How to treat chronic pyelonephritis. Treatment of pyelonephritis in acute or chronic form with medications and folk remedies. How to cure chronic pyelonephritis

Chronic pyelonephritis - inflammatory disease, which primarily affects pyelocalyceal system kidney It can develop at any age, in men and women, and can be an independent disease or a complication of other diseases or developmental anomalies.

According to statistics, up to 20% of the population suffers from this disease, but experts believe that in fact its prevalence is even higher.

What clinical symptoms are typical for chronic pyelonephritis?

In chronic pyelonephritis, the inflammatory process is localized in the area of ​​the calyces and pelvis of the kidneys.

• Lower back pain is often mild, aching, and usually asymmetrical. It has been noticed that pain often appears not on the affected side, but on the opposite side. There may be a feeling of discomfort and heaviness in the lower back, especially when walking or standing for long periods of time. Patients complain that their lower back is cold and try to dress warmer. Severe or cramping pain is more typical for urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.
• Temperature rise, not higher than 38 C, usually in the evening, without visible reasons.
• , especially at night.
• Promotion blood pressure. During remission, this may be the only symptom.
• Deterioration of health, fatigue and weakness, more pronounced in the morning, decreased mood, headaches.
• Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.

Laboratory signs of chronic pyelonephritis

• Decreased hemoglobin in a general blood test.
• A three-time urine test reveals an increased number of leukocytes (normally no more than 4-6 per field of view); bacteriuria more than 50-100 thousand microbial bodies in 1 ml; red blood cells (especially with urolithiasis); sometimes - protein, but not more than 1 g/l, and there are no cylinders at all.
• In Zimnitsky's sample, the specific gravity often decreases (in no single portion does it exceed 1018).
• In a biochemical blood test, total protein is within normal limits, albumin may decrease slightly, and when signs appear renal failure creatinine and urea increase.

Treatment of pyelonephritis

Elimination of the pathogen. For this purpose, antibiotics and uroseptics are used. The main requirements for the drugs: minimal nephrotoxicity and maximum effectiveness against the most common infectious agents: E. coli, Proteus, Klebsiella, staphylococcus, Pseudomonas aeruginosa, etc.

It is optimal to conduct a urine culture before starting treatment to determine sensitivity to antibiotics - then the choice will become more accurate. Most often prescribed

• penicillins (amoxicillin, carbenicillin, azlocillin) – with minimal nephrotoxicity, they have a wide spectrum of action;
• 2nd and 3rd generation cephalosporins are not inferior to the first in effectiveness, however, the bulk of the drugs are intended for injection, therefore they are used more often in hospitals, and in outpatient practice Suprax and Cedex are most often used;
• fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin) are effective against most pathogens of urinary tract infections, non-toxic, but they are prohibited for use in children, pregnant and lactating women. One of side effects– photosensitivity, so during treatment it is recommended to avoid visiting the solarium or going to the beach;
• sulfonamide drugs (in particular Biseptol) were used so often in our country at the end of the 20th century to treat literally any infections that now most bacteria are insensitive to them, so it should be used if culture has confirmed the sensitivity of the microorganism;
• nitrofurans (furadonin, furamag) are still very effective for pyelonephritis. However, sometimes side effects - nausea, bitterness in the mouth, even vomiting - force patients to refuse treatment with them;
• hydroxyquinolines (5-Nok, nitroxoline) are usually well tolerated, but sensitivity to these drugs, unfortunately, has also decreased recently.

The duration of treatment for chronic pyelonephritis is at least 14 days, and if complaints and changes in urine tests persist, it can last up to a month. It is advisable to change medications once every 10 days, repeating urine cultures and taking their results into account when choosing the next medication.

Detoxification

If not high pressure and severe edema, it is recommended to increase the amount of fluid you drink to 3 liters per day. You can drink water, juices, fruit drinks, and when high temperature and symptoms of intoxication - rehydron or citroglucosolan.

Phytotherapy

Most effective means herbal medicine for chronic pyelonephritis is bearberry leaf.

These folk remedies for treating pyelonephritis are effective as an addition to antibacterial therapy, but will not replace it, and should not be used during an exacerbation period. Herbal infusions should be taken long-term, in monthly courses after completion of antibacterial treatment or during remission, for prevention. It is optimal to do this 2-3 times a year, in the autumn-spring period. Undoubtedly, herbal medicine should be abandoned if there is a tendency to allergic reactions, especially hay fever.
Examples of fees:

• Bearberry (leaf) – 3 parts, cornflower (flowers), licorice (root) – 1 part each. Brew in a ratio of 1 tablespoon per glass of boiling water, leave for 30 minutes, drink a tablespoon 3 times a day.
• Birch leaf, corn silk, horsetail 1 part each, rose hips 2 parts. Pour a tablespoon of the mixture into 2 cups of boiling water, leave for half an hour, drink half a glass 3-4 times a day.

Drugs that improve renal blood flow:

• antiplatelet agents (trental, chimes);
• drugs that improve venous outflow (escusan, troxevasin) are prescribed in courses of 10 to 20 days.

