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Pyelonephritis: symptoms, treatment

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Pyelonephritis One of the most common urological diseases of an infectious nature, affecting the cup-pelvis system and the kidney parenchyma, is pyelonephritis. This rather dangerous pathology in the absence of timely competent treatment can lead to a violation of the excretory and filtering functions of the organ.

Nonspecific inflammatory process that affects the pelvic-dish system and the renal parenchyma, in particular, its interstitial (unformed connective) tissue, in clinical terminology is called pyelonephritis.

This disease can be considered as an independent nosological form, or as a complication of other pathologies of the urogenital system (urolithiasis, acute renal failure, adenoma and prostate cancer, gynecological diseases). Pilonephritis develops under various circumstances: against the background of a bacterial or viral infection, during the postoperative period, during pregnancy, etc.

As a rule, women are affected by this disease. In girls from 2 to 15 years old, pyelonephritis is diagnosed 6 times more often than theirs in their male peers. Approximately the same ratio is maintained in women and men of active reproductive age. At the same time, in advanced years, the disease, for the most part, is detected in representatives of the strong half of humanity. This is explained by the fact that for different age categories are characterized by various violations of urodynamics associated with infection of the urinary tract.



The causes of pyelonephritis

There are two main circumstances provoking the development of an infectious-inflammatory process: the presence of pathogenic microflora and the violation of the natural defense mechanisms of infection control. Factors that increase the likelihood of the disease include:

  • violation of urine outflow (blockage of urinary tract calculus or tumor);
  • abnormal development of the kidneys;
  • endocrine pathologies;
  • failure to follow basic rules of personal hygiene;
  • microtrauma resulting from sexual contact;
  • injuries of the lumbar region;
  • hypothermia;
  • diagnostic manipulation or surgery on the urinary tract;
  • remote lithotripsy (crushing of urinary stones);
  • use of a permanent catheter;
  • pregnancy (ureter hypotension);
  • use of intrauterine contraceptives.


Causative agents of pyelonephritis and ways of infection in the kidney

The most common cause of inflammation of the urinary tract becomes bacterium Kolya (E. coli), staphylococcus or enterococcus. Other Gram-negative bacteria are less likely to provoke a non-specific inflammatory process. Often, patients are found combined or multiresistant forms of infection (the latter are the result of uncontrolled and unsystematic antibacterial treatment). Nosocomial strains resistant to antibiotics are considered the most aggressive in terms of infection.

Ways of infection:

  • Ascending (from the rectum or foci of chronic inflammation, located in the urogenital organs);
  • Hematogenous (realized through the blood). In this situation, the source of infection can be any distant lesion located outside the urinary tract.



Pyelonephritis classification

  1. Acute and chronic form.
  2. Primary and secondary.
  3. Unilateral and bilateral.
  4. Phase active inflammation, latent form and remission stage.
  5. Serous, purulent and necrotic inflammation of the kidney.
  6. Apostematozny (formation of many small pustules), abscess, carbuncle, wrinkled kidney, pyonephrosis.
  7. Age pyelonephritis (n. Pregnant, senile, n. Child age);
  8. Inflammation that develops on the background of diabetes.

Symptoms of pyelonephritis

Clinical signs of acute pyelonephritis

In urological practice, depending on the passage (outflow) of urine, acute pyelonephritis is divided into non-obstructive and obstructive (disturbed). In the early stages of the pathological process, patients develop back pain, nausea and vomiting, body temperature rises to 38-39 ° C, and other symptoms of general intoxication are also observed. Often the precursor of the disease becomes acute cystitis (frequent painful urination).

With the development of non-obstructive pyelonephritis, body temperature rises almost on one day, pains occur in the affected kidney area and symptoms of general intoxication develop. Often the chill is replaced by short-term lowering of temperature and increased perspiration.

When the urinary tract is blocked with a stone, tumor or inflammation products (obstructive pyelonephritis), the disease develops gradually (back pain slowly increases, chills appear and body temperature rises).

In the early stages, acute inflammation of the kidney is serous. In this situation, tissue edema becomes the cause of urinary stagnation and impaired renal blood circulation. Then, as the pathological process develops, pus formation begins in the renal parenchyma (purulent pyelonephritis), which causes irreversible changes in the kidney.

Symptoms of chronic pyelonephritis

Chronic pyelonephritis is a sluggish, periodically exacerbating disease complicated by hypertension and renal failure. As a rule, patients complain of aching, non-intensive, more often unilateral back pain, aggravated during walking and during prolonged standing. Hypesthesia often develops (freezing of the loins). In children 10-12 years of age, as well as in patients with a mobile or low-lying kidney, abdominal pain is observed.

However, the symptoms of chronic inflammation of the renal parenchyma include a spontaneous increase in body temperature to 38 ° C, especially at bedtime, and frequent urination, which increases at night. During remission, the only clinical sign of chronic pyelonephritis may be arterial hypertension (increased blood pressure). Patients often have morning swelling of the face and hands, weakness, weakness, headaches, mood swings during the day, and swelling in the feet and lower legs in the evenings.

Diagnostics

The diagnosis is made taking into account the clinical picture and on the basis of the patient's history. It should be noted that in recent years, cases of oligosymptomatic or latent (latent) pyelonephritis have become frequent, which makes it difficult to identify not only the chronic, but sometimes the acute form of the disease.

