Acute pyelonephritis. Contours: on the left, uneven, fuzzy
Pyelonephritis
Pyelonephritis- a nonspecific infectious disease of the kidneys caused by various bacteria. Patients suffering from acute and chronic pyelonephritis account for about 2/3 of all urological patients. Pyelonephritis can occur in acute or chronic form, affecting one or both kidneys. The asymptomatic course of the disease or mild symptoms in chronic pyelonephritis often dulls the vigilance of patients who underestimate the severity of the disease and do not take treatment seriously enough. Pyelonephritis is diagnosed and treated by a nephrologist. In the absence of timely therapy for pyelonephritis, it can lead to such severe complications as kidney failure, carbuncle or kidney abscess, sepsis and bacterial shock.
Causes of pyelonephritis
The disease can occur at any age. More often pyelonephritis develops:
Any organic or functional causes that interfere with the normal outflow of urine increase the likelihood of developing the disease. Often pyelonephritis appears in patients with urolithiasis.
Unfavorable factors contributing to the occurrence of pyelonephritis include diabetes mellitus. immune disorders, chronic inflammatory diseases and frequent hypothermia. In some cases (usually in women), pyelonephritis develops after acute cystitis.
The asymptomatic course of the disease is the reason for the late diagnosis of chronic pyelonephritis. Patients begin treatment when kidney function is already impaired. Since the disease very often occurs in patients suffering from urolithiasis, therefore, such patients need special treatment even in the absence of symptoms of pyelonephritis.
Symptoms of pyelonephritis
Acute pyelonephritis is characterized by a sudden onset with sharp rise temperatures up to 39-40°C. Hyperthermia is accompanied by profuse sweating, loss of appetite, severe weakness, headache, and sometimes nausea and vomiting. Dull pain in the lumbar region (intensity of pain may vary), more often unilateral, appear simultaneously with fever. Physical examination reveals tenderness with tapping in the lumbar region (positive Pasternatsky's sign). The uncomplicated form of acute pyelonephritis does not cause urination disorders. Urine becomes cloudy or takes on a reddish tint. Laboratory examination of urine reveals bacteriuria, slight proteinuria and microhematuria. For a general blood test, leukocytosis and an increase in ESR are characteristic. In about 30% of cases, an increase in nitrogenous slags is noted in a biochemical blood test.
Chronic pyelonephritis often becomes the outcome of an undertreated acute process. Perhaps the development of primary chronic pyelonephritis, while acute pyelonephritis absent in the patient's history. Sometimes chronic pyelonephritis is discovered by chance during a urine test. Patients with chronic pyelonephritis complain of weakness, loss of appetite, headaches and frequent urination. Some patients have dull, aching pains in the lumbar region that are worse in cold, damp weather. With the progression of chronic bilateral pyelonephritis, kidney function is gradually impaired, which leads to a decrease in the specific gravity of urine, arterial hypertension and the development kidney failure. Symptoms indicating an exacerbation of chronic pyelonephritis coincide with the clinical picture of an acute process.
Complications of pyelonephritis
Bilateral acute pyelonephritis can cause acute renal failure. Sepsis and bacterial shock are among the most formidable complications.
In some cases, acute pyelonephritis is complicated by paranephritis. Perhaps the development of apostenomatous pyelonephritis (the formation of multiple small pustules on the surface of the kidney and in its cortical substance), carbuncle of the kidney (often occurs due to the fusion of pustules, is characterized by the presence of purulent-inflammatory, necrotic and ischemic processes) kidney abscess (melting of the renal parenchyma) and necrosis of the renal papillae . With the appearance of purulent-destructive changes in the kidney, an operation on the kidney is indicated.
If treatment is not carried out, the terminal stage of purulent-destructive pyelonephritis occurs. Pyonephrosis develops, in which the kidney is completely subjected to purulent fusion and is a focus consisting of cavities filled with urine, pus and tissue decay products.
Diagnosis of pyelonephritis
The diagnosis of "acute pyelonephritis" is usually not difficult for a nephrologist due to the presence of pronounced clinical symptoms.
The anamnesis often indicates the presence of chronic diseases or recent acute purulent processes. The clinical picture is formed by a combination of severe hyperthermia, characteristic of pyelonephritis, with lower back pain (usually unilateral), painful urination and changes in urine. Urine is cloudy or reddish in color and has a pronounced fetid odor.
Laboratory confirmation of the diagnosis is the detection of bacteria and small amounts of protein in the urine. To determine the pathogen, a urine culture is performed. The presence of acute inflammation is evidenced by leukocytosis and an increase in ESR in the general blood test. With the help of special test kits, the microflora that caused inflammation is identified.
When conducting survey urography an increase in the volume of one kidney is detected. Excretory urography indicates a sharp limitation of kidney mobility during orthoprobe. With apostematous pyelonephritis, there is a decrease in the excretory function on the side of the lesion (the shadow of the urinary tract appears late or is absent). With a carbuncle or abscess, an excretory urogram reveals swelling of the contour of the kidney, compression and deformation of the calyces and pelvis.
Diagnosis of structural changes in pyelonephritis is carried out using ultrasound of the kidneys. The concentration ability of the kidneys is assessed using the Zimntsky test. To exclude urolithiasis and anatomical abnormalities, a CT scan of the kidneys is performed.
Treatment of pyelonephritis
Uncomplicated acute pyelonephritis is treated conservatively in a hospital urology department. Antibacterial therapy is carried out. Medicines are selected taking into account the sensitivity of the bacteria found in the urine. In order to eliminate as quickly as possible inflammatory phenomena, preventing the transition of pyelonephritis to a purulent-destructive form, treatment begins with the most effective drug.
Conducted detoxification therapy, correction of immunity. When fever is prescribed diet with reduced content proteins, after normalization of the patient's temperature, they are transferred to a full-fledged diet with a high fluid content. At the first stage of therapy for secondary acute pyelonephritis, obstacles that impede the normal outflow of urine should be eliminated. The appointment of antibacterial drugs in case of impaired passage of urine does not give the desired effect and can lead to the development of serious complications.
The treatment of chronic pyelonephritis is carried out according to the same principles as the treatment of the acute process, but it is longer and more laborious. Therapy of chronic pyelonephritis includes the following therapeutic measures:
- elimination of the causes that led to difficulty in the outflow of urine or caused violations of the renal circulation;
- antibacterial therapy (treatment is prescribed taking into account the sensitivity of microorganisms);
- normalization of general immunity.
In the presence of obstructions, it is necessary to restore the normal passage of urine. Restoration of urine outflow is performed promptly (nephropexy for nephroptosis, removal of stones from the kidneys and urinary tract, removal of prostate adenoma, etc.). The elimination of obstacles that interfere with the passage of urine, in many cases, allows to achieve stable long-term remission.
Antibacterial drugs in the treatment of chronic pyelonephritis are prescribed taking into account the data of the antibiogram. Before determining the sensitivity of microorganisms, therapy with antibacterial drugs is carried out. a wide range actions.
Patients with chronic pyelonephritis require long-term systematic therapy for at least a year. Treatment begins with a continuous course antibiotic therapy lasting 6-8 weeks. This technique allows you to eliminate the purulent process in the kidney without the development of complications and the formation of scar tissue. If renal function is impaired, constant monitoring of the pharmacokinetics of nephrotoxic antibacterial drugs is required. To correct immunity, if necessary, use immunostimulants and immunomodulators. After achieving remission, the patient is prescribed intermittent courses of antibiotic therapy.
Patients with chronic pyelonephritis during remission are shown sanatorium treatment (Jermuk, Zheleznovodsk, Truskavets, etc.). It should be remembered about the mandatory continuity of therapy. Started in the hospital antibiotic treatment must be continued on an outpatient basis. The treatment regimen prescribed by the doctor of the sanatorium should include taking antibacterial drugs recommended by the doctor who constantly monitors the patient. Phytotherapy is used as an additional method of treatment.
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temperature for pyelonephritis
High body temperature is the main indicator of the presence of an inflammatory process in the body. Often a sick person tries to do without the help of specialists and swallows antipyretic pills in handfuls. Taking these drugs will only delay the inevitable visit to the clinic, and after all, a timely visit to the doctor reduces the time of treatment and avoids negative consequences and complications.
If acute pyelonephritis is not treated, then after a short time it will turn into a chronic form, which is difficult to treat with drug therapy.
It is important to monitor the temperature in a patient with pyelonephritis, as its repeated jumps may indicate the development purulent complications disease
Temperature in chronic pyelonephritis
The combination of all these signs, even without an increase in temperature, is the reason for contacting specialists. After passing the tests, the doctor will prescribe complex treatment. If you start the disease, then after a while it will remind you of itself again.
With an exacerbation of chronic pyelonephritis, the temperature rarely rises to high rates, as a rule, low-grade fever is noted, which does not reach 38?
Pyelonephritis in children: alarming thermometer readings
The disease in children can be more severe than in adults. When visiting a doctor, it is necessary to voice all the symptoms associated with a high temperature for a correct diagnosis.
As a rule, doctors recommend bringing down the temperature above 38-39 ° C. So the body successfully fights infection, kills harmful bacteria and viruses. But a temperature rise of more than 40 ° C becomes dangerous and serves as a signal for taking antipyretic drugs. They may be in the form rectal suppositories, capsules, tablets or syrups.
Whatever form of pyelonephritis is diagnosed in a patient, it should be remembered that with the flow of blood, the infection can penetrate into any internal organ. Subsequent treatment will be longer and more costly. Self-medication will only weaken the symptoms of the disease, will contribute to its further development.
Causes of elevated temperature in pyelonephritis
Bacteria are the etiological factor in the occurrence of pyelonephritis. The toxins they release are not specific to the human body, and with the help of elevated temperature, the body begins to destroy the foreign protein.
There are several classifications of the disease, but basically pyelonephritis is divided as follows:
A high temperature in pyelonephritis indicates intoxication of the body with bacterial decay products. Taking antipyretics medicines can alleviate the condition of a person, but will not weaken the course of the disease. Symptomatic treatment of pyelonephritis will only contribute to the further spread of the infection.
The main reason for the increase in temperature in pyelonephritis is pathogens (causative agents of the disease)
Acute pyelonephritis: temperature jumps
In acute pyelonephritis, temperature indicators directly depend on the state of human immunity and the stage of the course of the disease. With weakened immunity, the temperature increase is insignificant, in some cases it may not be at all. Experts distinguish three forms of the inflammatory process:
A decrease in temperature is not a reason to stop treatment. The remaining bacteria can cause a new round of the disease.
