Pyelonephritis: symptoms, treatment
- Causes of pyelonephritis
- The causative agents of pyelonephritis and the pathways of infection into the kidney
- Classification of pyelonephritis
- Symptoms of pyelonephritis
- Treatment of pyelonephritis
- Diet with pyelonephritis
- Possible complications of pyelonephritis
One of the most common urological diseases of infectious nature, affecting the cup-pelvis 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 function of the organ.
A nonspecific inflammatory process that affects the bowel-cup system and the parenchyma of the kidneys, in particular, its interstitial (unformed connective) tissue, is termed pyelonephritis in clinical terminology.
This disease can be considered as an independent nosological form, or as a complication of other pathologies of the genitourinary system (urolithiasis, acute renal failure, adenoma and prostate cancer, gynecological diseases). Develops pilonephritis under a variety of circumstances: against a background of bacterial or viral infection, during the postoperative period, during pregnancy, etc.
As a rule, women suffer from this disease. In girls 2 to 15 years of age, pyelonephritis is diagnosed 6 times more often than 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 revealed in the representatives of the strong half of humanity. This is due to the fact that for various age categories, various abnormalities of urodynamics associated with infection of the urinary tract are characteristic.
Causes of pyelonephritis
There are two main factors provoking the development of an infectious-inflammatory process: the presence of pathogenic microflora and the violation of natural defense mechanisms for fighting infection. Factors that increase the likelihood of the disease include:
- violation of the outflow of urine (obstruction of the urinary tract by concrement or swelling);
- abnormalities of kidney development;
- endocrine pathologies;
- non-observance of elementary rules of personal hygiene;
- microtrauma, obtained during sexual intercourse;
- trauma of the lumbar region;
- diagnostic manipulation or surgical intervention on the urinary tract;
- remote lithotripsy (crushing of urinary stones);
- use of a permanent catheter;
- pregnancy (hypotension of ureters);
- use of intrauterine contraceptives.
The causative agents of pyelonephritis and the pathways of infection into the kidney
Most often, the cause of the inflammation of the urinary tract is the bacteria Kolya (E. coli), staphylococcus or enterococcus. Less likely to provoke a nonspecific inflammatory process can other gram-negative bacteria. Often, patients are found co-infected or multidrug-resistant forms of infection (the latter are the result of uncontrolled and unsystematic antibacterial treatment). The most aggressive in terms of infection are considered hospital-acquired strains resistant to the action of antibiotics.
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 focus located outside the urinary tract.
Classification of pyelonephritis
- Acute and chronic form.
- Primary and secondary.
- One-sided and two-sided.
- Active inflammation phase, latent form and remission stage.
- Serous, purulent and necrotic inflammation of the kidney.
- Apostematous (formation of many small abscesses), abscess, carbuncle, shrinkage of the kidney, pionephrosis.
- Age pyelonephritis (pregnant, senile, etc.);
- Inflammation, which develops against the background of diabetes mellitus.
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. Often a precursor of the disease becomes acute cystitis (frequent painful urination).
With the development of nonobstructive pyelonephritis, body temperature rises almost in one day, pains occur in the affected kidney and symptoms of general intoxication develop. Often, chills are replaced by a short-term decrease in temperature and increased sweating.
When obstructing the urinary tract with a stone, tumor or products of inflammation (obstructive pyelonephritis), the disease develops gradually (pain in the lower back slowly increases, chills appear and body temperature rises).
In the early stages of acute inflammation of the kidney is serous. In this situation, the cause of stagnation of urine and the violation of renal circulation becomes tissue edema. Then, as the pathological process develops, the purulent pyelonephritis begins in the renal parenchyma, causing irreversible changes in the kidney.
Symptoms of chronic pyelonephritis
Chronic pyelonephritis is a slow, periodically exacerbating disease complicated by hypertension and kidney failure. As a rule, patients complain of aching, non-intensive, more often one-sided pains in a loin, strengthening at walking and at a long standing. Often develops hypoesthesia (loins the loins). In children 10-12 years old, 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 rise in body temperature to 38 C, especially at bedtime, and frequent urination, which intensifies at night. During the remission period, the only clinical sign of chronic pyelonephritis can be hypertension (increased blood pressure). Patients often have morning swelling of the face and hands, weakness, weakness, headaches, mood swings throughout the day, and edema in the feet and lower leg in the evenings.
The diagnosis is made taking into account the clinical picture and based on the patient's history. It should be noted that in recent years, cases of low-symptom or latent (latent) flow of pyelonephritis have become more frequent, which makes it difficult to detect not only chronic, but sometimes acute forms of the disease.
- General clinical analysis of urine. When microscopic sediment reveals an increased number of leukocytes (from 40 to 100 in the field of view), bacteriuria. Sternheimer-Malbin cells can be detected. In this situation, it is necessary to exclude the presence of gynecological disease. PH in the presence of infectious inflammation from mildly acidic changes in sharply alkaline.
