Inflammation of pyelonephritis symptoms. “Is chronic pyelonephritis more dangerous than acute kidney inflammation? How to treat it? How to treat pyelonephritis with folk remedies

Pyelonephritis is an infectious inflammation of the kidneys (the part of them that is responsible for the outflow of urine), occurring in both men, women and children, which in the case of further development can lead to serious consequences, including renal failure. Kidney pyelonephritis is an extremely common disease: about 2/3 of patients turn to specialists with this particular urological problem.

Medical Center "Energo" is a clinic where you can treat almost any urological disease, including pyelonephritis. The course of treatment will be selected individually, in accordance with the specifics of the disease, its causative agents, as well as the characteristics of the individual patient’s body.

Pyelonephritis: causes

The main cause of pyelonephritis is infection, which causes inflammation.

Infection can enter the kidney in various ways:

• ascending, or urogenic: the infection enters the kidney from the urethra, ureter or bladder;
• hematogenous: through the blood;
• lymphogenous: through lymph.

However, infection in the kidney does not mean the development of an inflammatory process: most often it occurs in the presence of other triggering factors:

• disturbance of the flow of urine: in the case of urine reflux from the bladder into the ureters, unusual structure, narrowing of the ureters, in the presence of kidney stones and other kidney problems (the so-called secondary pyelonephritis of the kidneys), as well as in prostate adenoma, etc.;
• circulatory disorders in the kidney due to hypertension, diabetes, local hypothermia and spasms;
• decreased immunity: in the case of chronic diseases (diabetes, for example), as well as taking certain medications (steroids, etc.);
• failure to maintain personal hygiene, including during sexual intercourse: pyelonephritis is possible, including as a side manifestation of many urological diseases, also of a venereal nature.

The factors described above largely explain the fact that pyelonephritis is most often observed:

• in young women, which contributes to female anatomy: most often, pyelonephritis occurs during pregnancy (gestational pyelonephritis), since the development of the fetus prevents the complete excretion of urine, the retention of which can provoke inflammation;
• in older men: mainly as a reaction in the case of prostate adenoma, which puts pressure on the urethra, which also causes stagnation of urine. In addition, prostate adenoma leads to a decrease in the amount of substances with an antibacterial effect that are usually produced by the prostate gland;
• in children under 7 years of age: most often due to anatomical features.

Complications of pyelonephritis

Experts distinguish two main types of pyelonephritis:

• spicy;
• chronic.

Acute pyelonephritis in case of untimely or inadequate intervention can:

• go to chronic pyelonephritis(the reason for this is the completion of the course of treatment ahead of schedule) with periodic exacerbations;
• go to purulent form(which is what makes pyelonephritis most dangerous): in this case, if the inflammation is not stopped in time, it is possible complete destruction organ, filling it with pus and urine, which can lead to septic shock, as the infection enters the blood.

Chronic pyelonephritis, in turn, often occurs with almost no symptoms, which causes an increased risk of exacerbations and complications; renal failure (acute or chronic) may occur - the most serious complication in case of of this disease. If this type of disease progresses, the kidney will lose its ability to cleanse the blood, which may lead to the need for dialysis and organ transplantation.

Gestational pyelonephritis in pregnant women can lead to a high risk of infection of the fetus and other serious problems(especially if it occurs on later), which include:

• premature birth;
• miscarriage;
• stillbirth;
• development possible pathologies fetus

Complications of pyelonephritis indicate that it is dangerous, especially for pregnant women, so the sooner it is treated, the better. Moreover, in case of pregnancy, any treatment the specified disease, including taking medications, should only be done under the supervision of a doctor and as prescribed.

Pyelonephritis: symptoms

The signs of pyelonephritis of both types are very similar.

Acute pyelonephritis has the following manifestations:

• general intoxication of the body: heat(39°C-40°C), chills, fever, vomiting;
• frequent and painful urination;
• change in urine: blood and pus may be observed in the urine;
• pain of varying intensity in the lower back in the area of ​​the kidneys, usually on one side (may intensify with movement and at night, and also radiate to the groin and genitals);
• headaches and muscle pain.

Symptoms of chronic pyelonephritis are usually very similar to acute symptoms:

• there is general fatigue, loss of appetite, mood changes;
• dull pain in the lumbar region, which makes itself felt especially in damp weather;
• problems with urination; as the disease progresses, the daily volume of urine excreted decreases;
• dry mouth, change skin(dry and pale skin), puffiness of the face also indicate problems with removing fluid from the body.

The manifestations of pyelonephritis are quite characteristic, and if they appear, you should consult a doctor, since pyelonephritis can be cured most successfully and relatively quickly only if there is no concomitant diseases and with timely contact with a specialist. At the same time, self-medication (especially in the case of pregnancy) is strongly not recommended, since in this way it is hardly possible to treat and cure pyelonephritis successfully - rather, it will only transfer the disease to a more serious stage, as well as cause additional health problems.

Treatment of this disease begins with contacting a nephrologist when the first symptoms or suspicion of the disease appear. It must be remembered that at an early stage the disease is easier and faster to cure; in turn, treatment of chronic pyelonephritis can take several months. In each specific case, the duration of treatment is, of course, individual and determined general condition the patient’s body, concomitant diseases and other factors.

Initial appointment

An initial appointment with a specialist involves taking a medical history (questioning and first examination of the patient), as well as prescribing tests and other diagnostic measures.

Diagnosis of pyelonephritis, both chronic and other types, is currently not particularly difficult and includes:

• urine analysis: for pyelonephritis is mandatory, since the level of protein and leukocytes in the urine allows us to determine the degree of inflammation, and culture determines the presence of bacteria and their type (which largely determines how exactly to treat pyelonephritis in each specific case);
• radiography and urography;
• Ultrasound of the kidneys;
• CT (computed tomography) of the kidneys.