Spa treatment

It makes sense, since the healing effect of mineral water is quickly lost when bottled. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

Chronic pyelonephritis - the most common infectious-inflammatory disease of the kidneys, occurring with alternating periods of latent inflammatory process in the kidneys with phases of exacerbations, which is chronic in nature.

The disease is usually associated with development in the kidneys bacterial infection, which first affects the renal pyelocaliceal system and tubules, and then moves to the glomeruli and vessels of the kidneys, affecting the renal papillae, as well as the cortex and medulla of the kidney.

Causes of chronic pyelonephritis

According to statistics, every tenth person on the planet suffers from pyelonephritis. Infection with pyelonephritis penetrates the kidneys or upward path through the bladder and ureters, or hematogenously through the bloodstream. The source of infection can be focal purulent-inflammatory diseases of other organs, such as sinusitis, tonsillitis (tonsillitis), stomatitis, dental caries, pneumonia, bronchitis, inflammatory processes in the genitals, cystitis. Often the cause of pyelonephritis is relatively harmless E. coli, which enters the urinary tract through the bloodstream, or as a result of improper hygiene of the genitourinary organs.

However, simply getting microbes into the kidney tissue is not enough for the development of pyelonephritis. The disease occurs under the influence of a complex of reasons: lack of vitamins in the body, hypothermia, overwork, stress and much more. What most contributes to the development of pyelonephritis is a delay in the outflow of urine associated with compression or obstruction of the urinary tract. This can be stones in the ureters and bladder, adenoma prostate gland in men, inflammation of the ovaries in women, various birth defects urinary system. It is no coincidence that pyelonephritis and urolithiasis disease so closely related to each other. Inflammation stimulates the formation of stones, and stones, by making it difficult to excrete urine, contribute to inflammation of the renal pelvis.

Usually, chronic pyelonephritis occurs as a result of incompletely cured acute pyelonephritis. Often the disease is asymptomatic for months and even years and is discovered either during an exacerbation or as a result of a long-term persistent impairment of kidney function, which has led to the death of part of the renal nephrons and the appearance of .

Often enough chronic pyelonephritis doesn't have severe symptoms. The patient sometimes complains that his lower back hurts, his head often hurts, and his blood pressure jumps, but he attributes all these manifestations of the disease to climatic factors and physical fatigue. The clinical picture depends on the form in which chronic pyelonephritis occurs in a given patient.

Forms of chronic pyelonephritis:

• By occurrence chronic pyelonephritis is divided into primary(occurring for the first time in a patient who does not have other urological diseases) and secondary(arising against the background of any existing urinary tract disease).
• By localization of the inflammatory process chronic pyelonephritis can be unilateral or bilateral.
• According to the clinical picture The following forms of chronic pyelonephritis are distinguished: latent, recurrent, hypertensive, anemic, azotemic, hematuric.

Symptoms of chronic pyelonephritis depending on the form of the disease:

• Latent form chronic pyelonephritis has an unexpressed clinical picture. Patients complain mainly of frequent urge to urinate, general weakness, headache, hypertension, fatigue, and occasionally there is an increase in temperature to low-grade fever. The latent form of chronic pyelonephritis is usually accompanied by impaired concentrating ability of the kidneys, decreased urine density and frequent urination with the release of light-colored urine. Urinary retention, pain in the lumbar region and swelling are usually absent in this form of the disease. Patients sometimes experience Pasternatsky's symptom, a small amount of protein is found in the urine, the number of leukocytes and bacteria remains normal. The disease is sluggish and dangerous in that it gradually leads to loss of kidney function and progressive chronic renal failure.
• Recurrent form chronic pyelonephritis is characterized by alternating periods of exacerbations and remissions. Patients complain about discomfort in the lumbar region, urinary problems, sudden fever and increased body temperature. During exacerbations, symptoms are similar to those acute pyelonephritis . Observed pronounced changes in urine (proteinuria, leukocyturia, cylindruria, bacteriuria and hematuria), ESR increases and the number of neutrophils increases (neutrophilic leukocytosis). Gradually, patients may develophypertensive syndromewith headaches, dizziness, heart pain, disorders visual function, oranemic syndrome,manifested by general weakness, fatigue, shortness of breath, decreased performance. As the disease progresses, it develops.
• Hypertensive form chronic pyelonephritis manifests itself by the development of severe hypertension . Patients complain of frequent headaches, dizziness, pain in the heart, shortness of breath, and sleep disturbances. Patients periodically experience hypertensive crises. This form of pyelonephritis is not characterized by urinary disorders, so diagnosing it is sometimes quite difficult.
• Anemic form chronic pyelonephritis is manifested primarily by symptoms of severeanemia. Patients have a sharp decline the number of red blood cells in the blood. This form of the disease is the most common in patients with chronic pyelonephritis and is accompanied by general weakness, fatigue, shortness of breath, and decreased performance. Urinary problems are minor or absent altogether.
• Azotemic form chronic pyelonephritis is characterized by an increasechronic renal failure. This form of the disease, as a rule, is a continuation of an existing one, but not detected in a timely manner.latent pyelonephritis. Patients suffer from an increase in azotemia, which manifests itself as swelling and itching of the skin. Kidney function declines and a severe form of chronic renal failure gradually develops.
• Hematuric form chronic pyelonephritis is manifested by repeated attacks of macrohematuria and persistent microhematuria, which is associated with venous hypertension, which contributes to the disruption of the integrity of the vessels of the fornical zone of the kidney and the development of fornical bleeding.

