The human body is the highest stage of evolution. A person breathes, lives and moves thanks to the coordinated work of the main organ systems. Each of them performs its specific role, but at the same time does not interfere with the functioning of the others.
Kidneys are a unique part of the body. This is a paired organ, which is entrusted with the task of purifying the blood of harmful substances. When a well-oiled mechanism fails, various diseases arise. Among the variety, the most common is secondary pyelonephritis (obstructive). His methods of diagnosis and treatment will be described in detail in today's article.
Medical certificate
Pyelonephritis is an inflammation in the kidneys caused by an infection. In this case, the renal calyces, pelvis and parenchyma are involved in the pathological process. It may be due to the activity of pathogenic flora. The causative agent of the disease, as a rule, enters the kidneys through the blood from the infected area. Significantly relievesthis process is a violation of the mechanism of excretion of urine.
Pyelonephritis is a fairly common ailment that occurs in people of all ages. In children, it is one of the top three diseases along with respiratory infections. The inflammatory process in the kidneys is also diagnosed in pregnant women. Of the adults, almost every third suffers from it. It is noteworthy that the fair sex more often go to the doctor. This is due to the anatomical features of the urethra: it is short and located next to the vagina.
Despite the infectious nature, often one causative agent-bacteria is not enough for the development of pathology. It is necessary to influence several provoking factors to create a favorable environment for the reproduction of pathogenic flora. Therefore, in medical practice, it is customary to distinguish between primary (inflammation develops in an absolutely he althy kidney) and secondary pyelonephritis, when the disease occurs against the background of concomitant diseases (prostate adenoma, urolithiasis, etc.).
The last variant of the pathology is more common and requires more attention from doctors. Its therapy is fraught with many difficulties, since it is necessary to treat both the pyelonephritis itself and the concomitant disease.
Main reasons
In the primary form of pyelonephritis, a he althy organ is damaged. In this case, microbes are the cause of the disease. They can live in the human body or enter the body from the outside. As a rule, during studies in the urine, Escherichia coli, Staphylococcus aureus, Klebsiella orenterococcus.
Somewhat different etiology in secondary pyelonephritis. Against the background of already existing pathologies and abnormalities in the work of the organ, this form of the disease develops. It is primarily about the following disorders:
- Urolithiasis. A calculus with a diameter of more than 5 mm can aggravate the outflow of urine in any part of the urinary system.
- Cystitis. In 50% of cases, inflammation of the bladder causes pyelonephritis. Infection from the bladder freely penetrates up the ureters into the pelvis and kidney tissue.
- Prostate adenoma. An enlarged prostate gland compresses the urethra, thereby provoking urine retention.
- Pregnancy. In women in position, chronic secondary pyelonephritis is most common. The medical history is often left unattended, so patients learn about the existing pathology late.
- Narrowing (stenosis) of the ureter. This disorder can be either congenital or acquired.
- Anomalies in the structure of organs (horseshoe-shaped kidney, prolapse of an organ, etc.). In almost 100% of cases, congenital malformations provoke the development of pyelonephritis.
Clinical picture
The disease is by definition secondary. Therefore, its appearance is often preceded by signs of primary pathology. This is the so-called triad of symptoms:
- temperature;
- discomfort in the lumbar region;
- changes in urine.
In some cases, secondary pyelonephritis has a latent course. The chronic form of the disease has severala different clinical picture, which will be discussed below. First you need to deal with the triad of symptoms characteristic of the acute course of the disease.
Temperature in the case of pyelonephritis always occurs unexpectedly and remains at high levels for several days. In this case, the patient's condition deteriorates sharply. He may complain of headache, fatigue, chills, and excessive sweating.
Pain in the lumbar region is always present from the side of the affected organ. Sometimes there is another symptom characteristic of the disease - renal colic. It is accompanied by paroxysmal severe pain, which literally blocks a person. He loses the ability to change the position of the body. In some patients, the pain is so severe that they even lose consciousness. It is possible to relieve an attack only with the help of potent antispasmodics.
In the "standard" course of the disease, changes can be observed in the urine. It becomes dark and cloudy, sometimes it starts to foam. In the case of subsequent microscopic examination, bacteria and leukocytes will be determined in the liquid. However, in secondary acute pyelonephritis, this kind of change rarely occurs. This is due to the fact that the obstruction of the ureter does not allow urine from the diseased kidney to enter the bladder. It will receive urine from a he althy organ. As a result, a standard urinalysis will be "clean". That is why ultrasound is always recommended to confirm the diagnosis.
The course of the disease inlittle patients
Secondary pyelonephritis in children usually presents with fever-like symptoms. The attack begins with the appearance of chills. At the same time, the baby shakes violently, the temperature may rise to high levels. Sometimes it reaches 41 degrees. General malaise is accompanied by nausea and vomiting. Excessive sweating leads to a decrease in temperature, severe weakness.
Children develop secondary chronic pyelonephritis much more frequently than adults. This is due to the anatomical and physiological characteristics of the child's kidneys, which have underdeveloped fat capsules. Therefore, hypothermia of the organ occurs very quickly, especially in the winter season. On the other hand, the circulatory system is not yet very extensive. For this reason, infections are much easier to get to the kidneys, because the immune system does not have time to destroy it.
Manifestation of a chronic form of the disease
Developing after primary acute pyelonephritis, the secondary form is often chronic. This situation is possible if the treatment was not effective enough. Secondary chronic pyelonephritis is characterized by the following clinical picture:
- headaches;
- chill;
- weakness;
- mild lower back pain, and it can be on the side of a he althy kidney;
- low temperature (no more than 38 degrees).
