Questionnaire for patients with pyelonephritis. Materials and methods
1Purpose this study was a study of the social and hygienic characteristics of patients with chronic pyelonephritis. 390 research conducted medical records patients suffering from chronic pyelonephritis, of which 77 were men and 313 were women. Next, 162 patients were selected from this group for questioning, of which 54 were men and 108 women. A greater proportion of the disease was found among females. The majority of patients, both men and women, were mature and elderly. By social status greatest number the patients were pensioners (32 % among men and 34 % among women), and persons engaged in physical labor(31 % among men and 30 % among women). Thus, we can conclude that there is a need for further study of this issue, as well as the development and implementation medical and social prevention among patients with chronic pyelonephritis, which will increase the effectiveness medical care and reduce morbidity rates.
social and hygienic characteristics
social status
bad habits
1. Kalushka G.V., Klunantseva M.S., Shehab L.F. Chronic pyelonephritis. Wedge. honey. – 1996. – No. 2. – P. 54–56.
2. Laurent O.B., Dubov S. Acute pyelonephritis. Doctor – 1998. – No. 1, pp. 13–16.
3. Laurent O.B., Sinyakova L.A. Inflammatory organ diseases urinary system. Current issues. Moscow, 2008. – 88 p.
4. Lopatkin N.A. Urology: pharmacotherapy without errors. Moscow, 2012.
5. Sigitova O.N., Arkhipov E.V., Davletshina R.Z. Antimicrobial therapy of patients with pyelonephritis in a clinic. Kazan Medical Journal, 2009. – T. 90, No. 3. – P. 390–394.
6. Smirnov A.V., Dobronravov V.A., Kayukov I.G. Epidemiology and socio-economic aspects chronic illness kidney //Nephrology. – 2006. – T. 10, No. 1. – P. 7–13.
7. Sokolova O.A., Logacheva T.M., Dyadik T.G. Sexual infection in children. Attending doctor. – 2005. – No. 7. – P. 22–26.
8. Comparative effectiveness of antibacterial drugs of the fluoroquinolone and β-lactam series in complex therapy patients with chronic pyelonephritis. Tverdoy V.E., Oskolkov S.A., Zhmurov V.A., Petrova Yu.A., Oborotova N.v. Journal of Urology. – 2012. – No. 4. – P. 8–12.
9. Tiktinsky O.L. Inflammatory nonspecific diseases genitourinary organs. Leningrad, 1984. – P. 5–192.
10. Urology: national leadership. Lopatkin N.A. – 2009. – P. 434–451.
In the last decade, there has been a clear trend towards an increase in the number and rejuvenation of people with pyelonephritis.
In the structure of kidney infections and urinary tract pyelonephritis firmly ranks first. When comparing primary disability indicators for the main groups of urological diseases, chronic pyelonephritis takes 2nd place (21.4-23%), second only to malignant neoplasms.
There is a steady increase in chronic renal failure worldwide. In Russia in the 70s, the frequency of chronic renal failure was 19-109.2 per 1 million people per year, in the last decade the frequency has been 100-600 people.
According to the data medical statistics in Russia, chronic pyelonephritis ranks second in the structure of causes of chronic renal failure and accounts for 17.1%.
There are more than 80 treatment regimens for kidney and urinary tract infections, but there are no effective methods prevention.
Target. Study of the social and hygienic characteristics of patients with chronic pyelonephritis.
Materials and research methods
We conducted a study of 390 medical records of patients suffering from chronic pyelonephritis according to three clinics in the city of Kazan, of which 77 were men and 313 women. Next, 202 patients were selected from this group for questioning, of which 64 were male and 138 were female.
The diagnosis of chronic pyelonephritis was established in accordance with clinical classification ON THE. Lopatkina and V.E. Rodoman based on the results of clinical, laboratory and ultrasound examinations. Laboratory research included a general urinalysis, urine analysis according to Nechiporenko, bacteriological examination urine with determination of sensitivity to antibacterial drugs, biochemical research blood, with determination of the level of creatinine, urea, glucose, total protein. X-ray methods examinations were carried out according to indications.
Research results and discussion
The ratio of patients with chronic pyelonephritis among men and women was 1:4. This indicates a higher proportion of female patients, which, according to literature data, is associated with anatomical and physiological characteristics female body which predispose to the incidence of kidney and urinary tract infections.
Among the patients studied: 77 (19.74%) men aged 21 to 68 years, average age was 44.5 ± 24 years and 313 (80.26%) women aged from 19 to 83 years, the average age was 51.2 ± 32 years. Patients were distributed by age categories according to WHO recommendations (Table 1).
Analyzing the above data, we can conclude that there is a higher proportion of mature and elderly people among patients with chronic pyelonephritis age group. This conclusion can be made for both men and women. According to the literature, chronic pyelonephritis in 84% of cases is secondary in nature and accompanies most urological diseases. More high incidence mature and elderly population may be associated with high level urological morbidity, as well as a higher incidence of medical care among this population group.
