Medicine pyelonephritis symptoms and treatment. Treatment of pyelonephritis in acute or chronic form with medications and folk remedies

In the nephrological and urological practice of doctors, such a disease as is often encountered. According to statistics, the disease occurs in 20% of the population of different age category. Treatment of pyelonephritis is a long and labor-intensive process, therefore, when diagnosing this disease, patients need not only to take medications for a long time, but also to follow a diet and give up bad habits. Medicines for pyelonephritis will help not only eliminate the symptoms of the disease, but also influence the very cause of its development.

Pyelonephritis, refers to infectious pathologies acute or chronic course. The disease can affect either one or both kidneys, causing very serious diseases. It develops as a result of the penetration of pathogenic pathogens into the lower parts of the genitourinary system, which multiply quite quickly, move through the canals of the genitourinary system, reach the kidneys, and then provoke inflammatory process.

Pyelonephritis is included in the group of diseases of the urinary system, the treatment of which should be carried out under the supervision of a doctor and only after the results of laboratory and instrumental diagnostics.

Drug treatment of pyelonephritis is aimed at suppressing and destroying pathogenic pathogens, therefore the first drugs for symptomatic treatment will be antimicrobial and antibacterial agents. The treatment regimen for pyelonephritis always consists of taking several medications different mechanism actions that will help not only suppress the aggressiveness of pathogenic bacteria, but also improve the functioning of the kidneys and urinary system as a whole. In order to successfully cure pyelonephritis, it is important not only to recognize the disease in time, but also to identify and eliminate its main cause.

A disease such as pyelonephritis develops as a result of pathogenic flora entering the genitourinary system. The causative agents of infection are often intestinal microorganisms - coli, enterococci, Proteus, staphylococci, streptococci and other bacteria that can stay in the body for a long time, show their aggressiveness against the background of a number of factors, or penetrate from external environment.

The disease is diagnosed in women much more often than in men. The reason for this is anatomical structure organs of the genitourinary system. The following factors can be a trigger for the development of pyelonephritis:

Hypothermia of the body.
Decreased immunity.
Concomitant diseases of the genitourinary system.
Frequent stress, nervous tension.
Failure to comply with personal hygiene rules.
Gynecological manipulations.
Bladder catheterization.

One of the causes of pyelonephritis is nervous tension and stress.

During the development of the inflammatory reaction in the kidneys, the outflow of urine through the ureter is disrupted, which causes an increase in intrapelvic pressure, disruption of capillary blood flow, and tissue hypoxia. Such pathological changes significantly disrupt kidney function and may have unpleasant consequences.

Pyelonephritis is treated quite complex diseases, so many people wonder whether pyelonephritis can be cured?

How to recognize the symptoms of pyelonephritis?

The first symptoms of pyelonephritis may appear several hours after contact with a pathogenic pathogen or after a few days. They can be expressed or erased and directly depend on the degree of the disease, its stage, accompanying symptoms sick. A characteristic symptom The disease is considered to be pain in the lumbar region, which can radiate to the back and lower abdomen. By character pain syndrome may have different intensity.

With pyelonephritis, patients complain of following symptoms:

Pain when urinating.
Copious and frequent urination.
Cloudy urine mixed with pus or blood.
Elevated leukocytes in the blood test.
Increase in body temperature to 39 degrees.
Fever.
Nausea, urge to vomit.

The clinical picture of the disease is more pronounced in acute period. In the chronic form of the disease, the symptoms are less pronounced, and the disease itself can be diagnosed accidentally after testing. For kidney pyelonephritis, the doctor prescribes a series of tests, studies the clinic, and then prescribes therapeutic therapy.

Principle of drug treatment

Treatment of pyelonephritis in adults, as well as in children, consists of a whole range of therapeutic measures aimed at suppressing the infection and its spread to other parts of the urinary system. Features of therapeutic therapy depend on the patient’s age and the degree of damage to the structures of the genitourinary system.

In order to cope with the disease, the doctor prescribes several drugs that not only eliminate pathogenic flora, but also restore kidney function. How to treat pyelonephritis and how to prevent it possible complications, determined by the attending physician after determining the nature of the disease.

Considering that this disease is infectious in nature, before prescribing treatment for pyelonephritis, it is important to determine the strain of the pathogen and select drugs to which the pathogen remains sensitive.

If the nature of the disease is not clear, doctors prescribe antimicrobial drugs that can suppress the aggressive flora. In addition to antibacterial drugs, the patient takes other medications to relieve pain, improve kidney function, and reduce the risk of exacerbations and complications.

Complex therapy for pyelonephritis often includes the following groups of drugs:

antibiotics;
diuretics;
immunomodulators;
antihistamines;
antispasmodics;
anti-inflammatory drugs;
vitamin therapy, immunotherapy;
herbal medicines.

The main thing in the treatment process is antibiotics, which can eliminate bacteria, relieve inflammation, thereby stopping the disease. Antibacterial therapy consists of taking antimicrobial drugs. The acute period of the disease always requires the use of anti-inflammatory, analgesic and antipyretic drugs, which should be taken for 3 to 7 days. Medicines based on herbs, which are well tolerated and interact ideally with antibiotics and other symptomatic drugs, can improve the functioning of the urinary system.

An important place in the treatment of pyelonephritis is occupied by pathogenetic treatment, which is aimed at the mechanisms of development of the disease itself, restoring general health, and reducing the risk of complications after the disease.

Statistics show that in approximately 20% of people suffering from pyelonephritis, the disease takes on a chronic form, which is characterized by periods of remission and exacerbation. In the acute period, the doctor will always prescribe antibacterial drugs, and during remission - preventive treatment which will reduce the frequency of exacerbations.

The acute form of pyelonephritis must be treated in a hospital setting, where the disease will be constantly monitored. With minor inflammation, satisfactory condition of the patient, healing process can be performed on an outpatient basis. Treatment at home must necessarily include taking certain medications, following a diet and all the doctor’s recommendations.

Basically, treatment for pyelonephritis lasts at least 2 weeks, so if after a few days of taking the patient the patient feels much better, you need to undergo a full treatment course, this will help reduce the risk of the disease becoming chronic.

Antibacterial therapy is considered the main thing in the treatment of pyelonephritis, but the choice of drug directly depends on the type of pathogen and the age of the patient. Doctors often use medications to treat the symptoms of pyelonephritis as quickly as possible. high efficiency. Therefore, patients must strictly adhere to the recommended doses, course, and frequency of taking them.

Nitrofurans

A common group of drugs used for the treatment of the urinary system are nitrofurans, which have a broad antimicrobial effect against gram-positive and gram-negative bacteria. Taking such medications allows you to suppress the aggressiveness of staphylococci, streptococci, trichomonas, E. coli and other microbes.

Representatives of this group:

Furagin.
Furadonin
Furazolidone.
Furamag.

The active components of such drugs quickly penetrate into the inflammation, block and destroy cell membranes pathogenic pathogens, thereby stopping their reproduction. Basically, such drugs are prescribed for the treatment of chronic pyelonephritis. General contraindications comes to their reception childhood up to 3 months, pregnancy, lactation. The course of treatment and dose are determined by the doctor for each patient.

Group representatives:

Norfloxacin (Nolitsin).
Ciprofloxacin (Ciprinol, Tsiprolet).
Ofloxacin.
Lomefloxacin (Lomflox).

Taking any medication from the fluoroquinolone group allows you to influence bacterial cells and disrupt them life cycle. Most often, these medications are used when other medications are ineffective. Taking any medicine from this group can only be prescribed by a doctor after identifying the pathogenic pathogen.

Sulfonamides

A group of drugs used to treat diseases of the genitourinary system caused by pathogenic bacteria. Sulfonamides are often used in combination with nitrofurans, which improves the efficiency and quality of treatment.

IN this group includes the following representatives:

Biseptol.
Urosulfan.
Nitroxoline.

In the last few years, they have been used quite rarely in the treatment of pyelonephritis, since most pathogenic bacteria are resistant to such drugs, so taking them may not bring the desired result. therapeutic effect.

Phosphonic acid derivatives

The only drug from this group is Monural, which has persistent antimicrobial properties and helps to quickly neutralize bacterial flora. The medicine is well tolerated and can be prescribed to children and even pregnant women.

The basis of the drug Monural is fosfomycin, which is an antibiotic. wide range actions. As practice shows, the effect after taking this drug can occur within 1 to 2 days. You can take the medicine only as prescribed by a urologist or nephrologist and only after making a final diagnosis.