For the acute stage of the disease, treatment will be required for two weeks. The purulent form of pyelonephritis is able to keep the patient in a hospital bed for more than a month.
Surprisingly, often people with this form of the disease do not even realize that they have pyelonephritis. A slight cold snap causes them a slight increase in subfebrile temperature - up to 37 ° C. Attributing the malaise to the symptoms of a cold, they begin to knock it down with antipyretic pills.
In chronic pyelonephritis, in addition to a slight fever, the following symptoms may occur:
In young children, pyelonephritis causes sudden temperature fluctuations. Parents often take a fever as a symptom of a cold, start looking in the medicine cabinet for how to bring the temperature down to optimal levels. It is worth contacting a pediatrician if you find the following symptoms in your child:
Children with the development of pyelonephritis are very prone to hyperthermia, which is dangerous for the development of febrile seizures.
Excerpt from work
1.4.1 Clinic of acute pyelonephritis
1.4.2 Clinic of chronic pyelonephritis
1.5 Complication
1.6 Diagnostics
1.7 Treatment
1.8 Prevention
Chapter 2. Practical part
2.1 Nursing process for pyelonephritis in children
2.2 Surveillance
2.2.1 Initial Patient Evaluation Sheet
2.2.2 Solving patient problems
2.2.3 Patient care plan
2.3 Laboratory studies
2.4 Checklist for problem solving in a patient with pyelonephritis
Conclusion
Bibliography
Application
Pyelonephritis in children occupies one of the leading places among the problems of modern pediatrics. The high numbers of its prevalence, the upward trend in the number of children with pyelonephritis dictate the need for close attention to this problem.
The urgency of the problem of pyelonephritis is due not only to its high prevalence among children, but also to the great variability of the clinical picture of the disease, and the increase in latent forms, the tendency to relapse, and the rare onset of a complete cure.
Data on the prevalence, structure and risk factors of this disease in children are ambiguous.
There are still difficulties in diagnosing this pathology. Clinical manifestations of pyelonephritis in children are quite diverse, characterized by a large number of clinical masks of pyelonephritis, which make it extremely difficult to diagnose the disease in a timely manner. It is known that leukocyturia and bacteriuria, which are the main laboratory symptoms of pyelonephritis, can also be manifestations of other pathologies of the genitourinary system, such as cystitis, vulvovaginitis, and urethritis. The similarity of the clinical picture and laboratory symptoms of pyelonephritis and pathology of the lower urinary tract makes it difficult to diagnose the disease and often leads to overdiagnosis of pyelonephritis and unreasonable long-term use of antibacterial drugs.
Successful treatment and prevention of pyelonephritis is impossible without a thorough study of the factors contributing to the formation and progression of the disease. One of the main causes of primary pyelonephritis in children is a change in their intestinal flora. Under adverse conditions, such as intestinal infections or frequent SARS. Secondary pyelonephritis is caused by congenital anomalies of the genitourinary system.
It is very difficult to identify the diagnosis and treatment of the problem of pyelonephritis before the appearance of a clinical picture and laboratory symptoms, and require knowledge of modern data on the etiology, pathogenesis, methods of diagnosis and treatment of pyelonephritis in children from the practitioner.
The treatment of pyelonephritis remains one of the most urgent tasks of pediatric nephrology in present stage. So far, antibacterial therapy has been most developed, there is a search for optimal drugs for the treatment of pyelonephritis, questions are being discussed on the selection of optimal anti-relapse therapy regimens and the duration of their implementation. The study of the pathogenesis of pyelonephritis made it possible to prove the significant role of activation of lipid peroxidation (LPO) processes in its development in children, which requires the use of drugs in the complex therapy of the disease that help normalize these processes. Currently, a large number of substances with an antioxidant effect have been identified and synthesized. Until now, questions about the tactics and timing of the use of antioxidant drugs are being discussed.
All of the above determines the relevance of the chosen research topic. The solution of these problems will make it possible to substantiate new approaches to the diagnosis of pyelonephritis and the choice of the optimal tactics for its treatment in children.
Nursing process for pyelonephritis in children
Patient with acute pyelonephritis
To identify the problems of a patient with acute pyelonephritis. Prepare a memo for working with the patient and his parents.
To achieve this goal of the study, it is necessary to study:
etiology and contributing factors of pyelonephritis;
the clinical picture and diagnostic features of this disease;
methods of examination and preparation for them;
principles of treatment and prevention of pyelonephritis;
manipulations performed by a nurse;
Peculiarities of the nursing process in this pathology.
To achieve this goal of the study, it is necessary to analyze:
a case describing the tactics of a nurse in the implementation of the nursing process in a patient with this disease;
· the main results of the examination and treatment of a patient with pyelonephritis, necessary to fill out the list of nursing interventions.
To achieve this goal, it is necessary to use all possible methods research such as:
scientific - theoretical (analysis medical literature for pyelonephritis);
Biographical (analysis of anamnestic information, study of medical records).
Empirical (observation, additional research methods):
Organizational (comparative, complex) method;
Subjective method of clinical examination of the patient (history taking);
Objective methods of examination of the patient (physical, instrumental, laboratory);
psychodiagnostic (conversation).
A detailed disclosure of the material on the topic of the course work "Nursing process in pyelonephritis in children" will improve the quality of nursing care.
Chapter 1. Pyelonephritis
pyelonephritis treatment nursing patient
Pyelonephritis - microbially inflammatory disease kidneys with lesions of the pelvicalyceal system, interstitial tissue parenchyma of the kidneys and tubules.
The cause of pyelonephritis is an infection. As well as the bacteria Klepsiella, Proteus, Escherichia coli, Mycoplasma, Staphylococcus, Enterococcus, Salmonella, viruses, fungi.
Primary pyelonephritis
Most often it occurs due to a change in the flora that is in the child's intestines and is considered opportunistic. Under adverse conditions (frequent SARS, intestinal infections) there is dysbacteriosis - one of the causes of pyelonephritis. Also, urologists consider complications of coccal infections to be the causes of primary inflammation of the kidneys, whether it is a skin disease or (much more often) tonsillitis, influenza. Cystitis also often becomes the culprit of pyelonephritis. Microbes enter the urinary system through urethra. Then they end up in the bladder, then in the ureters, pelvis, and finally in the kidneys.
Secondary pyelonephritis
Secondary pyelonephritis has a different nature. The occurrence of the disease is often due to congenital anomalies of the urinary system. The child may have abnormalities in the structure or location of the kidneys, ureters, bladder. Because of this, there is a violation of the outflow of urine, or it is thrown back into the kidney from the lower tract. Together with the jet, bacteria get there, which cause the inflammatory process.
There are cases of underdevelopment of the kidneys. Due to being too small, there is less kidney tissue functioning in the body than it needs. At first it is imperceptible. But the child grows, the load on the kidney tissue increases, and then the organ cannot cope with its function. Similar anatomical features are detected already in the first weeks of a child's life. In this connection, many doctors recommend an ultrasound examination as early as possible to make sure that everything is in order with the kidneys. And if a pathology is detected, start immediate treatment.
1) Violation of urodynamics - the presence of an anomaly of the urinary tract, leading to urinary retention;
2) Bacteriuria, which develops both in an acute disease and due to the presence of a chronic focus of infection (more often in the gastrointestinal tract with dysbacteriosis or external genitalia) or a breakthrough of bacteria through the mesenteric lymph nodes;
3) Previous damage to the interstitial tissue of the kidney (due to metabolic nephropathy, transferred viral diseases, abuse of certain drugs, hypervitaminosis D, etc.);
4) Violation of the reactivity of the body, its homeostasis, in particular, immunological reactivity.
Along the course, acute and chronic pyelonephritis are distinguished.
The following factors play an important role in the occurrence of pyelonephritis: the type and nature of the infectious agent; the presence of changes in the kidney and urinary tract, contributing to the fixation of the pathogen in them and the development of the process; ways of penetration of infection into the kidney; the general condition of the body and its immunobiological reactivity.
The disease in children can manifest itself in the following signs:
· Fever (up to 38-39 degrees), general weakness and headache. Appetite is reduced. There are no signs of a cold.
Retention (incontinence) of urine. With the usual drinking regimen, the child does not urinate for a long time or, on the contrary, does it too often and in small portions, especially at night, because of which he does not sleep well. In this case, there is a sharp fetid smell of urine.
Pain when urinating. This can be understood by the corresponding behavior of the child: he does not urinate immediately, making efforts and complaining of pain in the lower abdomen.
Change in color of urine. Normally, urine should be clear and straw-yellow, but if it becomes cloudy, dark or reddish, then there may be problems with the kidneys or bladder.
· Violation of the stool, nausea and vomiting. Symptoms of pyelonephritis in children, especially in newborns, are often similar to manifestations intestinal diseases. In this case, too slow weight gain occurs.
The clinical picture of acute pyelonephritis is typically characterized by:
1) Pain syndrome (pain in the lower back or abdomen);
2) Dysuric disorders (soreness or burning sensation, itching during urination);
3) Symptoms of intoxication (fever with chills, headache, lethargy, weakness).
Chronic pyelonephritis is diagnosed when clinical and (or) laboratory signs pyelonephritis observed in a child for more than 1 year.
Chronic pyelonephritis in children early age may note only such general symptoms as loss of appetite, insufficient increase in body weight, growth, psychomotor development lag, subfebrile condition.
In older children, the clinical picture may also be dominated by signs of intoxication: apathy, lethargy, headaches, poor appetite, eating disorder, fatigue, subfebrile temperature body, indefinite localization of pain in the abdomen, less often pain in the lower back with minimally expressed dysuric disorders or even their absence.
1) Apostematous nephritis (many abscesses in the kidneys), which occurs in children as an acute septic disease with high, often hectic, body temperature, severe intoxication and severe general condition (vomiting, nausea, dry skin, convulsions, dehydration). The diagnosis is made by ultrasound of the kidneys.
2) Paranephritis (inflammation of the perirenal tissue), the leading symptom is also pain in the lumbar region; in the future, leukocytes appear in the urine. There may also be a high fever. Find a positive Goldflam-Pasternatsky symptom. The diagnosis is made by ultrasound of the kidneys.
3) Necrosis of the renal papillae, manifested by bleeding - macrohematuria (sometimes with the discharge of sequesters of the renal tissue), may be the result of damage to the arteries of the sinus of the kidney (arterial penduculitis).
Urinalysis (general, according to Nechiporenko, according to Zemnitsky).
