Pyelonephritis. Causes, symptoms, modern diagnosis and effective treatment of the disease
The most common causative agents of the inflammatory process in the kidney are Escherichia coli (E. coli), Proteus (Proteus), enterococci (Enterococcus), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and staphylococcus (Staphylococcus).
The penetration of the pathogen into the kidney is most often associated with the reflux of urine into the kidneys (vesicoureteral reflux - VUR) due to obstructed outflow of urine, bladder overflow, increased intravesical pressure due to hypertonicity, structural anomaly, stones, or prostate enlargement.
Why is pyelonephritis dangerous?
Each new exacerbation of pyelonephritis involves all new areas of kidney tissue in the inflammatory process. Over time, normal kidney tissue dies at this site and a scar forms. As a result of a long course of chronic pyelonephritis, there is a gradual decrease in the functional tissue (parenchyma) of the kidney. Eventually, the kidney shrinks and stops functioning. With bilateral kidney damage, this leads to chronic renal failure. In this case, in order to maintain the vital activity of the body, the function of the kidneys must be replaced by an "artificial kidney" apparatus, that is, hemodialysis should be carried out regularly - artificial blood purification by passing through a filter.Forms of pyelonephritis
Diagnosis of pyelonephritis
Pyelonephritis is manifested by dull pain in the lower back, aching nature of low or moderate intensity, fever up to 38-40 ° C, chills, general weakness, loss of appetite and nausea (all symptoms may occur at once, and only some of them). Usually, with reflux, there is an expansion of the pelvicalyceal system (PCS), which is observed on ultrasound.Pyelonephritis is characterized by an increase in leukocytes, the presence of bacteria, protein, erythrocytes, salts and epithelium in the urine, its opacity, turbidity and sediment. The presence of protein indicates an inflammatory process in the kidneys and a violation of the blood filtration mechanism. The same can be said about the presence of salts: blood is salty, isn't it? The consumption of salty foods increases the burden on the kidneys, but is not the cause of the presence of salts in the urine. When the kidneys do not filter well enough, salts appear in the urine, but instead of looking for the cause of pyelonephritis, our favorite urologists with the letter X (do not think that they are good) recommend reducing the amount of salt consumed with food - is it normal?
Urologists also like to say that with pyelonephritis you need to consume as much liquid as possible, 2-3 liters per day, uroseptics, cranberries, lingonberries, etc. So it is, but not entirely. If the cause of pyelonephritis is not eliminated, then with an increase in the amount of fluid consumed, the reflux becomes even more intense, therefore, the kidneys become even more inflamed. First you need to ensure a normal passage of urine, exclude the possibility of overflow (no more than 250-350 ml, depending on the size of the bladder), and only then consume a lot of fluid, only in this case, fluid intake will be beneficial, but for some reason very often about this is forgotten.
Treatment of pyelonephritis
Treatment of pyelonephritis should be comprehensive, and should include not just antibiotic therapy, but, more importantly, measures aimed at eliminating the very cause of pyelonephritis.With the help of antibiotics, inflammation is removed in the shortest possible time, but if the cause itself is not eliminated, then after some time, after antibiotics are discontinued, pyelonephritis will worsen again and after a certain number of such relapses, the bacteria will acquire resistance (resistance) to this antibacterial drug. In this connection, the subsequent suppression of bacterial growth with this drug will be difficult or even impossible.
Antibacterial therapy
It is desirable that the antibiotic is selected on the basis of the results of bacteriological culture of urine with the determination of the sensitivity of the pathogen to various drugs. In the case of acute pyelonephritis, immediately after the seeding, a broad-spectrum antibiotic from the fluoroquinol group, for example, Tsiprolet, may be prescribed and adjusted according to the results of the seeding. Antibacterial therapy should continue for at least 2-3 weeks.Causes of pyelonephritis
The most likely causes of pyelonephritis include reflux caused by difficulty urinating, bladder overflow, increased intravesical pressure, complication of cystitis, as well as anatomical anomalies in the structure of the ureters, disruption of the sphincters.Urination disorders can be caused by hypertonicity of the sphincter of the bladder and the bladder itself, obstructed outflow of urine due to an inflammatory disease of the prostate gland (prostatitis), spasms, which may be caused by cystitis, structural changes in the ureteral sphincters and anomalies, impaired neuromuscular conduction and, at least degree - weakness of the smooth muscles of the bladder. Despite this, most urologists begin treatment by stimulating the force of detrusor contractions, which further exacerbates the situation, although in combination with antibiotic therapy, in most cases, this gives visible, but short-term improvements. In case of difficult passage (outflow) of urine, in order to prevent reflexes, it is necessary to resort to periodic catheterization of the bladder, or to install a Foley catheter with a change every 4-5 days.
In the case of hypertonicity of the sphincter of the bladder or itself, it is necessary to look for the cause of hypertonicity or spasms and eliminate it, thereby restoring the normal outflow of urine. If you are diagnosed with cystitis, then you need to treat it, since pyelonephritis can be a complication of cystitis.
In inflammatory diseases of the prostate, you need to undergo a course of treatment for prostatitis (read the article about prostatitis).
If there are structural anomalies of the bladder, urethra, ureters, you need to consult with doctors and take measures to eliminate defects, possibly surgically.
For the treatment of neuromuscular conduction disorders, there are many drugs and techniques, qualified doctors should select tactics.