Penicillins or cephalosporins

To relieve symptoms of pyelonephritis, treatment often includes taking medications from the group penicillin series or cephalosporin. Taking such medications allows you to suppress and destroy pathogenic flora.

These include:

Amoxiclav.
Augmentin.
Amoxicycline.
Cefazolin.
Ceftriaxone.
Emsef.

The treatment course with penicillin or cephalosporin drugs can take from 5 to 10 days. Such drugs are produced in different forms: tablets, suspension for children, or in ampoules for intramuscular or intravenous administration. Penicillins, as well as cephalosporins, can cause allergies, so before taking them you need to conduct a sensitivity test.

Natural preparations

Particularly popular are natural uroantiseptics for pyelonephritis, which contain medicinal herbs. Such drugs are prescribed in combination with other drugs, including synthetic antibiotics. Preparations based on medicinal plant extracts have pronounced antiseptic and diuretic properties.

Urolesan;
Phytolysin;
Cyston.

The advantage of such drugs is considered to be good tolerability and the absence of side effects even with long-term use. Uroseptics are considered ineffective for purulent pyelonephritis. Medicines from this group are prescribed for outpatient treatment or prevention of kidney and urinary system diseases.

Other drugs for the treatment of pyelonephritis

In addition to the main drugs for pyelonephritis, treatment includes the use symptomatic therapy, which will eliminate certain symptoms of the disease and improve the general condition of the patient.

Non-steroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Nimesulide, Voltaren, Movalis and others. Taking such medications allows you to relieve pain, normalize body temperature, and reduce the inflammatory process.

Probiotics – Linex, Laktovit, Ecoflor, Hilak forte. Used in combination with antibiotics and antimicrobials, protect the intestinal mucosa from dysbacteriosis.

Diuretics (diuretics) – Lasix, Furagin. They stimulate the outflow of urine from the renal tubules, thereby eliminating the occurrence of stagnant processes and reducing the risk of stone formation in the kidneys.

Complex therapy for pyelonephritis often includes taking drugs to stimulate the immune system, or vitamin therapy.

It is important to understand that you should not self-medicate inflammatory processes in the urinary system. Only a nephrologist or urologist knows how to cure pyelonephritis and eliminate all possible risks of its complications. It is known that preventing the development of pyelonephritis is much easier than treating it, so if a person monitors his health and seeks medical help on time, the risks are minimized.

Pyelonephritis is a name quite familiar to many people. But what does it mean? We're talking about . Urine becomes scanty, fluid accumulates in the body, pain occurs in the lumbar region - everyone who has had at least some kind of kidney disease knows these general symptoms. But still, each disease is unique and is treated in a special way..

What is pyelonephritis?

- This is inflammation of the renal pelvis. What then is pyelonephritis? This inflammatory disease, which affects the pelvis and parenchyma of the kidney, mainly its interstitial tissue. We can say that this disease can develop from pyelitis, which gave its complications and spread to healthy tissue. This also includes other kidney diseases that provoke pyelonephritis, for example, glomerulonephritis or urolithiasis.

Classification

The main classification of pyelonephritis should be considered:

By the number of affected kidneys:
- Unilateral: left-sided and right-sided - damage to one kidney;
- Bilateral – two kidneys are affected at once.
According to the flow form:
- Acute – develops quickly and brightly. Heals quickly. Lasts up to 20 days;
- Chronic – characterized by the manifestation of symptoms only at the time of exacerbation of the disease. Connective tissue grows, replacing the kidney, which leads to kidney failure and high blood pressure.
For the root cause:
- Primary – develops with inflammation of other organs, for example, with cholecystitis, sore throat, cystitis, caries, arthritis, tonsillitis;
- Secondary - occurs when there are disturbances in the outflow of urine, for example, with prostatitis, fibroids, nephroptosis, hydronephrosis, cancer, etc.
By type of inflammation:
- Serous;
- Purulent - is a chronic form of the disease that develops against the background of other existing kidney pathologies, affecting adipose tissue kidneys;
- Necrotizing papillitis.
By flow phases:
- Active inflammation is characterized by symptoms: increased temperature, pressure, abdominal and lower back pain, frequent urination, swelling;
- Latent inflammation is characterized by the absence of any symptoms and, accordingly, the patient’s complaints. However, pathologies are visible in urine analysis;
- Remission - there are no pathologies in the urine or symptoms.
Types:
- Apostematous;
- Kidney carbuncle;
- Pyonephrosis (wrinkling of the kidney);
- Kidney abscess.

Causes of pyelonephritis of the pelvis and kidney parenchyma

The main cause of pyelonephritis of the pelvis and kidney parenchyma is the penetration of infection. It can be endogenous (damaged by bacteria that are already in the body) or exogenous (bacteria penetrate from the external environment). Scientists do not single out certain type bacteria, since the kidney is often affected by various microorganisms at the same time (cocci and E. coli).

There are ways by which the infection penetrates the kidneys:

Hematogenous - through the blood;
Lymphogenic – through lymph from nearby affected organs;
Urethrogenic – from affected urine.

Not every person gets sick with pyelonephritis as soon as an infection enters the body. Many people lead far from peaceful lives, but if they get sick, it’s with other diseases. This suggests that facilitating factors are needed 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 and signs

Symptoms and signs of inflammation of the pelvis and kidney parenchyma appear in acute form and during exacerbations of chronic. What are these signs?

The composition of urine changes, causing it to become cloudy and even reddish (blood impurities). In this case, the smell of urine has a fetid and pungent odor.
Sharp or dull pain occurs in the lower back, joints, and groin. They intensify when urinating, as with cystitis, and bending forward.
The pain in the head gradually increases.
There is constant nausea with vomiting.
Appetite decreases.
Thirst appears.
Temperature may suddenly rise and chills may appear when a person feels normal.
General weakness appears.

Chronic pyelonephritis is characterized by its asymptomatic nature, which makes it difficult early detection diseases and treatment. Until remission occurs, symptoms similar to the acute form will not appear. There are phases of chronic pyelonephritis:

Asymptomatic (hidden). The temperature may rise slightly for no apparent reason.
Recurrent. General acute symptoms are observed (dizziness, weakness, fever, etc.), among which the main one is a change in urine. Hypertension, renal failure, and anemia may develop.

Pyelonephritis in children

Pyelonephritis in children is less common than in adults, but it ranks second (after respiratory diseases, such as bronchitis or pneumonia) for reasons for visiting a pediatrician. It is often asymptomatic, but parents should pay attention to some changes in the child’s behavior in order to contact a pediatrician for an examination:

Pale skin;
Frequent urination;
Unreasonable fatigue;
Change of mood.

Pyelonephritis often affects boys in infancy. However, after 6 years, girls often get it. If the disease is not treated, it can make the child disabled.

Pyelonephritis in adults

Pyelonephritis is common in adults. It occurs more often in women than in men. Some doctors associate this with the special structure of the genitourinary system. Others believe that the rules of healthy sexual intercourse were not followed here. Often girls who have had sexual intercourse for the first time experience this disease.

Nevertheless, pyelonephritis is a disease of adults after 30 years of age, regardless of gender. By this time, all pathologies and chronic diseases have already accumulated, which give their complications to the kidneys. In old age, men are more often affected than women.

Special attention should be paid to pregnant women, who may develop pyelonephritis around 22-25 weeks. This is due to the suppression of immunity during this period. Apart from pain when urinating, the disease does not manifest itself in any way. Here you should use medical assistance. In 95% of cases, pyelonephritis is quickly cured.

Diagnostics

Diagnosis of inflammation of the pelvis and renal parenchyma, as usual, begins with general examination after collecting patient complaints. Instrumental and laboratory studies that provide full picture happening:

Urinalysis, especially using the Nechiporenko method and Zemnitsky test.
Ultrasound of the abdominal cavity.
X-ray of the kidneys.
Immunological research.
Chromocystoscopy.
Kidney biopsy.
Scintigraphy and renography.

Treatment

Treatment of pyelonephritis takes place in 3 stages:

Diet.
Medicines.
Surgical intervention.

Diet

A diet that effectively promotes the patient’s recovery becomes very important. The main thing here is inclusion fresh vegetables and fruits, drinking plenty of fluids(more than 3 liters), as well as the exclusion of salty, fatty and fried foods.

