Inflammation that is caused by infection and affects the pelvis, calyx and tubules of the kidneys is called chronic pyelonephritis. This is the most common disease that occurs in 65% of cases of kidney pathology. Women are more susceptible to it, which is due to the structure of their urethra, as a result of which it is much easier for bacteria to enter the body. Chronic pyelonephritis according to the ICD-10 code has the value N11.
Reasons
There are some of the most common causes of the disease. The first factor in this disease is considered to be the appearance in the body and the prosperity of the infection of the so-called agent. Doctors consider Escherichia coli to be the most basic and frequent causative agent of pyelonephritis, but this does not mean that other infections do not cause it. For example, infections that can cause this disease are various staphylococci, streptococci, proteus, and enterococci.
In addition to bacteria, fungal infections can also cause disease. The transmission of these microorganisms occurs in two ways:
- Urinogenic, or ascending. Infection in contact with the urethrathe organ rises. The method of transmission of microorganisms occurs in women.
- Hematogenous. The route of transmission occurs through the blood flow. Bacteria and fungi are transferred from the affected area to the organ, which can become infected by blood vessels.
Disease is not able to attack a he althy organism. In this regard, there are certain factors in the presence of which pyelonephritis can occur. The first factor is a decrease in general immunity. And the second is congenital or acquired weakness of the kidneys or their diseases, which lead to a violation of the outflow of urine.
Signs of illness
The symptoms of chronic pyelonephritis depend on its stage. Primary pyelonephritis has more pronounced symptoms than secondary. With an exacerbation of chronic pyelonephritis, the following symptoms are distinguished:
- Increase in body temperature to 39 degrees.
- Appearance of pain in the pelvic area, including pain can be unilateral or bilateral.
- Identification of urinary disorders.
- Deterioration of the body, fatigue.
- Lack of appetite.
- Having persistent headaches.
- Pain in the abdomen with vomiting and nausea.
- Visual change in the body, that is, the presence of edema and swelling.
During remission, diagnosing this disease is much more difficult. Possible signs of chronic pyelonephritis of such a course are as follows:
- Slight and intermittent pain in the lumbar region.
- Painmay be pulling or aching.
- Irregularities in urination are absent, and if they are noticed, they are not critical for the patient in general.
- Body temperature remains almost unchanged, but there may be a slight increase to 37 degrees in the evening.
- Increased fatigue of the body, especially if the disease was neglected and not treated properly. Also, patients begin to notice drowsiness, loss of appetite and causeless headaches.
- As it develops, there is an increase in problems with urination, peeling, dryness and discoloration of the skin.
- A plaque appears on the oral cavity and a general dryness of the oral cavity is revealed.
- This disease is often accompanied by arterial hypertension, which provokes a pronounced increase in pressure.
- Possible nosebleeds.
In the advanced stages of chronic pyelonephritis, pain in the bones and joints is detected. The disease is manifested by increased urination (up to 3 liters of urine per day) and severe thirst.
Stages
Chronic pyelonephritis has four stages of development of inflammation in the kidney tissues.
The first stage is characterized by a uniform atrophy of the collecting ducts (tubes designed to remove urine). The glomeruli at this stage are completely he althy, pathological processes do not occur in them. There is also a slight leukocyte infiltration of the connective tissue of the medulla.
The second stage is characterized by the presence of connective tissue damage and atrophy of a smallnumber of glomeruli, after which they dissolve. Following the glomeruli, the surrounding renal tubules begin to die. Some vessels are significantly narrowed, pinched and closed.
In the third stage, he althy kidney tissue is replaced by scar tissue, the kidney shrinks in size and takes on a wrinkled appearance with bulges and depressions.
The fourth stage, depending on the activity of inflammation, is divided into the following:
- Active. This stage is capable of moving into the next one.
- Latent (calm stage). Able to move both to the next and return to the previous one.
- Remission is the stage of clinical recovery, that is, the absence of signs of the presence of the disease and improvement in urinalysis.
Complications and consequences
With improper treatment of chronic pyelonephritis, a period of exacerbation may occur. With a long period of exacerbation, complications appear that arise according to the mechanism of acute pyelonephritis. Complication, in all forms of chronic pyelonephritis, takes the form of chronic renal failure. A sign of this is an increase in the amount of urine excreted per day, as well as a decrease in its concentration, constant thirst and dry mouth.
Chronic renal failure has the following stages:
- Hidden (latent). At this stage, symptoms on the background of chronic pyelonephritis practically do not appear.