Determines the increased content of protein in the urine and the presence of a large number of red blood cells (hematuria)
TANK sowing
Allows you to identify the causative agent of the disease and its sensitivity to various antibiotics
Rehberg's test
Determines the renal excretory function, as well as the ability of the kidney tubules to secrete / absorb certain substances
· General blood analysis
Allows you to identify signs of inflammation: leukocytosis, increased ESR, increased protein concentration
Biochemistry of blood
Sets an increase in the concentration of urea and blood creatinine
Daily BP measurement
Ultrasound of the kidneys
Determines the increase in the size of the kidneys in acute pyelonephritis and wrinkling in chronic forms of the disease or renal failure
Treatment is aimed at combating the infectious process, intoxication, restoring urodynamics and kidney function, and increasing the body's reactivity.
In the acute period, bed rest is necessary, especially with high body temperature, chills, severe intoxication, dysuric disorders and pain syndrome. A diet is prescribed with a restriction of extractive substances excreted by the epithelium of the tubules and having an irritating effect (pepper, onion, garlic, rich broth, smoked meats, etc.). In order to force diuresis in the diet, it is advisable to include fresh fruits and vegetables with diuretic properties (watermelons, melons, zucchini, cucumbers). It is recommended to increase fluid intake by 50% compared to the age norm.
Due to the fact that pyelonephritis is a microbial inflammatory disease, it is necessary to prescribe:
· Antibacterial preparations
Uroseptic preparations
Phytotherapy
Treatment of oral diseases
As you know, any disease is easier to prevent than to treat, so it is so important to pay attention to the prevention of pyelonephritis in childhood. Most often, pyelonephritis develops against the background of an existing chronic infection. infectious foci in a child's body there may be carious milk teeth or adenoids. Microbes and pathogenic bacteria enter the kidney filters in various ways and linger there, provoking the development of the disease.
Therefore, first of all, infectious diseases should be treated at the first symptoms of their appearance. Sometimes parents believe that there is no need for treatment of milk teeth, as the teeth will fall out after a while. However, this is an erroneous opinion, since caries greatly increases the risk of developing pyelonephritis or other kidney diseases.
Compliance with hygiene rules
Two ways of getting the infection into the urinary tract should be distinguished: “from above” and “from below”. For example, the infection may descend to the kidneys from the adenoids or ascend from the vulva. In this regard, parents should pay due attention to the observance of hygiene rules in young children. The skin of children is very delicate. And the mucous membranes tend to quickly become inflamed, which is favorable conditions for the penetration of infection into the children's body. It is recommended to wash small children after each bowel movement, and older children should have water procedures at least once a day.
Treatment of diseases of the gastrointestinal tract
The causative agent of pyelonephritis in children can also be opportunistic microflora, for example, Escherichia coli. The risk of an inflammatory process in the kidneys increases after hypothermia or as a result of a recent viral infection. In such cases, favorable conditions are created for the activation of pathogens. Not so rare cases when the causative agent of pyelonephritis in children are opportunistic microbes, for example, Escherichia coli that lives in the intestine. With a viral infection in children, especially influenza, special attention should be paid to treatment. After recovery, it is imperative to conduct a course of immune therapy and allow the body to fully recover from the disease.
Nursing process is a method of evidence-based and practical actions of a nurse to provide care to patients.
Target this method— ensuring an acceptable quality of life in illness by providing the maximum available physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values.
Currently, the nursing process is one of the main concepts modern models nursing and includes five stages.
Immediately before nursing interventions needed:
questioning the patient or his relatives
objective examination - this will allow the nurse to evaluate the physical and mental condition patient
Identification of patient problems - allows you to suspect kidney disease, including pyelonephritis
drawing up a care plan - when interviewing a patient (or his relatives)
questions about previous diseases, the presence of pallor with a slight icteric tinge, increased blood pressure, pain in the lumbar region, changes in the urine
Analysis of the data obtained helps to identify the problems of the patient - nursing diagnosis
The most significant are:
dysuric disorders;
· headache;
pain in the lumbar region;
general weakness, increased fatigue;
· nausea, vomiting;
the need of the patient and his family members for information about the disease, methods of its prevention and treatment;
Of considerable importance in solving these problems is nursing care, but the main role is played by non-drug and drug therapy, which are prescribed by the doctor.
The nurse informs the patient and his family members about the essence of the disease, the principles of treatment and prevention, explains the course of certain instrumental and laboratory studies and preparation for them.
Nursing care for patients with pyelonephritis includes:
1) inform parents about the causes of the development of the disease, clinical manifestations, course features, principles of treatment and possible prognosis;
2) Convince parents and the child (if his age allows) of the need for hospitalization in the nephrology department of a hospital for a comprehensive examination and adequate treatment. Assist in hospitalization;
3) Provide the child with bed rest for the period of exacerbation of the disease. Create an atmosphere of psychological comfort in the ward, constantly provide support to him, introduce the child to peers in the ward, timely satisfy his physical and psychological needs;
4) Gradually expand the regimen after normalization of body temperature under the control of the condition and laboratory parameters;
5) Monitor vital functions (body temperature, heart rate, respiratory rate, blood pressure, daily diuresis);
6) As the regime expands, gradually introduce exercise therapy classes: at first, the exercises are light and familiar, you can lie down or sit in bed, then more difficult in a standing position. Gradually increase the duration of classes, perform them slowly with incomplete amplitude. Be sure to include breathing exercises and relaxation exercises in the complex;
7) Involve parents and the child in the planning and implementation of care: teach proper hand washing, toileting of the external genitalia, explain the technique of collecting urine for various types of research
8) Prepare the child in advance for laboratory and instrumental research methods with the help of a therapeutic game;
9) Familiarize parents with the basic principles of diet therapy: drinking plenty of water, especially in the early days (up to 1.5-2 liters of fluid per day), following a milk-vegetable diet with salt and protein restriction in the acute period, then table No. 5. Gradually, you can go on a zigzag diet: every 7-10 days alternate products that change the pH of urine to the acidic or alkaline side, then conditions are not created for the reproduction of pathogenic flora and the formation of stones;
10) Advise parents to continue herbal medicine at home and pick up herbs that have anti-inflammatory and diuretic effects, teach them how to prepare decoctions. The collection usually includes: lingonberries, cornflowers, St. John's wort, nettles, birch leaves, bear ears, horsetail, chamomile, rose hips, blueberries, mountain ash;
11) Constantly maintain a positive emotional mood in the child, give tasks appropriate for his age, correct behavior, engage him in reading books, quiet games, diversify leisure, encourage cognitive activity;
12) Persuade parents after discharge from the hospital to continue dynamic monitoring of the child by a pediatrician and nephrologist at a children's clinic for 5 years with control of urine tests, examination by a dentist and an otolaryngologist 2 times a year;
13) In the presence of vesicoureteral reflux or other anomalies in the development of the urinary tract, recommend that parents re-hospitalize the child after 1.5 years to resolve the issue of surgical correction.
2.2.1 Initial Patient Evaluation Sheet
Patient: Zenkova D.S., 6 years old, was admitted to the children's department with a diagnosis of acute pyelonephritis.
Carrying out the 1st stage of the nursing process - a nursing examination, the primary assessment sheet was filled out.
Complaints: headache, general weakness, loss of appetite, body temperature 38.6 C. Pain in the lumbar region of a aching nature, painful and frequent urination.
Objectively: skin is pale, clean. Tongue dry, covered with white coating. The abdomen is soft. NPV 26, PS 102 per min.
The 2nd stage of the nursing process is the identification of violated needs, the identification of problems: real, priority, potential.
- frequent urination;
- fever;
- decreased appetite;
- headache.
- the risk of violation of the integrity of the skin in the folds of the perineum
Priority problem: frequent urination
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Ministry of Health and social development Russian Federation Ministry of Health of the Orenburg Region SBEE SPO "Gaisky Medical College"
« The role of additional research methods in the detection of latent pyelonephritis "
Introduction
Chapter 1. Theoretical overview
1.1 Anatomical, physiological and clinical features of the course of chronic latent pyelonephritis
1.2 Classification of chronic latent pyelonephritis
1.3 Clinic of chronic latent pyelonephritis
1.4 Diagnosis of chronic latent pyelonephritis
1.5 Treatment of chronic latent pyelonephritis
Chapter 2. Practical part
2.1 Analysis of statistical data on incidence in the city of Yasny and Yasnensky district
2.2 Interviewing patients
2.3 Analysis of medical history
2.4 Interview with a urologist, therapist
2.5 Analysis of patient questionnaires
Conclusion
Bibliographic list
Annex 1
Appendix 2
Appendix 3
Appendix 4
INTRODUCTION
Chronic pyelonephritis (CP) is a non-specific infectious and inflammatory process of the pyelocaliceal system and tubules of the kidneys, followed by damage to the glomeruli and vessels of the kidneys without significant symptoms at first.
Relevance Problems research determined by the fact that pyelonephritis is the most common disease of the urinary system and ranks second in frequency of cases after diseases of the respiratory system. Over the past five years, in the Orenburg region, the Yasnensky district, the frequency of diseases of the urinary system has increased by almost 2 times, infectious and inflammatory diseases occupy the first place.
Chronic pyelonephritis, according to the latest data from the Orenburg region of the Yasnensky district, is estimated as the most common kidney disease in all age groups. The number of cases in recent years is from 8 to 20 percent per 1000 people. The predominance of women over men (7:1) remains. Clinical manifestations of the disease are very diverse, chronic pyelonephritis can occur under the "mask" of another disease.
Currently, there is a lot of information about the etiology and pathogenesis of the disease, research on pathomorphological changes in the urinary system in patients. Against this background, the results of treatment and rehabilitation are not sufficiently effective. Therefore, all kinds of attempts to improve the outcomes of treatment, to expand the range of assistance to patients are of particular relevance. The main task in the treatment of chronic pyelonephritis is the elimination of the inflammatory process in the renal tissue.
Purpose of the study:
Elucidation of the role of additional research methods in the detection of latent pyelonephritis.
Research objectives :
1. Based on literary sources characterize latent pyelonephritis;
2. Determine the most effective modern additional research methods in the detection of latent pyelonephritis;
3. To study the issues of prevention of latent pyelonephritis;
4. To analyze the statistical data in patients with latent chronic pyelonephritis of the therapeutic department of the State Budgetary Institution of Health of the Yasnenskaya Republic of Belarus;
Research methods :
v General theoretical (study of medical literature)
v Analytical (analysis of statistical data)
v Questioning, surveys.
Hypothesis: Due to the fact that at present there are new and effective additional research methods, it became possible early detection latent pyelonephritis.
Object of study are patients suffering from chronic latent pyelonephritis.