- Urinalysis by Nechiporenko. There is a significant increase in the white blood cell count against the normal number of erythrocytes.
- Bacteriological culture (urine test for sterility).
- Clinical blood test. In the presence of acute inflammation, the ESR and the level of leukocytes are increased. In the leukocyte formula, there is a shift to the left, and young forms of neutrophils are detected.
- Ultrasound examination (ultrasound of the kidneys). In patients with pyelonephritis, there is an enlargement of the renal pelvis, heterogeneity of the parenchyma, coarsening of the contour of the calyces.
- Survey urography. It allows to reveal roentgenpositive calculi, as well as to identify the contours and position of the kidney.
- CT. It is prescribed only for medical reasons, for differentiation of infectious inflammation from neoplastic tumor processes.
- Radionuclide diagnostics.
Treatment of pyelonephritis
Treatment of acute and chronic pyelonephritis is the prerogative of a nephrologist. It is held in a complex and includes the following activities:
- antibacterial therapy;
- correction of the underlying disease, which caused a violation of the outflow of urine;
- detoxification and anti-inflammatory therapy;
- herbal treatment;
- diet therapy.
In the absence of the effect of conservative treatment, a patient may be assigned a surgical operation.
The duration of antibacterial treatment for acute pyelonephritis is 5-14 days. In this case, injection and parenteral administration of broad-spectrum antibiotics is used. Currently, semi-synthetic penicillins, aminoglycosides and cephalosporins are used.
Other methods of drug treatment
In addition to antibiotic therapy, the complex treatment of pyelonephritis includes the use of drugs that improve microcirculation, detoxification and anti-inflammatory drugs.
To remove toxins from the body, intravenous infusions of sorbilact and rheosorbylact are prescribed. At the same time, patients may be advised to take enterosorbents (activated carbon, lactulose).
As anti-inflammatory drugs with pyelonephritis use NSAIDs (paracetamol, nimesulide, nimesil).
To relieve spasm, enlarge the renal tubules and increase the outflow of urine, papaverine or no-shpa is prescribed.
To improve blood circulation in the kidneys, the use of anticoagulants and venotonics (heparin, dipyridamole, troxevasin) is indicated. Periodically prescribed are strong diuretics, such as furosemide.
For the normalization of microbiocenosis (with long-term treatment of pyelonephritis), the intake of probiotics, prebiotic and antifungal agents is recommended.
Phytotherapy with pyelonephritis
When treating the disease, experts recommend that as a supplement to drug therapy use herbal products that have anti-inflammatory, antibacterial, diuretic and hemostatic effect (the latter - if necessary). Bearberry, corn stigmas, mountain ash, plantain, wild strawberry leaf, field horsetail, cowberry, etc. are plants that have a wide range of medicinal properties. When composing medicinal fees, these components mutually reinforce and complement the healing effect of each other.
One of the most famous and sought-after herbal remedies used in the treatment of pyelonephritis is Kanefron. 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, in conservative treatment, the patient's condition remains severe or worsens. As a rule, surgical correction is performed in case of purulent (apostemia) pyelonephritis, abscess or carbuncle of the kidney.
In this situation, the development of therapeutic tactics is carried out taking into account the nature and extent of the lesion of the parenchymal tissue. In the course of the operation, a calculus from the renal pelvis or ureter may be removed, a ureter resection followed by anastomosis, urethrokutaneostomy (in the presence of a tumor), dissection of abscesses, excision of carbuncles, decapsulation (kidney exposure), nephrostomy (urinary diversion through special drainage) and nephrectomy complete kidney removal).
Diet with pyelonephritis
In the acute stage, the diet should be as gentle as possible. It is necessary to reduce the consumption of salt sharply (no more than 5-10 g per day, with a high blood pressure 2-3 grams), and completely eliminate from the diet acute, spicy, smoked and canned foods, strong meat broths, spices, coffee and alcohol .
It is allowed: egg white, sour-milk products, vegetarian (vegetable) dishes, boiled or steamed. As the inflammation subsides, the fish and low-fat meat are introduced into the diet. It is recommended to consume juices, compotes, melons, vegetables, fruits, and also drink 2-2.5 liquids daily (in the absence of swelling).
During an exacerbation, it is strictly forbidden to use animal fats when cooking (only vegetable oils and not more than 15 grams per day of butter).
During the period of remission, the diet is allowed gradually, in small portions, to introduce some spices, garlic and onions. It is 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, lean boiled meat and fish, skimmed dairy products.
Possible complications of pyelonephritis
- Violation of the filtration capacity of the kidneys;
- Bacteremic shock;
- Toxic hepatitis.
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