Symptoms of pyelonephritis and topical treatments. Pyelonephritis - symptoms of acute and chronic forms, treatment and drugs

Pyelonephritis is a disease in which the parenchyma, or otherwise the kidney, becomes inflamed. In most cases, this condition is triggered by bacteria invading the kidneys, which can reach them through the urethra, bladder, or blood vessels.

Important for successful treatment pyelonephritis is early diagnosis and adequate treatment. If the problem is neglected, a kidney infection may be necessary condition for permanent damage or uncontrolled spread of bacteria in the blood and dangerous sepsis, even life threatening.

According to the method of flow, pyelonephritis is divided into:

acute pyelonephritis - the period of the disease up to 3 months;
chronic pyelonephritis - in patients with pyelonephritis, the infection is active for more than 3 months. There are signs of exacerbation and lull symptoms. What is typical in this case is that it is always the same cause;
recurrent pyelonephritis - in this form there are acute infections, the basis of which is another pathogen.

Chronic pyelonephritis

The frequency of chronic pyelonephritis is higher than in other forms. The disease itself is an inflammation of the kidney tissue that results from urinary tract obstruction or urinary reflux.

In many patients, it first appeared in childhood. Lack of adequate treatment is a prerequisite for the disease to become chronic. At a late stage of the disease, an infected kidney significantly reduces its size, changes the color and surface of the organ, and the kidneys are severely deformed.

When recognizing chronic pyelonephritis, attention should be paid to a number of individual symptoms. Their diversity is due various factors, predisposing factors and features of the organism itself.

To determine with certainty that this is a chronic form of the disease, it is noted that periods acute manifestation states alternate with moments of calm of symptoms. In matters of crisis, the patient complains of general fatigue, problems with urination, and pain in the waist area.

If no attention is paid to the condition, it is difficult for the infected kidney to function in the end stage of chronic pyelonephritis, which leads to kidney failure.

Causes of pyelonephritis

Most infections that affect the kidneys begin first in the lower urinary tract, in the urethra or bladder. Gradually, with reproduction, the bacteria rise up the urethra and reach the kidney. Among the most common causes of the disease is a bacterium Escherichia coli. Rarely - pathogens such as Proteus, Pseudomonas, Enterococcus, Stafilococ, Chlamydia and others.

Another possible scenario is the presence of an infection in the body, which reaches the kidney through the bloodstream and becomes a necessary condition for pyelonephritis. This happens relatively rarely, but the danger increases if the body has foreign body. heart valve, an artificial joint or another infected person is taken as such.

In rare cases, pyelonephritis develops after kidney surgery.

Risk factors for pyelonephritis

Considering the most common causes of kidney infection, one can also determine following groups risk factors:

Gender - Women are thought to be at greater risk of kidney infection than men. The reason lies in the anatomy excretory system at a woman. A woman's own urethra is much shorter than a man's, making it much easier for bacteria to move out of the external environment into the bladder. One more thing - the anatomical proximity of the urethra, vagina and anus also creates conditions for more mild infection Bladder and, therefore, for bacteria to enter the kidneys;
urination problems - obstruction of the urinary tract and all other problems that interfere with normal urination and prevent complete emptying of the bladder can lead to inflammation of the kidney tissue. This group of factors includes anomalies in the structure urinary tract, kidney stones, increase prostate in men and others;
weakened immune system - some diseases are considered a prerequisite for the development of pyelonephritis. Diabetes, HIV infection and others are similar. The target factor is also the deliberate weakening immune system for example, by taking medication after organ transplantation;
damaged nerves are irregularly functioning nerves around the bladder or spinal cord blocking the symptoms that accompany a bladder infection. Thus, the body does not respond to inflammation, which is easily transferred to the kidneys;
catheter - extended use of a catheter is a prerequisite for urinary tract infections;
vesicourethral reflux - last but not least, the risk factor is the so-called vesicourethral reflux, in which not a large number of urine returns from the bladder towards the urethra and kidneys.

Symptoms of pyelonephritis

Pain is often present in pyelonephritis!

If you have a bladder infection and have not received adequate treatment, expect some of the characteristic features inflammation of the parenchyma in the kidneys in the near future. Among the most common symptoms of the disease are the following:

fever body;
tingling pain in the back, waist, on one side of the body, or in the groin;
severe pain in the abdomen;
frequent, strong and uncontrollable urination urgency;
pain, burning and other complaints during urination;
blood or pus in the urine.

The symptoms listed above should be treated with due care. If adequate measures are not taken and timely treatment does not exist, there may be a number of complications, including:

renal failure - pyelonephritis may be at the root of chronic renal failure;
blood poisoning - due to the rich blood supply to the kidneys, the spread of bacteria multiplying in them quickly becomes colorless and can lead to complete blood poisoning;
in pregnancy - the main risk during pregnancy of untreated kidney disease is premature birth of an underweight newborn.

Pyelonephritis in a child

Infants and children at an early age have pyelonephritis with mild fever, vomiting. There is complete fatigue and lack of weight. The child indicates pain in the abdomen through anxiety.

If it's very Small child, kidney infection can also occur with weight loss, unreasonable excitement, seizures, darkening of the complexion or skin coloration in a white or yellow tint, swelling of the abdomen. You must immediately consult a doctor.

In older children, the main symptoms of inflammation of the kidney tissue are pain in the abdomen and waist, frequent urination, burning or pinching during urination. Complaints are supplemented by high fever, alternating constipation with diarrheal stools, lack of appetite, and headaches.

How to determine pyelonephritis

If you've had pain in your waist or groin, if you've got a fever, or if you've had a burning sensation while urinating, you're probably already convinced that you should go to the doctor's office. As soon as the specialist analyzes the symptoms that you have indicated, he will most likely diagnose pyelonephritis. As an accompanying diagnostic method physical examination, urinalysis and others are indicated. Urine itself is examined both microbiologically and under a microscope. The first test detects the presence of bacteria and it is important to combine this with pathogen susceptibility testing. this antibiotic. Under a microscope, a urine sample is monitored for the number of white and red blood cells, as well as for the presence of epithelial cells and squirrel.

Frequent imaging is an abdominal ultrasound. It controls the changes that occur in acute pyelonephritis. It should be borne in mind that the absence of changes in the kidneys does not exclude the presence of a kidney infection in all cases.

As possible methods detection of pyelonephritis are also shown more computed tomography, magnetic resonance imaging and venous urography.

Treatment of pyelonephritis

First of all - when it comes to the treatment of pyelonephritis, antibiotics are recommended. This is no coincidence - it is the antibiotic that can neutralize the harmful bacteria that cause kidney infections.

Usually within a few days of starting antibiotic therapy the general condition of the patient improves. In rare cases, a course of treatment lasting a week or more is required. It is extremely important not to stop taking medications after the symptoms disappear, as this can lead to resistance to other pathogens present in the body.

If the diagnosis is late and the patient's condition is already severe, it may be necessary to treat with intravenous antibiotics.

Surgical intervention for pyelonephritis is also not excluded. This is the case with defects in the structure of the organs of the urinary system, which provoke frequently recurring infections of the kidneys. Surgery is also necessary in case of large kidney abscesses leading to purulent outbreaks.

The main objectives of the treatment of pyelonephritis may be the following:

timely accurate diagnosis and appropriate initiation of treatment;
elimination of predisposing factors, as far as possible;
prescribing antibiotics according to antibiotic results;
simultaneous treatment and relapses in the presence of rabbits;
general strengthening of the body and strengthening of immune defenses.

Antibiotics for pyelonephritis

The most commonly assigned groups are:

aminoglycosides - this group includes amikacin, tobramycin, gentamicin and others;
beta-lactams - amoxicillin, zinaz and others;
quinolones - ciprofloxacin, ofloxacin and others;
macrolides;
polymyxins and others.
ciprofloxacin

Ciprofloxacin

One of the most commonly prescribed antibiotics for urinary tract infections is ciprofloxacin. It belongs to the group of fluoroquinolones, and its action is aimed directly at eliminating the cause of the infection. The data show that a course of treatment with ciprofloxacin for 7 days would be as effective in pyelonephritis as therapy with the same product for 14 days. It is usually taken from 5 to 21 days, and it is up to the doctor to determine the duration of treatment.