Table 1
Incidence rate of chronic pyelonephritis among men and women depending on age
According to E.M. Aryeva and A.N. Spiegel (1973), who observed 318 patients with bilateral chronic pyelonephritis; in those who fell ill at a young age, chronic renal failure was observed less frequently, whereas with the disease after 45 years of age, chronic renal failure appears relatively quickly, especially in men. Our data are presented in table. 2.
table 2
Age at which chronic pyelonephritis was first diagnosed
Social position is the place a person occupies within a community of people. There are several types of social statuses, but for medicine, only the acquired status is of interest, which includes: work, position held, occupational hazards, financial capabilities, etc. Any social status contributes to the development of a particular disease, and much has been devoted to this scientific research. However, in the literature there are no works studying the role of social status in the development of chronic pyelonephritis. The data we obtained is clearly presented in diagrams 1 and 2.
Both among men and women, the largest number of patients with chronic pyelonephritis is observed among pensioners and people engaged in manual labor. The large proportion of pensioners, and the bulk of the population here is made up of the elderly and senile population, may, as was described just above, be associated with a higher demand for medical care.
And among people of working age engaged in heavy physical labor - with occupational hazards, physical activity, frequent hypothermia and other negative factors.
According to the responses of patients who took part in the survey, 59.3% of men and 80.5% of women noted smoking, and 53.7% of men and women abused alcohol. Only 42.6% of men and 25% of women regularly engage in physical activity or sports. The majority of sick men and women had higher education, 42.6% and 80.5%, respectively. Average special education 20.4% of men and 9.2% of women have. 37% of men and 10.2% of women have secondary education.
Diagram 1
Diagram 2
All of the above dictates the need for further study of this problem. We can conclude that it is necessary to develop and implement medical and social prevention among patients with chronic pyelonephritis, which will improve the efficiency of medical care and reduce the incidence rate.
Bibliographic link
Khuzikhanov F.V., Aliev R.M. SOCIAL-HYGIENIC CHARACTERISTICS OF PATIENTS WITH CHRONIC PYELONEPHRITIS // International Journal of Applied and basic research. – 2014. – No. 10-3. – P. 161-163;URL: https://applied-research.ru/ru/article/view?id=6046 (access date: 03/20/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"
Patient Survey Questionnaire
The Moscow City Compulsory Medical Insurance Fund, studying the population’s attitude to reforms in the medical care system, urges you to express your opinion by answering the questions in our questionnaire.
It's easy to fill out the form. Questionnaires are provided for many questions. possible options answers. Choose from the suggested answers the one that matches your opinion and mark it. If none of the proposed answer options suits you, write the answer yourself.
The anonymity of your answers is guaranteed!
Thank you in advance for your cooperation!
We ask you to answer questions regarding your health
1. How do you assess your health?
1. Good => go to question 3
2. Average
2. How do you explain your health? (you can provide multiple answers)
1. Age
2. Unsatisfactory environmental and sanitary conditions of the area of residence (work)
3. Work overload
4. Lack of opportunity for regular rest
5. Poor nutrition
6. Long lasting conflict situation Houses
7. Long-term conflict situation at work
8. Inattention to your health, bad habits
9. Inaccessibility of quality medical care
10. Hereditary predisposition
11. Consequences of the war
12. Other (write)
3. For what diseases did you go to the clinic for Last year? (you can provide multiple answers)
1. Diseases of the heart and blood vessels (CHD, hypertonic disease, angina pectoris, myocardial infarction, atherosclerosis, arrhythmia, tachycardia, rheumatism, heart disease, strokes, varicose veins veins, thrombophlebitis, etc.)
2. Diseases of the digestive system (diseases of the teeth and oral cavity, esophagus, gastritis, duodenitis, enteritis, colitis, cholecystitis, cholelithiasis, pancreatitis, hepatitis, liver cirrhosis, peptic ulcer, hernia, etc.)
3. Diseases of the musculoskeletal system (diseases of the joints, curvature of the spine, radiculitis, osteoporosis, osteomyelitis, osteochondrosis, spinal hernia and
4. Respiratory diseases ( bronchial asthma, bronchitis, pneumonia, emphysema, pneumosclerosis, allergic and vasomotor rhinitis, nasopharyngitis, sinusitis, influenza, ARVI, etc.)
5. Endocrine diseases(diabetes, diseases thyroid gland, hormonal disorders and etc.)
6. Diseases genitourinary system (gynecological diseases, adenoma prostate gland, prostatitis, urolithiasis disease, pyelonephritis, glomerulonephritis, hematuria, cystitis, etc.)
