Prognosis for life in the presence of calculous pyelonephritis is determined by how severe the obstruction to urine outflow is. The prognosis is also determined by the intensity of inflammation. The more severe the pathological change, the more pronounced the clinical manifestation. The disease in this case is usually secondary. Calculous pyelonephritis (according to ICD N20.9.) is a nonspecific inflammation in the kidneys that develops against the background of urolithiasis. That is, it is a complication of urolithiasis. Next, we will find out what are the causes of the development of this disease, find out how it manifests itself, and get acquainted with the main methods of its treatment.
What are the features of this disease?
Factors that contribute to calculous pyelonephritis include:
- Having a large size or number of stones.
- Development of persistent urinary tract obstruction.
- Reduced immunereactivity of the human body.
- Period of old age.
- Presence of past inflammatory pathologies of the urinary tract.
Inflammation can take place in an extremely severe form of pyelonephritis (with an acute course), or with minor symptoms in a chronic type of disease. According to the data, urolithiasis occurs in forty percent of cases of urological pathologies. Its peculiarity lies in the development of the disease at working age (from twenty to fifty years), which occurs in sixty percent of patients. This contributes to disability in twenty-five percent of cases.
Where do rocks form?
Stones often form in the renal calyx, but can also occur in the ureters, pelvis, bladder, and so on. As a rule, there is a unilateral lesion. And in thirty percent of cases, the disease occurs on both sides. Stones are single or multiple, having a variety of shapes and sizes (from one millimeter to ten centimeters or more). Inflammation in the kidneys is mainly affected by women, however, calculi of the urinary canals are more common among men. In the elderly, the prevalence of the disease increases in both sexes. Next, find out what causes this pathology among the population.
Causes of disease
The following causes contribute to the development of calculous pyelonephritis:
- The presence of metabolic disorders along with an increase in the content of s alts andother chemical compounds in the form of cysteine, oxalates, fructose, galactose.
- Excess freeze-dried and canned food. Too much intake of vitamin D. Deficiency of vitamins A and C.
- High temperature along with the humidity of the climate (the fact is that increased sweating increases the concentration of s alt in the urine).
- Prolonged impaired urinary outflow combined with deterioration of microcirculation in the kidneys.
- The occurrence of chronic inflammatory diseases in other parts of the genitourinary system.
- Presence of foreign bodies in the urinary tract, and in addition, kidney injury.
- Prolonged bed rest (for example, in diseases of the spine and strokes).
- Some pathologies in the form of hyperparathyroidism, gout and more.
Microbial reproduction
Not every patient with urolithiasis can develop calculous pyelonephritis (ICD-10 N20.9.). In rare situations, its symptoms are not detected at all. However, the presence of stones favors the emergence and reproduction of microbes.
E. coli, coccal flora, enterococci or bacterial flora are often detected when a disease appears. Less commonly, Klebsiella can be found along with Pseudomonas aeruginosa, enterobacteria, cytobacteria, fungi, and so on. Now let's figure out what symptoms accompany this disease.
Symptomatics
The clinical picture of calculous pyelonephritis directly depends on many differentfactors, such as gender, age, and, in addition, physical activity. In some patients, pyelonephritis may be latent for years and will be discovered incidentally. In other situations, symptoms occur acutely. Often, calculous pyelonephritis has the following manifestations:
- increase in temperature;
- appearance of chills and sweating;
- appearance of pulling pains in the lumbar region;
- occurrence of pain in muscles and joints;
- appearance of changes in urinary frequency;
- appearance of discoloration of urine;
- presence of headache and general weakness.
Chronic form of this pathology
Chronic calculous pyelonephritis is found in a fairly large number of patients. It acts as an inflammatory disease that directly affects the functional system of the kidney. This disease can develop in a person at absolutely any age, and it occurs in both men and women. Chronic calculous pyelonephritis (ICD-10 N20.9.) is an independent disease or a direct consequence of another. Its symptoms are:
- Presence of aching, rather weak and asymmetrical pains. In the event that the kidney is mobile, the pain may be in the abdomen.
- Increase in body temperature to approximately thirty-eight degrees.
- Patient's urination becomes more frequent.
- Perceptibly increased pressure.
- Breakdown occurs along with weakness, mood swings, headaches and so on.
Treatment of this disease involves the elimination of the pathogen. For this, various antibiotics with uroseptics are used. Penicillins are also prescribed along with cephalosporins, fluoroquinolones, nitrofurans and oxyquinolines.