Gentamicin

Further, as a commonly prescribed antibiotic for pyelonephritis, gentamicin is mentioned. It should be borne in mind that patients with concomitant disease kidney and hearing impairment should be very careful while taking this medicine.

In severe cases of infection, treatment with gentamicin begins as intravenous therapy, then progresses to muscle injection. The dose is obtained by dissolving in saline.

Amoxicillin

Group penicillin preparations includes amoxicillin, which is also used to treat inflammation of the parenchyma in the kidneys. Recommended daily dose the drug is up to 3000 mg, divided into several receivers. The dose is determined based on the individual condition.

Osmamox and Amoxicl are similar products containing amoxicillin.

Levofloxacin

For the treatment of pyelonephritis, the antibiotic Levofloxacin or a similar product, Tavanic, is also often prescribed. They belong to quinol drugs and act against bacteria, causing infection in the human body.

Tobramycin

An antibiotic of the aminoglycoside group, Tobramycin is also prescribed for kidney infections depending on the results of the antibiotic. It is administered as an injectable solution that destroys the pathogens from which the disease arises.

Other drugs for the treatment of pyelonephritis

We have already mentioned that the main attention in the treatment of pyelonephritis is given to antibiotic therapy.

However, another group of drugs that many consider antibiotics also work for kidney problems. We are talking about chemotherapy drugs. The difference between the two classes of drugs is that while antibiotics are made from living microorganisms, chemotherapeutics are completely synthetic.

The most popular product of this group, which is applicable to pyelonephritis, is Biseptol. It is most often prescribed for acute illness and can be extended. The choice falls on this drug when single-component therapy is ineffective or there is no oral treatment.

Nitrox also belongs to the group of chemotherapeutic agents. It is used to treat kidney disorders, including pyelonephritis, caused by viral or fungal infections. It is also often prescribed to prevent relapse.

Nolicin contains norfloxacin and acts directly on the bacteria that cause kidney inflammation. It can also be used prophylactically.

uro-waxom is a drug commonly used for pyelonephritis. Its action, however, is aimed at increasing the immune capacity of the body and limiting infections of the urinary tract and urinary tract in general. It is used in frequent re-infections and also in antibiotic therapy for higher efficacy.

Homeopathy for pyelonephritis

We will also briefly mention some of the homeopathic products that are used for diseases of the urinary system, especially for kidney infection. As with other homeopathic treatments, it is also important to take the appropriate prescriptions regularly.

Apis- homeopathic product mainly used for urinary retention, but also for pain and discomfort during urination. The effect of therapy is the urgency of urination.

Arnica- its action is aimed at reducing pain during urination.

Berberis- Most often for the treatment of pyelonephritis, it is prescribed together with Calcarea Sulfurica. The combination of drugs is suitable in cases where the intensity of pain increases.

Pyelonephritis is understood as an infectious inflammatory pathology that develops as a result of penetration into the kidneys of pathogenic bacteria from lower divisions urinary system. The disease is accompanied by very pronounced pain and a significant deterioration in the well-being of a person. In the article you will learn everything about what pyelonephritis is, its causes, main signs, symptoms and treatment.

What you need to know about pyelonephritis

It is important to know interesting and important facts about such a common renal pathology.

It affects an average of 1 in 7,000 people. Significant amount of them are forced to undergo specialized therapy.
Acute pyelonephritis occurs much more frequently in women than in men.
The vast majority of patients feel positive changes within 2 days after the start of treatment.
Pyelonephritis can also develop in children. In about 20 percent of cases, this disease in a child can cause heavy changes renal parenchyma.
Significantly improves the human condition ordinary water. Increased urination helps to remove a significant amount of bacteria and toxins from the body.
With pyelonephritis, it is very important to move more, despite the fact that almost every movement causes severe pain in the patient.
A good helper in the fight against pyelonephritis is cranberry juice.

Causes and predisposing factors of development

When ascending path Infection bacteria enter the kidneys through the urethra. This is the most common cause occurrence of pathology. Moreover, pyelonephritis is usually caused by Escherichia coli. They can enter the urethra after a bowel movement. Women are more susceptible to this pathology due to anatomical features: external opening urethra they are located very close to the anus.

Among the causative agents of pathology include:

staphylococci;
Klebsiella;
Proteus;
enterococci;
pseudomonads;
enterobacteria;
pathogenic fungi.

Lymphogenous and hematogenous routes of infection are the most rare. Germs can also spread to the kidneys as a result of improperly performed bladder catheterization.

Acute pyelonephritis can develop in humans as a result of vesiculourethral reflux. This disrupts the normal outflow of urine through the ureters to the urea. The urine is thrown back into renal pelvis which leads to inflammation.

Repeated attacks of pyelonephritis with symptoms of vesiculourethral reflux can lead to severe kidney damage. The most severe complication of the disease in adults is scarring of the organ. It often happens in children.

The likelihood of kidney infection is significantly increased with urolithiasis, when the ureter is clogged with a stone.

Predisposing factors for the development of pyelonephritis:

Classification

In the classification, there are such types and varieties of pyelonephritis:

acute pyelonephritis;
chronic pyelonephritis;
gestational pyelonephritis (occurs during pregnancy);
apostematous pyelonephritis (combined with the presence in the renal parenchyma of a large number of small pustular formations);
purulent pyelonephritis of the kidneys;
obstructive;
non-obstructive;
primary (acts as an independent disease);
secondary (develops against the background of other pathologies);
left-handed or right-handed;
congenital (very rare in a child whose mother had pyelonephritis during pregnancy).

In the photo in the article, you can see different degrees of kidney damage in pyelonephritis.

Symptoms of the disease

One of the earliest signs of a disease in humans is fever and chills. Other common symptoms:

nausea;
vomit;
sweating;
increased fatigue and weakness;
the presence of discharge from the urethra;
the patient has pain in the kidneys on the affected side, in the lower back;
frequent urination (it can be very painful);
swelling;
diarrhea;
increased heart rate;
often the patient develops a feverish state.

Chronic kidney disease is characterized by more mild symptoms. They can persist in humans for a long time. A blood test usually shows no change.

Symptoms of concomitant inflammatory processes of the lower urinary organs are as follows:

very strong and sharp pain during urination;
the appearance of an admixture of blood in urine;
strong and very frequent urge to empty the bladder, which are accompanied by pain and pain;
turbidity and darkening of urine (sometimes it may have a pronounced unpleasant fishy odor);

Change in analyzes for pyelonephritis

With this disease, the patient's analyzes change dramatically. The doctor may note:

a significant increase in the number of leukocytes in the blood;
increase in ESR;
an increase in the number of microorganisms in urine due to a bacterial process;
the presence of blood in the urine (from microhematuria to macrohematuria);
in biochemical analysis, the level of creatinine, potassium and urea significantly increases (an increase in potassium levels indicates the development of renal failure);
ultrasound shows a significant increase in the kidneys and thickening of their parenchyma.

What is dangerous pyelonephritis

The disease is dangerous for its severe consequences and complications. The risk of their development increases significantly during childbearing and with diabetes mellitus. An exacerbation of the disease also occurs with the addition of a viral pathology.

The danger of sepsis

Pyelonephritis may not always respond to adequate therapy. This most often happens due to errors in the diagnosis. The disease can develop into a severe form even before the patient turns to a specialist (the so-called fulminant form of the disease). First aid for sepsis is an emergency call for an ambulance.

Sepsis occurs when bacteria from the kidneys enter the bloodstream. Develops a severe defeat of all shaped elements blood due to an infection in the kidneys. The only way to save the patient is to intensive care provided that it was started early. A significant number of people who got rid of such a disease became disabled.

Emphysematous pyelonephritis

This is a very serious complication of the inflammatory kidney disease that occurs in diabetes mellitus. The progression of the pathology often leads to the fact that the patient may completely lose the organ. The development of pathology is associated with a chronic increase in blood sugar levels and problems in compensating for diabetes mellitus.

The disease begins very sharply. The patient complains of chills, nausea, and vomiting. There are symptoms of peritonitis (they are associated with irritation of the peritoneum). The curved spine is visible on the urogram. A characteristic feature is the accumulation of gas in the perirenal region.

Conservative therapy of the disease is ineffective. Shown surgical intervention with the removal of the kidney. The prognosis for emphysematous pyelonephritis is doubtful: mortality can reach half of all cases.