Before you "stupidly" stimulate the force of contractions of the muscles of the bladder, you need to exclude the presence of all the above disorders, be vigilant and control the treatment you are prescribed yourself.
Exacerbations of pyelonephritis inevitably lead to a thinning of the functional part of the kidney and the death of nephrons, therefore, in order to preserve as much of the kidney as possible in working condition, it is extremely important to eliminate the cause of pyelonephritis in the shortest possible time. Ask to measure the thickness of the parenchyma of the kidneys during the ultrasound. The thickness of the parenchyma of healthy kidneys averages 18 mm.
Pyelonephritis is an acute or chronic kidney disease that develops as a result of exposure to the kidney of some causes (factors) that lead to inflammation of one of its structures, called the pelvicalyceal system (the structure of the kidney in which urine is accumulated and excreted) and adjacent to this structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.
The definition of "Pyelonephritis" comes from the Greek words ( pyelos- translates as, pelvis, and nephros-bud). Inflammation of the structures of the kidney occurs in turn or simultaneously, it depends on the cause of the developed pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 39 0 C, nausea, vomiting, impaired urination), with proper treatment after 10-20 days, the patient recovers completely.
Chronic pyelonephritis is characterized by exacerbations (most often in the cold season), and remissions (subsidence of symptoms). Its symptoms are mild, most often, it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, anomalies of the urinary system, prostate adenoma, and others).
Women, especially young and middle-aged women, get sick more often than males, approximately in a ratio of 6: 1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men are more likely to develop pyelonephritis at an older age, this is most often associated with the presence of prostate adenoma. Children also get sick, more often at an early age (up to 5-7 years), compared with older children, this is due to the low resistance of the body to various infections.
Kidney Anatomy
The kidney is an organ of the urinary system that is involved in removing excess water from the blood and products secreted by body tissues that were formed as a result of metabolism (urea, creatinine, drugs, toxic substances, and others). The kidneys remove urine from the body, further along the urinary tract (ureters, bladder, urethra), it is excreted into the environment.The kidney is a paired organ, in the form of a bean, dark brown in color, located in the lumbar region, on the sides of the spine.
The mass of one kidney is 120 - 200 g. The tissue of each of the kidneys consists of a medulla (in the form of pyramids) located in the center, and a cortical located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyxes (average 2-4 in one kidney). In the future, the large renal calyces pass into one large renal pelvis (a cavity in the kidney, funnel-shaped), which, in turn, passes into the next organ of the urinary system, which is called the ureter. From the ureter, urine enters the bladder (a reservoir for collecting urine), and from it through the urethra out.
Inflammatory processes in the calyces and pelvis of the kidney are called pyelonephritis.
Causes and risk factors in the development of pyelonephritis
| Features of the urinary tract | |
| R develop as a result of exposure to the fetus during pregnancy of adverse factors (smoking, alcohol, drugs) or hereditary factors (hereditary nephropathy, resulting from a mutation of the gene responsible for the development of the urinary system). Congenital anomalies leading to the development of pyelonephritis include the following malformations: narrowing of the ureter, underdeveloped kidney (small size), lowered kidney (located in the pelvic region). The presence of at least one of the above defects leads to stagnation of urine in the renal pelvis, and a violation of its excretion into the ureter, this is a favorable environment for the development of infection and further inflammation of the structures where urine has accumulated. |
| In women, compared to men, the urethra is shorter and larger in diameter, so sexually transmitted infections easily enter the urinary tract, rising to the level of the kidney, causing inflammation. |
| Hormonal changes in the body during pregnancy | |
| The pregnancy hormone, progesterone, has the ability to reduce the tone of the muscles of the genitourinary system, this ability has a positive effect (prevention of miscarriages) and a negative effect (violation of the outflow of urine). The development of pyelonephritis during pregnancy is a disturbed outflow of urine (a favorable environment for the reproduction of infection), which develops as a result of hormonal changes, and compression of the enlarged (during pregnancy) uterus of the ureter. | |
| reduced immunity | |
The task of the immune system is to eliminate all substances and microorganisms alien to our body, as a result of a decrease in the body's resistance to infections, pyelonephritis may develop.
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| Chronic diseases of the genitourinary system | |
| lead to a violation of the excretion of urine and its stagnation; |
| (inflammation of the bladder), in case of ineffective treatment or its absence, the infection spreads along the urinary tract upwards (to the kidney), and its further inflammation. |
| Infections such as chlamydia, trichomoniasis, when penetrating through the urethra, enter the urinary system, including the kidney. |
| Chronic amygdalitis, bronchitis, intestinal infections, furunculosis and other infectious diseases are a risk factor for the development of pyelonephritis . In the presence of a chronic focus of infection, its causative agent (staphylococcus, E. coli, Pseudomonas aeruginosa, Candida and others) can enter the kidneys with the blood stream. |
Symptoms of pyelonephritis
- burning and pain during urination, due to inflammation in the urinary tract;
- the need to urinate more often than usual, in small portions;
- beer-colored urine (dark and cloudy), is the result of the presence of a large number of bacteria in the urine,
- foul-smelling urine
- often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).
- Pasternatsky's symptom is positive - with a light blow with the edge of the palm on the lumbar region, pain appears.
- Edema, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appear on the face (under the eyes), legs, or other parts of the body. Edema appears in the morning, soft pasty consistency, symmetrical (on the left and right sides of the body of the same size).