- Conservative. Rapid fatigue is noticeable with slightphysical activity, general weakness, which is especially evident in the evening, a sharp decrease in weight and appetite.
- Severe symptoms begin to appear only at the terminal or final stage. At the same time, the smell of ammonia from the mouth and the presence of constant headaches are revealed. The skin becomes pale, dry, flabby. The work of all body systems is deteriorating. It is difficult to remove toxins from the body, which should normally be excreted in the urine.
Prolonged course of chronic pyelonephritis can lead to the development of diseases such as pedunculitis, that is, inflammation in the zone of the kidney gate, and nephrosclerosis, which leads to deformation of the kidney.
Diagnosis
As a rule, it is much more difficult to make a diagnosis in chronic forms of pyelonephritis. Diagnosis is complicated by the latent course of the disease. Information about other diseases allows us to clarify the causes of the development of this pathology. More often, when diagnosing doctors, they are interested in the presence or absence of the following anomalies:
- Pathologies of the kidneys and urinary organs.
- Inflammatory diseases of the female reproductive system.
Chronic biased pyelonephritis most often goes away with mild symptoms, which complicates its detection. Diagnosis in such cases is based on the results of laboratory and instrumental research methods. Physical examination may not reveal pathological processes in the kidneys. It consists in an objective examination for the presence of pallor of the skin, swelling of the face and eyelids,discomfort when hitting the lumbar region, and also helps to identify visual intoxication.
Laboratory studies of chronic pyelonephritis (ICD-10: N 11) in patients are as follows:
- Common urinalysis. With it, a quantitative indicator of leukocytes in the blood is detected.
- Urine analysis by the Zimnitsky method. Based on the results, the functional state of the kidneys is evaluated, the amount and density of urine are determined at different times of the day.
- Complete blood count is aimed at determining the amount of hemoglobin, erythrocyte sedimentation rate and cellular composition of blood.
- Biochemical blood test, which reveals the presence of a change in the electrolyte composition of the blood.
Instrumental examination in patients is as follows:
- Ultrasound of the kidneys allows you to examine both the inside of the kidney and its membrane.
- Ultrasound of the vessels surrounding the kidneys allow to assess the violation of the blood flow of the renal membrane.
- X-ray examination (including computed tomography) can detect large-scale anomalies of the kidneys and urinary tract, such as changes in the size or shape of organs.
- MRI is performed in patients who are contraindicated in the introduction of contrast agents into the body.
Chronic pyelonephritis (ICD-10: N 11) is similar in features to chronic glomerulonephritis, which complicates the diagnosis when using the above methods. Therefore, differential diagnosis is based ona set of anamnesis data, which are repeatedly refined by the above methods. With such a diagnosis, much attention is paid to the study of urine sediment, namely the determination of its bacteriological composition.
Drug therapy
It should be noted that without the use of antibiotics, chronic pyelonephritis in women and men cannot be cured. Therefore, when this stage is detected, they try to start taking antibiotics immediately. The type of drug will depend on the sensitivity of the bacteria that caused the inflammation of the kidneys to the antibiotic. The high effectiveness of treatment with such medicines can be lost if antibiotics are taken too late or an incomplete course is taken. This is due to the fact that over time the number of bacteria will increase, as will the affected area.
The main requirement in the treatment of chronic pyelonephritis to antibiotics: minimal toxicity with maximum efficiency. Also, the antibiotic should cope with most pathogenic bacteria.
The following medications are used to treat exacerbations of chronic pyelonephritis:
- penicillins ("Ampicillin", "Oxacillin", "Sultamicillin", "Amoxiclav");
- cephalosporins ("Ceporin", "Kefzol", "Cefepime", "Ceftriaxone", "Cefotaxime", "Cefixime");
- nalidixic acid ("Nevigramon", "Negram");
- aminoglycosides ("Kolimycin", "Kanamycin", "Gentamicin", "Amikacin","Tobramycin");
- fluoroquinolones ("Moxifloxacin", "Levofloxacin", "Ciprinol", "Ofloxacin");
- nitrofurans ("Furadonin", "Furazolidone");
- sulfonamides ("Etazol", "Urosulfan");
- antioxidants (tocopherol acetate, ascorbic acid, retinol, selenium).
Despite their high efficiency, antibiotics have a number of side effects. If a negative reaction is detected, it is necessary to adjust the dosage or replace the drug. To choose one or another antibiotic, the doctor must find out by urine analysis what acidity the patient has, since the effectiveness of treatment with this or that drug depends on this indicator.