Abscess

One of the complications of pyelonephritis is a renal abscess. With its development, the patient develops a fever, severe chills, a very frequent and weakly filled pulse, severe headache. The patient is in an immobilized state, often he is struck by euphoria. Severe pain is noted in the region of the kidney. They are especially amplified during palpation of the affected area.

A characteristic symptom of an abscess is the forced position of the patient. He lies on his side, and the leg leads to the stomach. In this way, the pain can be reduced. If you straighten the limb, then there is pain in lumbar region.

Treatment consists of decapsulation of the kidney. With occlusion, drainage is indicated. Extensive purulent necrotic kidney damage is an indication for emergency nephrectomy.

Complications during pregnancy

Bacteriuria can be in about 4 to 7 percent of all pregnant women. About a third of all women diagnosed with bacteriuria during childbearing may develop pyelonephritis. Most often, its symptoms appear in the second trimester.

Complications of this inflammatory kidney disease in pregnant women:

Diagnostics

When diagnosing, the following measures are prescribed:

general blood tests;
general urine analysis;
blood biochemistry;
Ultrasound of the kidneys and urinary tract.

It is possible to diagnose such a disease with the help of a computer or magnetic resonance imaging. Before prescribing antibiotics, a smear test is used.

Principles of treatment

Surgical intervention for pyelonephritis is indicated in cases where it has led to a violation of the urinary outflow, expressed purulent process, sharp drop blood pressure. The same treatment is carried out with contraindications to the use of antibiotics. In other cases, home treatment may be prescribed. As an auxiliary part of therapeutic measures, treatment with folk remedies and methods is used.

Symptomatic treatment must necessarily include:

bed rest;
the use of non-steroidal anti-inflammatory drugs to significantly reduce the intensity pain symptoms and relief of inflammation;
drink.

Important! Adults and children should categorically avoid cold, especially wet. The bladder needs to be emptied regularly.

Antibiotics

The basis of the treatment of pyelonephritis is the use of an antibacterial agent. Medications from the group of fluoroquinolones, cephalosporins are prescribed. Ciprofloxacin is the drug of choice in the treatment of kidney inflammation. Cephalosporins are convenient in that they should be taken no more than twice a day. Ampicillin is prescribed very rarely due to the fact that almost all pathogens renal pathologies become more and more resistant to it. , Vilprafen, Suprax are prescribed if necessary. Amoxiclav, Amoxicillin, Vugmentin are ineffective for getting rid of pyelonephritis. Before starting treatment, it is necessary to determine the degree of resistance of the pathogenic flora.

Ciprofloxacin for the kidneys and genitourinary system can be used in the form of tablets and injections. The most effective treatment regimen is weekly intake Ciprofloxacin (the effectiveness of this treatment is the same as a two-week intake of fluoroquinolones).

If the patient's condition does not improve after three days of treatment with Cifroploxacin, then he is given a tomography of the abdominal cavity. This is necessary to exclude a possible abscess or hydronephrosis. For prevention vascular disorders apply Curantyl.

Children are prescribed therapy with intravenous administration antibiotics. Ceftriaxone, Cefepime, Cefixin are prescribed.

Note! If the disease does not respond conservative therapy, then in urgently the issue of nephrectomy. In any case, such an operation is prescribed for all patients with increasing kidney failure.

Treatment with herbal preparations

Phytotherapy should be carried out only if the patient does not have an allergic reaction to herbs. With pyelonephritis, a large number of herbs have all the properties that are beneficial to the kidneys. Medicine recipes folk ways on the basis of plants are very simple: infusions and decoctions are usually prepared according to the traditional scheme.

bearberry and horsetail can quickly reduce swelling. They are often used as effective diuretic drugs.
Orthosiphon, oats are used for effective elimination spasms of the urinary tract.
Nettle and wild rose are able to reduce the manifestations of bleeding. Such plants are prescribed for the complex treatment of hematuria and the prevention of hematuria developing against its background.
Strawberry leaf, chamomile, plantain help get rid of dyspeptic symptoms.
With pyelonephritis on acute stage it is useful to take combined herbal preparations of uroseptics - such as Monurel, Fitolizin, Cyston.
Ready-made kidney teas prolong remission in chronic pyelonephritis.
With severe pain, painkillers, antispasmodics - No-shpa, etc. are indicated.

Features of the treatment of a chronic disease

Treatment of chronic pyelonephritis is longer and more laborious. Its main principles:

elimination of the causes that caused the violation of the urinal outflow;
appointment antibacterial drugs;
increase in the body's immune response.

To restore the outflow of urine in men, the removal of prostate adenoma is most often prescribed. Women can use urinary drainage. All antibiotics are used taking into account the sensitivity of the organism to antibacterial agents. A continuous course of antibiotic therapy should be continued for at least eight weeks. In CKD, the use of antibiotics should be very careful, as most of them are nephrotoxic.

Spa treatment

The expediency of spa treatment is determined only by a doctor. He also chooses the type of resort depending on the mineral water, the characteristics of the course of the pathology, the susceptibility of the body, etc.

In the conditions of the resort, antibiotic therapy, physiotherapy, a bath, etc. can be prescribed.

Important! During treatment, alcohol is strictly prohibited! Contraindications to sports are available only in the acute period.

At all stages of treatment, a diet is indicated. All fried, salty and pickled foods should be excluded.

Vitamins should be on the menu. Lemons, despite the presence of vitamin C, can be harmful. With urolithiasis, one should adhere to a diet that would not allow the formation of stones.

Prevention

Primary prevention of pyelonephritis consists of:

drinking enough water;
avoiding hypothermia;
timely and adequate treatment of viral pathologies;
support of immunity;
timely emptying of the bladder;
observance of intimate hygiene;
undergoing annual preventive examinations.

As medications prevention shows the use of phytopreparations. Antibacterial drugs are indicated in the presence of infectious processes in the urethra and prostate. Women need timely treatment gynecological pathologies. The use of uroantiseptics, antibacterial and anti-inflammatory drugs is shown.

Secondary prevention includes:

preventive laboratory tests;
the use of bacteriophages and phytopreparations;
prophylactic antibiotics.

During pregnancy, you must follow the basic rules of prevention recommended in the antenatal clinic.

Compliance with all preventive measures helps to eliminate risk factors and prevent the development of pathology. If, nevertheless, it has developed, it is necessary to immediately begin its treatment. It is possible to cure the disease by making great efforts for this.

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Good day, dear readers!

In today's article, we will consider with you such as pyelonephritis, as well as everything connected with it. So…

What is pyelonephritis?

Pyelonephritis – inflammatory disease kidneys, which affects mainly their pyelocaliceal system (calyces, pelvis, tubules and parenchyma of the kidneys, more often its interstitial tissues).

main cause of pyelonephritis- infection of the kidneys with E. coli (Escherichia coli), staphylococci, enterococci and other pathogens, but to a greater extent, still bacteria. It is not uncommon for the disease to develop due to the simultaneous damage to the organ by several types of infection, especially a pair of E. coli + enterococci.

Synonyms of pyelonephritis - pyelitis (inflammatory-infectious process is limited only to the pelvis of the kidney).

Pyelonephritis is characterized severe course and symptoms such as severe pain in the area of the affected kidney and increased, often to high body temperature.

If we talk about the distribution by gender, then pyelonephritis in women occurs almost 6 times more often than in men, and this inequality is observed even among children.

The appearance and development of pyelonephritis, as we said, is due. Pathogenic microflora reaches the pyelocaliceal system in an ascending way - from the reproductive system to the bladder and above, to the kidneys. Such a phenomenon usually produces poor urine patency, for example, with (prostatic hyperplasia), prostatitis, decreased tissue elasticity due to aging of the body. It is also allowed to get the infection downstream when a person becomes seriously ill, and the infection, getting into the bloodstream or lymphatic system spreads throughout the body.

The onset of the disease is predominantly severe - acute pyelonephritis. The kidney at the same time increases in size, its capsule becomes thickened. After, the surface of the kidney may bleed, signs of perinephritis may appear. In the kidney itself, during acute pyelonephritis, a large number of perivascular infiltrates are observed to the interstitial tissue, as well as a tendency to abscess formation (formation).

Purulent formations in combination with bacterial microflora move further and capture the lumen of the tubules and begin to form pustules in medulla kidneys, which in turn form serous-yellowish purulent stripes reaching the papillae. If the process is not stopped, the blood circulation in the kidney is disturbed and the parts of the organ cut off from the blood supply, and, accordingly, the nutrition, begin to die (necrosis).