Diagnosis of pyelonephritis
General urine analysis - indicates abnormal urine composition, but does not confirm the diagnosis of pyelonephritis, since any of the abnormalities may be present in other kidney diseases.Proper collection of urine: in the morning, the toilet of the external genital organs is performed, only after that the morning, first portion of urine is collected in a clean, dry dish (a special plastic cup with a lid). The collected urine can be stored for no more than 1.5-2 hours.
Indicators of a general urine test for pyelonephritis:
- High level of leukocytes (normal in men 0-3 leukocytes in the field of view, in women up to 0-6);
- Bacteria in urine >100,000 per ml; the excreted urine is normal, must be sterile, but when it is collected, hygienic conditions are often not observed, therefore, the presence of bacteria up to 100,000 is allowed;
- Urine density
- Ph urine - alkaline (normally acidic);
- The presence of protein, glucose (normally they are absent).
Urinalysis according to Nechiporenko:
- Leukocytes are increased (normal up to 2000/ml);
- Erythrocytes are increased (normal up to 1000/ml);
- The presence of cylinders (they are normally absent).
Ultrasound of the kidneys: is the most reliable method to determine the presence of pyelonephritis. Determines the different sizes of the kidneys, a decrease in the size of the affected kidney, deformation of the pelvicalyceal system, the detection of a stone or tumor, if any.
Excretory urography, is also a reliable method for detecting pyelonephritis, but compared with ultrasound, you can visualize the urinary tract (ureter, bladder), and in the presence of blockage (stone, tumor), determine its level.
CT scan, is the method of choice, using this method it is possible to assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)
Treatment of pyelonephritis
Medical treatment of pyelonephritis
- antibiotics, are prescribed for pyelonephritis, according to the results of bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.
Antibiotics and antiseptics in the treatment of pyelonephritis:
- Penicillins(Amoxicillin, Augmentin). Amoxicillin inside, 0.5 g 3 times a day;
- Cephalosporins(Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
- Aminoglycosides(Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg / kg 2 times a day;
- Tetracyclines (Doxycycline, orally 0.1 g 2 times a day);
- Levomycetin group(Chloramphenicol, orally 0.5 g 4 times a day).
- Sulfonamides(Urosulfan, inside 1 g 4 times a day);
- Nitrofurans(Furagin, inside 0.2 g 3 times a day);
- Quinolones(Nitroxoline, inside 0.1 g 4 times a day).
- Diuretic drugs: are prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and are not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
- Immunomodulators: increase the reactivity of the body during the disease, and to prevent exacerbation of chronic pyelonephritis.
- Timalin, intramuscularly 10-20 mg 1 time per day, 5 days;
- T-activin, intramuscularly, 100 mcg once a day, 5 days;
- Multivitamins , (Duovit, 1 tablet 1 time per day) Ginseng tincture - 30 drops 3 times a day are also used to improve immunity.
- Non-steroidal anti-inflammatory drugs (Voltaren), have an anti-inflammatory effect. Voltaren inside, 0.25 g 3 times a day, after meals.
- To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantyl, 0.025 g 3 times a day.
Phytotherapy for pyelonephritis
Herbal medicine for pyelonephritis is used as an adjunct to medical treatment, or to prevent exacerbation in chronic pyelonephritis, and is best used under medical supervision.Cranberry juice, has an antimicrobial effect, drink 1 glass 3 times a day.
A decoction of Bearberry, has an antimicrobial effect, take 2 tablespoons 5 times a day.
Boil 200 g of oats in one liter of milk, drink ¼ cup 3 times a day.
Kidney collection No. 1: A decoction of the mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.
Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, cowberry. Finely chop all these herbs, pour 2 tablespoons of water and boil for 20 minutes, take half a cup 4 times a day.
Many acute urinary infections become chronic for certain reasons. This is an unfavorable condition for the body as a whole. Patients wonder if chronic pyelonephritis can be completely cured. Let's take a closer look at what this disease is and how dangerous it is.
Features of the development of the disease
Chronic pyelonephritis is a long-term microbial-inflammatory process of the interstitial tissue and tubules of the kidneys, simultaneously or sequentially moving to the parenchymal layer and calyces. The terminal stage of development includes damage to blood vessels and glomeruli. Chronic kidney disease is the result of such widespread gross changes. Its outcome is considered to be renal failure (CRF).
The modern classification of chronic pyelonephritis provides for its division into several stages. The division is based on clinical and laboratory data. There are 3 stages of activity of the inflammatory process in this disease:
The listed phases sequentially replace each other, regardless of medical intervention. Also, for nephrologists and urologists, a conditional division according to the location of the lesion is significant. There are 2 types:
- unilateral;
- bilateral.
In chronic pyelonephritis, this classification is needed when forming risk groups for the occurrence of complications. It is also important for predicting the outcome. Bilateral pyelonephritis is the most unfavorable form. These patients are characterized by early and rapid development of end-stage renal disease.
Causes of the disease
The danger of the problem is dictated by several reasons:
- Wide coverage of all age groups of the population, including children of the first year of life.
- Rapid development of chronic renal failure without early diagnosis and therapy.
- Erasure of the clinical picture.
- Complications of chronic pyelonephritis lead to death.
- Early disability of patients.
- The duration of the treatment.