7. Diseases of the nervous system (parkinsonism, tremor, epilepsy, multiple sclerosis, migraine, etc.)
8. Ear diseases (otitis, diseases auditory nerve and etc.)
9. Eye diseases (cataracts, glaucoma, retinal diseases, etc.)
10. Oncological diseases
11. Skin diseases(dermatitis, psoriasis, lichen, urticaria, nail diseases, etc.)
12. Mental and behavioral disorders
13. Blood diseases and immunodeficiencies
14. Injuries, burns, frostbite, poisoning and their consequences
4. Do you suffer from chronic diseases?
2. No => go to question 10
5. Are you registered with a dispensary?
6. Do you undergo an annual medical examination?
1. Don't have => go to question 10
2. Applying now => go to question 10
3. I have group III
4. I have group II (with the right to work)
5. I have group II (without the right to work)
6. I have group I
7. Disabled childhood
8. As a result of the reform on monetization of benefits, you chose to receive:
1. Preferential medications
2. Cash compensation => go to question 10
9. Have you had any difficulties in obtaining subsidized medications?
When writing a prescription at a clinic
When receiving medicine from a pharmacy
10. Do you use the services traditional healers, homeopaths, psychics, etc.? (you can provide multiple answers)
1. Never had to before => go to question 12
2. Contacted a homeopath
5. To different healers
6. Other services (write)
11. Did this alternative treatment help you?
3. It got worse
4. I find it difficult to answer
12. In case of illness, do you turn to the Temple for help?
1. Yes, and this is my main support.
2. Yes, but I have other forms of support.
3. No, I don’t contact you
13. How do you eat?
2. Rather bad
3. Satisfactory
4. Rather good => go to question 15
5. Ok => go to question 15
6. Difficult to answer => go to question 15
14. What do you associate with poor nutrition? (you can provide multiple answers)
1. With financial difficulties
2. With working mode
2. No => go to question 19
16. Does your employer provide any support in obtaining medical care?
2. No => go to question 19
3. Undecided => go to question 19
17. How does your employer support you? (you can provide multiple answers)
1. Organizes medical stations
2. The enterprise has a medical facility for employees (for example, a clinic, a medical unit)
3. Provides spa treatment
4. Provides additional medical insurance (in the form of voluntary medical insurance)
5. Makes payment (full or partial) for medical care
6. Other (write)
18. What type of medical services were provided to you at the expense of your employer over the past year? (you can provide multiple answers)
1. Treatment in a clinic
2. Treatment in hospital
3. Treatment in medical institution enterprises
6. Dental care
7. Vaccination
8. Other (write)
9. I did not use any medical services from my employer
Please answer questions related to your contacts with the healthcare system (excluding dental care)
19. Where do you usually get treatment? (you can provide multiple answers)
1. At the district clinic at the place of registration
2. In the clinic at the place of actual residence
3. In a departmental clinic
4. In paid institutions
(1 - very poor quality, 2 - bad, 3 - satisfactory, 4 - good, 5 - very good, 6 - difficult to answer):
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| 1 | 2 | ? | 4 | $ | a | ||
| 1 | IVrtTOJPGYA POLNKI "PPPSN PLATE TFOPISKN | ||||||
| 1 | 1 Iiigiklshshka at the place of fact*geskpi p IIROZhINGINIA | ||||||
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1. Never => go to question 23
3. From 2 to 5 times
4. Over 5 times
22. For what purpose did you come to the clinic? (several options can be ticked)
1. Treatment
2. Walkthrough medical examination(medical examination)
3. Getting advice
4. Obtaining certificates, directions, prescriptions and other documents
5. Other (write)
To the therapist
2. To the surgeon
3. Neuropathologist
4. To the ophthalmologist
5. Otolaryngologist
6. To the dentist
7. Radiologist
8. Cardiologist
9. To the registry
10. To no one
1. Never
2. Once
3. Twice
4. Four times
5. More than four times
Total number of days of sick leave (write)_
25. How long does it take you to get to the clinic where you usually get treatment?
1. Up to 10 minutes inclusive
2. From 10 to 30 minutes inclusive
3. From 30 minutes to 1 hour inclusive
4. More than 1 hour
26. Is the work schedule of doctors and clinic services convenient for you?
27. How long on average after making an appointment can you get an appointment with a specialist doctor?
1. Same day
2. The next day
3. Within 2-7 days
4. Over a week
5. I generally can’t get an appointment with the right specialist.
28. How long does it take you to wait to see a doctor?
2. From 15 to 30 minutes
3. From 30 min to 1 hour
4. From 1 to 2 hours
5. Over 2 hours
6. Over 3 hours
29. Do you consider the duration of a medical appointment sufficient?
3. I find it difficult to answer
30. Do you think the medical workers at the clinic have sufficient qualifications?
3. I find it difficult to answer
31. Do you think medical workers carry out preventive measures (information, health education, medical examination, vaccination, etc.)?
