Pyelonephritis in uronephrological practice occurs in more than half of the patients who turned to a specialist with kidney problems. The inflammatory process most often develops due to the penetration of an infectious agent with blood, lymph or from the lower organs of the urinary system. Treatment of obstructive pyelonephritis is a long and complex process.
Disease types
There is no single generally accepted classification of pyelonephritis in medicine. In clinical practice, according to the nature of the course, pyelonephritis is divided into:
- acute and chronic;
- obstructive and non-obstructive;
- primary and secondary.
Pyelonephritis, which occurs on the basis of an already existing urological pathology, is considered to be obstructive. The therapy of this form of the disease is particularly difficult, since it is necessary not only to prevent the development of inflammation in the renal pelvis, but also in the ureter and urinary tract.bubble. Uronephrology also classifies pyelonephritis of childhood, pregnant women, the elderly (senile pyelonephritis), pathology that develops with diabetes mellitus, etc. Depending on the course of the disease and the individual characteristics of each patient, therapy will differ.
Forms of obstructive pyelonephritis
Uronephrology distinguishes two forms of the course of the disease:
- acute, which is characterized by a sharp increase in temperature up to 39-40 degrees, fever, loss of consciousness, the presence of blood and sediment (epithelium) in the urine, pain in the lumbar region and a sharp burning sensation when urinating;
- chronic, which is characterized by subfebrile temperature (37-37.5 degrees), weakness, asthenia, low blood pressure, aching back pain and burning sensation when urinating.
Acute obstructive pyelonephritis requires immediate hospitalization of the patient. In the absence of timely medical intervention, a fatal outcome is possible.
Symptomatics
Symptoms of chronic obstructive pyelonephritis:
- chronic fatigue;
- development of vegetovascular dystonia;
- hypotension;
- dizziness, headaches;
- failure even after little physical effort;
- constant subfebrile temperature;
- burning when urinating;
- cystitis;
- small portions of urine with frequent urination.
The chronic form of the disease can haunt the patient for months,before he decides on a full examination. The longer a sick person delays with a diagnosis, the more damage the tissues of the urinary system organs manage to get.
The acute form of the disease does not go unnoticed: high fever, fever and chills make the patient incapacitated. A critical condition should be the reason for going to an ambulance and hospitalization in a nephrology or urology department.
Reasons for the development of the disease
Reasons why obstructive pyelonephritis develops in children and adults:
- congenital or acquired pathologies of the urinary system;
- once experienced chronic pyelonephritis of the usual course;
- frequent inflammatory diseases of the bladder;
- pregnancy can be a catalyst for the development of obstructive pyelonephritis;
- adenoma in men;
- hypothermia of the lower back or the whole body;
- diabetes often provokes the development of inflammatory diseases of the kidneys and bladder;
- gout;
- prolonged and uncontrolled use of antibiotics;
- surgical interventions;
- psycho-emotional stress and chronic stress;
- infectious diseases of other organs.
Consequences and complications of the disease
Why should you never let the symptoms of obstructive pyelonephritis go untreated? The fact is that this disease often becomesthe cause of complete kidney dysfunction, bacteriotoxic shock, necrotic papillitis, arterial hypertension.
- Chronic renal failure (CRF) is a condition that develops under the influence of pathogenic compounds, in which there is a malfunction and death of organ tissues. Characterized by the complete loss of their functions by the kidneys. Without a blood transfusion, a person dies within five to seven days. Therefore, when diagnosing CRF, the patient is forced to attend hemodialysis procedures for the rest of his life and stand in line for a donor kidney transplant (in some cases, two are required at once). In our country, it is not always possible to wait for an organ transplant, so in some cases people die without waiting for the operation.
- Bacteriotoxic shock develops if obstructive pyelonephritis is accompanied by pus. This complication of pyelonephritis with bilateral kidney damage is extremely dangerous. Approximately half of the cases are fatal. With unilateral obstructive pyelonephritis, the probability of death in the development of bacteriotoxic shock is 35%. During pregnancy, bacteriotoxic shock leads to fetal death in almost all cases.
