Pyelonephritis is a nonspecific inflammation that affects not only the renal pelvis and calyces, but also affects the interstitial tissue. Subsequently, the vessels are involved in the course of the pathology. Regardless of the etiology of pyelonephritis, this disease affects mainly women due to the anatomical structure of their genitourinary system. Often, many begin to suffer from such a disease during the course of pregnancy.
In old age, the occurrence of inflammation of the kidneys is observed more often in men. The etiology of pyelonephritis in this case is associated with the pathology of the prostate. Often the disease manifests itself as a complication of diabetes.
Features of the disease
Regardless of the etiology and clinical presentation of pyelonephritis, this disease is a common urological pathology characterized by infectious and inflammatory processes in the kidneys. With the penetration of pathogens from the lower parts of the urinary system, inflammation develops.
The causative agent of the disease is mainly E. coli, which is found in the urine. Despite the etiology, the symptoms of pyelonephritis in women are much more pronounced than in men, since the resulting pain very quickly becomes acute and difficult to bear. It should be noted that the disease is divided into acute, chronic or exacerbated chronic form. In addition, the etiology, pathogenesis, clinic and treatment of pyelonephritis depend not only on its form, but also on gender.
Quite often, the disease occurs in childhood, which occurs when various pathogens enter the baby's body. The etiology of pyelonephritis in pregnant women is associated with hormonal changes, squeezing of the ureters, as well as a decrease in the tone of the urinary tract. All these factors create favorable conditions for exacerbation of the chronic type of the disease or the onset of an acute one.
Disease classification
Despite the development of medicine, there is no exact classification of pyelonephritis. Such a disease is provoked by many different causes, and is also characterized by various changes in the structure of the renal tissue. However, doctors often classify pyelonephritis as:
- the nature of the course - acute and chronic;
- localizations - one-sided and two-sided;
- cause of development - primary and secondary.
In addition, a complicated and uncomplicated form of the disease is distinguished depending on the general well-being of the patient.
Sharp shape
In the course of an acute form of the disease, the kidney increases in size, and its capsule thickens. The etiology of acute pyelonephritis is associated with the penetration of pathogens into the renal tissue. The disease occurs at absolutely any age in both sexes. However, young and middle-aged children and women suffer most from it.
The etiology of acute pyelonephritis is associated with the penetration of staphylococci into the body, and the clinical picture is characterized by a combination of local and general signs of the disease. Common manifestations include deterioration in general well-being, fever, severe chills and sweating, as well as signs of general intoxication. You can determine the presence of the disease by the presence of changes in blood and urine parameters.
Local symptoms include soreness, muscle tension, and sometimes frequent and painful urination.
Chronic form
The etiology of chronic pyelonephritis is mainly associated with an undertreated acute form of the disease. This happens in the case when it was possible to eliminate the inflammation, but the causative agents of the disease remained in the kidney, and it was not possible to normalize the outflow of urine. Chronic pyelonephritis can constantly cause discomfort to the patient and manifest itself in the form of aching dull pains in the lumbar region. They are especially acute in cold and damp weather. In addition, an exacerbation of the chronic process periodically occurs.
Doctors identify general and local signs of the course of the disease. Local symptoms are more pronounced in patients whose etiology of chronic pyelonephritis is associated with other diseases, in particular, such as:
- benign or malignant enlargement of the prostate;
- prolapsed kidney;
- urolithiasis;
- uterine fibromyoma.
Patients note the presence of recurrent pain in the lumbar region, which is often unilateral. Their occurrence mainly occurs at rest and is in no way connected with the active movements of the patient. In some cases, urination disorders are noted.
Features of the disease in children
Such a urological disease often occurs in childhood, and also has quite characteristic signs of a course. If the etiology of acute pyelonephritis in children is established in a timely manner, as well as the correct diagnosis and treatment are made, then dangerous pathological abnormalities in the child's body can be avoided in the future.