3. I find it difficult to answer
We ask you to answer questions regarding your relationship with medical professionals
32. What are the main emotions you experience in relation to the medical workers of the clinic?
1. Sympathy
2. Trust
3. Antipathy
4. Mistrust
5. Other (write)
6. I find it difficult to answer
33. From what sources do you mainly get medical information about diseases, methods of their treatment and medications?
1. From medical workers
2. From information announcements in the clinic
3. From friends and relatives
4. From popular science literature
5. From periodicals
6. On the radio
7. On TV
8. Via the Internet
9. Other (write)
34. Tell me, do you receive enough information about the state of your health from medical workers at the clinic?
1. Too much information
2. Yes, exactly as much as needed
3. No, I would like more
1. Complete trust and mutual understanding
2. Partial trust and understanding
3. Lack of any trust and mutual understanding
4. I find it difficult to answer
36. Do you understand what the doctor explains?
1. Yes, completely => go to question 38
2. Only partially
3. Nothing is clear
37. What makes it difficult to understand the explanations of medical workers?
1. They use too many complex, technical terms
2. They speak incomprehensibly, quickly, do not repeat or clarify anything incomprehensible.
3. They don’t explain, but write illegibly
4. Other (write)
5. I find it difficult to answer
38. When conducting an examination and prescribing treatment for you, the doctor takes into account your state of health, past illnesses and operations, age, etc.?
2. When and how
39. Do you think the doctor listens to your complaints carefully?
40. How do you assess the professional qualities of your doctor? Rate the following qualities on a scale of 1 to 5
(1 - very bad, 2 - bad, 3 - satisfactory, 4 - good, 5 - very good, 6 - difficult to answer):
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| 1 | 2 | 3 | 4 | S | 6 | ||
| 1 | Kompstsi gp that is, prof"itsiot niches | ||||||
| 2 | Spґ) і in singing profe^siopa.mmyuy notes | ||||||
| 3 | The consequences of treatment | ||||||
| 4 | And I sewed the approach | ||||||
| L my i and fi.ii tsi i failure Hitvi"i t. (11 t>I"tuk.tvie nіn working Jvkviv") | |||||||
41. What words do you think can most accurately describe your doctor:
1. Doctor-guardian (all decisions are made by the doctor without asking the patient’s opinion)
2. Persuading doctor (the doctor offers a choice of plans, treatment methods, medications and convinces of the need to choose one or another method)
3. A doctor who builds his relationship with the patient on mutual trust and consent (the patient’s role is passive, the doctor conveys to the patient only the information necessary in his opinion)
4. Doctor-informant, providing the patient with the necessary information and complete freedom of choice upon his request
5. Other (write)
42. Is the doctor involved in your problems, does he empathize with you?
2. When and how
43. Do you talk to your doctor about personal topics?
44. Describe your condition, which most often occurs after visiting a doctor?
1. There is optimism, a feeling of support, understanding, trust
2. Nothing changes
3. Pessimism, dejection, and concern appear
45. How long have you been seeing your doctor?
1. Less than a year
2. From 1 to 3 years
3. From 3 to 5 years
4. More than 5 years
46. In your opinion, is there a difference in the attitude of doctors towards different groups patients (men and women, young and old, etc.)?