Antibiotics are more often recommended for at least 2 months. Sometimes an effective measure is the alternation of the first antibiotic with the second during the course for each for 10 days. The duration of antibiotic treatment for a particular patient will depend on the results of the studies. They come down to sowing a colony taken from the affected organ and studying it for antibiotic sensitivity. If the disease is advanced and the patient's condition is severe, then combinations of antibiotics are prescribed to him. They are taken both as tablets orally and as injections.
Folk treatments
Parsley is the main assistant in the fight against chronic pyelonephritis. It will have a detoxifying and antispasmodic effect, serve as an antiseptic, and most importantly, it will enhance the function of the urinary system, helping to remove toxins accumulated inbody. Together with parsley, it is also recommended to use dill, celery, onion, lovage and lettuce, which will help enhance the effect of the main component on the kidney tissue. You need to use a bunch once a week without bread and s alt.
When treating chronic pyelonephritis in women, you should refuse to take water, replacing it with berries, such as:
- raspberries;
- strawberry;
- cranberries;
- lingonberries;
- blackberry.
They will help to replenish the moisture the body needs without creating a burden on the kidneys.
An important effect will have tinctures. The desired herbs should be taken in the same amount, mixed and poured with boiling water with the calculation of 200 milliliters of water per 1 tablespoon of raw materials. Leave for two hours and strain. You need to drink half a glass four times a day thirty minutes before meals. This medicine should be taken warm.
Required Herbal Fees:
- Anise fruits, birch leaves, St. John's wort, tricolor violet.
- Cowberry leaves, Ivan tea, parsley root, goose cinquefoil, parsley root.
Diet
Patients are prescribed a diet with a high amount of liquid in chronic pyelonephritis. Clinical recommendations should be strictly followed, otherwise the condition may worsen.
Under normal pressure, the daily norm should be as follows: proteins - 95-105 g, fats - 75-85 g, carbohydrates - 400 g, s alt - 7-9 g, liquid - about 2 liters, total calorie content at the same time should be2900-3100 calories. Number of receptions - 5 times.
With high pressure, the daily norm of elements is as follows: proteins - 70-80 g, fats - 55-75 g, carbohydrates - 400 g, s alt - 3-5 g, liquid - around 2 liters, total calorie content - 2400 -2900 calories. Number of receptions - 5 times.
It is sometimes recommended to spend fasting days. For example, eat more fruits today and more vegetables tomorrow.
When dieting, you should eat the following foods:
- diet grades of meat, poultry, fish, they are allowed to be boiled and steamed;
- meat broth-based soups;
- dairy products;
- white or gray bread;
- pasta, cereals and flour;
- raw vegetables;
- eggs;
- fruits and berries;
- honey, jam, marshmallow, marshmallows;
- any teas and juices.
In chronic pyelonephritis, the clinical guidelines for prohibited foods are as follows:
- smoked and s alty foods;
- any mushrooms;
- fatty broths;
- legumes;
- refractory fats;
- cake with rich creams;
- fast food and snacks with lots of s alt;
- coffee and chocolate;
- alcohol.
Prevention
You should know that chronic kidney pyelonephritis will cause a huge amount of inconvenience. Therefore, it is important to take preventive measures against this disease in order to prevent its development. To avoid the appearance of chronic pyelonephritis, it is necessary to completely cure the acute stage of this pathology and subsequently regularlysee a doctor. For prevention, it is important to protect the kidneys from bacteria.
To do this, it is necessary to completely cure the following diseases, in most cases aggravating the course of inflammation in the kidneys: coprostasis, chronic colitis, cholecystitis. It is important to prevent pyelonephritis in pregnant women. According to statistics, if you manage to defeat pyelonephritis during pregnancy, then the chronic form of the disease never occurs.
Also, when preventing exacerbations of chronic pyelonephritis, do not forget about observance of general hygiene measures, high-quality and balanced nutrition, the presence in the diet of foods rich in vitamins. It is important to timely prevent the development of other diseases and regularly conduct antibacterial courses aimed at reducing pathogenic microbes in the body.
Spa treatment
The sanatorium form of therapy brings a positive result in the treatment of chronic pyelonephritis (ICD-10 code - N11). In this case, the latest methods are used to help remove inflammation, cleanse the kidneys and bring the patient's condition back to normal. Thanks to the complex of actions that the sanatorium provides, the patient will return to a normal rhythm of life much faster.
How to treat chronic pyelonephritis in a sanatorium? This includes activities such as:
- Diet.
- Mud baths.
- Mineral water therapy.
- Hydrotreatment.
- Heat therapy.
Each of the procedures is carried out only after the appointmentDr.