In the chronic form, the diet becomes more strict:

Drink more than 2 liters of liquid (rosehip decoction, compotes, freshly squeezed juices from fruits and vegetables, tea, cranberry and lingonberry fruit drinks, etc.).
Accept multivitamin complexes.
Consume a maximum of 8 g of salt per day.
Exclude from the menu meat and fish broths, seasonings, sausages, smoked meats, canned food, marinades, alcohol, garlic, coffee, radishes, beans, horseradish.
Include well-cooked meat. Add watermelon, pumpkin, melon.

Medicines

As for medications, antibiotics and diuretics are mainly used if fluid stagnates. At the same time, it is forbidden to self-medicate and prescribe a course of medications to yourself. If treatment takes place at home, it is strictly under the guidance of the attending physician.

Surgical intervention

Surgical intervention is prescribed only if there is no effect from drug and dietary treatment. In this case, the source of inflammation is eliminated (which is often observed with purulent pyelonephritis), and also cleans the urine outflows if there were difficulties with urination. Renal catheterization is widely used here.

Herbal medicine at home

How to treat pyelonephritis at home? Herbal medicine (this does not exclude drug treatment):

Oats relieve spasms in the urinary ducts.
Rosehip and nettle reduce bleeding.
Bearberry and horsetail relieve swelling.
Strawberry leaf, plantain and chamomile relieve dyspepsia.
Herbal teas that are sold in pharmacies and treat kidney diseases.

Life forecast

The prognosis for life with pyelonephritis becomes disappointing if treatment is not carried out. How long do patients live? It all depends on the complications and their impact on overall health:

Renal hypertension.
Kidney failure.
Pyelonephrosis (purulent melting).
Transition of acute pyelonephritis to chronic.
Paranephritis.

Preventive measures that help both during recovery and in the absence of any kidney problems become important:

Drink about 3 liters of liquid.
Can't wait to go to the toilet.
Maintain genital hygiene.
Treat infectious diseases other systems.
Stick to healthy image: eat a balanced diet, exercise in moderation sports loads, take vitamins.
Avoid hypothermia.
Get checked periodically by a urologist (gynecologist).
Do not delay treatment of pyelonephritis if the first symptoms appear.

Okorokov A. N.
Treatment of diseases of internal organs:
Practical guide. Volume 2.
Minsk - 1997.

Treatment of chronic pyelonephritis

Chronic pyelonephritis- chronic nonspecific infectious-inflammatory process with predominant and initial damage interstitial tissue, pyelocaliceal system and renal tubules with subsequent involvement of the glomeruli and renal vessels.
Treatment program for chronic pyelonephritis.
1.
2.
3. (restoration of urine outflow and anti-infective therapy).
4.
5.
6.
7. .
8.
9.
10.
11.
12. .
13. Treatment of chronic renal failure (CRF).
1. Mode

The patient’s regimen is determined by the severity of the condition, the phase of the disease (exacerbation or remission), clinical features, the presence or absence of intoxication, complications of chronic pyelonephritis, the degree of chronic renal failure.

Indications for hospitalization of the patient are:

severe exacerbation of the disease;

development of difficult-to-correct arterial hypertension;

progression of chronic renal failure;

disturbance of urodynamics, requiring restoration of urine passage;

clarification of the functional state of the kidneys;

o development of an expert solution.

In any phase of the disease, patients should not be cooled, and significant physical activity should also be avoided.
With a latent course of chronic pyelonephritis with normal blood pressure or mild arterial hypertension, as well as with preserved renal function, regimen restrictions are not required.
During exacerbations of the disease, the regimen is limited, and patients with a high degree of activity and fever are prescribed bed rest. Visits to the dining room and toilet are allowed. In patients with high arterial hypertension and renal failure, it is advisable to limit physical activity.
As the exacerbation is eliminated, the symptoms of intoxication disappear, blood pressure normalizes, and the symptoms of chronic renal failure decrease or disappear, the patient’s regimen expands.
The entire period of treatment of exacerbation of chronic pyelonephritis until full expansion regimen takes about 4-6 weeks (S.I. Ryabov, 1982).

In case of chronic pyelonephritis, it is advisable to prescribe predominantly acidifying foods (bread, flour products, meat, eggs), then an alkalizing diet (vegetables, fruits, milk) for 2-3 days. This changes the pH of the urine, the interstitium of the kidneys and creates unfavorable conditions for microorganisms.

3. Etiological treatment

Etiological treatment includes eliminating the causes that caused the disruption of urine passage or renal circulation, especially venous circulation, as well as anti-infective therapy.

Restoration of urine outflow is achieved by using surgical interventions(removal of adenoma prostate gland, stones from the kidneys and urinary tract, nephropexy for nephroptosis, plastic surgery of the urethra or ureteropelvic segment, etc.), i.e. restoration of urine passage is necessary for so-called secondary pyelonephritis. Without sufficiently restored urine passage, the use of anti-infective therapy does not provide stable and long-term remission of the disease.

Anti-infective therapy for chronic pyelonephritis is the most important measure for both the secondary and primary variants of the disease (not associated with impaired urine outflow through the urinary tract). The choice of drugs is made taking into account the type of pathogen and its sensitivity to antibiotics, the effectiveness of previous courses of treatment, nephrotoxicity of drugs, the state of kidney function, the severity of chronic renal failure, the influence of urine reaction on the activity of drugs.

Chronic pyelonephritis is caused by a wide variety of flora. The most common pathogen is Escherichia coli, in addition, the disease can be caused by enterococcus, Proteus vulgaris, staphylococcus, streptococcus, Pseudomonas aeruginosa, mycoplasma, and less commonly by fungi and viruses.

Often chronic pyelonephritis is caused by microbial associations. In some cases, the disease is caused by L-forms of bacteria, i.e. transformed microorganisms with loss of cell wall. The L-form is an adaptive form of microorganisms in response to chemotherapeutic agents. Shell-free L-forms are not available for the most commonly used antibacterial agents, but retain all the toxic-allergic properties and are able to support the inflammatory process (in this case, bacteria are not detected by conventional methods).

For the treatment of chronic pyelonephritis, various anti-infective drugs - uroantiseptics - are used.

The main pathogens of pyelonephritis are sensitive to the following uroantiseptics.
Escherichia coli: highly effective are chloramphenicol, ampicillin, cephalosporins, carbenicillin, gentamicin, tetracyclines, nalidixic acid, nitrofuran compounds, sulfonamides, phosphacin, nolicin, palin.
Enterobacter: highly effective chloramphenicol, gentamicin, palin; Tetracyclines, cephalosporins, nitrofurans, and nalidixic acid are moderately effective.
Proteus: ampicillin, gentamicin, carbenicillin, nolicin, palin are highly effective; Levomycetin, cephalosporins, nalidixic acid, nitrofurans, sulfonamides are moderately effective.
Pseudomonas aeruginosa: gentamicin and carbenicillin are highly effective.
Enterococcus: ampicillin is highly effective; Carbenicillin, gentamicin, tetracyclines, and nitrofurans are moderately effective.
Staphylococcus aureus (does not form penicillinase): penicillin, ampicillin, cephalosporins, gentamicin are highly effective; Carbenicillin, nitrofurans, and sulfonamides are moderately effective.
Staphylococcus aureus (forming penicillinase): oxacillin, methicillin, cephalosporins, gentamicin are highly effective; Tetracyclines and nitrofurans are moderately effective.
Streptococcus: penicillin, carbenicillin, cephalosporins are highly effective; Ampicillin, tetracyclines, gentamicin, sulfonamides, nitrofurans are moderately effective.
Mycoplasma infection: tetracyclines and erythromycin are highly effective.

Active treatment uroantiseptics should be started from the first days of exacerbation and continued until all signs of the inflammatory process are eliminated. After this, an anti-relapse course of treatment must be prescribed.

Basic rules of appointment antibacterial therapy:
1. Correspondence of the antibacterial agent and the sensitivity of the urine microflora to it.
2. The dosage of the drug should be made taking into account the state of kidney function and the degree of chronic renal failure.
3. The nephrotoxicity of antibiotics and other uroantiseptics should be taken into account and the least nephrotoxic ones should be prescribed.
4. If there is no therapeutic effect, the drug should be changed within 2-3 days from the start of treatment.
5. In case of a high degree of activity of the inflammatory process, severe intoxication, severe course of the disease, or ineffectiveness of monotherapy, it is necessary to combine uroantiseptic agents.
6. It is necessary to strive to achieve a urine reaction that is most favorable for the action of the antibacterial agent.