Subject of study the influence of additional research methods in the detection of latent pylonephritis on the example of patients of the State Budgetary Institution of Health "Yasnenskaya RB".
Material processing method : manual.
CHAPTER 1. THEORETICAL REVIEW
1.1 Anatomical, physiological and clinical features of the course of chronic pyelonephritis
Chronic pyelonephritis is an infectious non-specific inflammatory process of the pyelocaliceal system and tubules of the kidneys, followed by damage to the glomeruli and vessels of the kidneys without significant symptoms at the beginning. The frequency of chronic pyelonephritis depends on age, gender and concomitant factors.
The most common chronic pyelonephritis is caused by Escherichia coli, Mycoplasma, Staphylococcus, Pseudomonas aeruginosa, in rare cases- viruses, fungi, salmonella. However, not in all cases of pyelonephritis it is possible to isolate the causative agent of the disease. Approximately 15% of cases it cannot be detected in the usual way neither in urine cultures, nor in cultures from kidney tissue taken during surgery. In some cases, this is due to the possibility of transforming the causative agents of pyelonephritis into peculiar, devoid of cell walls, forms that retain pathogenic properties and are resistant to ordinary species antibiotic therapy. All of the above shows that the achievement of remission of pyelonephritis with the absence of bacteriuria and other signs does not always indicate the complete suppression of the infection. The cause of the development of chronic pyelonephritis can also be foci of infection ( chronic tonsillitis, cholecystitis, osteomyelitis, furunculosis) both alone and in combination with inflammatory processes in the organs of the urogenital area (urethritis, cystitis, prostatitis, adnexitis, etc.), in the tissue of the pelvis (paraproctitis). Cooling, impaired urodynamics, urinary tract stones, prostate adenoma, diabetes mellitus, urological manipulations, and acute pyelonephritis contribute to the exacerbation and development of the disease.
Ways of penetration of infection in chronic pyelonephritis:
1- urogenic (ascending)
2 - hematogenous (descending)
3 - mixed (with localization of the focus of infection in the lower urinary tract)
Often, the route of infection cannot be established. The causative agent can be introduced during instrumental and surgical intervention, sexual intercourse.
In chronic pyelonephritis, complications can be varied and serious. In the kidney itself are possible different states: nephrosclerosis and pyonephrosis. Nephrosclerosis often develops as a result of latent flowing pyelonephritis without obstruction of the urinary tract. Pyonephrosis is more common with active secondary pyelonephritis, which is complicated by stones in the kidneys and ureters, occurs in conditions of impaired urine outflow; as well as in tuberculosis of the kidneys.
1.2 Classification of chronic pyelonephritis
I. By localization:
1. Pyelonephritis unilateral
2. Bilateral pyelonephritis
3. Total pyelonephritis (affecting the entire kidney)
4. Segmental pyelonephritis (affecting segment or part of the kidney)
II. By occurrence:
1. Primary pyelonephritis (not associated with a previous urological disease).
2. Pyelonephritis secondary (on the basis of lesions of the urinary tract of a urological nature)
III. According to the phase of the disease:
1.Phase of exacerbation
2. Phase of remission
IV. By clinical forms:
1.Hypertensive
2. Nephrotic
3.Septic
4. Hematuria
5.Anemic
6. Latent (little symptomatic)
7. Recurrent
V. Degree of chronic renal failure.
1.3 Clinic of chronic pyelonephritis
The clinical picture of chronic pyelonephritis is characterized by considerable diversity and the absence of specific changes. The symptomatology of the disease depends on its form and stage, the characteristics of the course, the degree of prevalence of the process in the kidneys, urinary tract obstruction, unilateral or bilateral lesions, and the presence of concomitant diseases.
Distinguish between general and common symptoms HP. Signs of the disease are usually minor, which hinders early diagnosis. Common symptoms include: increased fatigue, weakness, headache, deterioration in general well-being, drowsiness, unpleasant taste in the mouth, loss of appetite, low-grade fever.
Particular manifestations include pain in the lumbar region, urination disorders (pollakiuria, dysuria, etc.), a positive symptom of Pasternatsky. Often, pain is absent or (in secondary pyelonephritis) is masked by signs of a primary disease (urolithiasis, hydronephrosis, kidney tuberculosis, etc.)
IN active phase disease, all clinical symptoms are observed: subfebrile body temperature, dull pain in the kidney area, leukocytes and bacteriuria in the urine. The severity of pain is different: from a feeling of heaviness, awkwardness, discomfort to very severe pain. When the process passes into the latent stage, the temperature returns to normal, pain disappears, only slight bacteriuria and leukocyturia remain. In the remission phase, these changes are not detected in the urine, but they can occur under the influence of adverse factors (hypothermia, exacerbation of foci of infection in the body, impaired urine outflow). Then remission can go into the phase of latent or active inflammation.
Clinical forms of chronic pyelonephritis:
· latent;
Recurrent
hypertonic;
anemic;
Azotemic.
The latent form of chronic pyelonephritis is characterized by the paucity of clinical manifestations. Patients complain of general weakness, fatigue, headache, less often - an increase in temperature to subfebrile figures. As a rule, there are no dysuric phenomena; pain in the lumbar region and swelling. Some patients have a positive symptom of Pasternatsky. There is a slight proteinuria (from tenths to hundredths of a ppm). Leukocyturia and bacteriuria are intermittent. Latent pyelonephritis in most cases is accompanied by impaired renal function, primarily their concentrating ability, which is manifested by polyuria and hypostenuria. With unilateral pyelonephritis, a violation of the functional ability of a diseased kidney is more often detected only with a separate study of the function of both kidneys (radioisotope renography, etc.). Moderate anemia and mild hypertension sometimes develop.
The recurrent form of chronic pyelonephritis is characterized by alternating periods of exacerbations and remissions. Patients are concerned about constant discomfort in the lumbar region, dysuric phenomena, "causeless" fever, preceded by chills.
The exacerbation of the disease is characterized by the clinical picture of acute pyelonephritis. As the disease progresses, hypertensive syndrome with corresponding clinical symptoms: headaches, dizziness, visual impairment, pain in the heart area, etc. In other cases, anemic syndrome becomes predominant (weakness, fatigue, shortness of breath, pain in the heart area, etc.). In the future, chronic renal failure develops. Changes in the urine, especially during the period of exacerbation, are pronounced: proteinuria (up to 1-2 g per day); permanent leukocyturia, cylindruria, and less often - hematuria. The bacteriuria is also more constant. As a rule, the patient has an increased erythrocyte sedimentation rate, one or another degree of anemia, and during an exacerbation - neutrophilic leukocytosis.
The hypertensive form of chronic pyelonephritis is characterized by the prevalence of hypertensive syndrome in the clinical picture of the disease. Patients are concerned about headaches, dizziness, sleep disturbances, hypertensive crises, pain in the heart, shortness of breath. Urinary syndrome is not expressed, sometimes it is intermittent. Often, hypertension in chronic pyelonephritis has a malignant course. The anemic form is characterized by the fact that anemic syndrome prevails in the clinical symptoms of the disease. Anemia in patients with chronic pyelonephritis is more common and more pronounced than in other kidney diseases, and, as a rule, is hypochromic in nature. Urinary syndrome is scanty and not constant.
The azothemic form includes those cases of chronic pyelonephritis, in which the disease manifests itself only in the stage of chronic renal failure. These cases should be qualified as a further development of the previous latent chronic pyelonephritis that was not diagnosed in a timely manner. Clinical manifestations of the azotemic form and laboratory data are characteristic of chronic renal failure.
1.4 Diagnosis of chronic pyelonephritis
In the diagnosis of chronic pyelonephritis, a properly collected anamnesis is of great help. It is necessary to find out with perseverance in patients with diseases of the kidneys and urinary tract transferred in childhood. In women, attention should be paid to attacks of acute pyelonephritis or acute cystitis noted during pregnancy or shortly after childbirth. In men, special attention should be paid to past injuries of the spine, urethra, bladder and inflammatory diseases of the genitourinary organs. It is also necessary to identify the presence of factors predisposing to the occurrence of pyelonephritis, such as anomalies in the development of the kidneys and urinary tract, urolithiasis, nephroptosis, diabetes mellitus, prostate adenoma, etc.
Of great importance in the diagnosis of chronic pyelonephritis are laboratory, radiological and radioisotope research methods.
Leukocyturia is one of the most important and common symptoms of chronic pyelonephritis. However, a general urine test is of little use for detecting leukocyturia in pyelonephritis in the latent phase of inflammation. The inaccuracy of the general analysis lies in the fact that it does not strictly take into account the amount of supernatant urine remaining after centrifugation, the size of the drop taken for research, and the coverslip.
In almost half of patients with a latent phase of chronic pyelonephritis, leukocyturia is not detected in a general urine test. As a result, if you suspect the presence of chronic pyelonephritis, the detection of leukocyturia is shown using the methods of Kakovsky - Addis (the content of leukocytes in daily urine), Ambourg (the number of leukocytes released in 1 min), Nechiporenko (the number of leukocytes in 1 ml of urine), Stansfield - Webb (the number of leukocytes in 1 mm 3 non-centrifuged urine). Of the above, the most accurate is the Kakovsky-Addis method, since urine for research is collected over a long period of time. However, in order to avoid false positive results, urine should be collected in two containers: the first portions of urine are collected in one (30-40 ml with each urination), and the rest of the urine is collected in the other.
Since the first portion contains a large number of leukocytes due to flushing from the urethra, it is used only to account for the total amount of urine excreted. The study of urine from the second container allows you to determine the leukocyturia of urinary or renal origin. If the doctor assumes that the patient has chronic pyelonephritis in remission, provocative tests (prednisolone or pyrogenal) are used. The introduction of prednisolone or pyrogenal provokes the release of leukocytes from the focus of inflammation in a patient with chronic pyelonephritis. The appearance of leukocyturia after the administration of prednisolone or pyrogenal indicates the presence of chronic pyelonephritis.
This test becomes especially convincing if active leukocytes and Sternheimer-Malbin cells are simultaneously detected in the urine. Diagnostic value in chronic pyelonephritis, they also have a decrease in the osmotic concentration of urine (less than 400 mosm / l) and a decrease in endogenous creatinine clearance (below 80 ml / min). A decrease in the concentration ability of the kidney can often be observed in more early stages diseases. It indicates a violation of the ability of the distal tubules to maintain an osmotic gradient in the direction of blood - tubules. There is also a decrease in tubular secretion as more early symptom chronic pyelonephritis.