2. No => go to question 48
3. Difficult to answer => go to question 48
47. Which group of patients are doctors more attentive to?
1. Yes, always => go to question 50
49. Why don’t you follow your doctor’s orders?
1. I don’t trust the doctor
2. I don’t trust official medicine
3. I do not agree with the methods and medications chosen for treatment
4. I don’t like taking medications.
5. I don’t believe in the possibility of recovery.
6. There is not enough money for medicines
7. It’s not entirely clear what needs to be done
8. Because of your own laziness
9. Other (write)
10. I find it difficult to answer
50. What actions do you take if you do not agree with the doctor’s recommendations?
1. I don’t take any action, I do what I’m told
2. I explain my position to him.
3. I don’t say anything, I just don’t do them.
4. I accuse him of incompetence.
5. I turn to another specialist
6. Other (write)
51. Does it happen that a doctor does not carry out what you think are necessary diagnostic or therapeutic procedures?
1. Yes, quite often
2. Yes, sometimes
3. No, never
52. If you have any adverse reaction on the received medicinal product Who will you contact first?
1. To relatives
2. To friends or neighbors
3. See your doctor
4. To your friend’s doctor
5. Other (write)
Yes
3. I find it difficult to answer
54. Have you encountered medical errors?
1. Yes, often
2. Yes, sometimes
3. No, never
55. Do you have conflicts with medical workers?
1. Yes, all the time
1. With representatives of the clinic administration
2. With doctors
3. With nurses
4. With nurses
5. With reception staff
6. With everyone equally
57. What was the main reason for the conflict?
1. Inability to get an appointment with another doctor
2. Violation of medical ethics
3. Doctor making decisions without my consent
4. An attempt by the doctor to obtain personal material gain
5. Reluctance to prescribe a number of diagnostic and/or therapeutic procedures
6. Failure to disclose information about my health condition, disease or treatment
7. Medical error
8. Other (write)
58. What qualities of a doctor are most important to you?
1. Attentiveness and compassion for the patient
2. Communication skills
3. Qualification
6. The prestige of his specialty
7. His intelligence level
8. Other (write)
59. How do you see an ideal doctor?
1. Age_
3. Academic degree
4. Nationality
5. Religion
6. Personal qualities
7. Professional qualities
60. How do you assess the balance of rights and responsibilities between doctors and patients?
1. Patients have more rights than doctors.
2. Doctors have more rights than patients.
3. Patients and doctors have equal rights
6. I find it difficult to answer
61. Does it ever happen that you ask a doctor to prescribe you some kind of treatment or prescribe certain medications?
1. Yes, often
2. Yes, sometimes
3. No => go to question 63
4. I find it difficult to answer
62. In this case, does the doctor fulfill your wishes?
2. Yes, if the desire coincides with his opinion
3. Yes, if the desire corresponds to the data of tests and examinations
5. I find it difficult to answer
63. Do you think it is necessary to develop rules for communication between medical workers and patients?
3. I find it difficult to answer
We ask you to answer questions regarding the healthcare system as a whole
64. Have you ever had to refuse treatment due to lack of money?
(you can provide multiple answers)
1. Yes, I had to
65. Which of the following statements best suits your situation? (you can provide multiple answers)
1. Never used the services of private medical institutions
2. I can’t afford private ones. medical services
3. To pay for private medical services, I have to cut other expenses
4. I will be able to pay for private medical services without significantly reducing my (family) budget
5. Paying for private medical services is not a problem for me.
6. I find it difficult to answer
66. Do you support the development of a private (paid) healthcare system?
3. I find it difficult to answer
We ask you to answer questions related to healthcare financing
67. Which of the following statements can you agree with?
1. Medical care should be free, as before
2. Along with free help there should be paid medical services
3. Services should not be free
4. Services should be partially paid depending on the financial situation of the patient
5. I find it difficult to answer
68. Have you ever had to pay for medical services directly out of pocket?
2. No, never
3. I find it difficult to answer
69. Approximately what amount did you have to spend on shadow payments over the last year? (Please write)
70. How much out of pocket are you willing to spend annually on health-related services (including medications)?
1. Up to 1000 rub.
2. From 1000 to 2000 rubles.
3. From 2000 to 3000 rubles.
4. From 3000 to 4000 rubles.
5. More than 4000 rub.
6. I find it difficult to answer
Questions related to health insurance
71. What type of health insurance policy do you have?
1. Mandatory
2. Voluntary
3. Mandatory and voluntary
4. I don’t have
5. I find it difficult to answer
72. Do you have enough information on health insurance?
1. Yes, enough information
2. No, there is not enough information
73. Would you like to know more? (you can provide multiple answers)
1. Yes, about compulsory health insurance
2. Yes, about voluntary health insurance
Issues related to patients' rights
74. Have you ever had problems getting medical care outside the city?
1. Did not arise
2. I was denied due to lack of insurance
3. I was denied if I had a policy
75. Have you ever had to file a complaint against the work of your attending physician or a medical institution?
2. No => go to question 79
76. What was the reason for your complaint? (you can provide multiple answers)
1. Denial of medical care
2. Poor organization of patient reception
3. Payment for a service that should be free
4. Poor quality medical care
5. Problems with preferential drug coverage
6. Bad attitude by medical personnel
7. Inadequacy of medical care or services provided (for example, insufficient level of examination)
77. Where did you apply? (you can provide multiple answers)
1. To the administration of the medical institution
2. To the Health Committee
3. To a medical insurance organization
4. To the Moscow City Compulsory Medical Insurance Fund
6. To other organizations (write)
78. Are you satisfied with the response to the complaint?
3. There was no answer
79. As a patient, do you know your rights?
2. No => go to question 81
3. Difficult to answer => go to question 81
80. How did you find out about your rights? (you can provide multiple answers)
1. From the doctors who are treating me
2. In medical organizations that I visited
3. From employees of the compulsory health insurance fund
4. From information materials of the clinic stands
5. From the media
81. Who do you think represents the patient’s rights? (you can provide multiple answers)
2. Compulsory health insurance fund
3. Institution providing medical care (clinic or hospital)
4. Health authority
6. None of the above organizations
7. Others (write)
8. I find it difficult to answer
82. Compulsory health insurance gives patients the opportunity to choose medical institution And insurance company. Have you taken advantage of this right? (you can provide multiple answers)