The following antibacterial agents are used in the treatment of chronic pyelonephritis: antibiotics ( table 1), sulfonamide drugs, nitrofuran compounds, fluoroquinolones, nitroxoline, nevigramon, gramurin, palin.

3.1. Antibiotics

Table 1. Antibiotics for the treatment of chronic pyelonephritis

Preparation

Daily dose

Penicillin group
Benzylpenicillin Intramuscularly 500,000-1,000,000 units every 4 hours
Methicillin
Oxacillin Intramuscularly 1 g every 6 hours
Dicloxacillin Intramuscularly 0.5 g every 4 hours
Cloxacillin Intramuscularly 1 g every 4-6 hours
Ampicillin Intramuscularly 1 g every 6 hours, orally 0.5-1 g 4 times a day
Amoxicillin Orally 0.5 g every 8 hours
Augmentin (amoxicillin + clavulanate) Intramuscularly 1.2 g 4 times a day
Unazine (ampicillin +
sulbactam) Orally 0.375-0.75 g 2 times a day, intramuscularly 1.5-3 g 3-4 times a day
Ampiox (ampicillin +
oxacillin) Orally 0.5-1 g 4 times a day, intramuscularly 0.5-2 g 4 times a day
Carbenicillin Intramuscularly, intravenously 1-2 g 4 times a day
Azlocillin Intramuscularly 2 g every 6 hours or intravenously drip
Cephalosporins
Cefazolin (kefzol) Intramuscularly, intravenously 1-2 g every 8-12 hours
Cephalothin Intramuscularly, intravenously 0.5-2 g every 4-6 hours
Cephalexin
Cefuroxime (ketocef) Intramuscularly, intravenously 0.75-1.5 g 3 times a day
Cefuroxime-axetil Orally 0.25-0.5 g 2 times a day
Cefaclor (ceclor) Orally 0.25-0.5 g 3 times a day
Cefotaxime (claforan) Intramuscularly, intravenously 1-2 g 3 times a day
Ceftizoxime (epoceline) Intramuscularly, intravenously 1-4 g 2-3 times a day
Ceftazidime (Fortum) Intramuscularly, intravenously 1-2 g 2-3 times a day
Cephobid (cefoperazone) Intramuscularly, intravenously 2-4 g 2-3 times a day
Ceftriaxone (Longacef) Intramuscularly, intravenously 0.5-1 g 1-2 times a day
Carbapenems
Imipinem + cilastatin (1:1) Intravenous drip of 0.5-1 g per 100 ml of 5% glucose solution or intramuscularly of 0.5-0.75 g every 12 hours with lidocaine
Monobactams
Aztreonam (azaktam) Intramuscularly, intravenously 1-2 g every 6-8 hours or 0.5-1 g every 8-12 hours
Aminoglycosides
Gentamicin (Garamycin)
Tobramycin (brulamycin) Intramuscularly, intravenously 3-5 mg/kg per day in 2-3 injections
Sizomycin Intramuscular, intravenous drip in 5% glucose solution
Amikacin Intramuscularly, intravenously 15 mg/kg per day in 2 doses
Tetracyclines
Metacycline (Rondomycin) Orally 0.3 g 2 times a day 1-1.5 hours before meals
Doxycycline (Vibramycin) Orally, intravenously (drip) 0.1 g 2 times a day
Lincosamines
Lincomycin (lincocin) Inside, intravenously, intramuscularly; orally 0.5 g 4 times a day; parenterally 0.6 g 2 times a day
Clindamycin (Dalacin) Orally 0.15-0.45 g every 6 hours; intravenously, intramuscularly 0.6 g every 6-8 hours
Levomycetin group
Chloramphenicol (chloramphenicol) Orally 0.5 g 4 times a day
Levomycetin succinate (chlorocide C) Intramuscularly, intravenously 0.5-1 g 3 times a day
Fosfomycin (phosphocin) Orally 0.5 g every 6 hours; intravenous stream, drip 2-4 g every 6-8 hours

3.1.1. Penicillin group drugs
In case of unknown etiology of chronic pyelonephritis (the causative agent has not been identified), it is better to choose penicillins with an extended spectrum of activity (ampicillin, amoxicillin) from the penicillin group of drugs. These drugs actively affect gram-negative flora, most gram-positive microorganisms, but staphylococci that produce penicillinase are not sensitive to them. In this case, they must be combined with oxacillin (Ampiox) or use highly effective combinations of ampicillin with beta-lactamase (penicillinase) inhibitors: unasin (ampicillin + sulbactam) or augmentin (amoxicillin + clavulanate). Carbenicillin and azlocillin have pronounced antipseudomonas activity.

3.1.2. Drugs of the cephalosporin group
Cephalosporins are very active, have a powerful bactericidal effect, have a wide antimicrobial spectrum (actively affect gram-positive and gram-negative flora), but have little or no effect on enterococci. Active influence Of the cephalosporins, only ceftazidime (Fortum) and cefoperazone (cephobid) are effective against Pseudomonas aeruginosa.

3.1.3. Carbapenem drugs
Carbapenems have a wide spectrum of action (gram-positive and gram-negative flora, including Pseudomonas aeruginosa and staphylococci that produce penicillinase - beta-lactamase).
When treating pyelonephritis from drugs in this group, imipinem is used, but always in combination with cilastatin, since cilastatin is a dehydropeptidase inhibitor and inhibits the renal inactivation of imipinem.
Imipinem is a reserve antibiotic and is prescribed for severe infections caused by multi-resistant strains of microorganisms, as well as mixed infections.

3.1.4. Monobactam preparations
Monobactams (monocyclic beta-lactams) have a powerful bactericidal effect against gram-negative flora and are highly resistant to the action of penicillinases (beta-lactamases). Drugs in this group include aztreonam (azactam).
3.1.5. Aminoglycoside preparations
Aminoglycosides have a powerful and faster bactericidal effect than beta-lactam antibiotics and have a wide antimicrobial spectrum (gram-positive, gram-negative flora, Pseudomonas aeruginosa). You should be aware of the possible nephrotoxic effect of aminoglycosides.

3.1.6. Lincosamine preparations
Lincosamines (lincomycin, clindamycin) have a bacteriostatic effect and have a fairly narrow spectrum of activity (gram-positive cocci - streptococci, staphylococci, including those that produce penicillinase; non-spore-forming anaerobes). Lincosamines are not active against enterococci and gram-negative flora. Resistance of microflora, especially staphylococci, quickly develops to lincosamines. In severe cases of chronic pyelonephritis, lincosamines should be combined with aminoglycosides (gentamicin) or other antibiotics acting on gram-negative bacteria.

3.1.7. Levomycetin
Levomycetin is a bacteriostatic antibiotic, active against gram-positive, gram-negative, aerobic, anaerobic bacteria, mycoplasma, chlamydia. Pseudomonas aeruginosa is resistant to chloramphenicol.

3.1.8. Fosfomycin
Fosfomycin is a bactericidal antibiotic with a wide spectrum of action (acts on gram-positive and gram-negative microorganisms, and is also effective against pathogens resistant to other antibiotics). The drug is excreted unchanged in the urine, therefore it is very effective for pyelonephritis and is even considered a reserve drug for this disease.

3.1.9. Accounting for urine reaction
When prescribing antibiotics for pyelonephritis, the urine reaction should be taken into account.
With an acidic urine reaction, the effect is enhanced the following antibiotics:
- penicillin and its semisynthetic preparations;
- tetracyclines;
- novobiocin.
When urine is alkaline, the effect of the following antibiotics is enhanced:
- erythromycin;
- oleandomycin;
- lincomycin, dalacin;
- aminoglycosides.
Drugs whose action does not depend on the reaction of the environment:
- chloramphenicol;
- ristomycin;
- vancomycin.

3.2. Sulfonamides

Sulfonamides are used less frequently than antibiotics in the treatment of patients with chronic pyelonephritis. They have bacteriostatic properties and act on gram-positive and gram-negative cocci, gram-negative “bacillus” (Escherichia coli), and chlamydia. However, enterococci, Pseudomonas aeruginosa, and anaerobes are not sensitive to sulfonamides. The effect of sulfonamides increases with alkaline urine.

Urosulfan - 1 g is prescribed 4-6 times a day, while a high concentration of the drug is created in the urine.