All of the above diagnostic measures are aimed at determining whether one or two kidneys are involved in the inflammatory process, as well as its degree and effect on the kidney: whether the kidney has enlarged or not, whether a purulent process is developing, whether an abscess has formed, etc. In addition, ultrasound and CT scans make it possible to determine the presence of stones and other anatomical changes that can become a trigger for pyelonephritis.

If urine tests and other diagnostics upon treatment confirm the diagnosis of acute or chronic pyelonephritis, treatment will be prescribed by a specialist and aimed at both eliminating unpleasant symptoms and triggering mechanisms of the disease, primarily with medications.

Antibiotics for pyelonephritis are the main way to eliminate infection and relieve inflammation. In this case, antibiotics for pyelonephritis should be taken in full course, without interruption and under the strict supervision of a doctor. The antibiotics themselves are selected taking into account the type of infection that caused the kidney inflammation. During treatment, the set of antibiotics and their doses may change to achieve the best effect.

In addition to antibiotics, the drug regimen for pyelonephritis usually includes other anti-inflammatory and painkillers, as well as diuretics, including those based on medicinal herbs (herbal medicine).

In case of diagnosis urolithiasis(with secondary pyelonephritis) or the transition of the disease to the purulent stage may be recommended surgical intervention, suggesting:

• removal of kidney stones, if this could not be done with medications and physiotherapy and otherwise secondary pyelonephritis cannot be eliminated;
• ureteroplasty and other indicated intervention;
• removal of the kidney: in extreme cases, when it is severely purulent and threatens the patient’s life (very rare).

Among other things, when taking a course for pyelonephritis, the patient must follow the following recommendations:

• strengthen the immune system with medications and other means;
• stick to a diet. A diet for pyelonephritis involves avoiding fatty, heavy foods (including coffee and spices). Also, the diet for pyelonephritis includes increased consumption of vegetables and fruits (primarily diuretics);
• during the period of taking antibiotics, completely abstain from alcohol;
• In the acute form of the disease, bed rest is also prescribed.

Getting rid of pyelonephritis is most often a complex and lengthy process; in some cases, it is possible to achieve only stable remission (exacerbation of chronic pyelonephritis occurs much less frequently), but not complete relief from the disease, which is why they are of particular importance here preventive measures to prevent the development of the disease.

Prevention of pyelonephritis and other kidney diseases involves both general strengthening of the body and special attention to the genitourinary system and includes:

• strengthening the immune system: vitamins, moderate psychophysical exercise and healthy eating with enough fruits and vegetables (hypothermia should also be avoided if possible);
• maintaining personal hygiene rules, including in the intimate area, which helps avoid infection various diseases, including sexually transmitted diseases;
• maintaining the body's water balance by consuming enough liquid;
• If possible, regularly empty the bladder if the urge to urinate occurs;
• when infectious diseases of various kinds are detected, treat them promptly and fully (to the end);
• preventive examinations by specialists (even without symptoms of pyelonephritis): for men - in case of prostatitis, for women - during pregnancy, also if there are other kidney diseases, genitourinary system, diabetes, etc. If symptoms of the disease are detected, it is necessary to consult a doctor in a timely manner in order to recover as quickly as possible and avoid serious complications. The sooner you start treating pyelonephritis, the more successful results you can achieve.

You can make an appointment with a specialist at the Energo Medical Center either by phone or using a special form on the clinic’s website. Take care of your health and do not delay in seeing a doctor.

Pyelonephritis is a nonspecific infectious inflammatory disease of the kidneys that affects the renal parenchyma (mainly interstitial tissue), pelvis and calyces. The outcome of pyelonephritis is usually nephrosclerosis.

Prevalence

The incidence of acute pyelonephritis is 15.7 cases per 100,000 population per year, the prevalence of chronic pyelonephritis is 18 per 1000 population. The incidence of pyelonephritis has 3 age-related peaks associated with gender.

Early childhood (up to 3 years). There is a significant predominance of the disease among girls (8:1).

Active reproductive age (18-35 years), the predominance of women over men remains (on average 7:1).

Elderly and senile age; from the age of 60, the ratio of sick men and women equalizes, and after 70 years, men are more likely to suffer from pyelonephritis, which is associated with the development of hypertrophic and tumor processes of the prostate gland, leading to disruption of urodynamics.

The predominance of morbidity in girls and women in the first two age periods is due to both anatomical physiological characteristics urethra (short, proximity of the genital tract and rectum), and the characteristics of the hormonal status, which changes during pregnancy and leads to dilatation, hypotension and dyskinesia of the urinary tract. The development of such changes is also facilitated by the use of oral contraceptives.

CLASSIFICATIONS

Based on localization, unilateral and bilateral pyelonephritis is distinguished.

Pathogenesis

Routes of infection

There are urogenic and hematogenous routes of infection. At acute pyelonephritis, and also in men the hematogenous route of infection predominates, in chronic pyelonephritis, and also in women - the urogenic route of infection.

Factors contributing to the development of pyelonephritis

Obstruction urinary tract (including during catheterization).

Neurogenic bladder dysfunction(for diabetes, injuries and diseases spinal cord, multiple sclerosis). Urinary retention due to neurogenic dysfunction requires repeated catheterization of the bladder, which is accompanied by an additional risk of infection.

Sexual activity. In young women, bacteria penetrate into bladder Massage of the urethra and contraction of the muscles of the urogenital diaphragm during sexual intercourse contribute.

