Pyelonephritis is an inflammatory process in a chronic or acute form of the course. It involves not only the renal pelvis and calyces, but also the renal parenchyma with a predominant lesion of its interstitial tissue. This is the main difference between the clinic of pyelonephritis and other inflammatory processes in the tissues of the urinary system. This disease is quite difficult to treat and most often takes the form of a chronic course for the rest of your life. From this article, the reader will be able to learn about the etiology, pathogenesis, clinic, diagnosis and treatment of chronic pyelonephritis.
Disease classification
Uronephrology distinguishes between two types of disease course:
- spicy;
- chronic.
The clinic of acute and chronic pyelonephritis differ from each other, first of all, by the intensity of the inflammatoryprocess. These two forms of the disease can be distinguished even by a person ignorant of medicine, they are so different. Drug therapy in both cases will also differ significantly.
The acute pyelonephritis clinic distinguishes between primary and secondary types of the disease. Primary - if diseases of the kidneys and urinary tract do not precede, and secondary - if inflammation develops and persists against the background of a urological disease, leading to a violation of the outflow of urine or to a disorder in the circulation of lymph and blood in the pelvis and calyx of the kidney, as well as in the renal parenchyma. Acute pyelonephritis occurs at any age (10-15% of all diseases of the urinary system). Statistical data confirm that the clinic of acute pyelonephritis is most often characteristic in children and women under twenty years of age. Men suffer from such a pathology much less often, because their urinary system is arranged a little differently.
The clinic of pyelonephritis of chronic etiology is more difficult to treat, as the process goes unnoticed. In rare cases, the disease makes itself felt with a feeling of weakness, lack of vitality, dysphoria, jumps in blood pressure, swelling of the face and hands. Such a pathological process is extremely dangerous because the cells of the renal parenchyma can deform and degenerate, which will lead to the development of chronic renal failure within a few years.
Main symptoms
Signs and symptoms of acute pyelonephritis clinic:
- a sharp increase in temperature in an hour or two from 36degrees up to 40: the process is accompanied by chills, fever, tremor;
- the patient may lose consciousness, faint, his eyes may darken (this condition is caused by jumps in blood pressure, which are not uncommon in the clinic of acute pyelonephritis);
- Sometimes sharp or aching pains develop in the lumbar region, but most often the disease is painless;
- tachycardia and shortness of breath;
- urine may darken and sediment appears in it - but this does not always happen, it all depends on the degree of inflammation of the pelvis.
Acute pyelonephritis can be unilateral (inflammatory process in one kidney) or bilateral (respectively, in both kidneys). When the first signs appear (chills and fever up to forty degrees), an ambulance should be called. Do not hesitate and try to self-medicate. At home, it is impossible to conduct a competent diagnosis or determine the optimal antibiotic for a particular patient. Delay in some cases can lead to the loss of one or both kidneys of their functionality and the development of CRF (chronic renal failure).
Signs and symptoms of chronic type pyelonephritis clinic:
- the development of the inflammatory process is very slow - so the temperature either does not rise at all, or rises to 37.3 degrees and stays at this level for weeks;
- weakness, fatigue even after slight physical exertion;
- decreaseimmunity;
- headaches, dizziness, problems with blood pressure (possibly both increase and decrease).
Possible consequences if left untreated
If pyelonephritis is not treated, the patient will face the following complications:
- Chronic renal failure is the loss of one or two kidneys of their functions. This condition is incurable and means complete disability for the rest of your life. The patient requires either a kidney transplant from a donor, or, in the absence of such an opportunity, a regular visit to the hemodialysis procedure. This is a special medical practice in which the patient is transfused with his own purified blood, while the function of the damaged kidney is performed by a special hemodialysis machine.
- Bacteriotoxic shock - occurs with a purulent form of pyelonephritis. With bilateral kidney damage, this complication is very dangerous - in half of the cases it ends in the death of the patient. With unilateral pyelonephritis with bacteriotoxic shock, the probability of death is about 35%. During pregnancy, regardless of the trimester and the general he alth of the woman, bacteriotoxic shock leads to the death of the fetus.
- Secondary paranephritis develops with advanced pyelonephritis, both in acute and chronic course. The condition is characterized by damage to the perirenal tissues, in which, under the influence of pathological microorganisms, an inflammatory process develops. Paranephritis is characterized by the development of pain in the lower back of an acute, paroxysmal nature. In some casesthe pain may be mild and aching.
Features of the treatment of pyelonephritis
Uronephrology is engaged in research and treatment of the pyelonephritis clinic in adults.
First of all, the doctor determines which pathogen caused the development of inflammation (based on this information, further antibiotic therapy will be prescribed):
- E. coli;
- staph;
- enterococcus.
Approximately 20% of patients have microbial combinations. The most common combination in the clinic of pyelonephritis is Escherichia coli and Enterococcus. The patient may experience a change in the causative agent of the infectious process. Because of this, complex multi-resistant forms of microorganisms develop. This situation can threaten a person's life with the illiterate use of antibiotics.
Diagnostic Methods
Modern uronephrology uses the following diagnostic methods (the treatment and clinic of chronic pyelonephritis directly depend on the correct determination of the type of pathogen and the antibiotic therapy prescribed after that):
- Urine culture is considered an ideal way to identify the pathogen and select an adequate antibacterial drug. Alas, in reality this is not entirely true: a single test result provides 20% of false positive results. Because of this, triple seeding is common in the practice of nephrology. It takes from several days to a week to receive the results of such an analysis. In the treatment of an acute condition, whenthe countdown is on the clock, and delay threatens the life of the patient, such a long period is unacceptable.