Combined preparations of sulfonamides with trimethoprim are characterized by synergism, a pronounced bactericidal effect and a wide spectrum of activity (gram-positive flora - streptococci, staphylococci, including penicillinase-producing ones; gram-negative flora - bacteria, chlamydia, mycoplasma). The drugs do not act on Pseudomonas aeruginosa and anaerobes.
Bactrim (Biseptol) is a combination of 5 parts sulfamethoxazole and 1 part trimethoprim. Prescribed orally in tablets of 0.48 g, 5-6 mg/kg per day (in 2 doses); intravenously in ampoules of 5 ml (0.4 g of sulfamethoxazole and 0.08 g of trimethoprim) in isotonic sodium chloride solution 2 times a day.
Groseptol (0.4 g of sulfamerazole and 0.08 g of trimethoprim in 1 tablet) is prescribed orally 2 times a day at an average dose of 5-6 mg/kg per day.
Lidaprim - combination drug, containing sulfametrol and trimethoprim.

These sulfonamides are readily soluble in urine and almost do not precipitate in the form of crystals in urinary tract However, it is still advisable to wash down each dose with soda water. It is also necessary to monitor the number of leukocytes in the blood during treatment, as leukopenia may develop.

3.3. Quinolones

Quinolones are based on 4-quinolone and are classified into two generations:
I generation:
- nalidixic acid (nevigramone);
- oxolinic acid (gramurin);
- pipemidic acid (palin).
II generation (fluoroquinolones):
- ciprofloxacin (ciprobay);
- ofloxacin (Tarivid);
- pefloxacin (abactal);
- norfloxacin (nolitsin);
- lomefloxacin (maxaquin);
- enoxacin (Penetrex).

3.3.1. I generation quinolones
Nalidixic acid (nevigramon, negram) - the drug is effective against urinary tract infections caused by gram-negative bacteria, except Pseudomonas aeruginosa. Ineffective against gram-positive bacteria (staphylococcus, streptococcus) and anaerobes. It has a bacteriostatic and bactericidal effect. When taking the drug orally, a high concentration of it is created in the urine.
When urine becomes alkaline, the antimicrobial effect of nalidixic acid increases.
Available in capsules and tablets of 0.5 g. Prescribed orally, 1-2 tablets 4 times a day for at least 7 days. At long-term treatment apply 0.5 g 4 times a day.
Possible side effects of the drug: nausea, vomiting, headache, dizziness, allergic reactions(dermatitis, fever, eosinophilia), increased skin sensitivity to sunlight(photodermatoses).
Contraindications to the use of nevigramon: impaired liver function, renal failure.
Nalidixic acid should not be prescribed simultaneously with nitrofurans, as this reduces the antibacterial effect.

Oxolinic acid (gramurin) - according to antimicrobial spectrum gramurin is close to nalidixic acid, it is effective against gram-negative bacteria (Escherichia coli, Proteus), Staphylococcus aureus.
Available in tablets of 0.25 g. Prescribed 2 tablets 3 times a day after meals for at least 7-10 days (up to 2-4 weeks).
The side effects are the same as when treated with Nevigramon.

Pipemidic acid (palin) is effective against gram-negative flora, as well as pseudomonas, staphylococci.
Available in capsules of 0.2 g and tablets of 0.4 g. Prescribed 0.4 g 2 times a day for 10 days or more.
The drug is well tolerated, sometimes there is nausea and allergic skin reactions.

3.3.2. II generation quinolones (fluoroquinolones)
Fluoroquinolones are a new class of synthetic broad-spectrum antibacterial agents. Fluoroquinolones have a wide spectrum of action, they are active against gram-negative flora (Escherichia coli, Enterobacter, Pseudomonas aeruginosa), gram-positive bacteria (staphylococcus, streptococcus), legionella, mycoplasma. However, enterococci, chlamydia, and most anaerobes are insensitive to them. Fluoroquinolones penetrate well into various organs and tissues: lungs, kidneys, bones, prostate, and have a long half-life, so they can be used 1-2 times a day.
Side effects (allergic reactions, dyspeptic disorders, dysbacteriosis, agitation) are quite rare.

Ciprofloxacin (Ciprobay) is the “gold standard” among fluoroquinolones, as its antimicrobial action is superior to many antibiotics.
Available in tablets of 0.25 and 0.5 g and in bottles with infusion solution, containing 0.2 g of cyprobay. It is prescribed orally, regardless of food intake, 0.25-0.5 g 2 times a day; in case of very severe exacerbation of pyelonephritis, the drug is first administered intravenously in a drip of 0.2 g 2 times a day, and then oral administration is continued.

Ofloxacin (Tarivid) - available in tablets of 0.1 and 0.2 g and in vials for intravenous administration of 0.2 g.
Most often, ofloxacin is prescribed at a dose of 0.2 g 2 times a day orally; for very severe infections, the drug is first administered intravenously at a dose of 0.2 g 2 times a day, then switched to oral administration.

Pefloxacin (abactal) - available in tablets of 0.4 g and ampoules of 5 ml containing 400 mg of abactal. Prescribed orally 0.2 g 2 times a day with meals, with in serious condition 400 mg is administered intravenously in 250 ml of 5% glucose solution (abactal cannot be dissolved in saline solutions) in the morning and evening, and then switch to oral administration.

Norfloxacin (nolicin) - available in tablets of 0.4 g, prescribed orally at 0.2-0.4 g 2 times a day, for acute urinary tract infections for 7-10 days, for chronic and recurrent infections - up to 3 months.

Lomefloxacin (Maxaquin) - available in tablets of 0.4 g, prescribed orally at 400 mg once a day for 7-10 days, in severe cases it can be used for a longer period (up to 2-3 months).

Enoxacin (Penetrex) - available in tablets of 0.2 and 0.4 g, administered orally at 0.2-0.4 g 2 times a day, cannot be combined with NSAIDs (convulsions may occur).

Due to the fact that fluoroquinolones have a pronounced effect on pathogens of urinary infections, they are considered as the drug of choice in the treatment of chronic pyelonephritis. For uncomplicated urinary infections A three-day course of treatment with fluoroquinolones is considered sufficient; for complicated urinary infections, treatment is continued for 7-10 days; for chronic urinary tract infections, longer use is possible (3-4 weeks).

It has been established that it is possible to combine fluoroquinolones with bactericidal antibiotics - antipseudomonas penicillins (carbenicillin, azlocillin), ceftazidime and imipenem. These combinations are prescribed when bacterial strains resistant to fluoroquinolone monotherapy appear.
It should be emphasized low activity fluoroquinolones against pneumococcus and anaerobes.

3.4. Nitrofuran compounds

Nitrofuran compounds have a wide spectrum of activity (gram-positive cocci - streptococci, staphylococci; gram-negative bacilli - Escherichia coli, Proteus, Klebsiella, Enterobacter). Anaerobes and Pseudomonas are insensitive to nitrofuran compounds.
During treatment, nitrofuran compounds may have undesirable side effects: dyspeptic disorders;
hepatotoxicity; neurotoxicity (damage to the central and peripheral nervous system), especially in case of renal failure and long-term treatment (more than 1.5 months).
Contraindications to the use of nitrofuran compounds: severe liver pathology, renal failure, diseases of the nervous system.
The following nitrofuran compounds are most often used in the treatment of chronic pyelonephritis.

Furadonin - available in tablets of 0.1 g; is well absorbed from the gastrointestinal tract, creates low concentrations in the blood, high concentrations in the urine. Prescribed orally 0.1-0.15 g 3-4 times a day during or after meals. The duration of the course of treatment is 5-8 days; if there is no effect during this period, it is not advisable to continue treatment. The effect of furadonin is enhanced by acidic urine and weakened by urine pH > 8.
The drug is recommended for chronic pyelonephritis, but is not advisable for acute pyelonephritis, since it does not create a high concentration in the kidney tissue.

Furagin - compared to furadonin, is better absorbed from the gastrointestinal tract and is better tolerated, but its concentrations in urine are lower. Available in tablets and capsules of 0.05 g and in powder form in jars of 100 g.
Used orally at 0.15-0.2 g 3 times a day. The duration of treatment is 7-10 days. If necessary, the course of treatment is repeated after 10-15 days.
In case of severe exacerbation of chronic pyelonephritis, soluble furagin or solafur can be administered intravenously (300-500 ml of 0.1% solution during the day).