Pregnancy. Pyelonephritis is found in 3-8% of pregnant women (in 70% - unilateral, more often on the right, in 30% - bilateral). In the first pregnancy, pyelonephritis usually begins in the 4th month of pregnancy, in the second pregnancy - in the 6-7th month. Pyelonephritis in pregnant women develops due to decreased tone and peristalsis of the ureters and functional insufficiency of the vesicoureteral valves. There is a change in the hemodynamics of the kidney: the cortical renal blood flow decreases, phlebostasis develops in the medullary zone. Compression of the ureters by the enlarged uterus also plays a role, especially with an anatomically narrow pelvis, polyhydramnios, and a large fetus.

According to the nature of the flow: acute and chronic pyelonephritis. Chronic pyelonephritis in last years considered as chronic tubulointerstitial nephritis of bacterial origin (see Chapter 35 “Tubulointerstitial nephritis”).

By form: obstructive and non-obstructive pyelonephritis.

ETIOLOGY

Infectious agents: gram-negative coliform bacteria Escherichia coli (75%), Proteus mirabilis (10-15%), species Enterococcus, Enterobacter. Species found less frequently Klebsiella, Staphylococcus, and Candida albicans. Discussing the role Ureaplasma urealyticum, Mycoplasma hominis.

If pyelonephritis is a variant of a hospital infection, the pathogens most often found are Escherichia coli, kinds Klebsiella, Proteus, Staphylococcus aureus, Candida. Staphylococcus aureus usually found with purulent kidney lesions due to hematogenous spread of infection.

In 22% of patients, bacterial associations involving Escherichia coli are detected. In 15% of patients, routine urine cultures fail to isolate the pathogen, which does not always indicate remission of the disease, but is associated with the transformation of bacteria into peculiar forms lacking a cell wall (L-form). Under favorable conditions, unstable L-forms can undergo reverse transformation and support the inflammatory process.

Vesicoureteral reflux. It is usually noted in children with anatomical defects of the urinary tract or with recurrent urinary tract infections. In the latter case, it disappears as the child grows up.

Pathogenesis of arterial hypertension in chronic pyelonephritis

Infiltration of the interstitial tissue of the kidneys leads to disruption of intrarenal hemodynamics and increased secretion of renin. Resolution of the inflammatory process contributes to the reverse development of arterial hypertension. At the same time, sclerotic processes in the kidneys, especially in the area of ​​the vascular peduncle (pedunculitis), create the prerequisites for the consolidation of arterial hypertension.

With the onset of spring, all the benches in the parks are occupied. Young people come on a date, older people just bask in the sun. Wonderful time! But as a nephrologist, in the spring I have special reasons to worry about my patients. Sitting on a bench for a long time and the deceptive feeling of warmth pose a threat, especially for women. This threat is pyelonephritis

Pyelonephritis is an infectious and inflammatory kidney disease that primarily affects the renal pelvis, although renal tissue is often involved in the process. Most often one kidney is affected, but with a long course of the disease, the other often becomes inflamed.

This disease is more common in women, due to anatomical and physiological characteristics female body and hormonal changes during pregnancy or menopause. In men, pyelonephritis is most often associated with urolithiasis and prostate adenoma, so it usually occurs in them after 40-50 years.

There are acute and chronic pyelonephritis. Acute disease is characterized by a very rapid onset of the disease, which is usually triggered by hypothermia. Symptoms are high temperature, severe chills and fever, heavy sweating, unilateral aching pain in the lumbar region, increased blood pressure, nausea, increased frequency, and sometimes painful urination.

These symptoms may appear for several hours, and then suddenly disappear, just as they appeared. The person feels normal again and sees no reason to see a doctor, considering his severe malaise to be something accidental.

What makes pyelonephritis so insidious is that, despite external well-being, bacteria continue to multiply in the kidneys and the disease becomes chronic. With chronic pyelonephritis, relapses periodically occur - exacerbations with symptoms similar to the acute course, and if the disease is not treated, then after a few years the inflammatory process begins in the other kidney. Over time, the kidneys become sclerotic and decrease in size - renal failure occurs, in which the kidneys are no longer able to fully remove toxins. The body is poisoned by decay products, in particular urea.

Such a sad course of the disease can be avoided if treatment is started on time, after the first attack. Reliable signs the occurrence of an inflammatory process in the kidneys - the appearance of a small amount of protein in the urine and an increase in the number of leukocytes (more than 20 in the field of view). In this case, it is necessary to do a special urine test - culture to identify bacteria in order to detect the specific causative agent of the disease and select a drug that can destroy it.

The most common causative agents of pyelonephritis are bacteria of the intestinal group - Escherichia coli, enterococci, Proteus, Klebsiella, and less commonly it is caused by streptococci. IN Lately Cases have become more frequent when staphylococcus becomes the causative agent of various urinary infections.

Among the risk factors, in addition to hypothermia, the most significant are the already mentioned urolithiasis and prostate adenoma, as well as diabetes (glucose in the urine is a good breeding ground for bacteria), chronic intestinal infections, injuries and constipation. Infectious diseases(sore throat, acute respiratory infections, flu) can also cause inflammation of the kidneys - bacteria are carried there with the blood.

Knowing the risk factors for pyelonephritis, you can take preventive measures. First of all, it is necessary to get rid of all foci of infection in a timely manner to prevent it from spreading to the kidneys. We must beware of hypothermia, especially in the off-season, when it is possible sharp drop temperatures Finally, it is very important to strictly observe the rules of personal hygiene: every morning and evening, wash the external genitalia (especially for women) and the anus after defecation, as is customary among mountaineers and Muslims.

Treatment of chronic pyelonephritis is conventionally divided into two stages - relief of exacerbation (practically it does not differ from the treatment of acute pyelonephritis) and anti-relapse (preventive) therapy.

