Each patient has a different medical history. Pyelonephritis, as can be seen from medical statistics, was present at some point in time in many. The disease is nonspecific. The term refers to the presence of an infectious kidney infection. In this case, parenchymal tissues suffer, primarily interstitial, as well as calyces, pelvis of the organ. In the history of the disease, the doctor must record whether the disease affected one side or symmetrically, primary or appeared against the background of other diseases, proceeds in a chronic or acute form, is accompanied by serous discharge or suppuration. If there is a tendency to relapse, this fact will also be noted.
Features of pathology
The doctor always mentions the causes that provoked pyelonephritis in the patient's medical history, if it is possible to establish exactly what became of them. It is known that in the predominant percentage of cases, the condition is explained by infection with strepto-, staphylo-, enterococcus, Proteus or Escherichia. About a third of patients with the acute form manage toidentify multiple pathogens at once. Among chronic sufferers, this is true for two-thirds of all patients.
The treatment process is complicated by the addiction of pathological life forms to the antimicrobial drugs used, which is also necessarily recorded by the doctor in the map and case history. Pyelonephritis is a disease in which repeated urine cultures have to be done quite often in order to identify medications that are effective for a particular case. Take into account that culture does not reveal protoplasts that can cause recurrence.
Nuances of state
As a rule, the next recurrence of pyelonephritis in the medical history is mentioned when a person's immune status decreases for some reason or the state of the body worsens for other reasons. The development of the disease largely depends on the general condition of the person. The infectious agent gets the opportunity to penetrate into the renal pelvis through the blood or lymph flow, along the ureteral walls from the lower urinary excretion pathways. In the presence of retrograde reflux, pathological microflora can enter the kidneys through the lumen of the ureter.
Urine stasis, violation of the outflow of lymph, blood through the veins from the kidney area - such pathological conditions are often mentioned as symptoms in xp. pyelonephritis in the history of the disease. Often, before the initial case of detection, the patient had already turned to doctors with interstitial cystitis, which is also mentioned in the patient's personal record. There is a possibility that cystitis proceeded in a latent form. When choosing an appropriate therapy, it is necessarytake into account that the acute form of the disease without timely qualified assistance can cause nephritis, renal carbuncle.
How to notice?
All the symptoms with which the patient goes to the doctor are necessarily recorded in the card during the collection of anamnesis (compiling a medical history). Acute pyelonephritis in children and adults usually begins with a fever - sometimes the fever reaches 40 degrees. The patient is shivering, sweating profusely, the lower back hurts. On the side where the infection occurred, the anterior wall of the peritoneum is tense, the costal-vertebral region is given by a sharp and severe pain. A person feels weak, general malaise worries, thirsty. Possible pollakiuria, dysuria.
Over time, the acute form or exacerbation of pyelonephritis as an additional symptom provokes headache and nausea. Sometimes the patient vomits. These manifestations indicate that the poisoning of the body occurs very quickly. Possible leukocytosis, aneosinophilia, the presence in the urine of purulent secretions, blood and protein inclusions. If the condition worsens, leukocytosis may progress to leukopenia. Symptom Pasternatsky in the predominant percentage of cases is positive. With a bilateral acute infectious process, organ failure is observed. Frequent complications in the form of necrotic processes, paranephritis.
Status update
It is very important for a doctor to keep a detailed history of chronic pyelonephritis. The differential diagnosis for this disease andacute form is an important and crucial stage, since the manifestations are similar to some other disorders. As a rule, specifying the patient's condition, the doctor first of all collects a complete anamnesis. The high probability of pyelonephritis is indicated by some chronic pathologies, purulent diseases experienced in the recent past.
Sometimes a preliminary diagnosis is accurate even on the basis of information obtained from the examination and questioning of the patient. As is known from many case histories collected in the practice of doctors specializing in urology, pyelonephritis is very often accompanied by purulent, protein, blood inclusions in urine. The liquid contains bacteria, is quite dense. The patient is feverish, the lower back hurts. There is oliguria, dysuria.
To clarify the condition, it is necessary to make a number of specific tests. Differential diagnosis is carried out, given that bacterial inclusions can be explained by foci of infection not only of the kidneys, but also of other organs through which urine flows. As a rule, the patient is sent for an x-ray - with pyelonephritis, the diseased kidney is larger in volume; on urography, showing the restriction of the mobility of the organ during breathing. Carbuncle can be suspected by compression of the pelvis, calyx.
How can I help?
When a patient is diagnosed with chronic pyelonephritis in the acute stage in the medical history, the doctor not only records all the patient's complaints, test results, but also specifies which treatment program is chosen for a particular case. In particular, this is a specialized food. The acute stage of the disease calls to eat according to the seventh table(subtype A). You need to drink at least two liters of fluid per day, if possible more. The doctor controls the patient's condition, as it improves, expands the diet, increasing the protein saturation and fat content of the diet. If metabolic acidosis is observed, sodium bicarbonate should be used. Take orally up to 5 g or inject into a vein up to 60 ml of solution (not more saturated than 5%).