Chronic pyelonephritis usually develops over 10-15 years or more and ends with shrinkage of the kidneys. Wrinkling occurs unevenly with the formation of rough scars on the surface. If only one of the kidneys shrinks, then, as a rule, compensatory hypertrophy and hyperfunction of the second kidney is observed. That is, over the course of several weeks, the mass of the remaining kidney increases and it takes over the functions of the diseased kidney. At the final stage of chronic pyelonephritis, when both organs are affected, chronic renal failure.

Diagnosis of chronic pyelonephritis

It is often not possible to identify chronic pyelonephritis in a timely manner and accurately determine the form of its course, especially in a clinic setting. This is due to the variety of clinical manifestations of the disease, as well as its relatively frequent latent course.

Chronic pyelonephritis is recognized on the basis of anamnesis (medical history), existing symptoms, results of leukocyturia (examination of urinary sediment using the Kakovsky-Addis method), quantitative detection of active leukocytes in the urine, called Stenheimer-Malbin cells, bacteriological analysis of urine, as well as intravital kidney biopsy . If chronic pyelonephritis is suspected, a general blood test is also done to determine residual nitrogen, urea and creatinine in it, the electrolyte composition of blood and urine is determined and examined functional state kidney

Using the X-ray method, changes in the size of the kidneys, deformation of their pelvis and calyces, and disturbances in the tone of the upper urinary tract are determined, and radioisotope renography allows one to obtain graphic image and evaluate the functional state of each organ separately. As additional research methods for the diagnosis of chronic pyelonephritis, intravenous and retrograde pyelography and scenography, echographic examination of the kidneys, and chromocystoscopy are used.

Amyloidosis can be recognized by the presence of lesions chronic infection, the paucity of urinary sediment (there are only single leukocytes, red blood cells and casts, no sugar at all), as well as the absence of bacteriuria and radiological signs of pyelonephritis.

As for hypertension, it is more often observed in older people, occurs with hypertensive crises and more pronounced sclerotic changes in the coronary, cerebral vessels and aorta. In patients hypertension There is no leukocyturia, bacteriuria, or pronounced decrease in the relative density of urine characteristic of chronic pyelonephritis, and X-ray and radioindication studies do not reveal changes inherent in chronic pyelonephritis.

With diabetic glomerulosclerosis, the patient has signs of diabetes mellitus, and other symptoms of diabetic angiopathy are determined - generalized damage to blood vessels.

One of the diagnoses may sound like this: chronic bilateral pyelonephritis, recurrent, exacerbation phase, chronic renal failure, intermittent stage, arterial hypertension.

Treatment of chronic pyelonephritis

The treatment time for chronic pyelonephritis is usually at least four months. However, if the disease proceeds without complications, therapy can be reduced on the recommendation of a doctor. At the end of each month, the patient undergoes a urine test and an antibiogram. If the white blood cell count is still higher than normal, the drug should be replaced. Sometimes it happens that a month after the start of treatment, the tests are normal. But this does not mean that the disease has passed and the kidneys are out of danger. Under no circumstances should you give up treatment.

Antibiotics for pyelonephritis

The main treatment method for chronic pyelonephritis today is still antibacterial therapy. Taking antibiotics begins only after the causative agent of the infection has been identified and its sensitivity to drugs has been determined. Antibiotics that suppress gram-negative flora are usually indicated. The doctor should prescribe only those drugs that do not have a toxic effect on the kidneys. Treatment is carried out with regular laboratory monitoring of the sensitivity of microflora to the antibiotic.

Good therapeutic effect with low probability of relapse and adverse reactions modern fluoroquinolone antibiotics provide: ciprofloxacin, norfloxacin, levofloxacin, pefloxacin; cephalosporins: cephalexin, cefuroxime, cefenim, semisynthetic penicillins with beta-lactamase inhibitors augmentin, unasin.

Complex treatment of chronic pyelonephritis also involves taking non-steroidal anti-inflammatory drugs that prevent the formation of blood clots in the vessels. This can be aspirin, movalis, voltaren, ibuprofen and others.

To improve microcirculation in the kidneys, patients take chimes, trental or venoruton, and to activate renal circulation - urolesan, cystenal, olimetine, uroflux.

In case of severe disease and complications, especially in older people, the doctor may prescribe immunocorrective drugs. If a chronic urinary tract infection is detected, peptide bioregulators are prescribed.

To prevent taking antibiotics, especially powerful ones (the so-called fourth line), from leading to intestinal dysbiosis, you must follow a fermented milk diet throughout the entire course of treatment. But if dysbiosis does appear, then to restore the intestinal microflora, about a week before the end of the main therapy, it is necessary to start taking bifidumbacterin. In difficult cases, the doctor may prescribe antifungal drugs.