- Ultrasound examination allows diagnosing the expansion of the renal pelvis (characteristic of both acute and chronic pyelonephritis). Also, ultrasound allows you to consider the degree of coarsening of the contour of the cups, the state of the parenchyma, the presence of scarring (usually determined after several years of chronic pyelonephritis).
- Computed tomography is used in modern nephrology mainly to differentiate pyelonephritis from tumor processes. In other cases, if there is no suspicion of the development of neoplasms, this diagnostic method has practically no advantages over ultrasound.
Treatment of pyelonephritis in adults and children
Therapy in adults is faster, and the recovery period after hospitalization is shorter. The clinic of pyelonephritis in children most often has far-reaching consequences: in 90% of cases, the disease acquires a constant course. As a result, the child, even having matured, suffers from periodic exacerbations. In some cases, chronic pyelonephritis can lead to the development of chronic kidney failure in a few decades (and sometimes faster).
Therefore, when treating and diagnosing a pyelonephritis clinic in children, medical staff should be especially careful, and parents should scrupulously follow all the instructions of the urologist and nephrologist.
Use of antibiotic therapy
Successfultreatment of pyelonephritis depends on three components:
- well-chosen antibiotics;
- compliance with bed rest;
- diet diet 7.
Treatment of the pyelonephritis clinic can be carried out with the following antibiotic drugs:
- "Cefixime"("Supraks", "Cefspan");
- "Ceftibuten"("Cedex");
- "Cefuroxime" ("Zinnat").
Antibiotic drugs are selected based on urine culture results. Both intramuscular administration and oral administration are effective. In a hospital setting, it is better to choose injections. Introduction intravenously or intramuscularly reduces the toxicity of the drug to the organs of the gastrointestinal tract.
Surgical treatments
Surgical intervention is mainly necessary after the diagnosis of an acute pyelonephritis clinic with a complication of suppuration.
Apostemes and carbuncles of the kidney are to be removed. The question of the nature of the operation is finally decided at the time of the surgical intervention itself. It is determined by the scale of kidney damage and the pathogenesis of the disease.
The purpose of the operation for pyelonephritis with a purulent process, apostemes and carbuncles is to stop the progression of the purulent-inflammatory process in the affected kidney. It is very important to prevent its occurrence in a he althy kidney. Also, the task of the operating surgeon is to restore the outflow of urine along the upper urinary tract in case of its pathology.
Surgicalintervention, if necessary, can expose the kidney (lumbotomy, decapsulation) for the purpose of drainage. Such manipulation is necessary if the patient for one reason or another cannot urinate on his own (blockage of the ureter or too advanced inflammation).
The use of homeopathy and folk therapy: harm or benefit?
In modern nephrology, homeopathic medicines are widely used. This is Canephron, Renel. Impressive citizens who avoid visiting a doctor and consider antibiotics too harmful are very fond of self-treatment with these drugs.
In no case should competent treatment with antibiotic drugs that kill the source of inflammation of the kidneys be replaced with dubious homeopathic remedies and folk methods. Treatment with herbs and mushrooms, of course, can contribute to the diuretic effect or the discharge of sand, but the source of inflammation is not able to stop. The longer the patient delays and does not turn to a nephrologist, the more likely it is that the cells will begin to die and the process will develop into chronic renal failure.
It is especially dangerous to let it take its course and try to treat pyelonephritis with herbs in children. This condition does not go away on its own, the child's condition will worsen, and in the end he will either be hospitalized or he will die.
The clinic for pyelonephritis in pregnant women allows therapy with homeopathic medicines only under the supervision of a doctor. When pathogens multiplymicroorganisms will have to use antibiotics anyway. Modern drugs will not harm the growing fetus.
Medical diet in the treatment of chronic pyelonephritis
The clinic of the disease implies its constant chronic course, even if the patient feels well. In rare cases, the disease makes itself felt with a feeling of weakness, lack of vitality, dysphoria, jumps in blood pressure, swelling of the face and hands. Such a pathological process is extremely dangerous because the cells of the renal parenchyma can deform and degenerate, which will lead to the development of chronic renal failure within a few years.
Principles of diet 7 (healing nutrition for infectious and inflammatory diseases of the kidneys):
- limit the amount of protein in the diet to the minimum value (refuse meat and dairy products, eggs, protein mixtures);
- restrict or stop using s alt altogether (until test results return to normal);
- increase the proportion of vegetables and fruits in the diet to 70%;
- important to remember that fruits high in potassium are prohibited;
- It is strictly forbidden to drink alcoholic beverages of any strength;
- refuse to eat baked goods;
- in the acute course of the disease, it is sometimes worth limiting the amount of fluid consumed (after the recommendation of a doctor).
You can eat oatmeal and rice porridge every day withouts alt. As a dessert, you can eat bee products. Allowed vegetable salads with the addition of vegetable oils (but without s alt), vegetable puree soups, lean meat stews. It is optimal to consume turkey and chicken fillets - no more than 100 grams per day. Such a restriction is necessary in order not to exceed the proportion of protein in the diet.
How to prevent recurrence of pyelonephritis: advice from nephrologists and urologists
If you follow simple recommendations, you can achieve many years of remission and not remember the manifestations of pyelonephritis:
- follow the dietary guidelines for people with kidney disease;
- from time to time drink a course of "Canephron" in order to facilitate the work of the tissues of the kidneys and bladder;
- avoid hypothermia of both the whole body and its individual sections;
- don't get caught in the rain, don't bathe in pools of cold water;
- refuse to be in situations that plunge the patient into a state of stress;
- get enough rest, sleep at least ten hours a day.
Any nephrologist will confirm that the patient's psycho-emotional state is very important. Kidney diseases often have psychosomatic causes and develop after severe shocks and prolonged exposure to overwork and stress.