Methods for assessing immunological reactivity, studying the characteristics of proteinuria and determining antibacterial antibody titers are important. Immunological reactivity is currently assessed using a set of methods that involve the determination of cellular and humoral factors of immunity. Of the cellular methods, methods for determining the number of immunocompetent cells in peripheral blood and their functional usefulness. The number of immunocompetent cells is established in the rosette reaction, and various modifications make it possible to determine the number of thymus-dependent, thymus-independent and so-called null immunocompetent cells. Information about the functional usefulness of immunocytes is obtained during the reaction of blast transformation of peripheral blood lymphocytes.
Significant assistance in the diagnosis of latent pyelonephritis is provided by x-ray methods.
The main radiological symptoms of the disease are the following:
1) changes in the size and contours of the kidneys;
2) impaired renal excretion of a radiopaque substance;
3) pathological indicators of the renal-cortical index (RCI);
4) deformation of the pyelocaliceal system;
5) Hodson's symptom;
6) changes in the angioarchitectonics of the kidney.
On a survey radiograph in chronic pyelonephritis, a decrease in the size of one of the kidneys, a noticeable increase in the density of the shadow and a vertical arrangement of the axis of the affected kidney are found. (Appendix A)
Excretory urography in various modifications is the main method of X-ray diagnostics of chronic pyelonephritis. X-ray examination makes it possible to establish changes and deformations of the pelvicalyceal system. (Appendix A)
Chronic pyelonephritis is characterized by asymmetry of kidney damage and a decrease in their function, which is more clearly detected on excretory urograms made in the early stages (1, 3, 5 minutes) after the introduction of a radiopaque substance and delayed (40 minutes, 1 hour, 1.5 h). On late urograms, a slowdown in the release of a radiopaque substance by a more affected kidney is determined due to its delay in the dilated tubules.
Various deformations of the cups appear: they acquire a mushroom-shaped, club-shaped shape, they are displaced, their necks lengthen and narrow, the papillae are smoothed out.
Approximately 30% of patients with chronic pyelonephritis have Hodson's symptom. Its essence lies in the fact that on excretory or retrograde pyelograms, the line connecting the papillae of a pyelonephritically altered kidney turns out to be sharply tortuous, as it approaches the surface of the kidney in places of scarring of the parenchyma and moves away from it in areas of more intact tissue. In a healthy kidney, this line is evenly convex, without depressions, parallel to the outer contour of the kidney.
In chronic pyelonephritis, there is a gradual decrease in the parenchyma of the kidney, which can be more accurately determined using the renal cortical index (RCI). It is an indicator of the ratio of the area of the pelvicalyceal system to the area of the kidney. The value of the RCT lies in the fact that it indicates a decrease in the renal parenchyma in patients with chronic pyelonephritis in stages I and II of the disease, when this cannot be established without a calculation method.
Important information about the architectonics of the kidney in chronic pyelonephritis can be established by renal arteriography. There are three stages of vascular changes in the kidney in chronic pyelonephritis. Of the radioisotope research methods in chronic pyelonephritis, renography is used as a method for separately determining kidney function and establishing the side of the greatest lesion. The method also allows dynamic monitoring of the restoration of kidney function during treatment.
Computed tomography and magnetic resonance imaging are indicated if the ultrasound examination turned out to be uninformative or a tumor process is suspected. Before ultrasound examination, computed tomography has undoubted advantages in visualizing the prevalence of the inflammatory process beyond the kidney and assessing the involvement of neighboring organs in the process;
Differential Diagnosis chronic pyelonephritis most often has to be differentiated from kidney tuberculosis and glomerulonephritis. The transferred tuberculosis of other organs, dysuria, hematuria, cicatricial narrowing of the upper urinary tract, proteinuria, and a less pronounced predominance of leukocyturia over erythrocyturia testify in favor of kidney tuberculosis. Reliable signs of nephrotuberculosis are: the presence of mycobacterium tuberculosis in the urine, persistently acidic urine, a typical picture of tuberculous lesions of the bladder during cystoscopy and characteristic radiological signs diseases.
1.5 Treatment of pyelonephritis
An important place in the treatment of patients with latent pyelonephritis is occupied by the regimen, nutrition, and the use of antibacterial agents. Treatment is carried out in two stages: the first stage is the removal of exacerbation, the second stage is maintenance therapy (anti-relapse treatment). The first stage of treatment is usually carried out in a hospital, and the second is carried out for a long time on an outpatient basis. With a urinogenous infection with an obstruction to the outflow of urine, the listed measures are effective only in eliminating urinary tract obstruction and urinary stasis. Also, during periods of exacerbation of the disease, methods are used to improve microcirculation, detoxification. During the period of remission, phytotherapy is carried out.
Antibiotic therapy
With latent pyelonephritis, the duration of therapy is from 5 days to 2 weeks. It is preferable to start treatment with parenteral administration antibacterial agents, then moving on to oral administration. Of the modern drugs, fluoroquinolones (tavanic 250–500 mg 1 time per day) or β-lactams are used. III and IV generation cephalosporins, semisynthetic or ureidopenicillins, monobactams, penems and β-lactamase inhibitors are also used: ceftriaxone (2 g 1 time per day intramuscularly), cefazolin (1 g 3 times a day), amoxicillin (0.5 - 1 g 3 times a day intramuscularly, 0.25 or 0.5 g 3 times a day inside), ipipenem / cilastine (0.5 g / 0.5 g 3 times a day intramuscularly), amoxicillin (amoxiclav, augmentin; 1 g 3 times a day intravenously, 0.25--0.5 g 3 times a day inside), ampicillin. Despite the potential nephrotoxicity (requiring control of kidney function), aminoglycosides retain their positions: gentamicin. At the beginning of treatment with aminoglycosides, high doses (2.5–3 mg/kg per day) are recommended, which can then be reduced to maintenance doses (1–1.5 mg/kg per day). The frequency of administration can vary from 3 to 1 time per day (in the latter case, the administration of drugs at a dose of 5 mg / kg, which is considered more effective and less toxic, is recommended). Effective in the treatment of pyelonephritis and modern tetracyclines (doxycycline, doxiben), and macrolides (sumamed, rulid).
Therapeutic tactics for the treatment of acute and exacerbations of chronic pyelonephritis is similar; in addition to the mentioned chemotherapeutic agents, trimethoprim (biseptol; 0.48 g 2-4 times a day) or nalidixic acid preparations (neurigramon, blacks; 1 g 4 times a day) and its modifications (palin, pimidel; 0, 4 g 2 times a day). In chronic pyelonephritis, it is impossible to sterilize the urinary tract, so the treatment is aimed at stopping exacerbations and preventing relapses. To do this, it is recommended to use courses of preventive chemotherapy, less intensive than that prescribed in case of exacerbations. Such a tactic, however, is fraught with the development of flora resistance and side effects as a result of taking drugs, so herbal medicine can serve as an alternative in this case to some extent. When choosing an antibiotic, consider:
data of previous treatment;
the need for dosing antibacterial agents depending on the function of the kidneys;
Features of the pharmacokinetics of antibiotics;
The acidity of the urine
The duration of treatment depends on the clinical effect and elimination of the pathogen; therapy should be carried out in combination with bacteriological studies of urine.
Surgical treatment in cases where conservative therapy with the use of antibiotics and other drugs, as well as catheterization of the ureter in order to restore the patency of the upper urinary tract, do not bring success, and the patient's condition remains severe or worsens, surgical treatment is indicated. They operate mainly on purulent forms of pyelonephritis - apostemes and carbuncles of the kidney. The question of the nature of the operation is finally decided at the time of the surgical intervention and is determined both by the scale of the lesion and the pathogenesis of the disease.
CHAPTER 2. MATERIALS AND RESEARCH METHODS
2.1 Analysis of statistical data on incidence in the city of Yasny and Yasnensky district
To achieve this goal and confirm the hypothesis, I carried out research work. The research was carried out on the basis of GBUZ Yasnenskaya RB.
The purpose of this stage - to find out the role of new additional research methods in the detection of latent pyelonephritis.
Object of study - are patients suffering from chronic latent pyelonephritis.
Subject of study - the influence of additional research methods in the detection of latent pylonephritis on the example of patients of the Yasnenskaya RB.
To solve the tasks, an analysis of the medical history was carried out; analysis of statistical data; a survey of patients of the department of therapy, gynecology, surgery on the basis of the State Budgetary Healthcare Institution of the Yasnenskaya Republic of Belarus was conducted, and at the end of the survey, a survey was conducted with its subsequent analysis;
The picture of morbidity with latent pyelonephritis in the city of Yasnoy and the Yasnensky district is as follows. (APPENDIX B)
From the statistics for the Yasnenskaya Republic of Belarus, it is known that there were 13 cases of latent pyelonephritis in 2012-2013, and 23 cases in 2014-2015, therefore, cases of latent pyelonephritis are increasing every year.
For the period from 2012 to 2015, the most common form is latent and amounts to 65 cases, in second place is the hypertensive form and amounts to 33 cases. Less common anemic form(13 cases), Azotemic form (17 cases).
2.2 Patient Survey
Target: to analyze a survey of patients with chronic pyelonephritis in Yasnenskaya RB.
An object: oral questioning of outpatients and inpatients GBUZ Yasnenskaya RB.
Progress: to analyze the oral response of the patients of the Yasnenskaya RB and draw conclusions.
Patient #1 44 years old, patient of the second therapeutic department
I fell ill with this disease 18 years ago after pregnancy at 26 years old. Since then, I have been hospitalized every year. At the moment, the diagnosis is: chronic pyelonephritis, latent course, hospitalized on April 26, 2015, as planned. She complained of headache, loss of appetite, weakness, malaise; pain in the lower abdomen, in the lumbar region; frequent painful urination; the appearance of cloudy, with sediment and flakes of urine. I follow a strict diet, try to treat all infectious diseases, avoid hypothermia and dress warmly. Be sure to observe personal hygiene.
Patient #2 56 years old, came to the urologist with complaints of weakness, loss of appetite, headaches and frequent urination.
I have urolithiasis. Pain appeared 2 days ago. She took medication. I associate my disease with urolithiasis. There was an increased body temperature up to 38 degrees tonight. In the morning I decided to go to the doctor.
After passing urine tests (an increase in the number of leukocytes, the pH of urine is alkaline) and blood, the patient was diagnosed with chronic pyelonephritis.
Patient #3 man 76 years old. History of prostate adenoma. Went to see a urologist.
I have been suffering from this disease for over 20 years. The first signs appeared yesterday when I was cleaning the balcony, and there I caught it, probably, there was a draft. Pain is present in the lumbar region. After the examination, the doctor diagnosed him with chronic pyelonephritis. Aggravation.