In newborns and infants, the disease is expressed in general signs of intoxication, in particular, such as:
- sluggish sucking or breast rejection;
- vomiting and regurgitation after feeding;
- increase in temperature, which can trigger seizures.
The classic manifestation may be blanching of the skin with signs of cyanosis, which manifests itself in the form of blue skin around the mouth or above the upper lip. The etiology of pyelonephritis in infants is based on a change in conditionally pathogenic microflora, which provokessigns of dysbacteriosis, which occurs as a result of the penetration of coccal infections. At an older age, when a child may indicate pain, the course of the disease can be recognized by the presence of characteristic signs.
Depending on the etiology of pyelonephritis in children and the characteristics of its course, treatment can be carried out in a hospital or outpatient setting. Hospitalization is carried out in case of pronounced signs of intoxication. The main goal of therapy is:
- determining the etiology of pyelonephritis in children and eliminating the provoking factor;
- removal of pathogens from the child's urinary tract;
- administering antibiotic therapy;
- elimination of clinical symptoms;
- correction of existing urodynamic disorders.
During the course of an exacerbation, the child is recommended strict adherence to bed rest, as well as diet therapy with a limited intake of s alt and protein. In addition, fluid intake in large quantities is recommended.
Causes of occurrence
To date, it is still impossible to fully determine the etiology of pyelonephritis. That is why it is believed that the cause of the development of the disease may be the patient's own microorganisms or those that have penetrated from the outside. Often these are possible cocci or E. coli. Basically, pyelonephritis occurs in the presence of a mixed infection in the body. Doctors identify the following pathways for pathogens to enter:
- through infected urine;
- through lymph coming from nearby organs;
- together with blood flow.
There are certain factors that provoke the development of pyelonephritis, which include:
- chronic stress;
- lack of vitamins;
- weakness;
- chronic fatigue;
- lowered immunity.
In addition, it is possible to single out the presence of pathological conditions, during the course of which there is a certain obstacle to the normal outflow of urine. The etiology and pathogenesis of chronic pyelonephritis can be briefly described as follows: the patient experiences periodic relapses of the acute form of the disease. As a result of its course, there is a gradual replacement of normal renal tissue with connective tissue. In some cases, chronic pyelonephritis is complicated by the addition of arterial hypertension or renal failure.
Development pathogenesis
The etiology and pathogenesis of acute pyelonephritis are associated with the penetration of pathogens along with the blood flow into the vascular system of the renal glomeruli. As a result, inflammatory and degenerative changes develop. A leukocyte infiltrate is formed near the affected thrombi, the subsequent course of which largely depends on the characteristics of the treatment being carried out, as well as the general well-being of the patient.
In the event of a favorable course of the disease, the resulting infiltrates are replaced by connective tissue, followed by scarring. With progressionpathological process, a lot of abscesses are formed. The etiology and pathogenesis of pyelonephritis can also be associated with such a pathology as the formation of a reverse flow of urine, as a result of which pathogens penetrate into the renal pelvis, from where they enter the general circulation.
Subsequently, the pathogenic microflora along the wall of the urinary tract penetrates into the interstitial tissue of the kidney, where, under favorable conditions, inflammation develops. The etiology of pyelonephritis may be associated with general and local provoking factors. Common ones include:
- immunological state of the body;
- the presence of diseases that reduce immunity;
- overwork;
- general hypothermia.
Local factors include impaired urine outflow and the presence of ureteral reflux. Considering the pathogenesis and etiology of pyelonephritis, instrumental examination of the urinary tract and many other factors are often distinguished as a provoking factor and the cause of the onset of the disease. Depending on this, the disease is divided into primary and secondary.
Primary pyelonephritis refers to inflammation that does not show abnormal urodynamics or other kidney disease. The secondary form of the lesion occurs against the background of the presence of various diseases of the kidneys and urinary tract.