The causative agents of pyelonephritis are located in the kidneys, and only a doctor, depending on the nature of the bacteria and their sensitivity to medicines can prescribe to the patient effective treatment. In case of exacerbation, antibiotics are usually selected, most often semi-synthetic penicillins (ampicillin, ampiox, oxacillin), which actively affect E. coli - main reason (80 %) acute infections urinary system. Nitrofurans - furadonin, furagin - have an effect close to antibiotics. In addition, the doctor’s arsenal includes Nevigramon, Negram, 5-NOK - these drugs have a moderate therapeutic effect, they are usually used at the end of the course of treatment or to prevent exacerbations.

The duration of treatment may vary, depending on the course of the disease and individual characteristics sick. But usually, after eliminating the symptoms (this takes 7-14 days), preventive therapy is carried out: 2- or 3-month intake of nitrofurans, nevigramon, 5-NOK and mandatory herbal medicine. For patients over 65 years of age, the duration of antibacterial therapy should be minimal - approximately 5 days, the dose of medication should be half.

If you have pyelonephritis, you cannot do without herbal medicine. During the period when the process subsides, herbal medicine has a pronounced anti-inflammatory and preventive effect.

The main advantage of medicinal plants is that they simultaneously have antimicrobial, anti-inflammatory and diuretic properties. This is especially valuable for chronic processes in the kidneys and urinary tract. The leaves and fruits of lingonberries, cranberry fruits, elderberry flowers and roots, juniper fruits, calendula flowers, tansy and chamomile, lilac flowers and leaves, birch and sage leaves, horsetail grass, cornflower flowers have the greatest antibacterial and anti-inflammatory activity.

During the first year of the disease, in order to prevent its transition to chronic form, I recommend using herbal treatments continuously, changing them every two to three months. Now pharmacies sell good herbal mixtures - for example, Uroflux. It includes willow bark, birch leaves, bearberry, horsetail grass, roots of rudbeckia, licorice, steelweed and some other herbs. The collection is infused and drunk 3-5 cups per day. Kidney tea has long been known to patients and is effective.

In acute pyelonephritis and during exacerbation of a chronic disease, it is recommended to take infusions of herbs with anti-inflammatory and antimicrobial effects. You can make the following collection: blue cornflower flowers, speedwell grass, lingonberry, nettle and coltsfoot leaves (all in equal parts). Pour 10 g of powdered collection into a thermos, pour 0.5 liters of boiling water, leave for 8-10 hours, strain and take half a glass 4 times a day 20 minutes after meals.

The following collection is also good: fruits of anise and red rowan, leaves of lingonberry, lovage, knotweed grass, St. John's wort, motherwort, leaves of lovage, tricolor violet, oat straw. Prepare and take as the previous collection.

Between taking herbal infusions, you can drink infusions and decoctions of individual plants with anti-inflammatory properties. For example, a decoction of lingonberry leaves: pour 50 g of leaves with a liter of water, bring to a boil and keep in a water bath for 10 minutes. Take a warm glass 3 times a day 30 minutes before meals.

Or a steam of blue cornflower flowers: pour 10 g into 0.5 liters of boiling water, leave in a thermos for 20 minutes. Take half a glass 3-4 times a day before meals.

Or a decoction of birch leaves: pour 40 g into a liter of water, bring to a boil and keep in a water bath for 20 minutes. Take 1 glass warm 3 times a day before meals.

Medicinal plants are a powerful force in the fight against disease, but along with substances that have a therapeutic effect, they may also contain those that are undesirable for the patient. Therefore, I often prescribe to patients not infusions or decoctions, but special kvass prepared from herbs or infusions. The fact is that during the fermentation process, lactic acid bacteria process these unwanted compounds.

Preparing kvass is not difficult. Half a glass of any medicinal herb or herbal collection placed in a three-layer gauze bag with a weight and lowered to the bottom of a three-liter jar. Then add 0.5-1 glass of sugar, one tablespoon of loose (village) sour cream and pour filtered cooled boiled water. The jar must be covered with gauze folded in three layers and secured with an elastic band. Instead of water, it is good to use whey.

The jar is placed in a dark place, and after two weeks the kvass is ready. It is taken 0.5 cups 3 times a day 20 minutes before meals. After drinking 2-3 glasses from the jar, you should add the same amount of water with a spoonful of sugar, but there is no need to re-add sour cream. You can add water in this way for three months. After three months, a new kvass is prepared with different herbs.

In addition, during the treatment of chronic pyelonephritis, I recommend drugs and herbs that stimulate and regulate the work immune system organism: flowers, roots and leaves of dandelion, chamomile leaves, pharmaceutical tinctures of ginseng root, Chinese magnolia vine, eleutherococcus, etc.

Nutrition for chronic pyelonephritis is normal - natural products with restrictions on smoked meats, sausages and confectionery products. Drinking liquids in acute period illness should be increased to 2 liters per day, natural juices are very useful.

It should be borne in mind that antibiotics and other drugs do not have the best effect on the intestinal flora, killing beneficial bacteria and promoting the proliferation of putrefactive microbes. Therefore, it is necessary to include kefir and biokefir daily in the diet (at least 0.5 liters per day), foods rich in fiber (vegetables, whole grain cereals) and vitamins, especially group B (there are many of them in buckwheat, millet, oats). It is very useful to eat sprouts of wheat and rye grains (two tablespoons are enough). In extreme cases, sprouts can be replaced with pharmaceutical brewer's yeast.

For patients with chronic pyelonephritis with sufficient renal function and without severe arterial hypertension (BP not higher than 170/100 mm Hg), without exacerbation, it is useful to undergo Spa treatment(Krainka, Morshin, Zheleznovodsk, Truskavets, Southern coast of Crimea).

In the treatment of pyelonephritis, the main thing is that the acute process does not recur and the disease does not take a chronic course. In case of chronic pyelonephritis, preventive measures should be taken so as not to cause an exacerbation of the disease: treatment of foci of infection, periodic courses of herbal medicine.