- Necrotizing papillitis is the rarest complication of obstructive pyelonephritis. It develops most often as a result of a violation of the process of production and discharge of urine from the bladder. There is an increase in intrarenal pressure. This leads to disruption of blood flow to the organ. There is damage to the papillae of the kidneys and their further oxygenstarvation. Then necrosis of the tissues of the bladder and kidneys develops.
Diagnostic Methods
Obstructive pyelonephritis is diagnosed (according to ICD 10 code - N11.1) after the following studies:
- urine culture (allows you to determine the type of pathogenic bacterium that caused the development of inflammation - most often it is E. coli, staphylococcus aureus, enterococcus);
- ultrasound diagnostics (ultrasound) allows you to examine the tissues of the kidney and determine the presence of pus, stones, sand;
- computed tomography (CT) has no significant advantages over ultrasound. Mainly useful for differentiating pyelonephritis from tumor processes.
Antibacterial therapy
Treatment of any inflammatory process is not complete without taking antibiotics. Only these drugs can suppress the activity of pathogenic microorganisms and destroy their spores. If pyelonephritis of any form is not treated with antibiotic drugs, it will go into the chronic stage and provoke necrosis of the tissues of the urinary system.
In addition, in the absence of adequate antibiotic therapy, secondary obstructive pyelonephritis often develops. In children, this process can provoke the formation and discharge of pus, which will eventually lead to bacteriotoxic shock and, in some cases, death.
The duration of treatment and the type of antibiotic is prescribed by the uronephrologist after studying the results of the tests. The following are the most effectivepreparations:
- "Cefixime" - can be used both in the form of liquid for injection and in the form of tablets;
- "Ceftibuten" in the form of capsules or tablets;
- "Cefuroxime" both in the form of liquid for injection and in the form of tablets.
Surgery
Surgical treatment is indicated if standard antibiotic therapy has failed.
They operate mainly on purulent forms of obstructive pyelonephritis. In its classical course, there is often no need for intervention. The operation is usually quick and without complications. The main goal of surgical intervention for obstructive pyelonephritis is to stop the purulent-inflammatory process in the kidney or bladder. It is also important to restore the outflow of urine through the upper urinary tract.
Treatment with homeopathic medicines
The modern pharmacological market offers a variety of drugs for the treatment of inflammatory kidney diseases. There are a lot of homeopathic medicines among them, the action of which is based on herbs:
- "Canephron";
- "Phytolysin";
- "Renel";
- "Monural".
Uronephrologists emphasize that these drugs can be used to treat obstructive pyelonephritis (popo M 10 code - N11.1) only as part of a complextherapy. Only antibiotic preparations can kill pathogenic microflora. Yes, in some cases they are toxic and lead to the complication of diseases of the gastrointestinal tract. But without their use, pyelonephritis cannot be cured.
After repeated tests confirm the complete destruction of the causative agent of inflammation, you can restore urination with the help of "Canephron" or "Monural". And as an independent means of therapy, these drugs are useless.
Prevention of exacerbation of pyelonephritis
If there was at least one case of diagnosing obstructive pyelonephritis in the patient's history, then it is likely that from time to time it will recur in a chronic form. Therefore, it is very important to observe the following preventive rules to maintain kidney he alth:
- avoid hypothermia of both the whole body and its individual parts (especially the legs and lower back);
- monitor nutrition: from time to time arrange fasting days without s alt and on carbohydrates alone (apples, rice, buckwheat porridge);
- do not abuse alcohol and do not smoke (nicotine and tar are destructive to kidney tissue);
- follow the water regime: for the condition of the kidneys, not only the lack of clean drinking water is detrimental, but also its excess;
- he althy sleep and rest are necessary: every night you need to sleep at least eight hours, if necessary, try to sleep an hour or two during the day.
Stress should be avoidedand prevent the development of chronic fatigue: the psycho-emotional state is important for the organs of the urinary system. Many kidney diseases are psychosomatic in nature. As a result of nervous breakdowns, not only neurons suffer, but the whole body.