Main symptoms
If an infection in the bladder was found and no appropriate treatment was carried out, then after a while they maythere are characteristic signs of inflammation of the parenchyma in the kidneys. Among the most common signs of pyelonephritis, the following should be highlighted:
- tingling pain in the back or groin;
- temperature increase;
- severe abdominal pain;
- blood or pus in the urine;
- frequent and strong urination;
- pain and burning during urination.
All these signs must be considered more carefully, because if timely examination and treatment are not carried out, various complications may occur.
Diagnostics
When the first signs of the disease occur, you should immediately seek help from an experienced specialist. Be sure to take into account the etiology, pathogenesis and clinic when diagnosing pyelonephritis. Treatment is prescribed based on the data obtained, it must be comprehensive in order to prevent the likelihood of relapse.
To make a diagnosis, you will need to conduct a urine test. In the presence of pyelonephritis, protein and blood impurities can be detected in the tests. This is because inflammation interferes with the normal reabsorption process, causing blood cells and protein compounds to leak into the urine. Based on the results obtained, it is possible to determine the causative agent of the disease, as well as select the most effective drugs.
In addition, instrumental diagnostics using X-ray, ultrasound and radionuclide techniques are required. In some cases it maycystoscopy required.
When conducting ultrasound in patients with pyelonephritis, there is an expansion of the renal pelvis, the area of scarring. Later manifestations include a change in the contour of the kidney, a decrease in its size, which can also be observed in the course of other diseases. Another way to diagnose is radiopaque techniques that allow you to visualize the urinary tract and detect the presence of disorders.
Features of therapy
Etiology and clinic are very important when diagnosing. Treatment of pyelonephritis is prescribed only on the basis of the diagnosis. An integrated approach to therapy is recommended. For this, medications are prescribed, in particular, such as:
- antibiotics;
- antimicrobial;
- diuretics;
- drugs that improve blood circulation in the kidneys;
- vitamin and tonic preparations;
- herbal medicines.
In addition, the use of folk remedies and techniques as additional therapeutic measures gives a good effect. Throughout the entire period of therapy, strict adherence to the diet is required. It is worth remembering that when using antibacterial drugs, one must strictly observe their dosage and maintain the prescribed course of therapy, even in case of a significant improvement in well-being.
All medicines, as well as alternative methods, can be used only after consultation with your doctor. The secondary form of pyelonephritis means underis the elimination of the disease that provoked the onset of inflammation.
Medicated treatment
Depending on the etiology and symptoms of pyelonephritis, the principles of treatment and patient care are selected strictly individually. First of all, doctors recommend the use of antibacterial drugs for therapy. They help eliminate pathogens that cause kidney infections.
Basically, a few days after the start of antibiotic therapy, the general well-being of the patient returns to normal. In some cases, the course lasts for a week or more. It is very important not to stop therapy after relief of acute symptoms, as this can provoke relapses. In a severe course of the disease, intravenous administration of antibacterial drugs is required. Mostly antibiotics are prescribed, such as:
- aminoglycosides - Tobramycin, Amikacin, Gentamicin;
- quinolones - Ofloxacin, Ciprofloxacin;
- beta-lactams - "Zinaz", "Amoxicillin";
- macrolides;
- polymyxins.
To eliminate existing problems with the kidneys, it is imperative to use other medicines. In particular, these include chemotherapy drugs. The most popular means of this group is the drug "Biseptol". It is often used in the acute form of the disease. This drug is also prescribed in the case when one-component therapy is ineffective. In addition, this drugalso used after antibiotic therapy, as the urinary tract may still be vulnerable to infection.
Nitrox is a chemotherapeutic agent. It is used to treat kidney diseases, including pyelonephritis, provoked by fungal or viral infections. In addition, it is prescribed to prevent relapse.
In diseases of the urinary system, homeopathic remedies can also be prescribed, especially in the presence of a kidney infection. Apis is prescribed to eliminate pain and discomfort during urination. The effect of conducting is faster urination. In addition, Berberis is used to treat pyelonephritis. It is important that the prescribed drugs do not provoke the occurrence of side effects and are effective against the bacteria that provoked the disease.