- More often it affects females with preserved reproductive function, complicating the course of pregnancy.
Chronic pyelonephritis is always a consequence of an acute process. The reasons for this scenario are:
- staphylococci;
- Proteus;
- streptococci;
- coli, etc.
The provoking factors for the aggravation of the process are:
Why is the disease dangerous? Chronic pyelonephritis is prone to gradual involvement in the pathological process with each new exacerbation of a larger volume of kidney tissue. The result is the wrinkling of the body with gross violations of its basic functions.
What are the patients complaining about?
With a latent course and in remission, there may not be clinical signs of chronic pyelonephritis. During careful questioning, the patient may recall some minor complaints:
In chronic pyelonephritis, such a clinic passes very quickly. The patient does not focus on it and forgets after a while.
With a long course of pathology, patients may note:
- a persistent increase in blood pressure that cannot be corrected with antihypertensive drugs;
- prostration;
- decrease in working capacity;
- lack of desire to eat;
- an unpleasant taste in the mouth that appears in the morning;
- violation of the chair;
- pain in the back and abdomen;
- thirst;
- shortness of breath
- frequent urination, especially at night;
- slight chills;
- violations of the urinary stream (weak, intermittent).
Most often, these symptoms are associated with another disease, which increases the time of diagnostic search.
With exacerbation of chronic pyelonephritis of the kidneys, the symptoms are quite eloquent:
- previous action of provoking factors;
- high temperatures;
- drawing pains in the lower back;
- discomfort when urinating;
- loss of strength, headaches;
- frequent urge to urinate;
- vomiting (more common in children);
- drawing pains in the lower abdomen.
It is more difficult to identify the symptoms of chronic pyelonephritis in infants and toddlers under 3 years of age. Due to careful questioning and observation of parents, the following complaints can be identified:
Pediatricians often miss the described symptoms and prescribe inappropriate treatment, equating the manifestations with another pathology. Sometimes parents do not tell the attending physician about such situations due to the rapidly passing course of symptoms, not suspecting how dangerous such situations are.
This causes the development of severe forms of chronic pyelonephritis in young children. If you suspect a kidney pathology, you need to contact a nephrologist or urologist. Only they are engaged in identifying the disease and know how dangerous the hidden disease is and how to cure chronic pyelonephritis.
Diagnostic search
Identification of chronic forms of pyelonephritis is a very laborious process. Diagnostics is carried out comprehensively and includes:
Laboratory diagnosis of chronic pyelonephritis implies the appointment of:
In chronic pyelonephritis, diagnosis involves the use of additional methods:
The diagnostic algorithm is selected by the doctor individually for each individual patient. In this case, the equipment of the medical institution with the necessary equipment is also important.
Methods of therapy
The final diagnosis of chronic pyelonephritis is made after all the necessary examinations by summing up the results. Only after that, therapeutic measures are prescribed.
Treatment of chronic pyelonephritis consists of 4 points:
- general purpose;
- the use of drugs;
- herbal medicine;
- physiotherapy.
- control of chronic comorbidities;
- salt-restricted diet;
- prevention of viral and infectious diseases;
- personal hygiene (especially in girls).
Treatment of chronic pyelonephritis involves the use of:
- Antibiotics: Norfloxacin, Ciprofloxacin, Cefotaxime, Ceftriaxone.
- Antimicrobial medicines: Furagin, 5-NOC, Monural, Nitroxoline.
- Immunomodulators: Taktivin, Isoprinosine.
- Antispasmodic drugs: No-shpa, Papaverine.
In chronic pyelonephritis, treatment with synthetic drugs is necessarily combined with the appointment of herbal remedies:
- Kanefron;
- Urolesan;
- lingonberry leaf;
- Phytolysin.
For any symptoms, treatment includes such combinations in courses up to 2 months. An explanatory conversation is held with the patient. Its essence lies in the story of how to treat the disease correctly to prevent serious complications. This will eliminate possible errors in the implementation of all medical recommendations by patients.
In chronic pyelonephritis, symptoms and treatment are not interdependent. It depends on the results of laboratory and instrumental studies. Only in this case it will be possible to completely overcome the disease, and not just temporarily reduce the manifestations of symptoms.
Physiotherapy is contraindicated during exacerbation. They are assigned when the process subsides. Most effective:
- electrophoresis;
- laser therapy;
- magnetotherapy.
Surgical intervention is indicated for diseases that violate the outflow of urine. Treatment of chronic pyelonephritis with specific drugs, dosages and duration of administration is prescribed by a nephrologist. The age of the patient, comorbidities are taken into account.
Chronic pyelonephritis is an insidious, slowly progressive disease.
The patient's chances of recovery are higher with early diagnosis and an adequate course of therapy followed by constant monitoring. Therefore, it is important to know what chronic pyelonephritis is and how it manifests itself in order to identify the disease at an early stage.
Chronic pyelonephritis - the most common infectious and inflammatory disease of the kidneys, occurring with alternating periods of a latent inflammatory process in the kidneys with phases of exacerbations, which is chronic.
The disease is usually associated with the development of a bacterial infection in the kidneys, which first affects the pyelocaliceal system of the kidney and tubules, and then passes to the glomeruli and vessels of the kidneys, affecting the renal papillae, as well as the cortical and medulla of the kidney.