Prevention of chronic pyelonephritis

Prevention of chronic pyelonephritis must begin in childhood, instilling personal hygiene skills in children. In general, preventing the development of chronic pyelonephritis and its complications is possible only with constant monitoring of the patient by a urologist. Control tests and studies should be done at least three times a year. During this period, the patient should not have severe physical exercise, hypothermia, high humidity, such people should not work the night shift. Patients are removed from the register if they do not show signs of exacerbation of chronic pyelonephritis within two years.

For women suffering from chronic pyelonephritis, pregnancy is contraindicated. This is associated with a possible deterioration in health. After childbirth, they almost always develop chronic renal failure, and their further life expectancy is no more than 5 years. Therefore, before planning a pregnancy, women must first cure their kidneys.

To prevent chronic pyelonephritis, it is also recommended to conduct two two-month courses of herbal medicine with an interval of 3-4 weeks, using any of the known herbal preparations. In the future, it will not be superfluous to take a 2-3 month course. During prophylactic intake of the preparations for 6-8 months, it is necessary to do urine tests.

Chronic pyelonephritis is quite common. With this pathology, nonspecific inflammatory processes occur, caused by various bacteria. As a result, the renal pelvis, calyces and kidney parenchyma suffer. Most often, inflammation occurs due to the activity of E. coli or staphylococci. From this article you will learn answers to questions about what chronic pyelonephritis is, how, and what are the signs of chronic pyelonephritis.

Symptoms of the disease

Very often, patients have an asymptomatic course of the disease. Inflammation may not make itself felt long years, slowly affecting the kidneys before symptoms of chronic pyelonephritis begin to appear. Chronic pyelonephritis of the kidneys manifests itself with symptoms only during the period of exacerbation.

If you have been diagnosed with chronic pyelonephritis, then the symptoms and treatment largely depend on how the disease manifests itself and where exactly the disease is localized, as well as on the presence of other infectious pathogens.

During the period of exacerbation of chronic pyelonephritis, a picture is observed general inflammation. Patients experience increased body temperature, reaching up to 39 degrees. Pain sensations appear in the lumbar region, and the localization of pain depends on which kidney is affected by the disease (often both suffer from chronic pyelonephritis, which causes pain on both sides of the lumbar region).

When pyelonephritis appears, patients often complain of bad feeling, loss of appetite and headache. The presence of pyelonephritis can also be determined by the appearance of the patient: the face becomes slightly swollen, the eyelids may swell, the skin becomes pale and bags under the eyes are often observed.

When remission occurs (a period of illness during which there is a significant weakening of symptoms or their complete disappearance), it is quite difficult to determine the presence of chronic pyelonephritis in a patient based on symptoms. Unlike the period of exacerbation, when the kidneys are affected, chronic pyelonephritis during the “calm” may not bother the patient at all, but in some cases the following symptoms occur: rare and minor pain (pulling or aching pain) in the lumbar region, a slight increase in body temperature ( especially before bed), dry mouth and dark coating on the tongue, pale and dry skin, high blood pressure. If a patient suffers from chronic pyelonephritis for a long time without seeing a doctor, then he is often bothered by excessive fatigue, loss of appetite and subsequent weight loss, and causeless headaches. In some cases there is periodic nose bleed. Advanced stages of the disease are characterized by bone pain, frequent urination and excessive thirst.

If you experience one or more of the above symptoms, you should immediately seek help from a highly qualified specialist in order to begin treatment on time and prevent subsequent complications.

Causes of the disease

They lie in the causative agents of the disease that penetrate the human excretory system - various microorganisms (Escherichia coli, staphylococci, streptococci, enterococci and other microorganisms). After the pathogens enter the body for one reason or another, they begin the reproduction stage. Often, before the disease begins, there is acute inflammation kidney

The causes of chronic pyelonephritis can also be various undiagnosed kidney diseases. In children, the disease often appears after infections such as influenza, sore throat, and measles. This disease affects young girls who started having regular sex life early. Patients suffering from diabetes, obesity and diseases gastrointestinal tract, are also included in the risk group.

A special factor contributing to the onset of the disease is weakened the immune system, which can occur due to hypothermia of the body, especially from hypothermia in the kidney area.

Stages of the disease

For a disease such as chronic pyelonephritis, the stages are as follows:

Stage 1 – atrophy of the collecting ducts of the kidneys. The branches of the segmental arteries decrease in number.

Stage 2 – significant vasoconstriction occurs, some glomeruli become empty.

Stage 3 is characterized by severe tubular atrophy, many renal glomeruli die.

Stage 4 is characterized by intense damage to the glomeruli, a decrease in size and drying out of the kidney.

List of consequences of the disease

The development of pyonephrosis is a consequence of chronic pyelonephritis. Complications after suffering pyelonephritis occur mainly in people after thirty years of age. The consequence may be the presence of acute renal failure, expressed by disturbances in the functioning of the kidneys, and sometimes even a complete loss of the functional ability of the organ, the presence of paranephritis ( purulent inflammation), the presence of necrotizing papillitis (most often this complication, during which renal colic, hematuria and other serious disorders, women are susceptible to), the presence of urosepsis (is perhaps the most serious complication, during which a kidney infection affects the entire body, which almost always ends in death).