If you leave everything as it is, do not consult a doctor, or take any antibiotic without consultation that did not completely stop the spread of the infection, the disease often becomes chronic.

Acute pyelonephritis is accompanied by high body temperature, chills, acute pain, bacteriuria, leukocyturia.

Chronic pyelonephritis is characterized by less severe symptoms, however, exacerbations of the disease may periodically occur, especially when exposed to various pathological factors (hypothermia of the body and others).

Pyelonephritis can be primary and secondary.

Primary pyelonephritis develops as an independent disease - with direct infection of the kidneys.

Secondary develops against the background various diseases, for example, with urolithiasis.

Distribution of pyelonephritis

The disease pyelonephritis is annually diagnosed in 1% of the world's population (about 65,000,000 people).

Most of the pyelonephritis is in women, in a ratio of 6 to 1 compared to men.

The preponderance was also noticed between the children, to the side female body. However, in old age, pyelonephritis in men is more common, which is associated with some characterized by urodynamic disorders.

Pyelonephritis accounts for 14% of all kidney diseases.

Pyelonephritis in pregnant women, on average, occurs in 8% of women, and the trend is increasing - over the past 20 years, the number of cases has increased 5 times.

This kidney disease is considered difficult to diagnose. So, autopsies show that every 10-12 deceased had pyelonephritis.

With adequate therapy, symptoms are minimized in almost 95% of patients already in the first days from the start of treatment.

Pyelonephritis - ICD

ICD-10: N10-N12, N20.9;
ICD-9: 590, 592.9.

Among the main signs of the disease can be identified ...

Symptoms of acute pyelonephritis

Severe pain in pyelonephritis is one of the main signs of the disease, the localization of which depends on the affected kidney. Pain can also carry a girdle character, giving in lower part back. Increased pain is observed on palpation or deep breathing;
Symptoms of intoxication of the body, which are accompanied by a lack of appetite, and malaise;
, which during the day can either drop to 37 ° C, then rise again, ;
, muscle pain;
increased frequency of urination;
Moderate swelling of the patient;
The presence of bacteria and leukocytes in the urine and blood of the patient;
Approximately 10% of patients may develop bacterimic shock;
Among not specific symptoms can be observed - , .

Symptoms of chronic pyelonephritis

Frequent urge to urinate;
Pain during urination, with a feeling of cutting;
Urine is dark in color, often cloudy, sometimes bloody, and may smell like fish.

In urine and blood tests, the inflammatory process may not make itself felt - only a certain amount of leukocytes can be observed in the urine, and the period of remission, the indicators are mostly normal.

Complications of pyelonephritis

Among the complications of the disease can be identified:

kidney failure;
kidney abscess;
septic shock;
Kidney carbuncle;
kidney necrosis;
paranephritis;
Uronephritis;
Necrotic papillitis;
Lethal outcome (mainly due to sepsis).

The main cause of pyelonephritis is infection in the kidneys, mainly Escherichia coli, and others (Proteus, Clesibella, Pseudomonas, Enterobacter, mycotic microorganisms).

A secondary reason is a decrease in the reactivity of the immune system, due to which the body is not able to repel the attack of pathogens, stopping the infection, preventing it from settling and further spreading.

A decrease in the protective properties of immunity is facilitated by -, an inactive lifestyle, uncontrolled intake of medications.

How does infection get to the kidneys?

The source of E. coli, which is responsible for the development of pyelonephritis in 90% of all cases, is the intestine. Other types of infection can be acquired through contact with dirty hands, personal hygiene items.

During emptying, anus, the infection often enters the urinary system - the urethra, which is associated with their close location. It is because of this feature that pyelonephritis in women develops most often.

Pyelonephritis in children often develops due to a pathology such as vesiculourethral reflux (vesicoureteral reflux)

Vesiculourethral reflux is characterized by the reverse flow of urine from the bladder to the ureters and partly to the renal pelvis. If this pathology is not detected in time, frequent reflux of urine and its stagnation lead to the multiplication of pathological microorganisms throughout the urinary system, resulting in the development inflammatory process in the kidneys.

Another negative consequence of vesiculourethral reflux is a violation of the structure of the kidneys - the more often urine stagnation occurs with an acute inflammatory process, the faster normal kidney tissue replaced by scars. As a result, the work of the kidneys is disrupted, it is becoming more and more difficult for them to perform their function.

Doctors note the presence of vesicoureteral reflux in most children with diagnosed pyelonephritis, under the age of 6 years. In addition, kidney disease childhood often causes serious harm to health for the rest of a person's life - about 12% of all patients on hemodialysis in childhood had pyelonephritis.

Another cause of pyelonephritis, but quite rare, is the infection of the kidneys through the blood and lymphatic system from other organs and systems. This is facilitated by the presence of common infectious diseases, especially with complications.

Other Causes of Pyelonephritis (Risk Factors)

Urolithiasis, in which the normal outflow of urine is disturbed, and, accordingly, it stagnates;
kidney stone disease;
Transferred surgical methods of treatment of the pelvic organs;
Spinal cord injury;
, AIDS;
Obstruction of the bladder due to the introduction of a catheter into it;
Increased sexual activity in a woman;
Other diseases and various pathologies urinary system - urethritis, neurogenic bladder dysfunction, uterine displacement, etc.

Pyelonephritis in pregnant women can develop due to bearing a child. This is due to the fact that sometimes during pregnancy the tone decreases, and the peristalsis of the ureters also decreases. The risk is especially increased with a narrow pelvis, large fetus or polyhydramnios.

Types of pyelonephritis

The classification of pyelonephritis is as follows:

By occurrence:

Primary;
Secondary.

Along the way of infection:

Ascending - from the urethra to the kidneys, through the urinary canal;
Descending - through the blood and lymph.

According to the patency of the urinary tract:

obstructive;
Not obstructive.

By localization:

Unilateral;
Bilateral.

With the flow:

Acute pyelonephritis- can proceed according to the following type (form):

Serous;
Purulent;
- focal infiltrative;
- diffuse infiltrative;
- diffuse with abscesses;
with mesenchymal reaction.

Chronic pyelonephritis- can be divided into the following forms:

Asymptomatic;
Latent;
Anemic;
Azometic;
Hypertensive;
Remission.

Outcome:

Recovery;
Transition to a chronic form;
Secondary wrinkling of the kidney;
Pyonephrosis.

Classification of chronic pyelonephritis, taking into account the developments of V.V. Serov and T.N. Hansen:

- With minimal changes;
- interstitial-cellular, which can have the following forms:

infiltrative;
sclerosing.

- interstitial-vascular;
- interstitial-tubular;
— mixed form;
- sclerosing pyelonephritis with wrinkling of the kidney.

Diagnosis of pyelonephritis

Diagnosis of pyelonephritis includes following methods examinations:

Anamnesis;
Gynecological examination;
kidneys;
Cystography;
excretory urography;
Nephroscintigraphy;
renography;
Retrograde pyeloureterography;
Angiography of the arteries of the kidneys.

General urine analysis;
Bacteriological examination of urine;
Urinalysis according to Nechiporenko;
Zimnitsky's test;
Gram stain of urine;
prednisone test.

Pyelonephritis - treatment

How to treat pyelonephritis? Treatment of pyelonephritis includes the following items:

2. Drug treatment:
2.1. Antibacterial therapy;
2.2. antifungal therapy;
2.3. Anti-inflammatory therapy;
2.4. Infusion-detoxification therapy;
2.5. Strengthening the immune system;
2.6. Normalization of beneficial intestinal microflora;
2.7. Other medicines.
3. Physiotherapy.
4. Diet.
5. Surgical treatment.

1. Bed rest, hospitalization.

In the early days of acute pyelonephritis, bed rest must be observed, and it is especially important to focus on frequent stays in horizontal position, i.e. lie.

Damp cold is very dangerous during this period, so try to stay warm so that complications and exacerbation of pyelonephritis do not form.

If the patient's condition does not allow outpatient treatment and taking medications at home, the patient is subject to hospitalization.

2. Drug treatment (drugs for pyelonephritis)

Important! Before using medications, be sure to consult your doctor!