1. Yes, I chose (another) clinic
2. Yes, I chose (another) doctor
3. Yes, I changed my insurer
4. No, I wanted to change the medical institution, but I couldn’t.
5. No, I wanted to change doctor, but I couldn’t.
6. No, there has been no need for this until now
7. No, because I didn’t know about this right
83. How would you rate the quality of medical care provided:
1. Excellent
2. Good
3. Satisfactory
4. Bad
Improved
2. There have been no changes
3. Worsened
4. I find it difficult to answer
85. How do you assess the state of healthcare in Moscow?
1. Good
2. Satisfactory
4. I find it difficult to answer
We ask you to answer personal questions
1. Male
2. Female
87. Age
1. Up to 19 years of age inclusive
2. From 20 to 29 years old
3. From 30 to 39 years old
4. From 40 to 49 years old
5. From 50 to 59 years old
6. From 60 years and older
88. Education 1. Primary
4. Secondary special
5. Unfinished higher education
89. Social status(check only one answer, indicate your main status)
1. Student => go to question 91
2. Worker
3. Engineer, employee
4. Civil servant
5. Pensioner => go to question 91
6. Working pensioner
7. Unemployed => go to question 91
8. Housewife => go to question 91
90. What organization do you work for? (check only one answer, indicate your main place of work)
1. In a commercial organization
2. In a budget organization
91. Your marital status
1. Married
2. Single (not married)
92. Do you have children under the age of 18?
1. Yes (how much)
93. How many workers are there in your family? (specify exact number) Write
94. What is the average monthly income of your family per person?
1. Less than 1000 rub.
2. From 1000 to 2000 rubles.
3. From 2000 to 3000 rubles.
4. From 3000 to 4000 rubles.
5. From 4000 to 5000 rubles.
6. From 5000 to 6000 rubles.
7. From 6000 to 7000 rubles.
8. From 7000 to 8000 rubles.
9. More than 8,000 rubles.
10. I find it difficult to answer
Thank you for the information you provided!
Pyelonephritis is inflammation of the kidney tissue. Pyelonephritis can affect a person of any age, but more often it affects:
children under 7 years of age whose disease is associated with anatomical features development;
girls and women aged 18-30 years, in whom the appearance of pyelonephritis is associated with the onset of sexual activity, pregnancy or childbirth;
elderly men suffering from prostate adenoma.
In addition to the above, one of the most common causes of pyelonephritis is urolithiasis disease And frequent attacks renal colic.
With all these diseases and conditions, the outflow of urine from the kidney is disrupted, which allows microorganisms to multiply in it. Factors such as a decrease in the overall immunity of the body also contribute to the development of pyelonephritis, diabetes, chronic inflammatory diseases. In its course, pyelonephritis can be acute and chronic.
Symptoms:
The disease begins suddenly, the temperature rises sharply to 39-40 ° C, weakness appears, headache, profuse sweating, nausea and vomiting are possible. Simultaneously with the temperature, pain appears in the lower back, usually on one side. The pain is dull in nature, but its intensity can vary. If the disease develops against the background of urolithiasis, then the attack of pyelonephritis is preceded by an attack of renal colic. Urination in uncomplicated pyelonephritis is not impaired.
If left untreated, the disease either progresses to chronic form, or suppurative processes develop - an apostematous form of pyelonephritis, an abscess or carbuncle of the kidney. Suppurative processes are manifested by deterioration of the patient’s condition, sharp jumps temperatures (from 35-36 °C in the morning to 40-41 °C in the evening).
Chronic pyelonephritis, as a rule, is a consequence of untreated acute pyelonephritis, when it was possible to relieve acute inflammation, but it was not possible to completely destroy all pathogens in the kidney, nor to restore the normal outflow of urine from the kidney. Chronic pyelonephritis can constantly bother the patient with blunt aching pain in the lower back, especially in damp, cold weather. In addition, chronic pyelonephritis worsens from time to time, and then the patient develops all the signs of an acute process. Treatment of chronic pyelonephritis is fundamentally the same as acute pyelonephritis, but longer and more labor-intensive.
Diagnostics:
Blood and urine tests are carried out, as well as studies that show general state urinary tract (ultrasound, x-ray examinations). The diagnosis of acute pyelonephritis is usually not difficult.
Treatment:
Patients with acute pyelonephritis must be treated in a hospital. The uncomplicated form of pyelonephritis is treated conservatively, antibacterial, detoxification and immunostimulating therapy is carried out. Treatment is carried out until microbes completely disappear from the patient’s urine. Usually it is 2-3 weeks. In case of suppurative complications, surgery is indicated. Sometimes it is necessary to resort to surgical intervention also in case of urolithiasis, if the stone does not pass away on its own and cannot be removed by instrumental methods.
Prevention:
The main recommendation for the prevention of pyelonephritis is treatment of the underlying disease, which can lead to its development, primarily urolithiasis and prostate adenoma, as well as all diseases accompanied by impaired outflow of urine from the kidney. Pregnant women, especially those with multiple pregnancies, polyhydramnios, large fruit and with narrow pelvis must be carried out at least once a month bacteriological analysis urine and urodynamic studies.
Acute obstructive pyelonephritis is a severe infectious and inflammatory disease that develops against the background of urodynamic disturbances urinary tract. Its most dangerous complications are bacteriotoxic shock and sepsis. According to the literature, mortality in patients with acute obstructive pyelonephritis can reach 20%. Treatment success of this disease directly depends on timely detection and elimination of disturbances in urodynamics of the urinary tract, followed by the appointment of adequate empirical therapy. According to Russian and international clinical guidelines The main method of treatment at the first stage is kidney drainage. Despite this, about a quarter of patients undergo kidney drainage due to acute obstructive inflammatory process not fulfilled . The above determines the relevance of the study and subsequent analysis of the provision of specialized urological care to patients with acute obstructive pyelonephritis in Moscow hospitals.