Conclusion: about 30% of all urological patients are patients with chronic pyelonephritis. Many have a history of diseases such as prostate adenoma, acute undertreated pyelonephritis and a condition such as pregnancy.
2.3 Analysis of the medical history
Target: analyze the medical histories of patients of the Yasnenskaya RB with a diagnosis of chronic pyelonephritis latent course
An object: case histories of the first therapeutic department of GBUZ Yasnenskaya RB.
Progress: analyze the medical history of the patient GBUZ Yasnenskaya RB and draw conclusions.
Disease history
Patient born in 1958 (57 completed years)
Preliminary diagnosis: chronic pyelonephritis
Diagnosis at admission: chronic pyelonephritis
latent flow
Passport data
Surname First name Patronymic: Ivanova Maria Ivanovna
Age: 57
Place of residence: Orenburg region, Yasny, st. Lenina 56-9
Social status: disabled group II
Date of admission to the hospital: 05/01/2015
Blood type: I, Rh “+“
Allergy to bicillin-5 (urticaria)
Clinical diagnosis: chronic pyelonephritis latent course
Complaints: weakness, dizziness, stabbing pains in the left lumbar region.
Anamnesis morbi
She considers herself ill since 1996, after having been ill with acute pyelonephritis, she did not receive treatment. After that, 10 years later, chronic pyelonephritis was diagnosed. Annually treated in a hospital. Suffering long time hypertension (first diagnosed in 2001) and diabetes (since 1996). Hospitalized on 05/01/2015. in the therapeutic department in a planned manner.
At the time of admission, she complained of weakness, dry mouth, nausea, constipation, poor appetite, stabbing pains in the left lumbar region. Was diagnosed with chronic pyelonephritis latent course.
Anamnesis vitae
She was born on March 05, 1958. She was the second child in the family. She grew and developed normally, did not lag behind her peers in mental and physical development. Received a secondary education. In 1974 she entered the construction technical school. Then all her life she worked as a plasterer as a painter. Married. has 2 children. Hereditary history is not burdened. Injuries - fracture of the femur 2010.
Epidemic history: tuberculosis, Botkin's disease, venereal diseases denies. From past illnesses notes colds of the upper respiratory tract, diabetes mellitus, rheumatism, hypertension 2st. Bad habits are denied. Allergological history: allergy to bicillin-5 (urticaria). No blood transfusions were performed.
status praesens
General examination: General condition - moderate, consciousness - clear, patient's position - active, patient's physique - proportional, constitution - normosthenic, straight posture, height 155 cm, weight 63 kg, body temperature is normal (36.6 ° C).
Examination of individual parts of the body:
Integuments: Pale color, skin elasticity is reduced; Thinning of the skin or seals are not detected; Skin moisture is moderate; No rash was found.
Nails: The shape is rounded; Fragility and transverse striation are not observed.
Subcutaneous tissue: The development of the subcutaneous fat layer is normal. There is no edema.
Lymph nodes: Single palpable submandibular lymph nodes on the right and left, the size of a millet grain, round shape, elastic consistency, painless, mobile, not soldered to the skin and surrounding tissue; there are no ulcerations and fistulas; Occipital, cervical, supraclavicular, ulnar, bicipital, axillary, popliteal, inguinal lymph nodes are not palpable.
Saphenous veins: Inconspicuous. Thrombus and thrombophlebitis were not detected.
Head: Oval shape, head position straight; Trembling and swaying (Musset sign) negative.
Neck: Curvature - not curved; Palpation of the thyroid gland - not enlarged, uniform plastic consistency, painless.
Face: Facial expression is calm; The palpebral fissure is moderately enlarged; Eyelids pale, not swollen; trembling, xanthelasmas, barley, dermatomyosin glasses are absent;
Eyeball: no retraction and protrusion; Conjunctiva pale pink, moist, without subconjunctival hemorrhages; Sclera pale with a bluish tinge; The shape of the pupils is round, the reaction to light is friendly;
Nose: snub-nosed, no ulceration of the tips of the nose, wings of the nose do not participate in the act of breathing;
Lips: the corners of the mouth are symmetrical, there are no cleft lips, the mouth is ajar, the color of the lips is cyanotic; no rashes, no cracks, moist lips;
Oral cavity: no smell from the mouth; the presence of aphthae, pigmentation, Belsky-Filatov-Koplik spots, no hemorrhages on the oral mucosa, the color of the mucosa hard palate pale pink;
Gums: hyperemic, loose;
Tongue: the patient sticks out her tongue freely, there is no trembling of the tongue, the color of the tongue is pale pink, with misprints of teeth, partially lined with white coating, there are no cracks and sores;
Tonsils of the correct form, do not protrude from behind the temples, pale pink in color; raid, purulent plugs, no ulcers.
Examination of the musculoskeletal system:
Examination: There is no swelling, deformation and defiguration of the joints; The color of the skin over the joints is not changed; Muscles are developed according to age; no atrophy, muscle hypertrophy; There is no deformity of the joints and curvature of the bones.
Superficial palpation: The volume of active and passive movements in all planes is preserved; Joint noises are absent.
Deep palpation: The presence of effusion in the joint cavity and induration synovium at bimanual it is not revealed; The presence of "articular mice" was not revealed; Two-finger bimanual palpation is painless; Fluctuation symptom is negative; symptom of the anterior and posterior "drawer", the symptom of Kushelevsky are negative.
Percussion: There is no pain when tapping the bones. Respiratory examination:
Inspection of the chest: The shape of the chest is not changed, without curvature, symmetrical, the excursion of both sides of the chest during breathing is uniform, the type of breathing is mixed, respiratory rate is 18, the breathing rhythm is correct, there is no difficulty in nasal breathing;
Palpation of the chest: The chest is resistant, painless on palpation; Voice jitter Normal, there is no sensation of friction of the pleura on palpation.
Auscultation of the lungs: Breathing on the right and left vesicular,
Adverse respiratory sounds: dry, moist, small bubbling rales are not heard, there is no crepitus and pleural friction noise.
Examination of the circulatory organs:
Inspection of the heart and blood vessels
There is no defiguration in the region of the heart; apical and cardiac impulse is not visually determined; systolic retraction in the area of the apex beat is not determined; there is no pulsation in the second and fourth intercostal spaces on the left;
Pulsations in the extracardiac region: "dance of the carotid" pulsation of the jugular veins in the jugular fossae, epigastric pulsation was not detected; Quincke's pulse is negative;
Palpation of the heart area: The apex beat is palpated in the fifth intercostal space along the midclavicular line, spilled, resistant, high; systolic and diastolic trembling (symptom of "cat's purr") is absent; pulse 84 min. tachycardia, synchronous on both arms, the pulse is uniform, regular.
Auscultation of the heart and blood vessels: Heart sounds are muffled, weakening of the I tone at the apex of the heart; accent II tone over the aorta; slight tachycardia; Bifurcation, splitting, the appearance of additional noises (gallop rhythm, quail rhythm) are not auscultated;
Intracardiac murmur: Decreasing systolic murmur at apex
Extracardiac murmurs: Pericardial and pleuropericardial friction murmurs are not heard; vascular murmurs are not audible, blood pressure right hand 150/96 mm Hg - hypertension; BP on the left arm 150/96 mm Hg;
Abdominal examinations:
Inspection of the abdomen: The abdomen is rounded, symmetrical, participates in the act of breathing; peristaltic and antiperistaltic movements are not visually determined; subcutaneous venous anastomoses on the anterior abdominal wall are not developed; abdominal circumference 96 cm.
Palpation of the abdomen: On superficial palpation, the abdomen is painless; there is no tension in the abdominal wall. Hernial openings in the area of the umbilical ring and along the white line of the abdomen were not found. Shchetkin-Blumberg's symptom is negative; no tumor formations were found; The transverse colon, stomach and pancreas are not palpable. On palpation of the liver, the edge is rounded, the hepatic surface is smooth, soft, elastic consistency; the gallbladder is not palpable. Percussion reveals a tympanic percussion sound. Mendel's sign is negative; no free fluid was found in the abdominal cavity.
Abdominal auscultation: Intestinal peristalsis is heard over the abdominal cavity. There is no noise of friction of the peritoneum. Systolic murmur over the aorta renal arteries is not heard.
Examination of the urinary organs:
Inspection: Redness, swelling, swelling in the lumbar region is not observed. In the horizontal and vertical position, the kidneys are not palpable. Palpation in the suprapubic region did not reveal any foci of compaction; palpation is painless.
Percussion: Pasternatsky's symptom is negative;
status localis
The lumbar region is symmetrical, without visible impressions and deformities. Palpation of the kidney is painless. The symptom of tapping is negative on both sides. There is no pain along the ureters. The external genital organs are formed according to the female type, age-appropriate.
Bladder: protrusions over pubic area no, painless on palpation.
Maintenance plan:
1. General clinical examination
2. Ultrasound of the kidneys
3. Intravenous urography of the kidneys (did not do)
4. Antibacterial therapy
Plan for additional laboratory research methods
1. Complete blood count + Erythrocytes.
2. Blood for RW and HIV.
3. Urinalysis
4. Blood for sugar.
5. Biochemical blood test + leukoformula
6. Study for hemostasis
7. Study of the filtration and reabsorption function of the kidneys
Data from laboratory and instrumental studies:
Conclusion:Hemoglobin - 120 g/lErythrocytes - 4.4 * 10 12 / lLeukocytes - 9*10-9/lEosinophils - 0%Metamyelocytes - 6%Lymphocytes - 20%Monocytes - 11% |
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Conclusion: The result is negative. |
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3. Urinalysis dated 05/01/2015. |
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Conclusion: Protein - 0.15Sugar - negative |
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4. Blood sugar from 02.05.2015 - Conclusion: 8.2 mmol / l |
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5.Biochemical research blood dated 01.05.2015:Conclusion:Total bilirubin -15.0 mg% (up to 20.5)Creatinine 0.2 mmol/l |
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6. Study of the filtration and reabsorption function of the kidneys from 05.05.2015.Conclusion:Urine creatinine - 10 mmol / dayReabsorption - 95%Daily diuresis - 1860 ml. |
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7. Ultrasound of the kidneys from 05/05/2015:Dimensions: 135*58mmLeft 132*56 mm.In the area of \u200b\u200b\n there is an anechoic formation, 26 * 25 mm, in lat Cont. - 22*26 mm, at the border of the layers - 18*17 mm, 21*27 mm, in the area of n/a - 15*16mm, n/a medial cont. - 26*23 mm. Sinuses of the kidneys without deformities. |
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Follow the diet, prescribed treatment, sleep and wakefulness, avoid severe physical activity, avoid low temperatures and psycho-emotional stress.