2.1. Antibiotics for pyelonephritis

Antibacterial therapy for pyelonephritis is an integral part of the overall course of treatment, but only if the underlying cause this disease is a bacterial infection.

Before obtaining data from a bacteriological study of urine, antibiotics are prescribed empirically, i.e. wide spectrum of activity. After receiving these analyzes, therapy is adjusted - antibiotics are prescribed more purposefully, depending on the type of pathogen. This point is important enough so that in the future, not to develop resistance (resistance) to antibacterial drugs in the body.

Thus, at the beginning of antibacterial therapy against pyelonephritis, antibiotics fluoroquinolones ("Ciprofloxacin", "Ofloxacin") or cephalosporins ("Cefepin", "Cefixime", "Cefotaxime", "") are usually prescribed.

Further, combinations of more narrowly targeted antibiotics are prescribed - fluoroquinolones + cephalosporins or penicillin + aminoglycosides. The second combination is used less frequently, since many people of our time have developed resistance (resistance) of pathogenic microflora to penicillins.

To increase the effectiveness, it is best to use antibacterial drugs intravenously. Also, intravenous infusion of these drugs is advisable if the patient has nausea and bouts of vomiting.

The course of antibiotic therapy lasts from 1 to 2 weeks, which largely depends on the severity of the disease and the effectiveness of treatment. After the first course, the doctor may prescribe a second course of treatment, but with other antibacterial drugs.

The diagnosis of "Healthy" is made if, within a year after treatment, a bacteriological examination of urine does not show the presence of an infection in the body.

2.2. Antifungal therapy

Antifungal therapy is prescribed if the cause of pyelonephritis is a fungal infection.

Among antifungal drugs(antimycotics) for pyelonephritis, the most popular are Amphotericin, Fluconazole.

2.3. Anti-inflammatory therapy

Fever with pyelonephritis is considered normal, because this disease infectious nature, which is why immunity and raises the temperature to stop and destroy the infection.

If the temperature fluctuates around 37.5 ° C, you should not take any action, but to alleviate the course of the disease, you can apply a compress to the frontal part of the head (water at room temperature + vinegar).

In the case of a rapid increase in body temperature to high levels - up to 38.5 ° C and above (in children up to 38 ° C), then the administration of antipyretic drugs of the NSAID group (non-steroidal anti-inflammatory drugs) is prescribed - Diclofenac, Metamizol, "" , "". Children can accept "".

It is also worth noting that taking drugs from the NSAID group also relieves pain in pyelonephritis.

2.4. Infusion-detoxification therapy

Symptoms of intoxication, accompanied by nausea, vomiting, high body temperature, headache, lack of appetite, general weakness and malaise are the most frequent companions of infectious diseases. This is primarily due to the poisoning of the body not only by infectious agents, but also by the waste products of pathological microorganisms, which are actually toxins (poison). In addition, the use of antibacterial or antifungal drugs destroy the infection, but do not remove it from the body.

To cleanse the body of toxins, infusion-detoxification therapy is used, which includes:

Plentiful drink, preferably with the addition of vitamin C, the use of mineral waters is especially useful;
Intravenous infusion of glucose solutions, polysaccharides ("dextran") and water-salt solutions;
The use of detoxification drugs - "Atoxil", "Albumin".

2.5. Strengthening the immune system

The development of pyelonephritis, as we said, is due not only to the infection itself, but also to weakened immunity, which is responsible for preventing the spread of infectious agents throughout the body.

To strengthen immunity, immunomodulators are prescribed, among which are Imudon, IRS-19, Timogen.

Vitamin C (ascorbic acid) is considered a natural stimulant of immunity, a large amount of which can be found in, cranberries, dogwood, mountain ash, currants,.

2.6. Normalization of beneficial intestinal microflora

The disadvantage of antibiotic therapy is a number of side effects, one of which is the destruction of beneficial intestinal microflora, which is involved in the digestion and assimilation of food.

To restore the intestinal microflora, probiotics are prescribed - Linex, Bifiform, Acipol.

2.7. Other drugs and therapies

Treatment for pyelonephritis may additionally include the following medications:

Anticoagulants - reduce blood clotting, preventing the formation of blood clots: "Heparin", "Hirudin", "Dicoumarin";
Glucocorticoids (hormones) - are used to reduce the inflammatory process: "Dexamethasone", "Hydrocortisone".
Antioxidants - are prescribed to normalize the condition biological membranes, which has a beneficial effect on speedy recovery for diseases of the urinary system -, β-carotene, ubiquinone (coenzyme Q10), selenium and other substances;
Oxidants - are prescribed when signs of renal failure appear - cocarboxylase, pyridoxal phosphate;
For prescribe: beta-blockers ("Atenolol") or diuretics ("Furosemide");
Hemodialysis - is prescribed if the kidneys do not cope with their function;
To maintain the functioning of the kidney, functional passive gymnastics is sometimes used for them - 20 ml of furosemide is prescribed 1-2 times a week;
Other drugs for the treatment of pyelonephritis are Canephron, Urolesan, Fitolizin.

3. Physiotherapy

Physiotherapeutic procedures (physiotherapy) for pyelonephritis help to eliminate the inflammatory process, relieve pain, normalize urine outflow, relax the muscles of the urinary tract, which generally leads to an improvement in the course of the disease and accelerate recovery. However, physiotherapy is not used in the following cases – active phase pyelonephritis, terminal stage chronic form diseases, polycystic kidney disease, as well as hydronephrosis in the stage of decompensation.

Among the physiotherapeutic procedures for pyelonephritis are:

Electrophoresis with the use of antimicrobial drugs ("Furadonin" and others);
Magnetotherapy;
ultrasound therapy;
Microwave therapy;
Amplipulse therapy;
Laser therapy;
Therapeutic baths, using carbon dioxide and sodium chloride.

The diet for pyelonephritis has the following goals:

Reducing the burden on the kidneys and gastrointestinal tract;
Normalization of metabolic processes in the patient's body;
Lowering the patient's blood pressure to normal levels;
Removal of edema;
Removal of toxic substances from the body, in fact, this item duplicates the goal of detoxification therapy.

M.I. Pevzner developed a special therapeutic diet for the treatment of kidney diseases -, with nephritis - which are often used in the treatment of pyelonephritis.

The daily calorie content of the diet is 2400-2700 kcal.

Diet - 5-6 times a day.

Cooking method - steaming, boiling, baking.

Other features - the amount of protein is slightly reduced, and fats and carbohydrates are consumed as if normal condition health. The amount of salt should not exceed 6 g per day.

Emphasis needs to be placed on plentiful drink- at least 2-2.5 liters of water per day. The more you drink, the faster the infection with toxins is eliminated from the body.

When choosing food, remember that alkalization of the body contributes to the faster destruction of the infection, while acidity - favorable conditions for its reproduction.

What can you eat with pyelonephritis? Low-fat varieties of meat and fish (chicken, beef, hake), soups (with vegetables, milk, cereals), cereals, pasta, dairy products, butter, olive and sunflower oil, zucchini, pumpkin, carrots, beets, cucumbers, parsley, dill, unsalted yesterday's bread, watermelon, melon, pastries, weak tea, rosehip broth, cranberry and other fruit drinks, jelly, compote.
What can not be eaten with pyelonephritis? Rich broths, fatty meats and fish (carp, crucian carp, bream, pork), seafood, smoked meats, pickles, sauerkraut, marinades, semi-finished products (sausages, sausages, caviar), spinach, sorrel, radish, radish, onion, mushrooms, legumes (peas, beans, beans, chickpeas), margarine, alcoholic drinks, carbonated drinks, coffee, strong tea, cocoa.

Confectionery and pastries are limited. Eggs - no more than 1 per day.

4. Surgical treatment

Surgical treatment is advisable in the following cases:

Obstruction of the urinary tract, in which percutaneous puncture nephrostomy is used;
In violation of the outflow of urine from the affected kidney, ureteral catheterization is used;
With purulent formations in the kidneys, the kidney is decapsulated;
With apostematous pyelonephritis, decapsulation of the kidney is performed with opening of the apostem;
When it is opened and excised;
With an abscess, it is opened and the walls are excised;
With sepsis, increasing renal failure, nephrectomy (removal of the kidney) is used.

Important! Before using folk remedies against pyelonephritis, be sure to consult your doctor!