All selected activities, drugs, their dosages must be recorded in the medical history. Therapy of pyelonephritis requires taking measures to stimulate blood flow in the kidneys and reduce pain. Thermal procedures are shown. The doctor will explain how to make compresses, heating pads. A popular procedure is diathermy. If the soreness is still severe, the thermal effect does not weaken it, it is necessary to take medication. Antispasmodics - "Papaverine" and "Platifillin" will help. They are intended for short-term use, they can alleviate the condition, but you cannot take such drugs constantly - they are characterized by side effects.
Medicines: what will help?
All drugs chosen by the doctor must be fixed - this will allow to evaluate their effectiveness, and if resistance of pathological microflora is detected, replace them with more effective ones. The drugs used and dosages, all the features of the course, the doctor fixes in the medical history. Therapy of chronic pyelonephritis at the stage of exacerbation, acute involves the use of antibiotics. They usually start with nalidixic acid. In pharmacies, it is presented under the trade names Negram and Nevigramon. The duration of the program is a week or two, the dosage is 0.5-1 g, the frequency is four times daily.
Alternative nitrofuran pharmaceutical products. Their effectiveness in a particular case will also have to be recorded in the medical history. Therapy of chronic pyelonephritis at the stage of relapse, acute involves the use of "Furadonin" for a week four times a day, 0.15 g or "Nitroxoline", the dosage of which does not exceed 0.2 g, and the duration of the course reaches three weeks. Nitroxoline is taken four times daily.
Nuances of treatment
In case of exacerbation of pyelonephritis, the listed drugs are used in turn. At the same time, nitrofuran derivatives and nalidixic acid are strictly forbidden to use, since these two drugs mutually weaken the effect. In addition, the likelihood of developing resistance in pathological microflora increases.
Often, when managing a case of exacerbation of chronic pyelonephritis in the medical history, the doctor indicates that the patient was prescribed hexamethylenetetramine. This compound is marketed under the name Urotropin. The agent is used in the first six days of an acute case, if the pathological microflora shows increased resistance to antimicrobial drugs. "Urotropin" is taken daily four times. Dosage - up to a gram orally or intravenously up to 10 ml injection solution.
Combinations for increased efficiency
Especial attention is paid to acute pyelonephritis inpediatrics. There are a huge number of case histories - among children, pathology is quite widespread, and there are many reasons for this - lifestyle, low immunity, and a number of other individual factors. From the experience of doctors, it is known that in case of relapses, often the best approach is combined drug therapy, in which the patient is simultaneously prescribed antibacterial compounds and sulfonamides. Antibiotics are selected based on the analysis of the resistance of microorganisms to various substances.
Most often, treatment is practiced with penicillin formulations - they are quite widespread in acute pyelonephritis in pediatrics. The case histories of many children contain a mention of such a disease and the use of "Benzylpenicillin" at a dosage of 1-2 million units per day, or "Oxacillin" at a dose of 2-3 g daily. You can use "Ampicillin" in an amount up to 10 g per day, ampicillin s alt and "Streptomycin" - twice a day for half a gram or less.
Options and alternatives
Reports of allergic reactions to penicillin antibiotics are not uncommon, especially in the case history of children. Chronic pyelonephritis in this case, you can try to treat with tetracycline. The drug "Tetracycline" is used orally up to six times a day, the dosage reaches 0.3 g. You can use derivatives of the specified substance - "Metacycline" or "Morphocycline".
Macrolides have a rather mild effect and weak negative consequences, so they are also often resorted to if treatment is neededchildren. Widespread "Tetraolean", "Oletetrin" in pediatrics. In the history of chronic pyelonephritis in many patients, it is indicated that the drugs were prescribed at a quarter of a gram up to six times a day, and such therapy showed a pronounced result.
A possible approach to the treatment of pyelonephritis is the use of aminoglycosides. Of the pharmacy names, it is worth mentioning "Kanamycin", injected into muscle tissue twice or thrice daily for half a gram, as well as "Gentamicin", used in a similar way, but the dosage is less - 0.4 mg.
What else to try?
In pyelonephritis, cephalosporins are effective. Apply "Tseporin" and "Cefaloridin". Dosage - up to two grams per day.
Antimicrobial drugs are changed every ten days, used in moderate dosage. Doctors who prescribe a course to patients suffering from kidney failure should be especially careful.
Sulfanilamide medicines can be used. Of the pharmacy names, this is "Etazol", "Urosulfan". The dosage reaches a gram, the frequency of use is up to six times a day. Long-acting sulfonamides have proven themselves well. These are Sulfapyridazine, used in a two-gram dose on the first day, and then half as much for another two weeks, and Sulfadimethoxin, Sulfamonomethoxin.