And, of course, you need to remember about the danger of hypothermia, especially in the spring.

Those who are completely healthy and are ready to sit on a park bench for hours under the rays of the changing spring sun should not forget about this. The air has not yet warmed up, and as soon as the sun disappears into the clouds, the temperature will drop. A cooled bench will take away any remaining heat from you. Therefore, when going on a date in the spring, dear girls, wear not the shortest skirt, but one from under which warm (even thin, but woolen) panties will not peek out. For young mothers who take their children out to play in the sandbox in the spring, I advise them not to take off their leggings or trousers until it gets really warm. And I strongly recommend that older people take a mat with them to the park, which could be conveniently placed on a bench.

If these conditions are met, pyelonephritis, as well as inflammation of the appendages and bladder, will not threaten you.

Nina Samokhina, nephrologist

Chronic pyelonephritis is an inflammatory disease of the pyelocaliceal structure of the kidneys, resulting from an untreated acute process. Among all renal pathologies, the share of this disease reaches 15%. It is logical to assume that there should be fewer cases of chronic pyelonephritis than acute forms. In fact, it turns out the opposite.

Either this is due to low access to medical care, or a rapid transition directly into a chronic course (primarily chronic) is possible. The problem does not have the support of all researchers, but is being actively studied.

What causes chronic kidney inflammation?

In the development of long-term inflammation, infection always plays a decisive role. But a chronic process in the kidneys requires additional negative conditions:

• obstructed outflow of urine or disruption of its movement;
• decrease in the body's defenses (immunity).

Role of infection

The most common infectious agents are microorganisms that live in the intestines of healthy person. These include bacteria:

• enterococci,
• coli,
• klebsiella,
• Proteus,
• Staphylococcus aureus,
• Pseudomonas aeruginosa.

For chronic pyelonephritis in children, sources of infection from old foci of tonsillitis, dental caries, and constantly inflamed adenoids are important. In adults, chronic lesions are hidden in the genitals (adnexitis in women, prostatitis in men), paranasal sinuses, intestines, and gall bladder.

Much less common causes of inflammation are:

• viruses (including herpes, adenoviruses, parainfluenza viruses, enteroviruses);
• mushrooms of the genus Candida,
• mycoplasma,
• chlamydia.

E. coli causes almost half of cases of kidney inflammation. The microbe has particularly infectious properties in the form of specific O- and K-antigens to the renal epithelium.

Intestinal bacteria cling to the villi and move throughout the urinary system, causing chronic pyelonephritis

Klebsiella also contains K-antigen and produces toxins that can damage the smooth muscles of the urinary organs, causing paralysis and disruption of urine flow.

Proteus acts by changing the acidity of urine. It can break down urea into ammonia, thereby increasing alkalization and damage to the epithelium. Usually accompanies malformations of the urinary organs and general dysbacteriosis.

Pseudomonas aeruginosa has a capsule form, which phagocytes cannot destroy.

Staphylococci also inhibit local defensive reaction, accumulate in urine. Such microorganisms are called uropathogenic because they have specific properties of destruction and survival and are able to resist phagocytosis, the action of interferon, compliment, and lysozyme.

The meaning of impaired urine flow

Microorganisms enter the kidney:

• through vessels with blood (hematogenous route) from distant foci;
• By lymphatic vessels from neighboring organs and lymph nodes (lymphogenous), most often from the intestines and genitals;
• against the flow of urine through the epithelium of the urinary tract from the urethra, bladder, ureters (urinogenic).

The most favorable conditions for the proliferation of bacteria are created during dysbacteriosis. Pathogenic microorganisms begin to actively multiply.

Once in the blood and lymph, they are unevenly introduced into one kidney or both, so the process can be one-sided or two-sided.

Most in a simple way penetration of infection into the kidneys is considered urinogenic

Partial paralysis of the smooth muscles of the urinary tract leads to stagnation of urine and high blood pressure in the renal pelvis and ureters. This phenomenon forms a mechanism of reflux or reflux of urine against its normal direction.

There are 3 types of reflux:

• pelvic-renal,
• ureteropelvic,
• vesicoureteral.

The latter has highest value in kidney infection. Thanks to it, the infection enters from the lower tract into the pelvis, calyces and interstitial tissue. Diagnosis of pyelonephritis associated with reflux is important in proper organization patient treatment.

Urologists consider reflux not only as a mechanism for the development of pyelonephritis, but also as an independent disease

Chronic pyelonephritis in children occurs due to hereditary changes in metabolism, renal tissue (tubulopathy), and underdevelopment of necessary renal structures.

Why does an acute process become chronic?

The causes of chronic pyelonephritis can be considered:

• untimely diagnosis and treatment of diseases that impair the outflow of urine (urolithiasis, nephroptosis, vesicoureteral reflux, congenital anomalies narrowing of the urinary tract, prostate adenoma);
• poor quality treatment acute form pyelonephritis, failure of the patient to comply with the doctor’s clinical recommendations, failure dispensary observation for a child or adult;
• the ability of some pathogens to form L-forms, which can remain in the kidney tissue for a long time in an inactive state, but cause an exacerbation when the defenses are reduced or in immunodeficiency states;
• the presence of concomitant chronic diseases that undermine the body’s immunity, or are constant foci of infection (obesity, diabetes, sinusitis, tonsillitis, diseases of the gallbladder, intestines, pancreas).

There is no standard risk group for chronic pyelonephritis, but practitioners believe that the infection is most dangerous for:

• children under three years of age, mostly bottle-fed;
• girls during the onset of sexual activity;
• pregnant women;
• elderly people.

Prevention of chronic pyelonephritis is most indicated for these patients.