Bearberry. The use of bearberry relieves the inflammatory process, normalizes the functioning of the kidneys, improves urination, inhibits the vital activity of bacterial microflora and removes toxins from the body. Exacerbation of pyelonephritis and others, as well as pregnancy, are a contraindication to taking funds with bearberry.

To prepare the product, you need 1 tbsp. pour a spoonful of dry raw materials with a glass of water and set aside the product overnight for infusion. In the morning, the infusion is filtered and drunk 1-2 tbsp. spoons 3 times a day, before meals. The course of treatment is from 1 to several months.

Harlay (spreading cornflower, prostrate cornflower). Harlay grass helps relieve pain in pyelonephritis, as well as accelerate the recovery of the kidneys and other organs of the urinary system.

For cooking healing agent it is necessary to pour a pinch of chopped grass into a small saucepan / scoop and pour it with a glass of water. Then, over low heat, bring the product to a boil, boil it for another 2-3 minutes, remove from heat, cover and set aside to cool and infuse for 30 minutes. Next, strain the remedy and drink 3 approaches, 10 minutes before meals. The course of treatment is a month, after a monthly break is made and the course is repeated. The chronic form of the disease may require taking this remedy for a year or two.

Cranberry. Cranberry juice is very useful, which not only improves the general condition of the body due to the ascorbic acid and other vitamins it contains, but also helps to restore the immune system with other systems. To prepare cranberry juice, you need to squeeze the juice from a glass of cranberries and pour it into another container. Pour the remaining cake with 500 ml of boiling water, put on the stove and boil for 5 minutes, cool. Next, you need to mix boiled cake with pre-squeezed juice and drink 1 glass of fruit drink per day.

One of the most common urological diseases of an infectious nature, affecting the pyelocaliceal system and the renal parenchyma, is pyelonephritis. This rather dangerous pathology, in the absence of timely competent treatment, can lead to a violation of the excretory and filtering functions of the organ.

What kind of kidney disease is it, why is it so important to know the first symptoms and see a doctor in time, and how to start treatment different forms pyelonephritis, we will consider later in the article.

What is pyelonephritis

Pyelonephritis is an inflammatory disease of the kidneys characterized by damage to the parenchyma of the kidney, calyx, and renal pelvis.

In most cases, pyelonephritis is caused by the spread of infections from the bladder. The bacteria enter the body from the skin around the urethra. Then they rise from the urethra to the bladder and then enter the kidneys, where pyelonephritis develops.

Pyelonephritis may be independent disease, but more often complicates the course of various diseases (urolithiasis, prostate adenoma, diseases of the female genital organs, tumors of the genitourinary system,) or occurs as a postoperative complication.

Classification

Pyelonephritis of the kidneys is classified:

Due to development - primary (acute, or non-obstructive) and secondary (chronic, or obstructive). The first form is the result of infections and viruses in other organs, and the second is kidney anomalies.
According to the location of inflammation - bilateral and unilateral. In the first case, both kidneys are affected, in the second - only one, the disease can be left- or right-sided.
In the form of inflammation of the kidney - serous, purulent and necrotic.

Allocate:

Acute pyelonephritis is caused by a large number of microorganisms entering the kidneys, as well as by weakening the protective properties of the body ( weak immunity, transferred colds, overwork, stress, poor nutrition). The inflammatory process is pronounced. Most often, it is diagnosed in pregnant women, whose body is especially vulnerable.
What is chronic pyelonephritis? This is the same inflammation of the kidneys, only characterized by a latent course. Due to changes in the urinary system, the outflow of urine is disturbed, as a result of which the infection enters the kidneys by an ascending route.

By flow phases:

Active inflammation is characterized by symptoms: fever, pressure, pain in the abdomen and lower back, frequent urination, swelling;
Latent inflammation is characterized by the absence of any symptoms and, accordingly, the patient's complaints. However, in the analysis of urine, pathologies are visible;
Remission - there are no pathologies in the urine and symptoms.

Causes

With pyelonephritis, as we have already indicated, the kidneys are affected, and basically the effect of bacteria leads to this result. Microorganisms, being in the pelvis of the kidney or in it by the urinogenous or hematogenous way, settle in the interstitial tissue of the kidney, as well as in the tissue of the renal sinus.

The disease can occur at any age. More often pyelonephritis develops:

in children under the age of 7 years (the likelihood of pyelonephritis increases due to the peculiarities of anatomical development);
in young women aged 18-30 years (the occurrence of pyelonephritis is associated with the onset of sexual activity, pregnancy and childbirth);
in older men (with obstruction of the urinary tract due to the development of prostate adenoma).

Any organic or functional reasons that interfere with the normal outflow of urine, increase the likelihood of developing the disease. Often pyelonephritis appears in patients with urolithiasis.

The most common cause of inflammation of the urinary tract is:

bacterium Coli (E. coli), or enterococcus.
Less commonly, other gram-negative bacteria can provoke a nonspecific inflammatory process.
Often, patients have combined or multidrug-resistant forms of infection (the latter are the result of uncontrolled and unsystematic antibacterial treatment).

Routes of infection:

Ascending (from the rectum or lesions chronic inflammation located in the urogenital organs);
Hematogenous (implemented through the blood). In this situation, the source of infection can be any distant focus located outside the urinary tract.

For the occurrence of pyelonephritis, one penetration of microflora into the kidney is not enough. For this, in addition, predisposing factors are necessary, among which the main ones are:

violation of the outflow of urine from the kidney;
disorders of blood and lymph circulation in the body.

However, it is believed that in some cases, highly pathogenic microorganisms can cause acute pyelonephritis in intact kidneys in the absence of any predisposing causes.

Factors that will help bacteria develop in paired organs:

Lack of vitamins;
Reduced immunity;
Chronic stress and overwork;
Weakness;
Kidney disease or genetic predisposition to rapid damage to paired organs.

Symptoms of pyelonephritis in adults

Symptoms of pyelonephritis can vary depending on a person's age and may include the following:

Malaise;
Fever and / or chills, especially in case of acute pyelonephritis;
Nausea and vomiting;
Pain in the side under the lower ribs, in the back, radiating to the iliac fossa and suprapubic region;
confusion;
Frequent, painful urination;
blood in the urine (hematuria);
Turbid urine with a strong odor.

Pyelonephritis is often accompanied by dysuric disorders, manifested in the form of frequent or painful urination, separation of urine in small portions, the predominance of nocturnal diuresis over daytime.

Symptoms of an acute form of pyelonephritis of the kidneys

In this form, pyelonephritis occurs in combination with symptoms such as:

high fever, chills. Patients have increased sweating.
The kidney on the side of the lesion hurts.
On the 3-5th day of the manifestation of the disease, when feeling, it can be determined that the affected kidney is in an enlarged state, in addition, it is still painful.
Also, by the third day, pus is found in the urine (which is indicated medical term pyuria).
The appearance of chills and temperature is accompanied by headache, pain in the joints.
In parallel with these symptoms, there is an increase pain in the lumbar region, basically this pain still manifests itself on the side from which the kidney is affected.

Signs of chronic pyelonephritis

The symptoms of the chronic form of kidney disease are very conditional and the course does not have pronounced signs. Often, the inflammatory process in everyday life is perceived as a respiratory infection:

muscle weakness and headache;
febrile temperature.

However, in addition to these characteristic signs of the disease, the patient has frequent urination, with the appearance bad smell urine. In the lumbar region, a person feels a constant aching pain feels like urinating frequently.

Late common symptoms of chronic pyelonephritis are:

dryness of the oral mucosa (at first slight and intermittent)
discomfort in the adrenal region
heartburn
belching
psychological passivity
puffiness of the face
pallor of the skin.

All this can serve as manifestations of chronic renal failure and are characteristic of bilateral kidney damage, excretion of up to 2-3 liters of urine per day or more.

Complications

TO serious complications pyelonephritis include:

kidney failure;
paranephritis;
and bacterial shock;
kidney carbuncle.

Any of these diseases has serious consequences for the body.

All of the above symptoms and signs urological disease must have an adequate medical assessment. You should not endure and hope that everything will work out by itself, as well as engage in self-treatment without a preliminary examination by a medical worker.

Diagnostics

Diagnosis of inflammation of the pelvis and parenchyma of the kidneys, as usual, begins with general inspection after collecting patient complaints. Instrumental and laboratory studies become obligatory, which give complete picture what is happening.