Diagnostics

Diagnosing the disease is quite difficult. This is due to the fact that its manifestations can be varied, and it is also often possible to occur in a latent form. To make a diagnosis of chronic pyelonephritis, a specialist relies on the patient’s complaints and additional instrumental and laboratory tests. Diagnostics must be comprehensive.

In a row laboratory research includes: general tests urine and blood, prednisolone and pyrogenal tests (during the test the patient is injected with a drug, and after a while a series of urine samples are taken for analysis), the Sternheimer-Malbin test to determine the quantitative content of cells, bacteriological research urine and biochemical analysis blood, test for the content of electrolytes in the blood and urine.

A number of instrumental studies include: X-ray, thanks to which you can determine the size of the kidneys (with chronic pyelonephritis, the kidneys decrease); carrying out radioisotope renography, through which the functional abilities of each kidney are determined separately; performing a kidney biopsy, which allows you to determine the extent to which the kidneys are affected; chromocystoscopy, which allows you to determine how correctly the excretory function of the kidneys works; carrying out ultrasound examination kidney

It should also be noted that for an accurate diagnosis, often the doctor only needs to ask the patient in detail about his complaints.

In this case, the exclusion of amyloidosis is of particular importance when making a diagnosis. chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis, since these diseases are similar to chronic pyelonephritis in the general clinical picture.

Treatment of the disease

Is it possible to cure chronic pyelonephritis? Chronic pyelonephritis - what is it? Your doctor can answer these questions for you. If you have discovered chronic pyelonephritis, treatment is available using different methods. The process of treating the disease requires an individual approach to each patient. The main methods of treatment are a special diet and drug therapy. In case of exacerbation, the patient is recommended to undergo inpatient treatment under the supervision of a physician. The patient is prescribed a rest regimen in combination with compliance proper diet nutrition and reception special drugs. The duration of bed rest for the treatment of chronic pyelonephritis is determined based on the degree of the disease, as well as the quality of treatment.

Nutrition plays an important role. Moreover, diet is prerequisite treatment.

It is necessary to draw up proper diet nutrition, excluding the consumption of foods such as rich broths, fatty and spicy foods, various seasonings, as well as coffee and alcohol.

Food that irritates the urinary tract is prohibited. For example, consuming foods containing significant amounts of protein increases the acidity of urine, which has an adverse effect on the body suffering from the disease. Food containing oxalic and lactic acid is completely prohibited. The consumption of easily digestible carbohydrates (beans, peas, chickpeas and others) has a negative effect on the patient’s body, since under the influence of such products a favorable environment is created for the spread of microorganisms.

The list of prohibited foods also includes smoked foods, fatty dairy products, processed foods, mushrooms, and pickled foods. The consumption of confectionery products should be either limited or completely excluded from the diet.

The body of a person suffering from chronic pyelonephritis is beneficially affected by diets that normalize the patient’s metabolism, normalize blood pressure and help reduce the load on the kidneys.

The diet should contain a minimum amount of protein products. Carbohydrate and fat intake should be equal to physiological standards person. It is also necessary to enrich the diet with foods containing vitamins necessary for the health of the body.

As a result, the doctor prescribes the patient to take antibiotics - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin and other drugs that eliminate chronic infections. The drugs are prescribed to the patient for a long time - up to eight weeks. Before treating the disease and prescribing medications, the specialist needs to monitor the acidity level of the patient’s urine and only after that determine the medicine that corresponds to these indicators.

Treatment of chronic pyelonephritis will be provided by visiting a sanatorium specializing in diseases of the excretory system.

Prevention

Treated pyelonephritis must be monitored to prevent recurrence of exacerbation. As a preventive measure, people suffering from this disease are advised to monitor their diet, limit salt intake, and drink kidney tea. As soon as treatment for chronic pyelonephritis is completed, patients are registered at the dispensary to prevent the risk of recurrence of the disease. The disease dictates the need to maintain normal immunity, which is facilitated by maintaining a healthy lifestyle, Fresh air, hardening, as well as moderate physical activity. It is important to organize the right working environment for yourself, not to get a job at enterprises where people are exposed to hard physical labor, hypothermia and excessive nervous tension.

To prevent chronic pyelonephritis, it is necessary to ensure sufficient fluid intake, which guarantees normal urine outflow.

Treatment of chronic pyelonephritis should be aimed at the pathogenetic mechanisms of the disease. IN general scheme Several areas of therapy should be considered:

• remove infectious pathogens;
• normalize urine flow;
• increase the patient’s own immunity;
• eliminate the danger of chronic foci of infection and the possibility of re-infection by hematogenous and lymphogenous routes.

At the same time, we must not forget about the natural mechanisms of protection of the urinary tract. Only their failure causes bacterial aggression. Correct treatment chronic pyelonephritis should not disrupt the natural properties of the body, but maintain and restore the desired balance.

How does the body get rid of infection in the urinary tract?

Natural defense mechanisms can be supported by caring for your health, diet, folk remedies from medicinal plants. The kidneys have several options that make the spread of infection much more difficult. Each needs to be addressed to help control inflammation.