MATERIALS AND METHODS
We analyzed the provision of medical care to patients with acute obstructive pyelonephritis in Moscow. 400 questionnaires were sent to all urological hospitals under the jurisdiction of the Moscow Department of Health. In agreement with the heads of urology departments, one questionnaire was completed for each case of hospitalization for acute obstructive pyelonephritis. Based on the results of a survey conducted from June to September 2016, an analysis of demographic indicators, diagnostic methods, treatment, and disease outcomes of patients with acute obstructive pyelonephritis who were admitted to Moscow hospitals during this period was performed. Exclusion criteria for the study included indications of the presence of a ureteral stent and/or nephrostomy drainage or other methods of urine diversion at the time of hospitalization. We received and subjected to statistical processing 183 questionnaires sent from 17 urological departments. In order to determine statistical significance results, the construction method was used confidence intervals for proportions and the Mann-Whitney test.
RESULTS
The average age of patients admitted to urological hospitals in Moscow with a diagnosis of acute obstructive pyelonephritis was 55.4 years, while it was found that women were hospitalized three times more often than men: 137 (74.9%) and 46 (25.1 %) people, respectively. Of all admitted patients, 52 (28.4%) reported that they were working, 131 (71.6%) were not working at the time of admission.
83 (45.4%) patients were previously observed by a urologist for diseases of the genitourinary system; 32 (17.5%) patients underwent interventions on the upper urinary tract, and 19 (10.4%) - on the pelvic organs. 146 (79.8%) patients were delivered to the hospital by an ambulance team, 11 (6.0%) were admitted by referral from the outpatient network and 26 (14.2%) by gravity. The average bed day was 7.4 days. Mortality rate - 1.1%. Concomitant diseases were identified in 117 (63.9%) patients: arterial hypertension in 102 (55.7%) patients, coronary heart disease - in 62 (33.8%) and diabetes mellitus in 42 (22.9%) patients (Table 1).
Table 1. Comorbidities
| Accompanying illnesses | Number of patients, people | % |
|---|---|---|
| Arterial hypertension | 102 | 55,7 |
| IHD | 62 | 33,8 |
| Heart attack | 3 | 1,7 |
| Peptic ulcer of the stomach and 12 fingers. guts | 7 | 3,8 |
| Diabetes | 42 | 22,9 |
| Consequences of stroke | 7 | 3,8 |
| Bronchial asthma | 3 | 1,7 |
| Retroperitoneal fibrosis | 2 | 1 |
| Concomitant cancer diseases | 66 | 36,7 |
During their hospital stay, patients underwent the following laboratory and instrumental examinations: complete blood count (CBC) - 183 (100%) patients; general urinalysis (UU) - 160 (87.4%); urine culture - 148 (80.8%) patients; ultrasonography(ultrasound) of the kidneys and Bladder- 159 (86.9%) patients; survey urography - 97 (53%); excretory urography- 39 (21.3%) patients; native CT scan(CT) - 33 (18%), contrast-enhanced CT - 17 (9.2%) patients. Average level the level of leukocytes in the blood of patients was 14.4x109/l, however, it is noteworthy that the level of leukocytes less than 15x109/l was diagnosed in 30 (16.3%) patients, and above 15x109/l in 153 (83.6%) patients. Leukocyturia was observed in 149 (81.4%) patients, and bacteriuria in 74 (44.5%) patients. Urine culture in 90 (49.2%) patients revealed microorganisms in titers exceeding threshold values; most often (35.6%) E. coli was cultured as the main pathogen. Upon admission, the average body temperature of patients was 37.90 C; temperatures below 38 °C were observed in 46 (25.1%) patients. In 136 (74.3%) patients, the rise in body temperature was preceded by an episode of renal colic. Retention changes in the renal collecting system (PSS) were identified in 166 (90.7%) patients. The average size pelvis (according to ultrasound results) at the time of hospitalization was 27.4 mm (median = 25). In 153 (83.6% CI 77.4-88.6%) patients, the size of the pelvis exceeded 20 mm, in 30 (16.39 CI 11.34-22.57%) it was less than 20 mm, and only in 5 (2 .7%) of patients was less than 15 mm. The mean cup size (as measured by ultrasound) at the time of hospitalization was 13.7 mm (median = 12). 151 (82.5% CI 76.2-87.7%) patients had cup size greater than 10 mm, and 32 (17.5% CI 12.28-23.78%) had cup size less than 10 mm. Most common cause disturbances in the outflow of urine were ureteral stones, identified in 142 (77.6%) patients; the second most common cause (8.7%) was compression of the ureter by an extraorgan tumor; much less often, disturbances in the outflow of urine occurred against the background of a stricture of the ureter, pyelovasal conflict or bladder outlet obstruction . In 14 (7.7%) patients, the cause of obstruction could not be determined (Table 2).
Table 2. Causes of impaired urine outflow
In 4 (2.8%) patients, an isolated renal pelvis stone was detected, in 39 (27.5%) - kidney stones and ureteral stones, in 99 (69.7%) - isolated ureteral stones were diagnosed. Stone upper third A ureteral stone was diagnosed in 48 (33.8%), a middle third stone in 58 (40.8%) patients, and a lower third stone in 32 (22.5%) patients (Fig. 1). The mean ureteral stone size was 7.9 mm (median = 7).