Laboratory methods include:

General clinical analysis urine: when sowing the urinary sediment on a glass slide, an increase in the number of leukocytes and bacteria in the field of view is detected. Urine should normally be acidic in nature. infectious pathology it becomes alkaline;
General clinical blood test: in peripheral blood all signs of the inflammatory process appear, the erythrocyte sedimentation rate increases and the number of leukocytes in the field of view increases significantly.

Laboratory indicators:

in the blood test, an increase is determined with a shift of the formula to the left, accelerated ESR;
urine cloudy with mucus and flakes, sometimes has an unpleasant odor. It contains a small amount of protein, a significant number of leukocytes and single erythrocytes.
in urine cultures, true bacteriuria is determined - the number of microbial bodies in a milliliter of urine is >100 thousand.
the Nechiporenko test reveals the predominance of leukocytes in the middle portion of urine over erythrocytes.
at chronic process changes in biochemical analyzes are observed: an increase in creatinine and urea.

Among instrumental methods studies are assigned:

Ultrasound of the kidneys and abdominal cavity;
computed tomography or x-ray to detect changes in the structure of the affected kidney.

Treatment of kidney pyelonephritis

Kidney pyelonephritis should be treated comprehensively, including medication and physiotherapy methods. Well-conducted treatment for kidney disease contributes to speedy recovery patient from an infectious disease.

Medications

The aim of medical treatment is not only to destruction of pathogens and relief of symptomatic signs, but also to restore the vital functions of the body while the disease progressed pyelonephritis.

Preparations:

Antibiotics. In case of exacerbation, one cannot do without them, but it is optimal if they are prescribed by a doctor, even better if at the same time he explains how to collect and where to donate urine for sowing on microflora and sensitivity to antibiotics. Most often in outpatient practice are used:
- protected penicillins (Augmentin),
- 2nd generation cephalosporins (Ceftibuten, Cefuroxime),
- fluoroquinolones (Ciprofloxacin, Norfloxacin, Ofloxacin)
- nitrofurans (Furadonin, Furamag), as well as Palin, Biseptol and Nitroxoline.
Diuretics: prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), are not prescribed for acute. Furosemide 1 tablet 1 time per week.
Immunomodulators: increase the body's reactivity in case of illness, and to prevent exacerbation of chronic pyelonephritis.
- Timalin, intramuscularly, 10-20 mg 1 time per day, 5 days;
- T-activin, intramuscularly, 100 mcg once a day, 5 days;
Multivitamins, (Duovit, 1 tablet 1 time per day), Ginseng tincture - 30 drops 3 times a day, are also used to increase immunity.
Non-steroidal anti-inflammatory drugs(Voltaren), have an anti-inflammatory effect. Voltaren inside, 0.25 g 3 times a day, after meals.

The treatment of chronic pyelonephritis is carried out according to the same principles as the treatment of the acute process, but it is longer and more laborious. Therapy of chronic pyelonephritis includes the following therapeutic measures:

elimination of the causes that led to difficulty in the outflow of urine or caused violations of the renal circulation;
antibacterial therapy (treatment is prescribed taking into account the sensitivity of microorganisms);
normalization of general immunity.

The goal of treatment during an exacerbation is to achieve complete clinical and laboratory remission. Sometimes even a 6-week antibiotic treatment does not give the desired result. In these cases, a scheme is practiced when for six months every month for 10 days an antibacterial drug is prescribed (each time a different one, but taking into account the sensitivity spectrum), and the rest of the time - diuretic herbs.

Surgery

Surgical intervention is prescribed if during the conservative treatment the patient's condition remains severe or worsens. As a rule, surgical correction is performed when purulent (apostemic) pyelonephritis, abscess or carbuncle of the kidney is detected.

During the operation, the surgeon performs the restoration of the lumen of the ureter, excision of inflammatory tissues and the establishment of drains for the outflow of purulent fluid. If the kidney parenchyma is significantly destroyed, an operation is performed - nephrectomy.

Diet and proper nutrition

The goal pursued by the diet for pyelonephritis is

sparing kidney function, creating optimal conditions for their work,
normalization of metabolism not only in the kidneys, but also in other internal organs,
lowering blood pressure,
reduction of edema,
maximum excretion of salts, nitrogenous substances and toxins from the body.

According to the table of treatment tables according to Pevzner, the diet for pyelonephritis corresponds to table number 7.

General characteristics of the treatment table No. 7- this is a slight restriction of proteins, while fats and carbohydrates correspond to physiological norms. In addition, the diet should be fortified.

Products that need to be limited or, if possible, excluded for the period of treatment:

broths and soups on meat, rich fish broth - we are talking about the so-called "first" broths;
first legume dishes;
salted and smoked fish;
any fatty varieties of river and sea fish;
caviar of any fish;
seafood;
fatty meats;
lard and interior fat;
bread with salt;
any flour products with added salt;
mushrooms of any kind and cooked in any way;
strong tea and coffee;
chocolate;
confectionery (pastries and cakes);
sorrel and spinach;
radish and radish;
onion and garlic;
sausages and sausages - boiled, smoked, fried and baked;
any smoked products;
spicy and fatty cheeses;
canned meat and fish;
marinades and pickles;
high fat sour cream.

Allowed foods:

Lean meats, poultry and fish. Despite the fact that fried foods are acceptable, it is advised to boil and steam, stew and bake without salt and spices.
From drinks it is advised to drink more green tea, various fruit drinks, compotes, herbal teas and decoctions.
Low-fat soups, preferably with a vegetarian vegetable base.
The most preferred vegetables for this diet are pumpkin, potatoes, zucchini.
Cereals should be avoided, but buckwheat and oatmeal are acceptable and useful for this disease.
Bread is advised to eat without adding salt, it is not recommended to eat fresh bread immediately. It is advised to make toast out of bread, dry it in the oven. Pancakes and pancakes are also allowed.
With pyelonephritis, dairy products are allowed if they are low-fat or low-fat.
Fruits can be eaten in any quantity, they are useful in the inflammatory process of the kidneys.

Compliance with a diet for pyelonephritis facilitates the work of diseased kidneys and reduces the load on all organs of the urinary system.

Folk remedies

Before using folk remedies for pyelonephritis, be sure to consult your doctor, because. there may be individual contraindications for use.

10 grams of collection (prepared from lingonberry leaves, coltsfoot, strawberries, cornflower flowers, forest speedwell herbs, nettles and seeds seed flax) pour boiling water (0.5 liters) and place in a thermos for 9 hours. You need to use 1/2 cup at least 3 times a day.
Pumpkin juice is in high demand, which has a strong anti-inflammatory effect during and pyelonephritis. From a vegetable you can cook yourself medicinal porridge for breakfast or cook it for a couple, as well as in the oven.
Corn silk- hairs of ripe corn - as a diuretic for high blood pressure. In addition, the plant has an antispasmodic effect, which will eliminate the pain syndrome during the inflammatory process in the kidneys and other parts of the body, however, if blood clots form too often in the patient's blood, then corn stigmas will have to be abandoned.
- Dry and crush the plant.
- Pour 1 dessert spoon of hairs with 1 cup of boiling water.
- They simmer for 20 minutes.
- Insist 40 minutes.
- Take 2 tbsp. decoction every 3 hours.
Collection from kidney pyelonephritis: 50 g each - horsetail, strawberries (berries) and rose hips; 30 g each - nettle (leaves), plantain, lingonberry and bearberry; 20 g each - hops, juniper and birch leaves. Whole medicinal composition mix and fill with 500 ml of water. Bring the entire medicinal mass to a boil. After strain and drink 0.5 cup 3 times a day.

Prevention

visit a urologist (1 time in 3-4 months);
timely treat urological and gynecological diseases;
consume a large amount of fluid to normalize the outflow of urine;
avoid hypothermia;
lead a healthy lifestyle;
adhere to a balanced diet;
do not abuse protein foods;
men - to control the state of the urinary system, especially if there have been urological ailments in the past;
if there is an urge to urinate, do not delay the process;
follow the rules of personal hygiene.

Pyelonephritis of the kidneys is a serious disease that must be treated at the first signs so that there are no complications. Be sure to get diagnosed by a nephrologist or urologist, 1-2 times a year.