Nitrofuran compounds combine well with aminoglycoside antibiotics and cephalosporins, but do not combine with penicillins and chloramphenicol.

3.5. Quinolines (8-hydroxyquinoline derivatives)

Nitroxoline (5-NOK) - available in tablets of 0.05 g. It has a wide spectrum of antibacterial action, i.e. affects gram-negative and gram-positive flora, is quickly absorbed into the gastrointestinal tract, excreted unchanged by the kidneys and creates high concentration in urine.
Prescribed orally 2 tablets 4 times a day for at least 2-3 weeks. In resistant cases, 3-4 tablets are prescribed 4 times a day. If necessary, it can be used long-term in courses of 2 weeks per month.
The toxicity of the drug is insignificant, side effects are possible; gastrointestinal disorders, skin rashes. When treated with 5-NOK, the urine becomes saffron yellow.

When treating patients with chronic pyelonephritis, the nephrotoxicity of drugs should be taken into account and preference should be given to the least nephrotoxic ones - penicillin and semisynthetic penicillins, carbenicillin, cephalosporins, chloramphenicol, erythromycin. The group of aminoglycosides is the most nephrotoxic.

If it is impossible to determine the causative agent of chronic pyelonephritis or before obtaining antibiogram data, broad-spectrum antibacterial drugs should be prescribed: ampiox, carbenicillin, cephalosporins, quinolones, nitroxoline.

At development of chronic renal failure doses of uroantiseptics are reduced and intervals are increased (see "Treatment of chronic renal failure"). Aminoglycosides are not prescribed for chronic renal failure; nitrofuran compounds and nalidixic acid can be prescribed for chronic renal failure only in the latent and compensated stages.

Taking into account the need for dose adjustment in chronic renal failure, four groups of antibacterial agents can be distinguished:

antibiotics that can be used in usual doses: dicloxacillin, erythromycin, chloramphenicol, oleandomycin;

antibiotics, the dose of which is reduced by 30% when the urea content in the blood increases by more than 2.5 times compared to the norm: penicillin, ampicillin, oxacillin, methicillin; These drugs are not nephrotoxic, but in chronic renal failure they accumulate and give side effects;

antibacterial drugs, the use of which in chronic renal failure requires mandatory dose adjustment and administration intervals: gentamicin, carbenicillin, streptomycin, kanamycin, biseptol;

antibacterial agents, the use of which is not recommended for severe chronic renal failure: tetracyclines (except doxycycline), nitrofurans, nevigramon.

Treatment with antibacterial agents for chronic pyelonephritis is carried out systematically and for a long time. Initial course antibacterial treatment is 6-8 weeks, during which time it is necessary to achieve suppression of the infectious agent in the kidney. As a rule, during this period it is possible to achieve the elimination of clinical and laboratory manifestations activity of the inflammatory process. In severe cases of the inflammatory process, various combinations of antibacterial agents are used. A combination of penicillin and its semisynthetic drugs is effective. Nalidixic acid preparations can be combined with antibiotics (carbenicillin, aminoglycosides, cephalosporins). 5-NOK is combined with antibiotics. They combine perfectly and mutually enhance the effect bactericidal antibiotics(penicillins and cephalosporins, penicillins and aminoglycosides).

After the patient reaches remission, antibacterial treatment should be continued in intermittent courses. Repeated courses Antibacterial therapy for patients with chronic pyelonephritis should be prescribed 3-5 days before the expected onset of signs of exacerbation of the disease, so that the remission phase is constantly maintained for a long time. Repeated courses of antibacterial treatment are carried out for 8-10 days with drugs to which the sensitivity of the pathogen has previously been identified, since there is no bacteriuria in the latent phase of inflammation and during remission.

Methods of anti-relapse courses for chronic pyelonephritis are outlined below.

A. Ya. Pytel recommends treating chronic pyelonephritis in two stages. During the first period, treatment is carried out continuously, replacing the antibacterial drug with another every 7-10 days until the permanent disappearance of leukocyturia and bacteriuria occurs (for a period of at least 2 months). After this, intermittent treatment with antibacterial drugs is carried out for 4-5 months for 15 days at intervals of 15-20 days. In case of stable long-term remission (after 3-6 months of treatment), antibacterial agents may not be prescribed. After this, anti-relapse treatment is carried out - sequentially (3-4 times a year) course application antibacterial agents, antiseptics, medicinal plants.

4. Use of NSAIDs

In recent years, the possibility of using NSAIDs for chronic pyelonephritis has been discussed. These drugs have an anti-inflammatory effect due to a decrease in the energy supply to the site of inflammation, reduce capillary permeability, stabilize lysosome membranes, cause a mild immunosuppressive effect, antipyretic and analgesic effect.
In addition, the use of NSAIDs is aimed at reducing reactive phenomena caused by the infectious process, preventing proliferation, and destroying fibrous barriers so that antibacterial drugs reach the inflammatory focus. However, it has been established that indomethacin long-term use can cause necrosis of the renal papillae and impaired hemodynamics of the kidney (Yu. A. Pytel).
Of the NSAIDs, the most appropriate is to take voltaren (diclofenac sodium), which has a powerful anti-inflammatory effect and is the least toxic. Voltaren is prescribed 0.25 g 3-4 times a day after meals for 3-4 weeks.

5.Improving renal blood flow

Impaired renal blood flow plays an important role in the pathogenesis of chronic pyelonephritis. It has been established that with this disease there is an uneven distribution of renal blood flow, which is expressed in hypoxia of the cortex and phlebostasis in the medullary substance (Yu. A. Pytel, I. I. Zolotarev, 1974). In this regard, in the complex therapy of chronic pyelonephritis, it is necessary to use drugs that correct circulatory disorders in the kidney. For this purpose, the following means are used.

Trental (pentoxifylline) - increases the elasticity of red blood cells, reduces platelet aggregation, enhances glomerular filtration, renders easy diuretic effect, increases the delivery of oxygen to the area of tissue affected by ischemia, as well as the pulse blood supply to the kidney.
Trental is prescribed orally at 0.2-0.4 g 3 times a day after meals, after 1-2 weeks the dose is reduced to 0.1 g 3 times a day. The duration of treatment is 3-4 weeks.

Curantil - reduces platelet aggregation, improves microcirculation, prescribed 0.025 g 3-4 times a day for 3-4 weeks.

Venoruton (troxevasin) - reduces capillary permeability and edema, inhibits platelet and erythrocyte aggregation, reduces ischemic damage tissues, increases capillary blood flow And venous drainage from the kidney. Venoruton is a semi-synthetic derivative of rutin. The drug is available in capsules of 0.3 g and ampoules of 5 ml of 10% solution.
Yu. A. Pytel and Yu. M. Esilevsky suggest, in order to reduce the treatment time for exacerbation of chronic pyelonephritis, in addition to antibacterial therapy, prescribe venoruton intravenously at a dose of 10-15 mg/kg for 5 days, then orally 5 mg/kg 2 times a day day throughout the course of treatment.

Heparin - reduces platelet aggregation, improves microcirculation, has anti-inflammatory and anti-complementary, immunosuppressant effects, inhibits the cytotoxic effect of T-lymphocytes, and in small doses protects the vascular intima from the damaging effects of endotoxin.
In the absence of contraindications (hemorrhagic diathesis, stomach ulcers and duodenum) heparin can be prescribed against the background of complex therapy of chronic pyelonephritis, 5000 units 2-3 times a day under the skin of the abdomen for 2-3 weeks, followed by gradual decline doses for 7-10 days until complete withdrawal.

6. Functional passive kidney exercises

The essence of functional passive kidney gymnastics is periodic alternation functional load(due to the administration of saluretic) and a state of relative rest. Saluretics, causing polyuria, contribute to the maximum mobilization of all the reserve capabilities of the kidney by including a large number of nephrons in the activity (under normal physiological conditions, only 50-85% of the glomeruli are in an active state). With functional passive exercises of the kidneys, not only diuresis is increased, but also renal blood flow. Due to the resulting hypovolemia, the concentration of antibacterial substances in the blood serum increases, in renal tissue, their effectiveness in the area of inflammation increases.

Lasix is usually used as a means of functional passive kidney exercises (Yu. A. Pytel, I. I. Zolotarev, 1983). Prescribed 2-3 times a week 20 mg of Lasix intravenously or 40 mg of furosemide orally with monitoring of daily diuresis, electrolyte levels in the blood serum and biochemical parameters blood.