• An increase in urinary volume causes mechanical flushing of the tract and washes away excess bacteria. This means that in order to cure the disease you need to drink more fluids and use medicinal herbs that increase diuresis.
• An increase in acidity (pH less than 7), an increased content of urea and organic acids in the urine prevent the proliferation of microorganisms. Therefore, dietary adjustments affect bacterial viability.
• Immune cells are located not only in the blood, but also in the submucosal layer of the urinary tract.
• The vagina in women and the prostate in men produce a secreting substance that inhibits the spread of bacterial flora. Therefore, when choosing local contraceptives, adults should not forget to maintain the balance of microorganisms and use proven means for douching and daily toileting.

Using means to activate the immune system in chronic pyelonephritis, we achieve local destruction of harmful pathogens

Treatment for chronic pyelonephritis necessarily includes an integrated approach with the step-by-step use of inpatient capacity and therapy at home.

What is necessary for successful antibacterial therapy?

Antibacterial therapy is of primary importance in the treatment of kidney inflammation. One of the reasons for the chronicity of the process is considered to be insufficient or inadequate use of antimicrobial drugs in the acute stage of the disease.

Therefore, in order to get rid of pyelonephritis forever, you need to follow the principles of use antibacterial agents.

Treatment standards require:

• prescribe medications as early as possible;
• The duration of the course should be selected individually depending on the activity of pathogenic microorganisms and the severity of inflammation;
• strictly take into account the identified sensitivity of the microflora, according to the conclusion obtained by the tank method. urine culture;
• If necessary, combine antibacterial drugs using compatibility properties;
• replace medications if low sensitivity is detected;
• to prevent negative effects, fungal growth, use antifungal drugs in cases long course treatment;
• simultaneously prescribe vitamins and immunostimulants.

In the treatment of pyelonephritis, choose the drug around which bacteria do not grow

If these principles are not observed, the desired result cannot be achieved from antibacterial therapy, as well as with persistent obstacles to the outflow of urine.

In the later stages of the disease, sclerotic changes occur in the kidney tissues, blood flow in the glomeruli and the filtration process are disrupted. Therefore, it is impossible to create a sufficient concentration of antibacterial agents. Their effectiveness drops sharply, despite high doses.

If treatment is delayed, microorganisms degenerate into drug-resistant strains and form microbial associations with different sensitivities.

Preparations for antibacterial treatment

Chronic pyelonephritis, according to developed recommendations, must be treated simultaneously with a combination of several groups medicines:

• antibiotics;
• sulfonamides (Urosulfan, Sulfadimethoxine);
• nitrofurans (Furagin, Furazolidone);
• preparations from nalidixic acid (Nilidixan, Nevigramon);
• hydroxyquinoline derivatives (5-NOK, Nitroxoline);
• combined agents such as Biseptol, Bactrim (sulfamethoxazole + trimethoprim).

A drug with the greatest flora sensitivity and the least toxic effect on renal tissue is selected for each patient.

Drugs with minimal toxicity include:

• antibiotics penicillin group(Ampicillin, Oxacillin);
• Erythromycin;
• Levomycetin;
• cephalosporins (Tseporin, Kefzol).

The following are considered moderately toxic:

• nitrofurans;
• 5-NOK;
• nalidixic acid and its derivatives.

To highly toxic drugs include aminoglycoside antibiotics (Kanamycin, Kolimycin, Gentamicin).

They are used only in severe cases, in the presence of resistance to other drugs, and in short courses (5–7 days).

When choosing the most effective antibiotic it is necessary to take into account such a property as the dependence of activity on the reaction of urine:

• Gentamicin and Erythromycin act most effectively in environments with alkaline reaction at pH 7.5 – 8. When using them, a dairy and predominantly plant diet, alkalizing mineral waters (Borjomi) are recommended.
• Ampicillin and 5-NOK differ in activity in an acidic environment at pH 5–5.5.
• Cephalosporins, Levomycetin, tetracyclines are quite effective in both alkaline and acidic urine at pH 2–9.

The most active uroseptics with wide range actions are considered:

• 5-NOK,
• Levomycetin,
• Gentamicin.

Gentamicin is excreted up to 90% in the urine and reaches the kidneys unchanged, therefore creating a locally high concentration.

Gentamicin is used intramuscularly and intravenously

Antibiotics are combined with drugs of other effects. They reinforce each other, accelerating the anti-inflammatory effect. Doctors often resort to the following combinations:

• antibiotic + sulfonamide;
• antibiotic + nitrofuran (Furagin);
• all together + 5-NOK.

Medicines made from nalidixic acid are not recommended to be combined with nitrofurans (they weaken the effect, add up the toxic effect), and are contraindicated during pregnancy in the first trimester and in children under two years of age. These products are characterized by the least ability to produce resistant types of microbes. In addition to Nevigramon, the group includes:

• Nagram,
• Negro,
• Cystidix,
• Nilidixan,
• Nalix,
• Notricel,
• Nalidin,
• Nalidixin,
• Nalix,
• Naligram,
• Naxuril,
• Nogram.

Examples of effective combinations include:

• Carbenicillin or an aminoglycoside antibiotic + nalidixic acid;
• Gentamicin + Kefzol;
• antibiotics-cephalosporins + nitrofurans;
• Penicillin or Erythromycin + 5-NOK.