EXECUTIVE EPICRISIS.
Patient Ivanova Maria Ivanovna, 57 years old, was hospitalized from 05/01/2015 to 05/15/2015.
- Complaints of weakness, dizziness, stabbing pains in the left lumbar region.
Plan for conducting laboratory and instrumental research methods.
1. Complete blood count dated 05/01/2015.
Hemoglobin - 120 g/l
Erythrocytes - 4.4 * 10 12 / l
Leukocytes - 9*10-9/l
Eosinophils - 0%
Metamyelocytes - 6%
Stab neutrophils - 5%
Segmented neutrophils - 65%
Lymphocytes - 20%
Monocytes - 11%
ROE - 13 mm/hour
2. Blood test for RW and HIV from 05/01/2015.
The result is negative.
3. Urine examination from 05/01/2015.
Color straw yellow
Protein - 0.15
Sugar - negative
Epithelial cells are squamous -1-2 in the field of view
Leukocytes - 2-3 in the field of view
Erythrocytes - 10 - 15 per field of view
Reaction - sour
Density: 1.021
4. Blood sugar from 05/02/2015.
8.2 mmol / l.
5. Biochemical blood tests from 05/01/2015:
Total bilirubin -15.0 mg% (up to 20.5)
Indirect bilirubin -13.0 mg% (up to 5.2)
Direct bilirubin - 4.6 mg% (up to 5.1)
Urea 19.3 mmol/l
Creatinine 0.2 mmol/l
Thymol test 1.5 units.
6. Study of the filtration and reabsorption function of the kidneys from 05/05/2015.
Blood creatinine - 0.2 mmol / day
Urine creatinine 10 mmol/day
Glomerular filtration - 30 ml\min
Reabsorption - 95%
Daily diuresis - 1860 ml.
Ultrasound of the kidneys from 05/05/2015:
Mutual position: located separately
Localization: in normal projection
Dimensions: 135*58mm
Left 132*56 mm.
Contours: on the left, uneven, fuzzy
Echozone ratio (parenchyma - renal sinus):
The boundary between the layers is different.
The echostructure is heterogeneous on the left due to:
In the area of \u200b\u200b\n there is an anechoic formation, 26 * 25 mm, in lat Cont. - 22*26 mm, at the border of the layers - 18*17 mm, 21*27 mm, in the area of n/a - 15*16 mm, n/a medial contact. - 26*23 mm. Sinuses of the kidneys without deformities.
Calculi: multiple on the left - 3-4 m.
Conclusion: chronic pyelonephritis, microcalculi.
The patient received treatment:
Diet therapy, antibiotics (lincomycin), anti-inflammatory drugs (potassium chloride), uroseptics (furazolidone), urolytics (cystenal), drugs that improve renal blood flow (pentoxifylline), vitamins (C, B1, B12), herbal medicine, physiotherapy.
The patient was discharged in a satisfactory condition: the pain syndrome was stopped, dysuric phenomena were not observed.
Diet: limit spicy, salty, fried foods. Drink low mineral water. Physiotherapy, herbal medicine, occupation physical therapy, observation by a nephrologist, massage therapy, spa treatment.
2.4 Interview with the therapist Kolchek Natalia Nikolaevna, head. first therapeutic department, urologist Bukumabaev Zhaslan Madiyarovich
Target: Assess the level of morbidity with a diagnosis of chronic pyelonephritis in the hospital and in the clinic of the Yasnenskaya RB
An object: Physician and urologist.
Progress: interview a general practitioner and urologist at Yasnenskaya RB and draw conclusions.
1. Nadezhda Vasilievna Kabachek graduated from the Rostov State medical University in 2009 with a degree in General Medicine. At the moment he is the head of the first therapeutic department.
2. Bukumbaev Zhaslan Madiyarovich graduated from the Orenburg medical academy in 2013 with a degree in Urology
During the interview, the general practitioner and the urologist and I discussed a number of the following questions:
1. Clinical picture of latent pyelonephritis?
2. What do you think, what common cause diseases such as latent pyelonephritis?
3. How many patients are currently treated as outpatients with this disease?
4. What are the statistics for 2014-2015?
5. Do you take measures to prevent latent pyelonephritis?
Date of the interview April 22, 2015 at 14.30 in an informal setting. The interview with the doctor was conducted in the office of the department of therapeutic head. branch of the Yasnenskaya RB.
2.5 Analysis of the questionnaire survey of patients with chronic pyelonephritis latent course
The date of the: in April - May 2015, a survey of patients was conducted in the inpatient departments of the Yasnenskaya RB.
The purpose of the survey:
Analysis of the prevalence of the disease depending on age
Analysis of the prevalence of the disease depending on gender,
Analysis of the frequency of seeking medical help,
The study of factors affecting this disease
Analysis of the fulfillment of the doctor's prescription by patients.
The survey was conducted in the department of therapy, in the surgical department, in the department of pathology of pregnant women, in the gynecological department. 16 people took part in the survey. The main reason for refusal to participate in the survey indicated poor health of patients. pyelonephritis kidney chronic x-ray
The structure of respondents by departments was distributed as follows:
1) department of therapy - 8 people (50% of the total number of respondents),
2) obstetric department- 2 people (12.5% of the total number of respondents),
3) surgery department- 2 people (12.5% of the total number of respondents),
4) gynecological department - 4 people (12.5% of the total number of respondents)
Survey results: (APPENDIX B)
CONCLUSION
From the statistics for the Yasnenskaya Republic of Belarus, it is known that there were 13 cases of latent pyelonephritis in 2012-2013, and 23 cases in 2014-2015, therefore, cases of latent pyelonephritis are increasing every year. In a survey, about 30% of all urological patients are patients with chronic pyelonephritis. Many have a history of diseases such as prostate adenoma, acute undertreated pyelonephritis and a condition such as pregnancy.
Currently, new and effective research methods are used to detect latent pyelonephritis. These are X-ray examinations of the kidneys, excretory urography of the kidneys, computed tomography of the kidneys.
Based on the scientific and theoretical substantiation of the problem of the studied literature, I have identified several main types of prevention of latent pyelonephritis: clinical nutrition, massage therapy, physiotherapy, physiotherapy exercises;
Thanks to the above preventive measures, it is possible to significantly reduce the frequency and duration of this disease.
CONCLUSION
The goals of the research work have been achieved, namely the development of stages of diagnostic activity (algorithms) for making a diagnosis with pathology of the urinary system and caring for a patient with pyelonephritis in the features of a hospital and a polyclinic. Therefore, we conducted a study of the influence of factors on the occurrence of latent pyelonephritis, namely: interviewing a doctor - urologist, therapist; conducting a survey and questioning of patients in the department of therapy, gynecology, surgery; analysis of statistical data on the incidence of latent pyelonephritis in the city of Yasnoy and the Yasnensky district; questioning of patients and students of the MMC; As a result, the goal: to clarify the role of additional research methods in the detection of latent pyelonephritis, was achieved;
Tasks completed: on the basis of literary sources, characteristics of latent pyelonephritis are given; issues of prevention have been studied; the general principles of medical rehabilitation of patients with this disease are determined. Preventive measures have been identified to help reduce the risk of developing pyelonephritis; the statistical data of patients with latent pyelonephritis of the Yasnenskaya RB were analyzed;
When solving the above tasks, we learned that the incidence of latent chronic pyelonephritis in 2012-2013 was 28 cases, and in 2014-2015 it was 37 cases. According to the data obtained, it can be seen that the statistics increased by 9 cases.
It can be concluded that due to the fact that there are currently new additional research methods, it became possible to diagnose latent pyelonephritis early. Thus, the hypothesis was proved by us.
REFERENCES
1.Butozova O.V. Medicines. Complete guide / Eksmo 2012. - 556-557 p.
2. Druzhinin, K.V. Special features of sports urology / K.V. Druzhin // Sport, medicine and health. - 2011. - 25 - 28 p.
3. Danilyuk, O.A. Practical iridology and phytotherapy /
O.A. Danilyuk. - Rostov-on-Don: Phoenix, 2006. - 599 p.
4. Kozlova, L.V. Prevention of chronic pyelonephritis: textbook. allowance / L.V. Kozlova, S.A. Kozlov, L.A. Semenenko. - Rostov-on-Don: Phoenix, 2008. - 475 p.
5.Muratov I.V. Fundamentals private pathology: studies. Allowance / I.V. Muratov; Far East GAFC. - Khabarovsk: Far East GAFC, 2012. - 150 p.
6. Ogulov A.T. Early diagnosis and prevention of renal disorders / A.T. Ogulov O.A. Khazova, O.E. Khazov. - M. : Forerunner, 2011.
7. Pirogov K.T. Internal illnesses/ K.T. Pirogov. - M. : EKSMO, 2013. - 137 p.
8. Pronchenko G.E. Research on the development of quality control methods for the collection for the treatment of pyelonephritis / G.E. Pronchenko, T.D. Rendyuk // Traditional medicine. - 2010. - 129c .
9. Popova S.N. Therapeutic physical culture / S.N. Popova // -2010 139 p.
10. Petrushkina, N.P. Phytotherapy and phytoprophylaxis of internal diseases: textbook. allowance for independent work/ N.P. Petrushkin; UralGUFK. - Chelyabinsk: UralGUFK, 2010. - 148 p.
11.Raduzhny N.L. Internal diseases / N.L. Rainbow. - M. : ARKTI, 2012. - 110 p.
12. Rodionov, V.A. Optimization of the rehabilitation treatment of children with pyelonephritis / V.A. Rodionov, I.E. Ivanova // Bulletin of restorative medicine. - 2010. - 62 - 64 p.
13. Rudichenko E.V. Complex restorative treatment of patients with chronic pyelonephritis / E.V. Rudichenko, T.A. Gvozdenko, M.V. Antanyuk // Questions of balneology of physiotherapy and medical physical culture. - 2010. - 95 p.
14. Sirotko V.L. All about internal diseases: textbook. - method. manual for graduate students / V.L. Sirotko. - M. : ARKTI, 2010. - 198 p.
15. Smoleva, E.V. Therapy with a course of primary health care: textbook. - method. allowance / E.V. Smoleva, E.V. Apodiakos. - Rostov n / a: Phoenix, 2011. - 544 p.
16. Stozharov A.N., N.N. Silivonchik, T.V. Mohort. - Early diagnosis of urological diseases - Minsk: graduate School, 2014. - 377 p.
