Pyelonephritis is a rather unpleasant and complex process of inflammation of the tissues of the kidneys, which has a non-specific bacterial etiology and mainly affects the interstitial tissue of the kidney parenchyma.
It is noteworthy that this disease is quite common in people of different ages, and according to doctors, pyelonephritis occupies the highest position in its prevalence after SARS. So, over the past year, about a million cases of pyelonephritis have been identified in Russia.
It is known that this disease is characterized by the presence of some age peaks, and also depends on gender. The first cases of pyelonephritis development occur in childhood and adolescence, and in women its manifestations occur much more often than in men.
The last peak in the development of pyelonephritis occurs in old age. By the way, in this group, pyelonephritis overwhelmingly affects men due to problems with the prostate gland.
What are the consequences of pyelonephritis in children and adults may occur in the future? We will talk about this further.
Predisposing factors
The possibility of this disease to a large extent depends on the state of the body, and what indicators of the functioning of human immunity. There are several known ways for pathogens to enter the kidneys: lymphogenous, hematogenous, or ascending, in which the infection travels up the genitourinary system, especially in the presence of reflux in the urine.
The following risk factors are noted:
- Urine stasis due to urodynamic disturbances.
- Problems in the outflow in the veins of the kidney.
- Anatomical deficiencies of the urinary tract, which may be congenital or acquired.
- Prolapsed kidneys.
- Having an epicystostomy to drain urine.
- Problems with the innervation of the walls of the bladder.
- Presence of bacteriuria, even if it is asymptomatic.
- Other conditions that reduce the overall reactivity of the body.
Another risk factor for the development of pyelonephritis is female adherence to this disease, since they have a special anatomy, which facilitates the entry of harmful microorganisms into the kidney tissue.
Symptoms of disease
The specificity and severity of the symptoms of this disease dependsfrom its evolving form. Acute pyelonephritis has a visible severity, and in order to better understand the clinical picture, the syndromes are conventionally divided into the following groups:
- Pain syndrome can have different intensity and increase in the lumbar region and navel.
- Intoxication - the patient is worried about fatigue, excessive weakness, fever to febrile or subfebrile, decreased appetite, pale skin, chills and excessive sweating.
- The main consequence of acute pyelonephritis in women is that the temperature can change to febrile, the patient is worried about vomiting and nausea.
- Urinary syndrome - an increase in microproteinuria, bacteriuria and leukocyturia. If a person has urolithiasis, hematuria and crystalluria may develop.
- Dysuric disorders are characterized by impaired urination, the development of pollakiuria and nocturia.
- Extrarenal symptoms - the patient develops edema and arterial hypertension, changes in acid-base balance, itching and dry skin.
Chronic form of pyelonephritis
Chronic inflammation of the kidney parenchyma can develop without any symptoms, as a result of which this type of pyelonephritis can be detected late. Improper therapy, as well as disturbances in the outflow of urine, contribute to chronic inflammation. In the early stages, the consequences of pyelonephritis during pregnancy for a child are not so severe, butthe disease will leave a certain imprint on the he alth of the baby.
Chronic inflammation causes:
- recurring relapses of acute pyelonephritis;
- impaired patency of the genitourinary system and other urological pathologies;
- chronic urinary reflux;
- Wrong selection of antibiotics;
- development of extrarenal localization.
Usually this type of inflammation of the tissues of the kidneys is a unilateral process, which is characterized by the appearance of dull pain in the affected kidney. In addition, the patient has pain when urinating.
During the period of exacerbation, only a quarter of patients have such a consequence of pyelonephritis during pregnancy as an increase in temperature, leukocytes predominate in the urine, and the amount of protein increases. After some time, the severity of the syndromes may subside, which is explained by wrinkling of the organ and a decrease in its filtration rates.
Despite this, over time, the inflammatory process can quickly spread to the surrounding tissues of the kidneys, affecting the tubules as well, causing tubular atrophy - wrinkling of the organ.
Due to impaired functioning of kidney tissues, a consequence of chronic pyelonephritis during pregnancy for the child and mother, namely arterial hypertension, may develop.
Laboratory diagnostics
Before a patient is diagnosed with pyelonephritis, the doctor prescribes some informativelaboratory research. They are carried out in all people who are suspected of having the disease, including pregnant women. After all, the consequences of pyelonephritis during pregnancy for a child can be different:
- Bacteriological culture of urine.
- Complete urinalysis, and it may not be negative, so the diagnosis is considered doubtful.
When pyelonephritis increases the number of leukocytes - develops leukocyturia. The protein content in the urine does not exceed the permissible norm, so proteinuria may not be detected due to microalbuminuria. Assessing the density of urine, hypostenuria or hyperstenuria is usually detected - a malfunction in the filtration of the kidneys, as well as a decrease in the amount of urine excreted. When necrosis of the glomeruli of the kidneys occurs, macrohematuria is usually determined.
In case of poor urine test results, Nechiporenko analysis is supposed to be performed, which makes it possible to assess the level of uniform sediment. The analysis according to Zimnitsky, which evaluates the concentration function of the kidneys, is also effective.
If a person has a risk of pyelonephritis, a bakposev is indicated, which helps:
- Determine how the pathogen responds to the prescribed empiric antimicrobial therapy.
- Count the number of harmful microorganisms.
- Assess the effect of the therapy performed.
If necessary, the following diagnostic methods can be additionally prescribed:
- Clinical blood test to monitor the level of leukocytes and neurophils.