It is known that nitroxolines (5-NOC) are inhibited by the use of acid reducers gastric juice, so when concomitant treatment stomach diseases this should be remembered

The duration of antibiotic therapy lasts from four to eight weeks.

How can we judge the success of antibacterial therapy?

The criteria for obtaining a positive result are:

• liquidation clinical symptoms inflammation ( elevated temperature, pain syndrome, dysuric phenomena);
• changes in control blood and urine tests before normal indicators(leukocytes and blood ESR, absence of protein, bacteria in the urine, disappearance of active leukocytes and leukocytosis in the sediment).

ABOUT clinical signs exacerbations of chronic pyelonephritis can be found out.

Outpatient treatment after relapse of the disease

Relapses of chronic pyelonephritis occur in 60–80% of patients even after effective treatment. Therefore, it is recommended to carry out long-term anti-relapse therapy at home.

The drugs are selected and alternated in courses. The doctor necessarily focuses on the level of leukocyturia, bacteriuria, protein levels in the blood and urine. Various authors suggest duration outpatient treatment keep from six months to two years.

The monthly medication regimen looks like this:

• an antibiotic is prescribed for the first 7–10 days, alternating in the next period with other antimicrobial drugs (Urosulfan, 5-NOK);
• For the remaining 20 days, it is recommended to take folk remedies.

Tea made from lingonberry leaves washes the urinary tract well

The entire cycle is repeated under the supervision of a doctor and tests.

Bactrim (Biseptol) is contraindicated in cases where the patient has:

• leukopenia, agranulocytosis;
• aplastic and B 12-deficient anemia;
• impaired renal excretory function.

It is not used:

• in the treatment of children under 3 months of age;
• during pregnancy and lactation.

Folk remedies in the treatment of pyelonephritis

At home, folk remedy therapy includes decoctions and infusions of plant materials that have a diuretic effect, a slight bacteriostatic effect, and increase the tone of the bladder and tract.

A self-prepared drink does not interfere with the action of medications, flushes the kidneys and removes bacteria. Before use, it is better to consult your doctor.

The most popular purpose of bearberry is; it is also known as “bear ears.” You can brew it in a thermos (2 tablespoons of dry herbs per liter of boiling water) for half an hour. After straining, you can drink a partial glass three times a day. To improve the taste, it is recommended to add honey. Cannot be used during pregnancy (the tone of the uterus increases).

A decoction of corn silk is prepared at home by pre-boiling for 5–7 minutes. Then it is infused and taken as bearberry.

Pyelonephritis in children is treated by adding delicious cranberry juice, a decoction of rose hips, and figs to their drink.

You can prepare a combined decoction of viburnum berries, sea buckthorn and rose hips. It is left in a thermos overnight. These products not only have a bactericidal effect, but also activate the immune system and contain the necessary vitamins.

It is useful for pregnant women to brew lingonberry leaves and rose hips.

What other medications are prescribed for pyelonephritis?

To reduce allergenic manifestations, patients are prescribed antihistamines:

• Diphenhydramine,
• Tavegil,
• Suprastin,
• Loratadine.

In the treatment of renal hypertension, strong antihypertensive drugs from the group of β-blockers, combinations with calcium channel blockers. The appearance of signs of heart failure requires careful use of glycosides in drops and tablets (Digoxin, Celanide). Attacks of suffocation are relieved intravenous administration Strophanthin, Korglycona.

When is surgical treatment used?

Surgical treatment is used in advanced stages of chronic pyelonephritis, when the patient is admitted to the urology department with the following complications:

• encysted abscesses in the kidneys (abscesses, carbuncles);
• paranephritis - inflammation extends beyond the boundaries of the renal tissue into the perinephric tissue;
• urosepsis with bacteremic shock (bacterial decay products are absorbed into the blood);
• hydronephrosis;
• urolithiasis;
• sclerosis of the affected kidney.

Most often, nephrectomy (removal of the diseased organ) is indicated if it is unilaterally affected.

Rarely available birth defect in the form of doubling of the kidney and ureters, partial resection of the necrotic area is performed after opening the capsule. At the same time, stones that obstruct the passage of urine (in the pelvis, ureter) are removed. The question of the viability of the kidney and the preservation of functions is resolved during the examination.

IN practical application Urologists have an operation to restore the blood supply to the kidney by wrapping it with an omentum. It is indicated for the treatment of renal hypertension.

Nephrectomy has long been considered contraindicated in cases of bilateral disease and severe concomitant diseases that increase the risk of intervention. Currently, it is being replaced by a donor kidney transplant after both of her own have been removed. Before surgery, the patient undergoes systematic hemodialysis.

To reduce symptoms of intoxication, the patient is given the following in the preoperative period:

• Hemodez,
• plasma,
• isotonic solutions,
• if necessary, red blood cell mass.

Against the background of high blood pressure, antihypertensive drugs are necessary.

During resection, the renal artery is temporarily clamped. At the end of the operation, a drainage tube is inserted into the perinephric space to drain blood and administer antibiotics. It is removed after 10 days.

To prevent a fistula from forming from urine being sucked into the wound, operating surgeons carefully check the suturing of the walls of the cups and vessels; for this it is better to use chrome-plated catgut.

