

What diseases can be confused with acute pyelonephritis?

With an acute onset of pyelonephritis, patient complaints of dull back pain, the appearance of dysuric disorders and changes in urine and blood tests, it is not difficult to diagnose the disease. However, when making a diagnosis, it should be remembered that the blockage of the urinary tract by pathological exudate may not alter the composition of urine, then red and white blood cells in the urine are absent. That is why in the diagnosis of pyelonephritis patients prescribed several laboratory tests of urine and blood, with a frequency of 1-2 days. It is more difficult to differentiate pyelonephritis in the presence of concomitant inflammatory processes in the organs of the urinary system and in the course of the disease with mild symptoms.

Acute pyelonephritis must be differentiated from acute cystitis. For this, physicians use the three-glass test method: in case of inflammation of the bladder, the third urine sample contains a large number of different formed elements. In addition, cystitis occurs with brighter dysuric manifestations - severe pain, burning sensation when emptying the bladder, frequent urge to urinate, and a few drops of blood at the end of urination.

In addition to laboratory methods for the diagnosis of acute pyelonephritis, kidney radiography, excretory urography with the introduction of a contrast agent into the vein and isotope renography are required.

The course of acute pyelonephritis and prognosis

With timely treatment of the patient to the doctor and properly prescribed treatment, the course of the acute form of pyelonephritis is favorable. Since antibiotics are the basis for the treatment of inflammation of the kidneys, they very rarely resort to surgery. With careful adherence to medical recommendations in a patient after 2 weeks there is a significant improvement.

If you ignore the doctor's instructions, do not follow the schedule for taking medications, independently reduce the dose of the antibiotic and refuse the diet, many patients experience a relapse of the disease, which can later lead to the acute pyelonephritis becoming chronic.

In addition, the course of the acute form of pyelonephritis in some cases may be complicated by the development of a kidney abscess or purulent inflammation of the kidney tissue. In rare cases, acute pyelonephritis leads to urosepsis and the development of renal failure. When the course of pyelonephritis is neglected, the patient quickly develops septic shock.

Approximately 80% of patients are completely cured of pyelonephritis, subject to all instructions of the doctor and timely diagnosis. The rest observed the transition of an acute inflammatory process to a chronic form.

Treatment of acute pyelonephritis

During the acute stage of the inflammatory process in the kidneys, the patient must observe bed rest until the dysuria phenomena disappear and the body temperature is normalized.

The patient must comply with therapeutic diet. When pyelonephritis shows the table number 7. Diet is to exclude spicy dishes, spices, canned food, coffee and strong tea, alcoholic beverages. Limit the daily dose of salt (up to 4-5 g), so as not to provoke stagnant fluids in the body and the development of edema.

For the purpose of natural washing of the urinary tract and kidneys, it is recommended that the patient drink plenty of up to 3 liters per day, provided that there is no arterial hypertension. Mineral waters such as Mirgorodskaya, Essentuki, Naftusya, Berezovskaya are excellent for this purpose. A natural antiseptic effect has a juice from cranberries, cranberries, raspberries.

Food should be easily absorbed by the body. Vegetarian soups, lean boiled or stewed fish, vegetable dishes, cereals, eggs, steam omelets, baked apples are recommended for the patient.

In case of severe pain syndrome, analgesics are indicated for the patient. For painful urination disorders, candles with papaverine are prescribed rectally or with belladonna.

The main methods of treatment of the acute form of pyelonephritis, of course, are antibiotics. When oligosymptomatic pyelonephritis, without complications and related pathologies, sulfanilamide preparations are prescribed to the patient. At the same time be sure to monitor the outflow of urine and the absence of symptoms of increasing renal failure.

In the case of a pronounced clinic, broad-spectrum antibiotics are prescribed to which infectious agents are sensitive. In combination with the main antibiotic, it is often prescribed drugs of the nitrofuran group (furadonin, furazolidone), nitroxoline and others.

Intravenous administration of antibiotics is shown to the patient after the started inflammatory process and purulent forms of pyelonephritis. As a rule, antibiotic therapy is used until the patient's body temperature normalizes, and blood and urine tests do not improve. On average, treatment of pyelonephritis lasts 10-14 days, if necessary, and up to 1 month.

In the absence of a therapeutic effect from antibiotics and an increasing septic condition in a patient, the question arises of the surgical removal of the affected kidney (provided that the second kidney functions normally). After treatment of acute pyelonephritis, such patients should be observed for a year at the district general practitioner.

Prevention of pyelonephritis

Preventing the onset of pyelonephritis lies in the rehabilitation of the foci of chronic infection in the body - carious teeth, chronic inflammation of the tonsils, treatment of cholecystitis, sinusitis and other diseases. Remember that in case of inflammatory diseases of the urinary system organs it is impossible to self-medicate, since common cystitis can often lead to the spread of infection in the kidneys.

It is very important to monitor personal intimate hygiene (especially for girls and women), since pyelonephritis is promoted by ascending infection through the urinary tract.

If there are problems in the form of stones and sand in the bladder, the ureters should be removed in a timely manner, as mechanical obstacles that prevent the normal flow of urine lead to stretching of the renal pelvis, the development of congestion in it and subsequent kidney inflammation.

In order to avoid infection of the urinary tract during diagnostic procedures (cystoscopy, catheterization of the bladder and others), the doctor must comply with aseptic measures and antiseptics.

If you find symptoms of pyelonephritis, do not hesitate to consult a doctor! A timely diagnosis and the treatment started will avoid the transition of the disease to the chronic form.

| 5 December 2014 | | 3 539 | Diseases of the genitourinary system