Attention to analyzes
In the predominant percentage of cases, soon after the start of the therapeutic course, urine in patients becomes normal, does not contain pathological indicationsinclusions. This is not a reason for cancellation - antibiotics must be taken further, as a rule - a month. If conservative treatment does not show the desired result, urgent surgery is required. This is usually necessary for carbuncle, nephritis.
If acute pyelonephritis was left without attention or was not treated, the disease becomes chronic. Primary chronic is also possible, but this is less common - this is diagnosed if from the very beginning the pathology does not manifest itself as severe symptoms.
Chronic pyelonephritis is more common in children, higher risk for girls. When examining a strand of a third of all patients, it is not possible to immediately determine the signs that allow an accurate diagnosis of the disease. But a feverish state without a reason for it is a manifestation that indicates a relapse and helps the doctor make an accurate diagnosis. As can be seen from the statistics, in recent years, cases of a combined disease have become more frequent - pyelonephritis and glomerulonephritis disturb the patient at the same time, both proceed in the form of a chronicle.
Unilateral pyelonephritis: features
This disease is characterized by dull pain in the lumbar region on one side (where the focus of infection is localized). The pain is constant. Dysuria is usually absent. With exacerbation, fever is observed in every fifth patient. There are more leukocytes in the urine sediment than other structures. With wrinkling of the diseased kidney, the urinary syndrome becomes less pronounced. Urine density does not change.
When making a diagnosis, it is important to determine the concentration of active leukocytes. With a latent form of the diseaseyou need to test with prednisolone. 30 mg of the substance is dissolved in 10 ml of liquid and injected into a vein in five minutes, after which several portions of urine are taken for examination - one hour after the procedure, two and three hours later. Such a test is considered positive if after an hour there are 400 thousand or more leukocytes in the urine, of which the main percentage is active. When Sternheimer-Malbin structures are detected, it is possible to diagnose with certainty the focus of inflammation, although this is not an undeniable indication of pyelonephritis.
Features of symptoms
Often, doctors record in the case history of gestational pyelonephritis (as, indeed, any other) that a high concentration of bacteria was detected in the patient's urine. If the number of microorganisms per 1 ml of liquid is 100 thousand or more, samples of the liquid should be taken to determine resistance to antimicrobial agents and chemotherapy drugs.
Often, indirectly, pyelonephritis is indicated by increased pressure in the arteries. To a greater extent, this is characteristic of a bilateral process, a chronic form.
To identify the features of the condition, it is necessary to do chromocystoscopy, urography, evaluate creatinine clearance for each of the kidneys. They take an x-ray using hippuran, scan the kidneys. In the chronic, the concentration ability of the organ is quickly disturbed, but the release of nitrogen is possible for a long time.
Because in pyelonephritis the tubules of the organ cannot work normally, gradually observedacidosis. In some patients, pyelonephritis is indicated by parathyroidism, osteodystrophy of the kidneys, due to the leaching of phosphate compounds and calcium from organic tissues.
Progress of disease
As pyelonephritis develops, it causes dry skin, pallor. The patient vomits and is sick. Nosebleeds are possible. As a rule, patients lose weight, anemia is observed, iron concentration decreases, while urine does not contain pathological inclusions.
Pyelonephritis can cause necrotic processes, suppuration, nephrolithiasis.
Nuances of clinical practice: chronicle
Particular difficulties are associated with clarifying the condition: chronic pyelonephritis is in many ways similar to chronic glomerulonephritis. To clarify the condition, it is important to carefully analyze the urinary syndrome, evaluate the content of various components in urine, and also identify all the features of the functioning of the organ through urography. Glomerulonephritis is indicated by nephrotic cider.
Hypertension, vasorenal hypertension and the kidney disease in question should be considered for elevated blood pressure. In order for differential diagnosis to give the most correct result, it is necessary to analyze the urinary syndrome, x-ray, and the results of a radionuclide study. Pyelonephritis will be indicated by the asymmetry of the excretion of the coloring component during chromocystoscopy.
It is possible to distinguish a pathological condition from vasorenal hypertension through urography, renography, aortoarteriography.
The nuances of chronic disease therapy
In the chronic form of the disease, treatment stretches for many years. As a rule, the course begins with the use of nitrofurans, combined with nalidixic acid and sulfonamides. Specific names are listed above. All these groups of funds alternate with each other. To improve efficiency, the patient is prescribed cranberry extract for continuous use.
If these remedies do not show the desired result, antimicrobials with a broad spectrum of effectiveness come to the rescue. Urine samples are taken before initiation of treatment to determine the resistance of life forms. Courses of treatment are usually ten days, although in some cases, after such a program, signs of infection can still be detected in urine. Patients with this course of the disease are shown to take antibiotics continuously, switching between forms every week.