Mechanism of disease development

Inflammation begins in the pelvis, then moves to the calyces and interstitial tissue with the renal tubules. First they infiltrate, swell and undergo atrophy distal sections, then the proximal ones are affected. The renal parenchyma is replaced by scar tissue.

Changes in the glomeruli form only at the late, severe stage of the disease. First, endarteritis develops in the vessels with the growth of the middle layer. Then the arterioles become sclerotic. The filtration function of the kidneys is impaired. Renal blood flow decreases and, as a result, increases arterial pressure.

Characteristic anatomical and morphological changes

When there is inflammation in one kidney, it differs from a healthy one in being much smaller in size due to multiple scars and adhesions. The mass of the affected organ reaches 40–60 g. The surface is covered with large dense bumps. Fibrous capsule thickened

The calyces and pelvis in chronic pyelonephritis do not have dilated cavities with thickened walls and sclerotic mucosa

Foci of healthy tissue and a surrounding zone of infiltration and scarring are visible. Inflammation has a different duration, determined by relapses.

The process of damage to the glomeruli and tubules is slow. The kidneys first lose the ability to concentrate urine, so tests determine a low specific gravity. The outcome is more favorable compared to chronic glomerulonephritis, which is accompanied by damage to the glomeruli with initial stage diseases.

The inflammatory process goes through 3 stages of development:

• Stage I - leukocytes infiltrate the medulla, causing tubular atrophy, but the glomeruli are not affected.
• Stage II - cicatricial and sclerotic changes in the interstitium and tubules increase, the distal parts of the nephrons die, and the collecting ducts are compressed. Due to the expansion of the cortical sections of the tubules and the overflow of protein masses, the structure begins to resemble tissue thyroid gland. Develops around the glomeruli fibrous tissue, which causes their desolation. The vessels are narrowed or completely closed.
• III final stage- almost all of the kidney tissue is replaced by scar tissue, the organ has the appearance of a wrinkled kidney.

Existing classifications

There is no unified classification of chronic pyelonephritis. IN different countries urologists use their practical recommendations. According to ICD-10, the disease code accepted for statistical registration is N11. The types and names of forms of chronic pyelonephritis are determined by their connection with various factors.

Depending on the presence of predisposing diseases and the causes of organic kidney damage, the following are distinguished:

• primary chronic form - no causes have been identified, inflammation develops earlier healthy kidneys, often has a bilateral nature;
• secondary chronic pyelonephritis - the disease is a complication or negative consequence existing pathology of the urinary tract, at first it is unilateral in nature, then damage to the second kidney is added.

• out-of-hospital;
• intrahospital - at the onset of the disease after two days of hospital stay.

This attitude is important for the organization of treatment, since nosocomial pathogens are highly resistant to antibiotics. In addition, identifying hospital-acquired infections allows us to identify shortcomings in the organization. nursing process patient services.

Depending on the location of the inflammation and the coverage of the kidneys, there are:

• one-way process;
• bilateral (observed more often).

The clinical course suggests differences in the periods of exacerbation and remission:

• inflammation is considered latent (50–60% of cases of chronic pyelonephritis) in the absence of typical symptoms, but abnormalities are detected in tests; manifestations such as increased weakness, chilling, and a slight increase in temperature in the evening are possible;
• active inflammation must be confirmed by symptoms of pyelonephritis and laboratory indicators;
• The remission stage is determined by the normalization of well-being and the elimination of pathology after treatment.

In the absence of exacerbations for five years, recovery can be judged, and the diagnosis of chronic pyelonephritis is removed.

Depending on the severity of the disease, pyelonephritis is distinguished:

• uncomplicated;
• complicated - includes all cases of the disease occurring against the background of other renal and non-renal pathologies, which arose after urological procedures and manipulations (cystoscopy, bladder catheterization), particular importance is attached to the presence of immunodeficiency conditions (HIV, diabetes mellitus).

Chronic pyelonephritis with renal failure is taken into account separately.

Practice shows that the most often complicated forms are identified in men.

Depending on the extrarenal disorders, the following forms are distinguished:

• with secondary reno-parenchymal hypertension;
• with anemia.

The nature morphological changes variants of the disease with:

• minimal damage;
• interstitial-cellular nature of inflammation:
• infiltrative course;
• sclerosing stage;
• interstitial-tubular lesion;
• interstitial-vascular variant of vascular changes;
• mixed character;
• sclerosis and wrinkled kidney.

Depending on the connection with reflux and the ways in which the infection likely enters the kidneys, it is customary to distinguish:

• non-obstructive pyelonephritis- occurs against the background of previously unidentified and unresolved reflux of urine from the underlying urinary level;
• obstructive - occurs after a postponed and missed acute illness, against the background of other renal pathology, symptoms of severe concomitant diseases, while impaired urine passage also occurs, but its origin is secondary.

Symptoms and clinical course

The clinical picture of chronic pyelonephritis depends on:

• stages and forms of inflammation;
• damage to one or both kidneys;
• existing obstruction to the outflow of urine;
• concomitant diseases;
• effectiveness of previous treatment.

Often chronic pyelonephritis begins in childhood with acute attacks that go unnoticed during other infectious lesions (sore throat, influenza, pneumonia, otitis media, enterocolitis). Such masking diseases simultaneously affect the kidneys. Girls are more prone to them.

With the latent course of pyelonephritis, the pain is not constant

If therapy is not sustained or prescribed incorrectly, the child develops chronic pyelonephritis and proceeds in waves: the active phase is replaced by remission.

With a latent course, there are no symptoms. Signs of kidney damage in the primary disease are less pronounced. Patients retrospectively recall:

• intermittent mild pain in the lower back;
• rare pain when urinating;
• sometimes a slight increase in temperature.