The prognosis for the patient's life is always favorable. Not in every case it is possible to eliminate hypertension. IN postoperative period with a single kidney remaining, the patient should be under the supervision of a urologist at the clinic and undergo preventive treatment and examination. Overstrain of one organ significantly increases the risk of infection.

Spa treatment

Treatment is indicated at balneological resorts with natural healing springs. These include: Truskavets, Zheleznovodsk, Kislovodsk, Sairme.

Drinking natural mineral waters helps flush out toxins and bacteria from the kidneys and restore local immunity.

Bottled water from the store most often does not contain bioactive components, is a product of chemical mixing of ingredients, and therefore does not have such strength.

In the presence of hypertension, anemia, or renal failure, spa treatment is not indicated; it has no effect.

Measures for the treatment of chronic pyelonephritis are more effective the earlier their use is started. Refusal medical care seriously worsens the patient's life prognosis.

– infectious and inflammatory disease of the kidneys, with predominant localization in the tubulointerstitial zone.

Urologists often encounter this pathology, since the incidence is 19 cases per 1000 people. Women are susceptible to pathology 1.5 times more often than men.

Table of contents:

Classification of chronic pyelonephritis

Primary chronic pyelonephritis is distinguished; damage to the microbial flora is considered the root cause for its development. There are no obstacles to the outflow of urine.

Secondary chronic pyelonephritis develops against the background of diseases leading to disturbances in urodynamics:

• anomalies in the development of the structure of the organs of the genitourinary system;
• nephrourolithiasis;
• narrowing of the ureter;
• reflux;
• retroperitoneal sclerosis;
• neurogenic disorders of the bladder of the hypotonic type;
• sclerosis of the bladder neck;
• prostatic hyperplasia and sclerotic changes;
• malignant and benign formations.

Pyelonephritis can be unilateral or bilateral.

During chronic pyelonephritis, the following phases are distinguished:

• active;
• latent;
• remission;
• clinical recovery.

Symptoms and signs of chronic pyelonephritis

Complaints in chronic pyelonephritis are present during the period of exacerbation. The patient complains of dullness. Dysuric disorders are not typical, but may be present. From common symptoms note the following:

• weakness, apathy;
• decreased performance;
• heaviness in the lower back;
• an unreasonable increase in temperature to 37 - 37.2 degrees.

If the process is complicated by the accession, then signs of loss of functional ability of the kidneys appear.

During the latent phase or remission phase there are no manifestations, and when making a diagnosis, laboratory test data are taken into account.

The following are considered predisposing factors to the development of chronic pyelonephritis:

• immunodeficiency states;
• in severe form;
• infectious diseases;
• gestation;
• history of diseases of the urogenital tract;
• foci of chronic infection (, etc.);
• surgeries on the urinary system.

A physical examination reveals pain on palpation of the kidney/kidneys and a positive symptom of tapping in the lumbar region. With a long-term process, there may be polyuria (an increase in the daily amount of urine).

In secondary chronic pyelonephritis against the background of kidney abnormalities, an increase in blood pressure is often noted.

Laboratory and instrumental examination methods

You can use decoctions of diuretic and anti-inflammatory herbs:

Sanatorium and resort treatment in Pyatigorsk, Truskavets, Essentuki, Zheleznovodsk is possible only during the period of remission.

If a patient has chronic pyelonephritis accompanied by increased blood pressure, then limit salt to 5-6 g/day. Liquids can be drunk up to 1000 ml.

For nephrogenic hypertension supported by chronic pyelonephritis, ACE inhibitors are prescribed, since the increase in pressure is associated with an increase in renin in the blood.

In case of intolerance due to side effects, angiotensin II receptor antagonists are used.

Tactics for managing patients with exacerbation of chronic pyelonephritis with some concomitant pathology

If the patient has a concomitant disease diabetes, then aminopenicillins and ciprofloxacins are used.

For patients with chronic renal failure, drugs with hepatic or dual route of elimination are selected:

• Pefloxacin;
• Ceftriaxone;
• Cefoperazone.

Smart choice antibacterial drugs ensures safe use and simplifies dosage selection.

Patients with chronic renal failure are not prescribed aminoglycosides and glycopeptides due to their nephrotoxicity.

In patients and drug addicts, the causative agent of pyelonephritis may be uncharacteristic. Preference is given to fluoroquinolones (levofloxacin), aminoglycosides and cephalosporins, since they are not metabolized in the body and are excreted by the kidneys.

Exclusion from the group of cephalosporins:

• Cefatoxime;
• Cefoperazone;
• Ceftriaxone.

Exacerbation of chronic pyelonephritis associated with resistant hospital strains of bacteria is extremely rare. This may be a complication of medical procedures or a history of inadequate antibiotic use.

In these cases, Ceftazidimi and Amikacin are used.

Cefazidime is prescribed as a single antibiotic, or in combination with Amikacin.

Carbapenems are considered reserve drugs (with the exception of ertapenem).

Surgery

Indications for surgery are all violations of the outflow of urine.

If chronic pyelonephritis is complicated by the formation of apostema or renal carbuncle, an operation involving decapsulation is performed, followed by the installation of nephrostomy drainage.

In the most advanced cases, nephrectomy is resorted to.