Causes of chronic pyelonephritis
According to statistics, every tenth person on the planet suffers from pyelonephritis. Infection with pyelonephritis penetrates the kidneys either ascending through the bladder and ureters, or hematogenously through the bloodstream. The source of infection can be focal purulent-inflammatory diseases of other organs, such as sinusitis, tonsillitis (tonsillitis), stomatitis, dental caries, pneumonia, bronchitis, inflammatory processes in the genital organs, cystitis. Often the cause of pyelonephritis is a relatively harmless Escherichia coli that enters the urinary tract with the blood stream, or as a result of improper hygiene of the urinary organs.
However, the mere entry of microbes into the renal tissue for the development of pyelonephritis is still not enough. The disease occurs under the influence of a complex of reasons: a lack of vitamins in the body, hypothermia, overwork, stress, and much more. Most of all contributes to the development of pyelonephritis retention of urine outflow associated with squeezing or obstruction of the urinary tract. These can be stones in the ureters and bladder, prostate adenoma in men, inflammation of the ovaries in women, various congenital defects of the urinary system. It is no coincidence that pyelonephritis and urolithiasis are so closely related to each other. Inflammation stimulates the formation of stones, and stones, making it difficult to excrete urine, contribute to inflammation of the kidney pelvis.
Usually, chronic pyelonephritis occurs as a result of not fully cured acute pyelonephritis. Often the disease is asymptomatic for months and even years and is detected either during an exacerbation or as a result of a long-term persistent disruption of the kidneys, which led to the death of part of the renal nephrons and the appearance .
Often enough chronic pyelonephritis has no obvious symptoms. The patient sometimes complains that his back hurts, his head often hurts, there are jumps in blood pressure, but he attributes all these manifestations of the disease to climatic factors and physical overwork. The clinical picture depends on the form in which chronic pyelonephritis occurs in this patient.
Forms of chronic pyelonephritis:
- Upon emergence chronic pyelonephritis is divided into primary(appearing for the first time in a patient without other urological diseases) and secondary(arising against the background of any existing urinary tract disease).
- According to the localization of the inflammatory process chronic pyelonephritis is unilateral and bilateral.
- According to the clinical picture allocate the following forms of chronic pyelonephritis: latent, recurrent, hypertensive, anemic, azotamic, hematuric.
- latent form chronic pyelonephritis has an unexpressed clinical picture. Patients complain mainly of frequent urge to urinate, general weakness, headache, hypertension, fatigue, occasionally there is an increase in temperature to subfebrile. The latent form of chronic pyelonephritis is usually accompanied by a violation of the concentration ability of the kidneys, a decrease in urine density and frequent urination with a light-colored urine. Urinary retention, pain in the lumbar region and swelling in this form of the disease, as a rule, are absent. Patients sometimes have Pasternatsky's symptom, a small amount of protein in the urine is found, the number of leukocytes and bacteria remains normal. The disease proceeds sluggishly and is dangerous in that it gradually leads to loss of kidney function and progressive chronic renal failure.
- Recurrent form chronic pyelonephritis is characterized by alternating periods of exacerbations and remissions. Patients complain of discomfort in the lumbar region, urination disorders, sudden fever and fever. During exacerbations, the symptoms are similar to those acute pyelonephritis . There are pronounced changes in the composition of urine (proteinuria, leukocyturia, cylindruria, bacteriuria and hematuria), the ESR increases and there is an increase in the number of neutrophils (neutrophilic leukocytosis). Gradually, patients may develophypertensive syndromewith headaches, dizziness, heart pain, visual impairment, oranemic syndrome,manifested by general weakness, fatigue, shortness of breath, decreased performance. As the disease progresses, it develops.
- Hypertonic form chronic pyelonephritis manifests itself by the development of severe hypertension . Patients complain of frequent headaches, dizziness, pain in the heart, shortness of breath, sleep disturbances. Patients periodically experience hypertensive crises. This form of pyelonephritis is not characterized by urination disorders, so it is sometimes quite difficult to diagnose it.
- anemic form chronic pyelonephritis is manifested primarily by symptoms of severeanemia. Patients experience a sharp decrease in the number of red blood cells in the blood. This form of the disease is the most common in patients with chronic pyelonephritis and is accompanied by general weakness, fatigue, shortness of breath, decreased performance. Urination disorders are minor or absent.
- Azotemic form chronic pyelonephritis is characterized by an increasechronic renal failure. This form of the disease, as a rule, is a continuation of an existing, but not timely detectedlatent pyelonephritis. Patients suffer from an increase in azotemia, which manifests itself as swelling and itching of the skin. Kidney function decreases and a severe form of chronic renal failure gradually develops.
- Hematuric form Chronic pyelonephritis is manifested by repeated bouts of macrohematuria and persistent microhematuria, which is associated with venous hypertension, which contributes to the violation of the integrity of the vessels of the fornic zone of the kidney and the development of fornic bleeding.
Chronic pyelonephritis usually develops over 10-15 years or more and ends with wrinkling of the kidneys. Wrinkling occurs unevenly with the formation of rough scars on the surface. If only one of the kidneys is wrinkled, then, as a rule, compensatory hypertrophy and hyperfunction of the second kidney are observed. That is, within a few weeks, the mass of the remaining kidney increases, and it takes over the functions of the diseased kidney. At the final stage of chronic pyelonephritis, when both organs are affected, develops chronic renal failure.