Negative reactions that may occur during passive kidney exercises:

long-term use the method can lead to depletion of the reserve capacity of the kidneys, which is manifested by a deterioration in their function;

uncontrolled passive kidney exercises can lead to disruption of water and electrolyte balance;

Passive kidney exercises are contraindicated in cases of impaired urine passage from the upper urinary tract.

7. Herbal medicine

In the complex therapy of chronic pyelonephritis, drugs are used that have an anti-inflammatory, diuretic, and, in the case of hematuria, a hemostatic effect ( table 2).

Table 2. Medicinal plants used for chronic pyelonephritis

Plant name

Action

diuretic

bactericidal

astringent

hemostatic

Althea
Cowberry
Black elderberry
Elecampane
St. John's wort
Corn silk
Nettle
Angelica root
Birch leaves
Wheatgrass
Kidney tea
Horsetail
Chamomile
Rowan
Bearberry
Cornflower flowers
Cranberry
Strawberry leaf
-
++
++
++
+
++
-
++
++
++
+++
+++
-
++
+++
++
+
+

++
++
+
+
+++
++
++
-
-
-
-
+
++
+
++
+
+
-

-
-
+
-
++
+
+
-
-
-
-
+
-
+
+
-
-
-

-
-
-
+
+
+
+++
-
-
-
-
++
-
++
-
-
-
++

Bearberry (bear ears) - contains arbutin, which is broken down in the body into hydroquinone (an antiseptic that has an antibacterial effect in the urinary tract) and glucose. Used in the form of decoctions (30 g per 500 ml) 2 tablespoons 5-6 times a day. Bearberry exhibits its effect in an alkaline environment, so taking the decoction should be combined with ingesting alkaline mineral waters (Borjomi), soda solutions. To alkalize urine, use apples, pears, and raspberries.

Lingonberry leaves have antimicrobial and diuretic effects. The latter is due to the presence of hydroquinone in lingonberry leaves. Used as a decoction (2 tablespoons per 1.5 cups of water). Prescribed 2 tablespoons 5-6 times a day. Just like bearberry, it works better in an alkaline environment. Alkalinization of urine is carried out in the same way as described above.

cranberry juice, fruit drink (contains sodium benzoate) - has an antiseptic effect (synthesis in the liver from benzoate of hippuric acid increases, which, when excreted in the urine, causes a bacteriostatic effect). Take 2-4 glasses per day.

For the treatment of chronic pyelonephritis, the following preparations are recommended (E. A. Ladynina, R. S. Morozova, 1987).

Collection No. 1

Collection No. 2

Collection No. 3

With exacerbation of chronic pyelonephritis, accompanied by alkaline reaction, it is advisable to use the following fee:

Collection No. 4

The following collection is recommended as maintenance antibiotic therapy:

Collection No. 5

It is considered appropriate for chronic pyelonephritis to prescribe combinations of herbs as follows: one diuretic and two bactericidal for 10 days (for example, cornflower flowers - lingonberry leaves - bearberry leaves), and then two diuretics and one bactericidal (for example, cornflower flowers - birch leaves - leaves bearberry). Treatment with medicinal plants takes a long time - months and even years.
During the entire autumn season, it is advisable to eat watermelons due to their pronounced diuretic effect.

Along with taking infusions, baths with medicinal plants are useful:

Collection No. 6(for bath)

8. Increasing the general reactivity of the body and immunomodulatory therapy

In order to increase the body's reactivity and to quickly stop an exacerbation, the following are recommended:

multivitamin complexes;

adaptogens (tincture of ginseng, Chinese magnolia vine, 30-40 drops 3 times a day) during the entire period of treatment of an exacerbation;

methyluracil 1 g 4 times a day for 15 days.

In recent years, a major role of autoimmune mechanisms in the development of chronic pyelonephritis has been established. Autoimmune reactions are promoted by a deficiency of T-suppressor function of lymphocytes. To eliminate immune disorders immunomodulators are used. They are prescribed for long-term, poorly controlled exacerbation of chronic pyelonephritis. The following drugs are used as immunomodulators.

Levamisole (decaris) - stimulates the function of phagocytosis, normalizes the function of T- and B-lymphocytes, increases the interferon-producing ability of T-lymphocytes. Prescribed 150 mg once every 3 days for 2-3 weeks under the control of the number of leukocytes in the blood (there is a danger of leukopenia).

Timalin - normalizes the function of T- and B-lymphocytes, administered intramuscularly at 10-20 mg once a day for 5 days.

T-activin - the mechanism of action is the same, applied intramuscularly at 100 mcg once a day for 5-6 days.

By reducing the severity of autoimmune reactions and normalizing the functioning of the immune system, immunomodulators contribute to the rapid relief of exacerbations of chronic pyelonephritis and reduce the number of relapses. During treatment with immunomodulators, it is necessary to monitor the immune status.

9. Physiotherapeutic treatment

Physiotherapeutic treatment is used in the complex therapy of chronic pyelonephritis.
Physiotherapeutic techniques provide next impact:
- increase blood supply to the kidney, increase renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
- relieve spasm of the smooth muscles of the renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

The following physiotherapy procedures are used.
1. Electrophoresis of furadonin on the kidney area. The solution for electrophoresis contains: furadonin - 1 g, 1N NaOH solution - 2.5 g, distilled water - 100 ml. The drug moves from the cathode to the anode. The course of treatment consists of 8-10 procedures.
2. Electrophoresis of erythromycin on the kidney area. The solution for electrophoresis contains: erythromycin - 100,000 units, ethyl alcohol 70% - 100 g. The drug moves from the anode to the cathode.
3. Calcium chloride electrophoresis on the kidney area.
4. USV at a dose of 0.2-0.4 W/cm 2 in pulse mode for 10-15 minutes in the absence of urolithiasis.
5. Centimeter waves (“Luch-58”) to the kidney area, 6-8 procedures per course of treatment.
6. Thermal procedures on the area of the diseased kidney: diathermy, therapeutic mud, diathermo mud, ozokerite and paraffin applications.
10. Symptomatic treatment

With the development of arterial hypertension, prescribed antihypertensive drugs(reserpine, adelphan, brinerdine, cristepine, dopegit), with the development of anemia - iron-containing drugs, with severe intoxication - intravenous drip infusion of hemodez, neocompensan.

11. Spa treatment

The main sanatorium-resort factor for chronic pyelonephritis is mineral waters, which are used internally and in the form of mineral baths.

Mineral waters have an anti-inflammatory effect, improve renal plasma flow, glomerular filtration, have a diuretic effect, promote the excretion of salts, and affect urine pH (shift the urine reaction to the alkaline side).

The following resorts use mineral waters: Zheleznovodsk, Truskavets, Jermuk, Sairme, Berezovsky mineral waters, Slavyanovsky and Smirnovsky mineral springs.

Mineral water "Naftusya" of the Truskavets resort reduces spasms of smooth muscles renal pelvis and ureters, which promotes the passage of small stones. In addition, it also has an anti-inflammatory effect.

"Smirnovskaya", "Slavyanovskaya" mineral waters are hydrocarbonate-sulfate-sodium-calcium, which determines their anti-inflammatory effect.

Taking mineral waters internally helps reduce inflammation in the kidneys and urinary tract, “washing out” mucus, microbes, small stones, and “sand” from them.

At resorts, treatment with mineral waters is combined with physiotherapeutic treatment.

Contraindications to sanatorium-resort treatment are:
- high arterial hypertension;
- severe anemia;
- Chronic renal failure.

12. Planned anti-relapse treatment

The goal of planned anti-relapse treatment is to prevent the development of relapse and exacerbation of chronic pyelonephritis. Unified system There is no anti-relapse treatment.

O. L. Tiktinsky (1974) recommends the following method of anti-relapse treatment:
1st week - biseptol (1-2 tablets at night);
2nd week - herbal uroantiseptic;
3rd week - 2 tablets of 5-NOK at night;
4th week - chloramphenicol (1 tablet at night).
In subsequent months, maintaining the specified sequence, you can replace the drugs with similar ones from the same group. If there is no exacerbation within 3 months, you can switch to herbal uroantiseptics for 2 weeks a month. A similar cycle is repeated, after which, in the absence of exacerbation, breaks in treatment lasting 1-2 weeks are possible.