Laboratory diagnosis

  1. General clinical analysis of urine. Microscopy of the sediment revealed an increased number of leukocytes (from 40 to 100 in sight), bacteriuria. Sternheimer-Malbin cells can be detected. In this situation, it is necessary to exclude the presence of gynecological disease. In the presence of infectious inflammation, the pH value changes from slightly acid to sharply alkaline.
  2. Urine analysis according to Nechyporenko. There is a significant increase in the content of leukocytes on the background of the normal number of red blood cells.
  3. Bacteriological culture (urine test for sterility).
  4. Clinical blood test. In the presence of acute inflammation, ESR and leukocyte levels are increased. In the leukocyte formula, a shift to the left is noted, and young forms of neutrophils are detected.

Instrumental diagnostics

  1. Ultrasound (kidney ultrasound). In patients with pyelonephritis, there is an expansion of the renal pelvis, heterogeneity of the parenchyma, coarsening of the contour of the cups.
  2. Survey urography. Allows you to identify X-ray calculus, as well as to identify the contours and position of the kidney.
  3. CT Appointed only for medical reasons, to differentiate infectious inflammation from neoplastic tumors.
  4. Radionuclide diagnostics.

Pyelonephritis treatment

Treatment of acute and chronic pyelonephritis is the prerogative of the nephrologist. It is held in the complex and includes the following activities:

  • antibiotic therapy;
  • correction of the underlying disease that caused the violation of urine outflow;
  • detoxification and anti-inflammatory therapy;
  • herbal therapy;
  • diet therapy.

In the absence of the effect of conservative treatment, the patient may be prescribed surgery.

Antibacterial therapy

The duration of antibiotic treatment for acute pyelonephritis is 5-14 days. It uses injection and parenteral administration of broad-spectrum antibiotics. Currently used semi-synthetic penicillins, aminoglycosides and cephalosporins.

Other methods of drug treatment

In addition to antibiotic therapy, complex treatment of pyelonephritis includes the use of drugs that improve microcirculation, detoxification and anti-inflammatory drugs.

For removal of toxins from the body, intravenous infusions of sorbilact and reosorbilact are prescribed. However, patients may be recommended admission of enterosorbents (activated carbon, lactulose).

NSAIDs (paracetamol, nimesulide, nimesil) are used as anti-inflammatory drugs for pyelonephritis.

To relieve spasm, enlargement of the renal tubules and enhance urine outflow, papaverine or no-spa is prescribed.

To improve blood circulation in the kidneys, the use of anticoagulant drugs and venotonics (heparin, dipyridamole, troxevasin) is indicated. Periodically appointed strong diuretics, such as furosemide.

To normalize the microbiocenosis (with long-term treatment of pyelonephritis), it is recommended to take probiotics, prebiotic and antifungal drugs.

Herbal medicine for pyelonephritis

When treating a disease, experts recommend using herbal preparations with anti-inflammatory, antibacterial, diuretic and hemostatic effects as a supplement to drug therapy (the latter, if necessary). Bearberry, corn stigmas, mountain ash, plantain, strawberry leaf, horsetail, lingonberry, etc. are plants with a wide range of healing properties. In the preparation of medicinal fees, these components mutually reinforce and complement the healing effects of each other.

One of the most famous and popular herbal preparations used in the treatment of pyelonephritis is Canephron. It has anti-inflammatory and antimicrobial activity, enhances the effect of antibacterial therapy, has a diuretic effect, increases blood circulation and eliminates renal vascular spasm.

Surgical treatment of pyelonephritis

Surgical intervention is prescribed if during the conservative treatment the patient's condition remains severe or worsens. As a rule, surgical correction is carried out with the detection of purulent (apostemozny) pyelonephritis, abscess, or carbuncle of the kidney.

In this situation, the development of medical tactics is carried out taking into account the nature and extent of damage to the parenchymal tissue. During the operation, it can be removed concretion of the renal pelvis or ureter, held resection ureter and subsequent insertion of the anastomosis, uretrokutaneostomiya (in the presence of a tumor), opening of abscesses, excision carbuncles, decapsulation (kidney exposure) nephrostomy (urinary diversion through a special drainage) and nefroektomiya ( complete removal of the kidney).

Diet for pyelonephritis

In the acute stage, the diet should be as gentle as possible. It is necessary to sharply reduce salt intake (no more than 5-10 grams per day, with high blood pressure - 2-3 grams), and completely exclude spicy, spicy, smoked and canned foods, strong meat broths, spices, coffee and alcohol from the diet. .

Allowed: egg white, dairy products, vegetarian (vegetable) dishes, boiled or steamed. As the inflammation subsides, fish and lean meat are introduced into the diet. It is recommended to consume juices, compotes, melons and gourds, vegetables, fruits, as well as drink 2-2.5 liquids daily (in the absence of edema).

During exacerbation it is strictly forbidden to use animal fats (only vegetable oils and no more than 15 grams per day of butter) when cooking.

During remission, it is allowed to gradually enter the diet, in small portions to introduce some spices, garlic and onions. Very useful for patients suffering from chronic pyelonephritis, cranberry juice, stimulating the production of hippuric acid (an effective bacteriostatic agent). Permitted products: fruits, vegetables, cereals, eggs, low-fat boiled meat and fish, low-fat dairy products.

Possible complications of pyelonephritis

  • Paranephritis;
  • Impaired filtration ability of the kidneys;
  • Urosepsis;
  • Bacteriemic shock;
  • Pyonephrosis;
  • Toxic hepatitis.

| 28 May 2015 | | 3,874 | Uncategorized
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