Diagnosis of chronic pyelonephritis
It is often not possible to identify chronic pyelonephritis in time and accurately determine the form of its course, especially in a clinic. This is due to the variety of clinical manifestations of the disease, as well as its relatively frequent latent course.
Chronic pyelonephritis is recognized on the basis of anamnesis (medical history), symptoms, leukocyturia results (urinary sediment study using the Kakovsky-Addis method), quantitative detection of active leukocytes in the urine, called Stenheimer-Malbin cells, bacteriological analysis of urine, as well as intravital kidney biopsy . If chronic pyelonephritis is suspected, a general blood test is also done to determine residual nitrogen, urea and creatinine in it, the electrolyte composition of blood and urine is detected, and the functional state of the kidneys is examined.
With the help of the X-ray method, changes in the size of the kidneys, deformation of their pelvises and calyces, violation of the tone of the upper urinary tract are established, and radioisotope renography allows you to obtain a graphic image and evaluate the functional state of each organ separately. As additional research methods for the diagnosis of chronic pyelonephritis, intravenous and retrograde pyelography and scannography, echographic examination of the kidneys, and chromocystoscopy are used.
Amyloidosis can be recognized by the presence of foci of chronic infection, the scarcity of urinary sediment (there are only single leukocytes, erythrocytes and cylinders, there is no sugar at all), as well as the absence of bacteriuria and radiological signs of pyelonephritis.
As for hypertension, it is more often observed in older people, occurs with hypertensive crises and more pronounced sclerotic changes in the coronary, cerebral vessels and aorta. In patients with hypertension, there are no leukocyturia, bacteriuria, characteristic of chronic pyelonephritis, a pronounced decrease in the relative density of urine, and X-ray and radioindication studies do not reveal changes inherent in chronic pyelonephritis.
With diabetic glomerulosclerosis, the patient has signs of diabetes mellitus, and other symptoms of diabetic angiopathy, a generalized lesion of blood vessels, are also determined.
One of the diagnoses may be as follows: chronic bilateral pyelonephritis, recurrent, exacerbation phase, chronic renal failure, intermittent stage, arterial hypertension.
Treatment of chronic pyelonephritis
The treatment time for chronic pyelonephritis is usually at least four months. However, if the disease proceeds without complications, therapy on the recommendation of a doctor can be reduced. At the end of each month, the patient is given a urine test and an antibiogram. If the white blood cell count is still higher than normal, the drug should be replaced. Sometimes it happens that already a month after the start of treatment, the tests correspond to the norm. But this does not mean at all that the disease has passed and the kidneys are out of danger. Under no circumstances should you stop treatment.
Antibiotics for pyelonephritis
The main method of treatment of chronic pyelonephritis today is still antibiotic therapy. Antibiotics are started only after the causative agent of the infection is identified and its sensitivity to drugs is determined. Antibiotics that suppress gram-negative flora are usually indicated. The doctor should prescribe only those drugs that do not have a toxic effect on the kidneys. Treatment takes place with regular laboratory monitoring of the sensitivity of the microflora to the antibiotic.
A good therapeutic effect with a low probability of relapses and adverse reactions is provided by modern antibiotics of the fluoroquinolone series: ciprofloxacin, norfloxacin, levofloxacin, pefloxacin; cephalosporins: cephalexin, cefuroxime, cefenim, semi-synthetic penicillins with beta-lactamase inhibitors augmentin, unazine.
Complex treatment of chronic pyelonephritis also involves the use of non-steroidal anti-inflammatory drugs that prevent the formation of blood clots in the vessels. It can be aspirin, movalis, voltaren, ibuprofen and others.
To improve microcirculation in the kidneys, patients take chimes, trental or venoruton, and to activate renal circulation - urolesan, cystenal, olimetin, uroflux.
In severe cases of the disease and complications, especially in the elderly, the doctor may prescribe immunocorrective agents. If a chronic urinary tract infection is detected, peptide bioregulators are prescribed.
So that taking antibiotics, especially powerful ones (the so-called fourth row), does not lead to intestinal dysbacteriosis, a sour-milk diet must be observed throughout the course of treatment. But if dysbacteriosis nevertheless appeared, then in order to restore the intestinal microflora, about a week before the end of the main therapy, it is necessary to start taking bifidumbacterin. In difficult cases, the doctor may prescribe antifungal drugs.
Prevention of chronic pyelonephritis
Prevention of chronic pyelonephritis must begin from childhood, instilling personal hygiene skills in children. In general, the prevention of the development of chronic pyelonephritis and its complications is possible only with constant monitoring of the patient by a urologist. Control tests and studies should be done at least three times a year. During this period, the patient at work should not have heavy physical exertion, hypothermia, high humidity, such people should not work on the night shift. Patients are removed from the register if they do not have signs of exacerbation of chronic pyelonephritis within two years.
Women suffering from chronic pyelonephritis, pregnancy is contraindicated. This is associated with a possible deterioration in health. After childbirth, they almost always develop chronic renal failure, and their further life expectancy is no more than 5 years. Therefore, women, before planning a pregnancy, must first cure the kidneys.
For the prevention of chronic pyelonephritis, it is also recommended to conduct two two-month courses of herbal medicine with an interval of 3-4 weeks, using any of the known fees. In the future, it will not be superfluous to take 2-3 monthly courses. During the prophylactic intake of fees for 6-8 months, it is imperative to do urine tests.