There is another option for anti-relapse treatment:
1st week - cranberry juice, rosehip decoctions, multivitamins;
2nd and 3rd weeks - medicinal fees(field horsetail, juniper fruits, licorice root, birch leaves, bearberry, lingonberry, celandine herb);
4th week - antibacterial drug, changing every month.

Treatment of pyelonephritis at home is of interest to many people who suffer from this pathology. It should be noted that now there are more and more of them. Therefore, this issue should be carefully considered.

Features of the disease

Pyelonephritis is an inflammatory disease of an infectious nature. It is non-specific. The main target of the lesion is the calyx and pelvis. If this pathology is not treated in time, a more complex disease may develop - nephrosclerosis.

The infection presented is not epidemic in nature, but the number of cases is increasing every year. Moreover, people may have different forms of this pathology. Treatment of pyelonephritis at home is effective, but it should be used only after consultation with a doctor, and in complex therapy.

Where does the disease come from?

First you need to find out why this problem occurs. Among the reasons for the development of pathology are the following:

1. General decrease protective forces body.

2. Obstructed outflow of urine from the kidneys.

3. Chronic inflammatory processes in the body.

4. Frequent hypothermia.

5. In men, the cause of the development of the disease can be prostate adenoma.

6. Urolithiasis.

Before you start treating pyelonephritis at home, you should definitely visit a doctor and determine what exactly caused the problem. Only in this case can adequate therapy be prescribed.

Types of disease

More often this pathology occurs in two forms: acute and chronic. The second type of disease appears only if you have not completed treatment of the first. That is, an acute attack is characterized by more severe symptoms and often requires immediate medical attention.

The chronic form of pyelonephritis can take much longer to develop. In this case, the strength of the symptoms may not be so pronounced. However, in any case, treatment will be required. It should be noted that the pathology can be unilateral or bilateral.

Symptoms of the disease

Before starting treatment for pyelonephritis at home, it is necessary to determine not only the cause and type of pathology, but also to determine its symptoms as accurately as possible. The acute form is characterized by the following symptoms:

The appearance of general weakness, headache, decreased ability to work;

In some cases, vomiting and nausea are possible;

A sharp increase in temperature up to 40 degrees;

Painful sensations stupid character in the area lumbar region(the intensity of the syndrome may vary);

Presence purulent discharge in urine.

As for the chronic form of pathology, it is characterized by all previous symptoms, expressed in varying degrees. In addition, difficulty urinating and lack of appetite may be added.

Complications

If you have and the treatment of which depends on the type of pathology, then you should definitely get rid of it. The fact is that any delay is fraught with serious complications. In addition to constantly feeling discomfort and pain, you can significantly damage your kidneys.

First of all, the chronic form of the pathology can periodically worsen. If left untreated, it can lead to kidney failure. Small ulcers, abscesses, and carbuncles may appear in the damaged organ. This complication requires immediate surgical intervention.

The most severe form of pathology, which often leads to death, is pyonephrosis. In this case, the kidney is destroyed by pus. That is, the damaged organ is filled with pus, tissue decay products and urine. In this case, the kidney consists of separate cavities.

After all that has been said, you must understand that if you have pyelonephritis, only a specialist can determine the symptoms and treatment.

Diagnosis of the disease

The presented pathology must be correctly diagnosed, because the symptoms may not show the full picture. However, the signs are playing important role in diagnostics. In addition, the doctor will order blood and urine tests for the patient to see if there is an increase in the number of white blood cells and protein. And some tests can determine which bacterium is the causative agent of the disease.

In addition to the tests, the doctor must also collect the patient’s medical history and see if there have been any recent inflammatory processes. To complete the picture, radiography is performed, excretory urography. These studies will help determine the size of the kidneys and the degree of their damage.

Features of eliminating an acute attack

If you have pyelonephritis, your doctor must determine the symptoms and treatment. So, the presented disease can occur in an acute form. Naturally, it is not enough to simply relieve the symptoms and call it a day. A problem has arisen and needs to be solved.

Most often, during an acute attack, the patient must be hospitalized and prescribed drug therapy. That is, the patient must take antibiotics that effectively act on pathogens. In addition, the patient should take medications that will help the body maintain its natural defenses.

At this stage, all the doctors’ efforts are concentrated on eliminating the source of inflammation, getting rid of the symptoms and preventing the transition of the acute form to a purulent-destructive one. Naturally, during therapy it is imperative to restore the function of urine outflow from the kidneys.

Traditional treatment of chronic form

Before using a folk remedy for pyelonephritis, you should definitely consult your doctor. Conservative therapy involves the use of antibacterial and immunostimulating drugs.

Surgery may be used to restore the flow of urine. When comes quite quickly. Antibiotics should be prescribed only taking into account how the urine microflora will react to the drugs. As for anti-inflammatory drugs, drugs such as Nimesil and Voltaren can be used. To improve blood flow from the kidneys, you can use Trental and Heparin.

If you develop pyelonephritis, treatment folk remedies, reviews of which are mostly positive, can become an additional stage of therapy that will speed up the elimination of the disease. However, you should definitely consult your doctor.

How to get rid of pathology using non-traditional means?

So, herbs have been our helpers in the fight against many diseases for many hundreds of years. If you have pyelonephritis, it will help you in this case too.

Let's look at the most effective folk medicines:

1. A large spoonful of flax seeds must be steamed with a glass of boiling water. Next, the mixture will have to be boiled over high heat for about 3 minutes. One hour is enough to infuse the drink. You only need to drink the prepared product for 2 days, half a glass twice a day. This drink will help relieve inflammation and further cleanse your kidneys.

2. If you have chronic pyelonephritis, treatment with folk remedies will be very effective. For example, use hop cones. To prepare the decoction, take only 2 tbsp. spoons of raw materials and steam them with half a liter of boiling water. The mixture should sit for 2 hours. The drink should be consumed up to 4 times a day before meals. You only need to drink half a glass.

3. When kidney diseases Sea buckthorn berries help a lot.

4. Honey and viburnum are the richest in vitamins and other useful substances means. To prepare the medicine, you just need to mix the raw materials in equal quantities. You should take it 1 large spoon three times a day. Moreover, this should be done before eating.

5. To ensure that urine leaves the kidneys well, try to eat at least 2 kg of watermelon per day. Moreover, it doesn’t matter at all when you use it: during the day or at night.

Herbs such as stinging nettle, bearberry, oats, smooth hernia, chamomile, cornflower, and yarrow help greatly with this disease. If you have been diagnosed with pyelonephritis, herbal treatment may be an alternative to antibiotics. Although in some cases you should not refuse them, so as not to aggravate the situation.

Nutritional Features

Therapy is not the only method of getting rid of the disease. The point is that the approach must be comprehensive. Naturally, the patient will have to adjust his diet and diet. That is, you need to eat small meals at least 4-5 times a day. At the same time, spicy, canned, smoked, sweet and too salty foods are excluded from the diet. Do not consume spices, coffee, cocoa, or citrus juices.

Meat and fish should be eaten boiled. It is better to cook soups only from vegetables, adding a small amount of oil. Any porridge is very useful. Try to eat more vegetables and fruits, and the most effective foods are those that have a large amount of fiber in their composition.

If you cannot give up sweets, then simply limit the amount. You are allowed to eat marshmallows, honey, pancakes, and jam. Drink more compotes, water, juices, milk, kefir. Cottage cheese, cheese, sour cream are useful. Eggs can be eaten in any form.

In order for vitamins C and P to enter the body, try to drink teas from chokeberry, currants and rose hips. Moreover, they should be consumed only 2-3 times a day. The amount of fluid consumed per day should be at least 1 liter in children preschool age and 2.5 liters for an adult.

Prevention of disease

If you have pyelonephritis, traditional treatment methods will help you quickly get rid of this problem. However, at all times it was believed that prevention is the best cure for all diseases.

So, so that you do not have to suffer from this pathology, try to strictly observe personal hygiene and do not catch a cold. Any infectious or inflammatory process should also be treated in a timely manner. Watch your diet and do exercises that strengthen your body physical exercise, strengthen your immune system.

If you have any problems with your kidneys, you should immediately consult a doctor who can promptly recognize and eliminate the source of the disease. Do not try to delay treatment, because the pathology can develop into a form where doctors are powerless. In this case, it produces a fairly strong blow to the entire body.

Now you know how to treat chronic pyelonephritis with herbs. However, always be careful and attentive so as not to harm yourself further. Be healthy!