Rice. 1. Localization of stones
Kidney drainage was performed in 170 patients (92.9%). The most common procedures performed were ureteral stenting - 112 (61.2%) and percutaneous puncture nephrostomy - 54 (29.5%) patients. The average time from the moment of hospitalization of the patient to the moment of drainage was 4 hours. In 18 (10.6%) patients, drainage of the upper urinary tract was performed 24 hours after hospitalization (Table 3).
Table 3. Methods of kidney drainage
| Methods of kidney drainage | Quantity patients, people |
Share,% |
|---|---|---|
| Puncture nephrostomy | 54 | 29,51 |
| Ureteral stenting | 112 | 61,2 |
| Other | 3 | 1,64 |
| Ureteral catheterization | 1 | 0,55 |
Empirical antibacterial therapy was prescribed to all patients: cephalosporins were used most often (50.8%), drugs of the fluoroquinolone group were second most often (22.4%), penicillins were prescribed in 8.2% of cases, the remaining 18.5% of patients used combinations of antibacterial drugs (Table . 4). Average duration Antibacterial therapy was 7 days. In 17 (9.3%) cases, the need to intensify antibacterial therapy was noted.
Table 4. Antibacterial therapy
Complications of acute obstructive pyelonephritis were noted in 15 (8.2%) patients: 7 (3.83%) were diagnosed with a purulent-destructive form of an infectious-inflammatory process in the kidney, 9 (4.9%) were diagnosed with sepsis, 4 of them (2.2%) developed bacteriotoxic shock, which caused the death of two patients (Table 5). Due to the purulent-destructive complications that arose, 7 (3.83%) patients underwent surgical interventions: 4 (2.2%) patients underwent open revision of the kidney with drainage of the purulent focus or nephrectomy, and in three (1.7%) cases, percutaneous puncture drainage of the purulent focus was performed.
Table 5. Complications of obstructive pyelonephritis
Median age (72 vs. 56 years, p=0.034), higher median leukocytosis (20.5x109/l vs. 13x109/l, p=0.04551) during hospitalization was significantly higher in patients with complicated pyelonephritis. For all other parameters significant differences with complicated and uncomplicated pyelonephritis was not observed.
DISCUSSION
Analysis of the data obtained during the survey showed that the majority of patients admitted to urological hospitals in Moscow with clinical picture acute obstructive pyelonephritis, women. The average age of the patients was 55 years, which determines the high social significance of this disease. More than half of patients have accompanying illnesses, which is an indication for consultation with other specialists. In most cases, the rise in the patient's body temperature was preceded by an episode of renal colic. On admission, the majority of patients had an increase in body temperature above 380C, blood leukocytosis above 15x109/l, dilation of the renal pelvis by more than 20 mm and calyces by more than 10 mm, which makes it possible to classify these symptoms as reliable signs of acute obstructive pyelonephritis.
Our study revealed a relatively small percentage of bacteriuria - 49.2%, compared to data from other authors - 73.9%.
The most common cause of acute obstructive pyelonephritis remains ureteral stones. Noteworthy is the extremely low rate of in-hospital X-ray contrast examinations, which may be explained by the fact that most patients undergo kidney drainage within the first 24 hours based on clinical data and ultrasound data.
According to our study, kidney drainage was performed in more than 90% of patients with acute obstructive pyelonephritis, and the time from hospitalization to drainage in most cases did not exceed 24 hours. These figures differ significantly from the data of some foreign authors, according to which about 25% of patients do not undergo kidney drainage. The main method of kidney drainage in urological hospitals in Moscow is ureteral stenting.
In a larger percentage of cases, patients with acute obstructive pyelonephritis after drainage of the urinary tract are prescribed adequate empirical antibacterial therapy, which does not require intensification. The main group of antibacterial drugs prescribed for the treatment of acute obstructive pyelonephritis are cephalosporins. In 18.5% of cases, a combination of several antibacterial drugs is used. A complicated course of obstructive pyelonephritis was noted in less than 10% of patients, and sepsis was diagnosed in 5% of patients. This figure differs significantly from the data of foreign authors, according to which the incidence of sepsis can reach 33.3%.
Lumbotomy with subsequent revision of the kidney was performed only if there was destructive form pyelonephritis.
In our study, the mortality rate was 1.1%. In addition, analysis of the data obtained during the study showed that the median age and concentration of blood leukocytes on admission were significantly higher in the group of patients with a complicated course of the disease, which allows us to consider these indicators as risk factors for the course of obstructive pyelonephritis. These data are confirmed in a study by K. Yoshimura et al., who showed that older patient age is associated with more high risk surgical treatment.
CONCLUSIONS
Most patients with acute obstructive pyelonephritis and complications that develop against its background receive adequate and timely treatment in urological hospitals medical organizations Department of Health of the City of Moscow, consistent with the clinical recommendations of leading professional societies. The incidence of sepsis is low and does not exceed similar indicators presented in foreign literature. It is necessary to continue further research aimed at developing mechanisms for optimizing medical care for patients with acute obstructive pyelonephritis.
LITERATURE
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