How to treat chronic pyelonephritis in women and men at home?
In childhood, from 2 to 15 years, girls are more likely to suffer from it; in old age, the disease affects more men. Despite this, pyelonephritis is considered a predominantly female disease due to the anatomical location of the genitourinary organs and other functional features of the female body.
What it is?
Chronic pyelonephritis is a disease that has an infectious and inflammatory nature in which the calyxes, pelvises and tubules of the kidneys are involved in the pathological process, followed by damage to their glomeruli and blood vessels.
According to statistics, chronic pyelonephritis among all diseases of the genitourinary organs with an inflammatory nonspecific nature is diagnosed in 60-65% of cases. Moreover, in 20-30% of cases it is.
Causes
The main causes of pyelonephritis are microbes - Escherichia coli, staphylococcus aureus, enterococci, Proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis, forms of microbes that are resistant to negative factors and antibiotics are especially relevant. They can persist for a long time in the region of the calyces and pelvis, with a decrease in immune defense, causing activation of inflammation.
Why does an acute process become chronic?
The causes of chronic pyelonephritis can be considered:
- poor-quality treatment of an acute form of pyelonephritis, non-compliance by the patient with the clinical recommendations of a doctor, disruption of dispensary observation of a child or adult;
- untimely diagnosis and treatment of diseases that violate the outflow of urine (, nephroptosis, vesicoureteral reflux, congenital anomalies of narrowing of the urinary tract,);
- the presence of concomitant chronic diseases that undermine the body's immunity, or are constant foci of infection (obesity, diabetes, diseases of the gallbladder, intestines, pancreas);
- the ability of some pathogens to form L-forms, which can be inactive for a long time in the renal tissue, but cause an exacerbation with a decrease in protective forces or immunodeficiency states.
There is no standard risk group for chronic pyelonephritis, but practitioners believe that the infection is most dangerous for:
- pregnant women;
- children under three years of age, predominantly bottle-fed;
- girls during the onset of sexual activity;
- people in old age.
These patients are most indicated for the prevention of chronic pyelonephritis.
Classification
Forms of chronic pyelonephritis:
- latent form. It is characterized by minor clinical manifestations. The patient may be disturbed by general weakness, fatigue, headache, sometimes the temperature may rise slightly. As a rule, pain in the lower back, edema and dysuric phenomena are absent, although some have a positive Pasternatsky symptom (pain with tapping in the lumbar region). In the general analysis of urine, a slight proteinuria is detected, leukocytes and bacteria can be excreted in the urine periodically. With a latent course, the concentration ability of the kidneys is usually impaired, therefore, a decrease in urine density and polyuria are characteristic. Occasionally, mild anemia and a slight increase in blood pressure can be detected.
- relapsing form. The change of periods of exacerbation and remission is characteristic. The patient may be disturbed by discomfort in the lower back, chills, fever. Dysuric phenomena appear (frequent urination, sometimes painful).
- Azotemic form. There are those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of the already existing, but not timely detected latent course of the disease. It is the azotemicheskaya form that is characteristic of chronic renal failure.
- hypertonic form. Arterial hypertension predominates. There are headache, dizziness, sleep disturbance, stabbing pains in the projection of the heart, frequent hypertensive crises, shortness of breath. Changes in the urine are not very pronounced and are not permanent. Hypertension in pyelonephritis is often malignant.
- anemic form. It is characterized by the fact that among the signs of the disease, symptoms of anemia predominate - a decrease in the number of full-fledged red blood cells in the blood. This form of the disease in patients with chronic pyelonephritis is more common, more pronounced than in other kidney diseases, and is usually hypochromic in nature. Violations in urination are mild.
Exacerbation of chronic pyelonephritis clinically resembles a picture of acute inflammation. As the process progresses, the leading syndrome becomes hypertensive, which is manifested by headache, dizziness, visual impairment, pain in the heart. Sometimes, as a result of long-term pyelonephritis, an anemic syndrome develops. The outcome of the disease is chronic renal failure.
stages
In chronic pyelonephritis, there are three stages of disease progression:
- the initial degree is characterized by the development of the process of inflammation, swelling of the connective tissues of the inner layer of the urinary organ, as a result of which the vessels are compressed, atrophy of the tubules appears, renal bleeding decreases;
- the second degree is detected by means of a nephrogram, where diffuse narrowing of the arterial renal bed is noted, the size of the cortical substance becomes smaller, there are no interlobar arteries;
- the third degree in pyelonephritis is expressed by narrowing and changing the shape of all vessels of the urinary organ, the renal tissue is replaced by scar tissue, the kidney becomes wrinkled.
Symptoms
The degree of manifestation of symptoms of pyelonephritis depends on the localization of inflammation (on one side or both kidneys), on the degree of inflammation activity, on concomitant obstructions to the outflow of urine and previous treatment. In the remission stage, there may be no manifestations at all, or they may be minimal - minor changes in urine tests.
The main symptoms of pyelonephritis in women and men:
- Deterioration of health, weakness and weakness, more pronounced in the morning, decreased mood, headaches.
- Temperature rise, not higher than 38 C, usually in the evening, for no apparent reason.
- Frequent urination, especially at night.
- Increase in blood pressure. During remission, this may be the only symptom.
- Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.
- 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.