How long is the therapy?
The duration of active therapy for chronic calculous pyelonephritis is usually at least two weeks, and in the case of remaining complaints, it can last up to one month. It is recommended to replace the indicated drugs every ten days, repeating the urine culture, and also taking into account the effectiveness of each of the medications.
What is the diagnosis of this disease?
In diagnostics, methods can be used simultaneously that detect signs of urolithiasis and calculous pyelonephritis (ICD-10 code N20.9.). Patients are scheduled for the following examinations:
- Passing general urine and blood tests.
- Carrying out a biochemical blood test. The indicators of this study make it possible to suspect the disease. In order to clarify the diagnosis, a more thorough examination is required.
- Ultrasound examination of the kidneys.
- Perform cystoscopy and excretory urography.
- Performing a scintigraphy with radioactive drugs. At the same time, the functional state of the kidneys can be assessed.
- Performing computed tomography and magnetic resonance imaging.
How is this pathology treated?
Treatment of calculous pyelonephritiscarried out according to the general principles of therapy of the secondary form of pathology. Of particular importance is the treatment of urolithiasis, which is the root cause of pyelonephritis. The most effective is the removal of stones. In this case, the main cause of pyelonephritis is eliminated. Surgical techniques are dangerous with the occurrence of complications and do not exclude the recurrence of stones. Depending on the indication (as determined by the doctor), the following treatments are used:
- Return to conservative methods for the passage of stones. For example, the use of citric acid medicines (Uralit and Blemaren) to remove urate stones. The use of a dry extract of madder, Cystenal and other drugs may also be prescribed. Water loads are often used, such as drinking up to two liters of warm tea (which should be drunk thirty minutes in advance), and then administering antispasmodics and diuretics.
- Relief of renal colic in a patient. Antispasmodics are usually used in the form of "Baralgin", they are combined with a thermal procedure (heater or hot bath).
- Carrying out an operation to remove stones. There are different techniques, such as the use of endoscopic techniques in combination with percutaneous techniques. In complicated and severe cases, open surgery is performed.
- Performing medical or instrumental destruction of stones. The most widely used is extracorporeal wave lithotripsy (when ultrasonic waves are applied).
- Folk treatments also take place. ATBasically, such methods are used during the period of remission. Herbal preparations can have a positive effect. Mineral waters also have a healing effect. They are used for small stones (up to fifty millimeters in diameter), as well as in the absence of severe urinary tract obstruction. Indications for prescribing therapy are determined by the doctor. With incorrect use of mineral waters, the opposite effect is possible (that is, an increase in stones).
- In the treatment of chronic calculous pyelonephritis, diet is important. In the event of the appearance of urate stones in the diet, limit or exclude the use of smoked and fried meat, meat broths, dried fish and offal. In the case of the formation of phosphate stones, a meat diet is recommended with the exception of dairy products, peas and beans. In the presence of oxalate stones, it is undesirable to eat tomatoes, sorrel, tomato paste and herbs.
Are complications of the disease possible?
Calculous pyelonephritis is fraught with the following complications:
- Development of hydronephrosis and secondary wrinkling of the kidney (in case of long-term persistence of pyelonephritis).
- Acute kidney failure. The occurrence of manifestations such as anuria along with thirst, nausea, vomiting and other signs. In the case of sluggish pyelonephritis, the patient may develop chronic insufficiency of this organ.
- The development of paranephritis (inflammation of the perirenal tissues), along with the spread of purulent inflammation to other organs of the abdominal region.
- Infectious and toxicshock.
- Occurrence of kidney bleeding. This happens due to damage to the mucous membrane stones, necrosis of the renal tissues and disorders in the coagulation system.
- Development of anemia. This occurs in an acute form as a result of toxic exposure or with a prolonged course of the disease.
- Development of symptomatic nephrogenic arterial hypertension (due to nephrosclerosis or fluid retention).
Urologist's advice for this pathology
Urologists in the framework of the prevention of this disease are advised to follow a diet that limits meat broths, coffee, fried and spicy dishes with dairy products. In addition, you should consume at least one and a half liters of fluid per day.
Doctors also insist on timely detection of early forms of urolithiasis and pyelonephritis. No less important, according to experts, is the rehabilitation of foci of acute or chronic infection. Among other things, careful control over the compensation of diabetes, gout and other diseases is recommended.