Each new exacerbation manifests itself as acute pyelonephritis. The most typical symptoms are:

• increase in body temperature up to 39 degrees;
• lower back pain on one or both sides;
• pain when urinating;
• increased urge to urinate;
• headache;
• general weakness;
• Children often experience vomiting, nausea, and abdominal pain.

A medical examination shows:

• swelling of the eyelids, puffiness of the face;
• pallor;
• pain when tapping on the lower back.

A long period of illness leads to the occurrence in patients of:

• severe fatigue;
• reduced ability to work;
• losing weight;
• poor appetite;
• drowsiness;
• headaches;
• dry with a grayish skin tone;
• permanent swelling of the eyelids.

Appears arterial hypertension, which is persistent and differs from true hypertension by an increase in diastolic pressure.

Severe swelling is not typical for chronic pyelonephritis. In later stages, polyuria occurs ( copious discharge urine).

The diagnosis is made based on the study of symptoms and clinical signs in laboratory diagnostics.

Meaning:

• in the blood test: leukocytosis, acceleration of ESR, decrease in protein, increase in nitrogenous waste, decrease in potassium, sodium and chlorine;
• in urine: a large number of leukocytes, bacteria, low specific gravity, appearance of protein;
• in order to study the concentration ability of the kidneys, a Zimnitsky test is performed;
• the Nechiporenko and Addis-Kakovsky test is used to judge the severity of bacterial damage to the kidneys.

Microscopic examination of urine sediment reveals large white salt crystals and rod-shaped bacteria, which may be the cause. chronic course pyelonephritis

• Ultrasound, which allows to identify the size of the kidneys and their structures, the presence of additional organic lesions, anomalies;
• Contrast X-ray examination to study the paths of urine outflow, identify shadows of stones, and variants of reflux.

IN difficult cases resort to puncture biopsy of the kidneys with a detailed analysis of the histological structure.

Treatment

Treatment of chronic pyelonephritis during exacerbation is carried out in a hospital. Patients are referred depending on the cause of inflammation:

• for primary pyelonephritis - to the therapeutic department;
• in case of secondary - to urological.

Surgery may be necessary to eliminate reflux and obstruction of the urinary tract.

The treatment plan is developed individually.

It must include:

• bed rest;
• dietary requirements;
• antibacterial and anti-inflammatory drugs;
• compensation for losses of protein and electrolytes;
• restoration of immunity to independently fight infection;
• vitamin therapy.

Diet features

Patients with chronic kidney inflammation are prescribed a diet with a sufficient content of energy and plastic materials, vitamins. Most shown:

• vegetable dishes (from potatoes, cabbage, carrots, beets);
• fresh fruits and juices (apples, figs, apricots);
• milk, cottage cheese, kefir;
• eggs;
• lean meat and fish.

Fruits and vegetables contain sufficient amounts of vitamins and help to cope with the disease faster

Contraindications concern:

• hot seasonings;
• fatty foods;
• rich broths;
• strong coffee;
• alcohol.

The absence of edema allows you to drink enough juices, compotes, fruit drinks, herbal decoctions, and mineral water. The doctor will warn you about fluid restriction if the patient has high blood pressure or has difficulty urinating. At the same time, they are strict about salt consumption.

For the purpose of a diuretic effect, the following is prescribed:

• watermelon,
• melon,
• pumpkin

They flush out infection from the urinary tract.

Of the antibacterial drugs, the most significant are:

• antibiotics after determining the sensitivity of the flora;
• nitrofuran group;
• sulfonamides.

Antibiotics have to be changed and combined. The total duration of anti-inflammatory treatment is up to 8 weeks.

We can speak about the effectiveness of the treatment applied if the temperature has returned to normal, pain and dysuria have disappeared, and there is no pathology in blood and urine tests.

With such long-term treatment have a good supporting and bacteriostatic effect medicinal herbs. Urologists recommend preparing and taking long-term decoctions from:

• cranberries,
• rosehip,
• horsetail,
• juniper berries,
• birch and lingonberry leaves,
• celandine stems.

Juniper berries are a natural phytoncide that help destroy pathogenic microorganisms

At long courses antibiotics, antifungal drugs and vitamins are necessarily prescribed.

Renal pressure is treated by selecting antihypertensive drugs.

For anemia, the following are indicated:

• vitamin B 12,
• folic acid,
• hormonal anabolics,
• in severe cases - red blood cell transfusion.

In case of secondary pyelonephritis with impaired urine passage, treatment is futile without surgery to remove:

• stones (urolithiasis);
• prostate adenoma, compressing the urethra;
• bladder tumors.

Sanatorium-resort treatment is most indicated taking into account natural sources of mineral waters. Before traveling, you should consult your doctor.

Prevention

To prevent chronic pyelonephritis, it is necessary to monitor the cure of the acute form of the disease. In order not to miss and adequately treat patients, it is necessary:

• parents and pediatricians monitor the child’s urine and blood tests after childhood infections or colds;
• girls and women should especially carefully monitor the condition of the intestines and genitals, check urine tests after suffering from sore throats and flu;
• persons of any gender are required to sanitize their teeth, nasopharynx, maxillary sinuses, biliary tract, they can provoke the spread of infection to the kidneys;
• It is important for men to undergo examination with rectal palpation of the prostate gland, early stages Prostatitis and adenoma are treated with medications.

You should always remember that today's girl will soon grow up and want to give birth to healthy offspring. .

People of working age may need employment. It is necessary to visit a doctor after an exacerbation at least twice a year. In this case, you should undergo all control tests (blood, urine, according to Zimnitsky and Nechiporenko, protein fractions) if necessary - ultrasound and x-ray examination.

Signs of renal failure and high blood pressure require checking the fundus and monitoring the accumulation of nitrogenous substances (creatinine, residual nitrogen, urea).

Persistent hypertension is dangerous due to its complications (stroke, myocardial infarction). Therefore, the patient has to constantly take antihypertensive drugs.