Folk techniques
Medicinal plants have good diuretic, antiseptic and anti-inflammatory qualities, in particular, such as:
- elderberry;
- Highlander bird;
- birch;
- cornflower;
- bearberry;
- juniper;
- parsley;
- wheatgrass.
It is necessary to use medicinal preparations prepared from medicinal plants before meals. The course of therapy is carried out until the symptoms disappear completely.
Dieting
All patients, regardless of the stage and characteristics of the course of the disease, are recommended to use a largeamount of liquid. You can drink fruit and herbal decoctions, fruit drinks, juices, weak tea. Cowberry or cranberry juice and mineral water will be especially useful for patients. The total amount of liquid consumed per day should be approximately 2 liters.
When following a diet, melons and gourds must be included in the usual diet, as they have good diuretic qualities. The food consumed should contain a large amount of protein, however, during the period of exacerbation, only dairy-vegetable and unloading fruit days are recommended. In the absence of renal insufficiency and hypertension, significant s alt restriction is not required. Be sure to completely exclude alcohol, coffee, spicy dishes, canned food, spices, strong broths.
In the chronic form of the disease, the diet is about the same as in acute pyelonephritis. The diet should be designed in such a way as to prevent the occurrence of beriberi. The usual menu must contain low-fat fish and meat, dairy products, fruits and vegetables. It is recommended to consume honey instead of sugar. Fractional meals are considered ideal.
Surgery
Depending on the etiology and symptoms of pyelonephritis, treatment can be carried out with the help of surgery. If conservative methods of therapy with the use of antibacterial drugs did not bring the desired result and the patient's he alth continues to deteriorate, it is shownoperation.
Surgical intervention is prescribed mainly for the course of a purulent form of the disease, in particular the presence of carbuncles and apostema of the kidneys. The degree of intervention is determined strictly individually and at the time of the operation itself. All this depends not only on the affected area, but also on the existing pathogenesis.
The main purpose of the operation is to prevent the formation of a purulent-inflammatory process in the affected organ and prevent the occurrence of relapses, as well as the repetition of a similar situation in a he althy kidney. If the patient has a violation of the normal outflow of urine, then during the surgical intervention it is also eliminated.
Possible Complications
Pyelonephritis itself is not as dangerous as its complications. First of all, the acute undertreated form of the disease can pass into the chronic stage with periodic relapses. Chronic pyelonephritis can cause significant discomfort.
In addition, it is worth noting that suppuration can join the infectious process, and this can lead to kidney loss, which is why treatment must be approached with all responsibility. The insidiousness of pyelonephritis lies in the fact that it often occurs without obvious signs, or the symptoms are quite blurred. Among the main complications, the following should be highlighted:
- abscess formation;
- acute renal pelvis infection;
- scar formation;
- kidney failure;
- hypertension;
- shock,sepsis.
In some cases, pyelonephritis can lead to papillary necrosis.
Prevention and prognosis
Preventive measures are the timely sanitation of foci of infection, especially in the presence of chronic diseases of the genitourinary system. Timely treatment of diabetes is also required.
Prevention means carrying out activities aimed at increasing immunity. The main condition for the normalization of the outflow of urine is the observance of hygiene rules and maintaining a he althy lifestyle. During the period of remission, sanitary-resort treatment will be a very good prevention of relapse. Mud baths, mineral water, and other physiotherapy methods have a beneficial effect on the kidneys.
Diet nutrition is of particular importance. It is worth limiting the consumption of fatty and spicy foods. Food should be fractional and you need to eat in small portions. To prevent a relapse, you need to pass the scheduled examination in a timely manner.
With uncomplicated pyelonephritis, the prognosis is quite good and rarely leads to kidney damage. The repeated course of the disease can lead to its transition to a chronic form, as well as provoke the development of various complications.