It is very difficult to detect this form of the disease in time. Weakness throughout the body, lethargy and back pain - such symptoms can indicate not onlysecondary chronic pyelonephritis. They are characteristic of many disorders, which include the inflammatory process in the body, and recent stress, and even the common cold. That is why you should not try to independently diagnose yourself, start treatment. It is better to seek help from a specialized specialist.
Medical examination
Diagnosis of the disease is carried out exclusively in the clinical setting. A timely visit to a doctor allows not only to make a correct diagnosis and start therapy, but also to avoid the development of serious complications.
To confirm secondary (obstructive) pyelonephritis, a comprehensive examination is carried out, consisting of the following activities:
- Urine analysis. With an active inflammatory process, it will show leukocyturia and bacteriuria. Protein may also be present in the urine.
- Blood test. An increase in leukocytes and lymphocytes, an acceleration of ESR up to 45 mm / h indicates pyelonephritis.
- Indicators of comparative leukocytosis are needed to determine which of the kidneys is involved in the pathological process. For this purpose, blood sampling is carried out from the fingers of both hands.
- Overview radiography. Helps to determine the presence of stones or tumor formations in the organs, which are most often the cause of the disease.
- Research of blood serum for urea.
- Ultrasound of the pelvic organs.
- Urogram using a contrast agent. Conducted to assess the conditionexcretory system. The study is recommended to be repeated three times with an interval of 30 minutes.
Mandatory is a physical examination of the patient with palpation of the affected area. During such an examination, the doctor specifies the time of appearance of the initial symptoms of the disorder, possible causes. The anamnesis and past kidney diseases are studied in detail.
Conservative Therapy
Treatment of secondary pyelonephritis, especially with attacks of renal colic, is carried out in a hospital setting. Recovery at home is possible only in exceptional cases and with a mild form of the disease.
First of all, with pyelonephritis, the patient is prescribed a therapeutic diet. It implies the exclusion of spicy and fried foods, spices, rich fish and meat broths. Alcoholic beverages and coffee are banned. The diet should mainly consist of vegetables and fruits. Lean varieties of fish are allowed. It is recommended to pay special attention to the drinking regimen. For example, you should drink at least 3 liters of fluid per day. Compotes, milk and liquid dishes cannot be included in this volume.
Antibiotics are considered the “gold standard” for the treatment of secondary pyelonephritis. Initially, broad-spectrum drugs are prescribed intravenously or intramuscularly. All patients, without exception, during the course of diagnosis, urine culture is prescribed for microflora with further determination of the sensitivity of the pathogen to antibiotics. The results of such an analysis come no earlier than after 7 days. After that, the previously prescribed antibiotics are canceled, and only those to which the causative agent of the disease is sensitive are left.
Symptomatic therapy involves the use of antispasmodics ("No-shpa", "Drotaverine"), anti-inflammatory ("Ketorol", "Diclofenac") and antipyretics.
Surgery
Surgery for secondary pyelonephritis is prescribed in case of ureter occlusion by stones. The volume of intervention is determined by the severity of the pathology, the size of foreign objects in the genitourinary system.
If the stone is small, a catheter is inserted into the ureter. Another condition for the procedure is the duration of the disease. Catheterization is possible only in the first 3 days of the exacerbation phase of chronic pyelonephritis.
When the course of the pathology is complicated by large calculi, the patient is prescribed a series of successive operations. First, a puncture nephrostomy is performed - drainage of the kidney under the control of an ultrasound machine. This procedure allows you to get rid of internal pressure, and the patient gets the opportunity to eat and drink normally.
Then the kidney itself is examined for its functionality. If the organ is he althy and has a positive prognosis for recovery, an operation is prescribed to remove the stone. Most often resort to laparoscopic intervention. A more advanced method is stone crushing by means of ultrasound. The remaining sand and fragments are excreted from the bodynaturally.
Sometimes a patient comes too late for help. In such cases, the course of secondary pyelonephritis may be complicated by pyonephrosis, purulent fusion of the parenchyma. Such unpleasant consequences are an indication for nephrectomy - organ resection. The operation avoids subsequent necrosis and blood poisoning. It is performed under general anesthesia, and in the future the patient is given a disability group.
Help of traditional medicine
For the treatment of an acute inflammatory process, the recipes of folk healers show little effectiveness. Their help is usually resorted to in the chronic course of the pathology and only as an addition to the main course of therapy.
For example, herbal tea helps to relieve pain and reduce swelling. It is prepared using chamomile, celandine, burdock and elderberry. All ingredients must be mixed in equal proportions, pour a glass of 2 liters of boiling water and take the infusion several times a day.
Before using this or that prescription, you should always consult with your doctor. Some advice from folk healers can do more harm than potential benefit to the body.
Prevention Methods
Prevention of secondary pyelonephritis is reduced to the treatment of the underlying disease. For example, with urolithiasis, a strict diet must be followed to avoid the re-formation of stones. In case of cystitis - monitor the hygiene of the genitalsorgans, do not supercool the body. In case of anomalies in the structure of the organs of the genitourinary system, timely surgical intervention is recommended.
Also, to prevent the disease, you should undergo a comprehensive medical examination twice a year with a mandatory urine test. Men are advised to treat “profile” diseases in a timely manner. We are talking about prostatitis, adenoma and prostate cancer.
In the fair sex, inflammatory processes in the kidneys occur mainly in the second half of pregnancy. At this time, the fetus begins to put especially strong pressure on the pelvic organs. To prevent secondary pyelonephritis, doctors advise several times a day to take a body position that excludes increased pressure on the ureters. In addition, you should regularly visit a gynecologist and undergo the examination recommended by a specialist on time.