- Biochemical blood test, within which, in the case of an uncomplicated form of this disease, the indicators are acceptable, but fluctuations in electrolyte ratios may be noted. If kidney failure joins pyelonephritis, the level of urea and creatinine usually increases in the blood from the vein.
To confirm the presence of pyelonephritis in a person, methods of instrumental diagnostics also help: specialists perform excretory urography, radiography and ultrasound. On ultrasound of the kidneys, the expansion of the pelvis and calyces is visible, the renal capsule swells and thickens, their parenchyma changes.
X-ray shows an enlargement of the affected kidney, urography shows some decrease in the mobility of the affected kidney during inspiration.
If a patient has a fever for 3 days, with properly selected antibiotics, doctors usually prescribe multispiral tomography, which helps to exclude a renal abscess, tumors and hematomas.
Chronic diagnosis
Since pyelonephritis does not have a bright clinical picture, the diagnosis of chronic kidney disease is somewhat difficult. It is necessary to carefully analyze the history of the disease and determine the presence of Sternheimer-Malbin cells and "live" leukocytes.
To detect them, a small amount of dye is added to the urine, as a result of which viable leukocytes may have different shades, or not be stained at all. Dead leukocytes are stained in a light pink color, which can turn into morebright shade.
Blue leukocytes can be different in size and structure. With an excessive increase in leukocytes, the formation of a lobulated nucleus, this phenomenon is called Sternheimer-Malbin cells, the presence of which indicates inflammation of the genitourinary system in a chronic form.
If chronic pyelonephritis is suspected, but active leukocytes are not detected, it is recommended to perform a stress test by performing intravenous administration of the drug Prednisolone. The result is evaluated after 1, 2 and 3 hours, as well as one day after the procedure.
The test can be considered positive if at least 400,000 leukocytes are excreted in the urine after the injection, and the preferred part must be "live", active.
Resistant bacteriuria is a sign of inflammation of the genitourinary system. If bacteria are detected in the urine in an amount of more than 100,00 per 1 mm, it is necessary to determine their susceptibility to antibiotics and find out the need for uroseptic measures.
Symptomatic drugs
Symptom therapy is intended to eliminate fluid deficiency, relieve pain and correct intoxication. Fever is not recommended to be brought down with anti-inflammatory and antipyretic drugs due to their nephrotoxic effect.
To relieve pain, doctors prescribe antispasmodics to patients:
- "Platifillin";
- "Papaverine";
- "Drotaverine".
Whenin hospital treatment, it is preferable to use parenteral forms of these drugs. The use of tablets and capsules "Sparex" and "No-shpa" is also effective.
Treatment of pyelonephritis
For effective treatment of the acute form, it is first necessary to reduce the amount of fluid, especially if the patient has heart disease, arterial hypertension.
Herbal decoctions and sour fruit drinks, which have a diuretic and antiseptic effect, will be useful:
- kidney fees;
- rosehip decoctions;
- lingonberries;
- fruit drinks from cranberries, etc.
In our time, the pharmacology market offers a fairly large selection of medicines for the effective treatment of pyelonephritis:
- "Canephron";
- "Brusniver";
- "Cyston".
Antibiotics
The patient is prescribed etiotropic antibiotic therapy for 5-14 days. In uncomplicated pyelonephritis, which, however, has an acute form, antibiotics with fluoroquinolones are prescribed:
- Ciprofloxacin;
- Ofloxacin;
- Levofloxacin.
Cephalosporins
Cefalosporins are used as an alternative:
- Ceftibuten;
- Ceftriaxone;
- Cefotaxime.
Inhibitor-protected penicillins, especially Amoxiclav, are also effective in pyelonephritis.
In inpatient treatment, therapy is carried out with parenteral fluoroquinolones, eventually switching to tablets. But atGram-positive microbes in the urine are treated with inhibitor-protected cephalosporins.
In the acute form of the disease, therapy should be aimed at eliminating the obstruction that occurs in the genitourinary system. It is possible to combine aminoglycosides with fluoroquinolones, which will have low toxicity.
Therapy of chronic pyelonephritis
Before starting antibiotic therapy for this disease in a chronic form, it is necessary to eliminate foci of infection as quickly as possible: for example, dental caries and tonsillitis, since even with high-quality treatment, there is a possibility of reinfection.
Antibiotics should be chosen correctly and carefully, taking into account the results of bakposev, as well as determining the sensitivity to the medications used. It is not recommended to prescribe empirical treatment without exacerbation and conditions that may be life-threatening.
During treatment, it is necessary to constantly monitor the development of pathogenic microflora, regularly donating urine for bakposev, since antibiotic-resistant strains may form that require a change in the treatment regimen.
Treatment of chronic pyelonephritis requires the use of nitroxoline, nalidixic acid and nitrofurans, replacing them from time to time. This is a rather lengthy process that can take several months. Symptoms of pyelonephritis usually subside after 10 days of antibiotic therapy.
But there are cases when, even with effective treatment, the pathogenic flora can continue to be sown. With such flowdisease, continuous and fairly long antibiotic therapy is indicated, changing drugs every week.
To effectively cure pyelonephritis in a patient, it is necessary to eliminate the source of infection, use tablet forms of antibiotics and herbal preparations. In chronic pyelonephritis, which occurs in the latent phase, the patient is recommended sanatorium or spa treatment.