Attitude towards military service

Conscripts and their parents are concerned about the question: are young people with chronic pyelonephritis accepted into the army? If there are indications in medical documents about acute or chronic pyelonephritis, the conscript is sent for examination to a specialized urological department. Here, the excretory and other functions of the kidneys, the duration of bacteriuria in the urine, ultrasound and x-ray examination. If necessary, a course of treatment is carried out.

Depending on the results of discharge, the young man may be recognized by the medical commission as:

• exempt from conscription;
• limited fit;
• fit for military service.

Chronic pyelonephritis differs from other diseases in its latent course, so patients do not consult a doctor for a long time. You can prevent it only by monitoring your health and protecting yourself from any infection.

Acute pyelonephritis is a nonspecific infectious inflammation collecting system and renal parenchyma. Acute pyelonephritis is more often observed in women.

The main routes of infection into the kidney:

• ascending - from foci of chronic inflammation of the female genital organs, lower urinary tract, colon;
• hematogenous - from foci of inflammation of distant organs (mastitis, tonsillitis, boil or carbuncle, etc.).

The cause of the development of acute pyelonephritis is disturbances in hemodynamics or urodynamics in the kidney or upper urinary tract. Depending on the passage of urine through the upper urinary tract, i.e. from the kidney to the pelvis and further along the ureter, a distinction is made between non-obstructive acute pyelonephritis (if it is preserved) and obstructive (if it is disrupted). Obstructive acute pyelonephritis occurs due to blockage of the ureter with a stone, products of chronic inflammation of the kidney, with external compression - retroperitoneal fibrosis, tumor, enlarged The lymph nodes etc.

Symptoms of acute pyelonephritis

• Pain in the lower back (side) on the side of the affected kidney.
• Pain in the lumbar region during urination.
• Gradually increasing or acute pain in the lower back on the affected side (with obstructive pyelonephritis).
• Increased body temperature (38-39 °C and above).
• Chills.
• Nausea and vomiting.
• Severe general weakness, fatigue.

Complications of obstructive acute pyelonephritis:

• Severe impairment of renal function.
• Bacteriotoxic shock.
• Urosepsis.
• Toxic hepatitis.
• Paranephritis.
• Pyonephrosis.

Diagnosis of acute pyelonephritis

1. General urine analysis: leukocyturia, but in obstructive acute pyelonephritis it may be absent, since urine from the affected kidney does not enter the bladder.
2. General blood test: leukocytosis, shift of the leukocyte blood count to the left (the number of band neutrophils is 20% or higher).
3. Biochemical analysis blood: increased levels of urea and creatinine.
4. Bacteriological culture of urine (performed before antibacterial therapy): allows you to isolate the causative agent of the disease and determine its sensitivity to antibacterial drugs.
5. To clarify the form of acute pyelonephritis, the following is additionally carried out:
   • Ultrasound of the kidneys and bladder;
   • excretory urography;
   • computed tomography;
   • magnetic resonance imaging.

Treatment of acute pyelonephritis

Treatment begins with dietary measures:

• Increasing the amount of fluid consumed to 2 liters per day for people over 16 years old, up to 1.5 liters for children 8-16 years old, up to 1 liter for children 1-8 years old.
• Refusal of fried, rich, baked, fatty, spicy and very salty foods, fresh bread, other baked products.
• Reducing consumption table salt up to 5 g per day or less.
• Refusal from strong meat broths and foods that cause strong taste sensations.

Therapeutic measures:

1. Normalization of urine passage from the kidney:
   • installation of a ureteral catheter or stent;
   • installation of a catheter in the bladder if vesicoureteral reflux is suspected (lower back pain during urination);
   • nephrostomia.
2. Antibacterial therapy depends on the severity of the disease:
   • mild - oral drugs from the fluoroquinolone group;
   • moderate and severe - parenteral aminoglycosides in combination with or without ampicillin, fluoroquinolones, third and fourth generation cephalosporins in combination with or without aminoglycosides.
3. Surgical treatment shown when:
   • ineffectiveness of antibacterial therapy within 3 days;
   • severe course of the disease;
   • purulent pyelonephritis.
4. Detoxification therapy.

Essential drugs

There are contraindications. Specialist consultation is required.

• (antibacterial drug group of fluoroquinolones). Dosage regimen: for mild acute pyelonephritis, 500-750 mg orally 2 times a day. The duration of treatment depends on the severity of the disease, but treatment should always continue for at least two more days after the symptoms of the disease have disappeared. Usually the duration of treatment is 7-10 days.
• (an antibacterial drug from the fluoroquinolone group). Dosage regimen: for mild acute pyelonephritis, 250-500 mg orally 1 time/day. The duration of treatment depends on the severity of the disease, but treatment should always continue for at least two more days after the symptoms of the disease have disappeared. Usually the duration of treatment is 7-10 days. Or 750 mg 1 time/day. for 5 days.
• (third generation cephalosporin). Dosage regimen: for moderate to severe acute pyelonephritis for adults and children over 12 years of age, the average dose of Cefotaxime is 2 g intramuscularly every 12 hours. The duration of treatment depends on the severity of the disease, but treatment should always continue for at least two more days after disappearance of symptoms of the disease.
• (IV generation cephalosporin). Dosage regimen: for moderate to severe acute pyelonephritis for adults, the average dose of Cefepime is 1-2 g intramuscularly every 12 hours. The duration of treatment depends on the severity of the disease, but treatment should always continue for at least two more days after the symptoms of the disease disappear.

• Consult a urologist if you suspect non-obstructive acute pyelonephritis.
• Call an ambulance medical care if obstructive acute pyelonephritis is suspected.
• Do an ultrasound of the kidneys and bladder.
• Pass general analysis urine.