Pyelonephritis is the most common infectious and inflammatory disease of the kidneys that requires treatment. In the absence of timely and correct therapy, complications of pyelonephritis develop, which lead to kidney dysfunction and require a long recovery.

Pyelonephritis in urological practice occurs in more than half of the patients who applied to medical institutions with kidney problems. The inflammatory process develops as a result of the penetration of an infectious agent with blood, lymph or from the lower organs of the urinary system.

The main reason for the development of inflammation is the stagnation of urine as a result of a violation of its discharge. Urination is impaired when the ureter is blocked by stones, blood clots, pus, mucus, benign or malignant tumors. Also, squeezing of the ureter by organs that are nearby, whose size increases due to infectious and inflammatory diseases (prostatitis, inflammation of the tissues of the uterus, ovaries, and others) also leads to stagnation of urine.

Often, pyelonephritis develops with an abnormal structure of the organs of the urinary system, which leads to difficulty in passing urine. Such anomalies are hereditary or formed during the period prenatal development under the influence of negative factors.

Inflammation may be affected autoimmune diseases, endocrine pathologies, hypothermia, chronic inflammatory and other infectious diseases.

With pyelonephritis, the patient has sharp rise body temperature, which is accompanied by chills and worsening general condition. Stagnation of urine leads to swelling of the limbs, face, on final stages the whole body swells. The inflammatory process is indicated by pain in the lower back and lower abdomen, loss of appetite, flatulence, nausea, and vomiting.

Diuretic disorders appear frequent urges to the toilet. In this case, the process of emptying the bladder is accompanied by pain, burning in the urethra. Urine changes its color against the background of an increase in the number of leukocytes and erythrocytes.

Complications of pyelonephritis develop with untimely appeal V medical institution, which does not allow timely diagnosis and treatment. Self-treatment is especially detrimental to the health of the patient. Treatment that is not prescribed in accordance with the current stage of the pathology can also have an impact on the development of complications. Often to backfire results in non-compliance bed rest and diets, hypothermia, other chronic diseases.

Most often, pyelonephritis accompanies bacteriotoxic shock, hypertension. Acute pyelonephritis leads to the development of paranephritis, retroperitonitis, urosepsis, acute renal failure. Complications of chronic pyelonephritis: nephrosclerosis, pyonephrosis, chronic renal failure.

Bacteriotoxic shock

This complication is most often diagnosed with purulent form pyelonephritis. It develops more often in older people. Formed as a result of hitting pathogenic microorganisms into the blood.

The main contributing factors for the development of a complicated course of the inflammatory process are anomalies in the structure of the organs of the urinary system, the occurrence of obstacles to the passage of urine (stones, mucus, blood clots, tumors). Often, serious injuries of the pelvic organs, polycystic and inflammatory diseases organs that are near the kidneys and ureter. Sometimes toxic poisoning is caused by kinking or compression of the ureter during nephroptosis or pregnancy under fetal pressure.

A similar complication of pyelonephritis with bilateral kidney damage is extremely dangerous, since in more than half of the cases it ends in the death of the patient. With unilateral pyelonephritis, the probability of death is 35%. During pregnancy, bacteriotoxic shock leads to fetal death.

kidney failure

Acute renal failure is a complication of acute pyelonephritis, which develops a few days after the onset of the inflammatory process. Kidney failure is caused by infectious agents, pus, and tissue breakdown products. Under the influence of pathogenic compounds, there is a violation of the working capacity and death of the tissues of the organ.

The rate of development of renal failure depends on the degree of tissue damage. acute form kidney failure is treatable timely diagnosis. To restore the health of the body, it is necessary to reduce the load by monitoring nutrition and the amount of fluid you drink. During therapy, antibiotics and diuretics are prescribed to eliminate bacterial infection and its speedy removal. With bilateral pathology or significant damage to one kidney, extrarenal blood purification is used.

The development of renal failure can be recognized by severe swelling, pain syndrome in the lumbar region and symptoms of general intoxication of the body. Damage to the tissues of the kidneys leads to a decrease in the volume of daily urine.

A complication of chronic pyelonephritis is chronic renal failure. Predisposing factors along with pyelonephritis include urolithiasis, nephropathy, hydronephrosis, polycystic.

The course of the chronic form of renal failure occurs abruptly. During the period of remission, the patient has an improvement in the general condition and a relative normalization of the urinary function. During the period of relapse, urine output is disturbed (the daily volume decreases, while night diuresis increases). The patient is tormented by severe edema, disorders of the digestive system. Anemia, hypertension, tachycardia develop. The patient complains of poor sleep, depression.

Treatment of chronic renal failure includes diet, antibiotic therapy, physiotherapy, hemodialysis. In severe cases, a kidney transplant is needed.

Secondary paranephritis

Complicated pyelonephritis can occur with paranephritis, which is characterized by fever, general deterioration, malaise, chills. Paranephritis, like pyelonephritis, is accompanied by pain in the lumbar region, which radiates to the lower abdomen, thigh and inguinal region.

The disease is characterized by damage to the perirenal tissues, in which, under the influence of pathological microorganisms, an inflammatory process develops.

To treat this complication after pyelonephritis, antibiotic therapy is necessary, which is aimed at the underlying disease. With paranephritis, the removal of pus from the perirenal tissues is required, for this purpose a drainage system is used.

Necrotic papillitis

Necrotizing papillitis is the most a rare consequence pyelonephritis. It develops as a result of a violation of the process of production and discharge of urine. Against the background of a disturbed urination process, an increase in intrarenal pressure occurs, which leads to a violation of blood flow to the organ. As a result of these pathological processes, the papillae of the kidneys are damaged and their further oxygen starvation, which is fraught with necrosis.

Accompanied by necrotic papillitis with back pain, colic, leukocyturia, hematuria, hypertension, fever, chills. In addition, the discharge of urine is disturbed, its volume decreases. At severe forms in urine, necrotic masses (renal papillae, pus) can be detected.

Treatment of this complication is accompanied by drug therapy, which is aimed at suppressing the development of pathological microorganisms in the kidneys and their excretion. For this purpose, antibacterial drugs are used. In a complicated form, surgical intervention is required to clean the organ from necrotic masses.

Arterial hypertension

Pyelonephritis, complicated kidney failure, glomerulonephritis, papillitis, often leads to an increase in blood pressure. Hypertension develops against the background of increased intrarenal pressure. The main causes are necrosis of the kidney parenchyma or inflammatory pathologies that affect the circulatory and lymphatic systems of the kidneys.

Signs of the onset of the development of the disease are a sharp increase in blood pressure of more than 140/90 mm, while in the future there is a rapid increase in the lower indicator. The patient is tormented by headaches, swelling develops, vision is impaired, dysfunctions in the work of the heart are noted.

At arterial hypertension as a complication of pyelonephritis probability full recovery after conservative therapy does not exceed 25%. Most effective method is the removal of the kidney or partial removal of its affected part.

Consequences

Complications of acute and chronic pyelonephritis do not go unnoticed. More than half of patients suffer from relapses of pathology that develop under the influence of negative internal and external factors.

The consequences of pyelonephritis for each age group are different. Newborns after pyelonephritis and its complications often undergo other infectious diseases, among which the first place is occupied by pneumonia. Less often in children under one year of age, there are violations in the developmental process. internal organs and oxygen starvation of the brain.

In almost all newborns and preschool children, against the background of antibiotic therapy, a change in the intestinal microflora occurs - dysbacteriosis develops. Preschool children are often exposed to diseases associated with metabolic disorders (rickets, dermatitis, and others). There are frequent cases of iron deficiency anemia.

In adulthood, after suffering pyelonephritis, problems with urination may remain. There is a high probability of recurrence of pathology, as well as late development of complications.

During pregnancy, pyelonephritis is especially dangerous, since in the second half of pregnancy it can lead to spontaneous abortion. Maternal kidney infection can lead to intrauterine pathologies in the fetus or its death.

During the period of gestation, pyelonephritis and its complications affect the metabolic processes between the mother and the fetus, causing oxygen starvation. After birth, hypoxia manifests itself as iron deficiency anemia, tachycardia and vegetovascular dystonia.

Pyelonephritis in the absence of timely treatment leads to serious complications, including bacteriotoxic shock, papillitis, paranephritis, hypertension and others. Therapy of complications always begins with the treatment of the underlying disease with antibacterial drugs. If indicated, use artificial methods blood purification or surgery.