In remission, all symptoms of pyelonephritis are minimal, but the longer there is pyelonephritis, the higher the likelihood of arterial hypertension, cardiac hypertrophy, the development of chronic renal failure and secondary dystrophic changes in the kidneys. In the later stages, polyneuritis, bone pain, hemorrhage, polyuria with the release of up to 3 or more liters of urine with thirst and dry mouth, anemia may occur.
Complications
With the progression of chronic pyelonephritis develops. It is manifested by an increase in the amount of daily urine and especially the night portion, a decrease in the density of urine, thirst, dry mouth.
A sharp exacerbation of chronic pyelonephritis may be accompanied by the development of acute renal failure.
Diagnostics
Acute and chronic pyelonephritis is diagnosed on the basis of patient complaints and the clinical picture of the disease. The doctor finds out whether attacks of acute pyelonephritis, cystitis, inflammation of the urinary tract and kidneys were tolerated in childhood or during pregnancy in women.
When interviewing men, special attention is paid to past injuries of the spine, bladder and inflammation of the urogenital organs. The doctor detects the presence of factors that predispose to the occurrence of pyelonephritis - the presence of chronic diseases (prostate adenoma, diabetes mellitus, etc.).
Differential diagnosis is carried out with a number of such diseases:
- Hypertension. The disease affects the elderly, there are no changes in the blood and urine.
- Chronic glomerulonephritis. In pathology, there are no active leukocytes and pathogens, but erythrocytes are present.
- Amyloidosis of the kidneys. Bacteria and signs of inflammation are absent. The disease is characterized by the presence of foci of infection and poor urine sediment.
- Diabetic glomerulosclerosis. Accompanying diabetes mellitus, manifested by signs of angiopathy.
Examination of a patient with chronic pyelonephritis in this way will help to avoid medical errors and prescribe effective treatment.
How to treat chronic pyelonephritis?
Therapy should be aimed at eliminating such problems:
- elimination of the causes that caused a violation of the normal functioning of the kidneys;
- the use of antibacterial medicines and other medicines;
- boosting immunity.
The most effective drugs are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.
Medical treatment
Antibiotics during an exacerbation of the disease are prescribed for up to 8 weeks. The specific duration of therapy will be determined by the results of the laboratory tests performed. If the patient's condition is severe, then combinations of antibacterial agents are prescribed to him, they are administered parenterally or intravenously and in large doses. One of the most effective modern uroseptics is the drug 5-NOC.
Self-medication is strictly prohibited, although there are many drugs for the treatment of pyelonephritis. This disease is exclusively in the competence of specialists.
Usually, the following drugs are used to treat chronic pyelonephritis:
- Nitrofurans - Furazolidone, Furadonin.
- Sulfonamides - Urosulfan, Etazol, etc.
- Nalidixic acid - Negram, Nevigramone.
- Cephalosporins - Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.
- Semi-synthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.
- Fluoroquinolones: Levofloxacin, Ofloxacin, Ciprinol, Moxifloxacin, etc.
- Antioxidant therapy comes down to taking Tocopherol, Ascorbic acid, Retinol, Selenium, etc.
- Aminoglycosides are used in severe cases of the disease - Kanamycin, Gentamicin, Colimycin, Tobramycin, Amikacin.
Before choosing one or another antibacterial drug, the doctor should familiarize himself with the acidity of the urine of patients, as it affects the effectiveness of drugs.
Physiotherapy treatment
Physiotherapy techniques have the following effects:
- increase the blood filling of the kidney, increase the renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
- relieve spasm of smooth muscles of the renal pelvis and ureters, which contributes to the discharge of mucus, urinary crystals, bacteria.
Physiotherapy treatment is used in the complex therapy of chronic pyelonephritis.
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.
Raw cold, smoking and alcohol adversely affect the course of pyelonephritis. And regular examinations with monitoring of urine tests, and preventive courses of treatment contribute to long-term remission and prevent the development of renal failure.
Diet and nutrition rules
The chronic course of the disease requires a serious attitude to the diet. Recommended:
- cereals, dairy products and vegetarian dishes;
- watermelons, melons and pumpkin dishes;
- increase fluid intake to 2.5 liters;
- include in the diet a small amount of meat or fish broths;
- boil fish and meat of non-fatty varieties, or cook only for a couple;
- fresh and boiled vegetables and fruits;
- horseradish, garlic and radish should be excluded from the diet;
- limit salt intake per day to 8 grams.
A balanced diet promotes a quick recovery. With an exacerbation of the disease, fresh fruits and vegetables, as well as at least 2 liters of liquid, should be included in the diet. Unacceptable in the diet - fried, spicy, fatty and salty foods.
Prevention
Even in the absence of signs of active infection, it is necessary to periodically (once a year or every six months) examine the function of a previously affected kidney. In the presence of frequent exacerbations in women, long-term use of antibacterial agents in low doses (biseptol or furadonin) is recommended.
All pregnant women in the first trimester need to conduct a bacteriological study of urine. If bacteriuria is detected, treatment with penicillins or nitrofurans is carried out.
As a preventive measure for exacerbations, it is also recommended to conduct 10-day antibacterial courses, and then for 20 days a course of herbal medicine is carried out (a decoction of bear's eye grass, birch leaves, horsetail, juniper fruits, cornflower flowers). It is necessary to conduct several such courses, every month it is recommended to change the antibacterial agent.