17. Sadchikov D.V. Acute and chronic pyelonephritis - textbook. - method. allowance / D.V. Sadchikova: Phoenix, 2010. - 130 p.
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After questioning patients with glomerulonephritis, we obtained following results:
To the first question, “Do you know what causes glomerulonephritis?” answered:
YES - 1 patient
NO - 9 patients
To the second question, “Do you know about the possible complications after the onset of glomerulonephritis?” answered:
YES - 2 patients
NO - 8 patients
To the third question, “Do you know that the frequent occurrence of infectious diseases can lead to chronic glomerulonephritis?” answered:
YES - 3 patients
NO - 7 patients
To the fourth question, “Are you following the diet prescribed by your doctor?” answered:
YES - 5 patients
NO - 5 patients
To the fifth question “Do you follow the medications prescribed by your doctor?” answered:
YES - 8 patients
NO - 2 patients
To the sixth question “Do you follow daily hygiene care?” answered:
YES - 10 patients
NO - 0 patients
To the seventh question, “Do you know how much salt you need to take so that there is no edema in the future?” answered:
YES - 4 patients
NO - 6 patients
To the eighth question “Do you know about the need for daily monitoring blood pressure? answered:
YES - 4 patients
NO - 6 patients
To the ninth question "Do you know about the need to comply with the regime of physical activity?" answered:
YES - 7 patients
NO - 3 patients
To the tenth question "Do you know about the measures to prevent the occurrence of glomerulonephritis?" answered:
YES - 5 patients
NO - 5 patients
A graphic representation of the knowledge deficit and a diagram, the results of the study are presented in APPENDIX I.
Analysis of results
Summing up the results of the survey on the first question, it became known that most of the respondents - 9 people, have a lack of knowledge about the causes of glomerulonephritis, due to insufficiently frequent visits to the doctor.
In the second question, 8 people have a lack of knowledge about complications, due to an irresponsible attitude to their health and doctor's prescriptions.
The third question revealed that 7 subjects do not know that the frequent occurrence of infectious diseases leads to complications.
The fourth question revealed that patients have a lack of knowledge when eating food in their diet, or patients do not adhere to the diet at all, which was recommended and compiled by the doctor during the illness, which in this case can lead to a deterioration in the patient's condition.
In the next question of the questionnaire about the regular intake of medications by the patient, 8 people follow the recommendations and rules for taking medications, and only 2 people answered “no” to this question, which indicates the irresponsibility of patients for their health.
In the sixth question, regarding the personal hygiene of patients, all the respondents answered that they follow the principles of daily hygiene care and they do not have any questions on this topic.
The seventh issue is the lack of knowledge due to improper salt intake in the diet, this gap arises due to the patient's inattention to the specifics of his disease.
In the eighth question, not all respondents know that it is necessary to carry out control monitoring of blood pressure, which arises as a result of a lack of knowledge of the patient due to insufficiently attentive attitude of medical personnel to the patient's disease, which in the future can lead to impaired renal function.
In the ninth question, we found that 7 subjects are aware of the restriction of motor activity, but 3 patients are not aware of the correct daily routine.
In the tenth question, 5 patients showed a lack of knowledge about measures to prevent glomerulonephritis.
After analyzing the results of the study, we made the following conclusions:
1. 90% of patients lack knowledge about the disease itself, they do not know what causes glomerulonephritis.
2. 80% of patients have a lack of knowledge in following the diet prescribed by their doctor.
3. 20% have a lack of knowledge about taking medications.
4. 60% showed a lack of knowledge about the need for daily monitoring of blood pressure.
5. 60% of more than half have a lack of knowledge due to improper salt intake, which further leads to edema.
6. 30% of patients have no knowledge about the motor daily routine.
7. 50% of patients do not know about disease prevention measures.
Based on the results of our survey, we can identify many problems that patients often face and, based on them, make recommendations.
1. To eliminate the lack of knowledge of patients on the disease itself, namely the causes and risk factors for the occurrence of glomerulonephritis, we made recommendations that include the causes of glomerulonephritis, and this is due to the transfer of early infectious diseases, such as tonsillitis, tonsillitis, scarlet fever, chickenpox , pneumonia and so on. It is also possible to develop as a result of rheumatic and autoimmune diseases, a complication after vaccination, intoxication with substances, but the most common factor is hypothermia, while there is a reflex violation of the blood supply to the kidneys, which has a great influence on immunological reactions. But in addition to these reasons, malnutrition, bad habits and low physical activity can adversely affect. To eliminate this problem, we have compiled a memo that indicates the causes of occurrence, as well as the development of further complications. (APPENDIX K)
2. To eliminate the lack of knowledge associated with adherence to diet therapy, we have compiled a memo that contains the following information. The most important condition for the recovery period is nutrition. The main rule on which nutrition is based is to reduce the intake of salt and protein. We conduct a conversation with patients, explaining that the total calorie content of food should be satisfied at the expense of carbohydrates and fats, limit salt intake and drink. Limit protein intake to 0.5/kg for 3-4 weeks. The diet should contain enough vitamins and calcium salts, contributing to the thickening of the vascular wall, reducing inflammatory exudation and increasing blood clotting. Food should be taken fractionally, in small portions 5-6 times. In order to replenish knowledge, we have compiled a memo that describes the rules for consuming products in your diet. (APPENDIX K)
3. To address the lack of knowledge about taking medications, recommendations were made, which include individual scheduling of medications. In this case, it is also necessary to convey to patients that complications may occur after the disease, due to a lack of care, in order to avoid this, it is necessary to clearly convey to the patient that he strictly adheres to the doctor's recommendations, take medications on time and takes his health more seriously and recommend that they draw up schedule for taking medications and attach it in a conspicuous place.
4. To eliminate the lack of knowledge about the need for daily monitoring of blood pressure, we have compiled a memo in which, in short and understandable words, self-monitoring of the condition of patients, namely the measurement of blood pressure, is described. (APPENDIX M) We also had a conversation in which we said that arterial hypertension in acute glomerulonephritis is usually moderately expressed, does not exceed 160/100 mm Hg. Art., and to maintain normal pressure, it is necessary to reduce salt intake, since salt contributes to an increase in blood pressure. However, persistent long-term hypertension has a poor prognosis.
5. To eliminate the lack of knowledge arising from improper salt intake, we have compiled a memo that says what should be consumed from food and what should be discarded. (APPENDIX H) A conversation was also held with the patient about the harmful effects of salt and excessively salty and smoked foods on his body.
6. To eliminate the lack of knowledge that occurs in the motor mode, we have compiled a memo that includes all the recommendations for a therapeutic and prophylactic culture. (APPENDIX P) Exercise therapy is prescribed by a doctor to each individual, taking into account all the characteristics of the patient's body at different stages of the disease with the determination of the mode of physical activity. A conversation was also held with the patient, where it was said that the exercises are performed at a slow pace, the movements are smooth with full amplitude, attention is focused on inhalation and exhalation, the load alternates with different groups muscles in order to redistribute blood and is performed on all muscle groups, especially the muscles of the back, abdominals, buttocks, and thighs.
7. To eliminate the lack of knowledge in preventive measures, a memo was compiled, which includes primary preventive measures aimed at preventing the onset of the disease, secondary - the development of complications, which are described more briefly, but clearly. (APPENDIX P) We also had a conversation in which it was said that the prevention of glomerulonephritis can be primary and secondary. Primary prevention of the disease is aimed at preventing its occurrence and consists in the timely detection of foci of chronic infection. Treatment of streptococcal infections of the pharynx and tonsils, staphylococcal skin diseases and paranasal sinuses should be not only timely, but also adequate. Another preventive measure is hardening and strengthening immune system organism in combination with a balanced diet. Salt and alcoholic beverages should not be abused, and the calorie content of food consumed should be calculated based on age-related needs. In this case, it is highly undesirable to experience strong thirst or hunger. Secondary prevention does not replace the disease, but only supplements the primary one, in order to exclude the possibility of recurrence of glomerulonephritis. Therefore, people who have had the disease are under dispensary observation by a nephrologist for 2 years, control their blood pressure and periodically take a urine test. Doctors recommend that such people avoid work associated with great physical stress, as well as beware of hypothermia and suspend classes. water sports sports. With the diagnosis of "chronic glomerulonephritis", work with harmful and toxic substances, long business trips and duty in night shift. Women after acute glomerulonephritis for three years are not recommended to become pregnant and give birth.
CONCLUSION
Practical significance of this work lies in the fact that it shows how relevant and significant the activity of a nurse is when caring for a patient with glomerulonephritis.
The research work is based on a survey of a group of people who have suffered glomerulonephritis. This questionnaire was developed in order to identify the patient's initial level of knowledge about the disease in general, the causes of its occurrence, the prevention of its complications, as well as the principles of therapeutic nutrition.
The data obtained during the survey were analyzed, which allowed us to identify the lack of knowledge in the issues of interest to us, based on this, we made recommendations and memos.
allow to improve the quality of the nurse's activities, thereby helping her to understand the problems of a patient with glomerulonephritis, and then organize optimal process care for this patient.
social significance work is expressed in the fact that it encourages people to be more attentive to the issues of hygienic care and the implementation of all medical advice, after the development of the disease, and also shows the significance and necessity of the above rules and aspects to prevent the development of further complications and obtain visible effects in compliance with the recommendations.
Also, based on our work, the nurse will know the importance of conducting conversations with patients with this disease. And in the future he will make for himself what aspects will need to be touched upon in depth in these conversations. Since the lack of knowledge of patients indicates poor-quality educational work of medical personnel. After consultations, the nurse can evaluate the results of self-care, as well as the development of complications in him.
Thus, based on our conclusions, as well as based on the identified significance of the work, I can say that the goals and objectives set by us have been achieved, which will help in the future to prevent and to some extent reduce the development of glomerulonephritis, as well as its complications.
LIST OF USED LITERATURE
1. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition Volume 6 2009. pp.278-290
2. Davidenko N.S. Doctor of the 2nd category "Diseases of the kidneys and urinary tract: glomerulonephritis" 2007. pp. 52-83
3. Dvurechenskaya, V.M., Dvurechenskaya, A.A. Kaplina, R.N. Chuprina. "Preparation for Research" Ed. Phoenix - 2002. pp.76-78
4. Eliseeva Yu.Yu. "Handbook of a nurse" Ed. Moscow: Eksmo-2004. - 840s.
5. Petrovsky B.V. "Glomerulonephritis" - 2005. From 11-18
6. Podlesnova A.F. Doctor II category “Glomerulonephritis. Diagnosis and treatment. Diet in acute and chronic glomerulonephritis. Prevention of glomerulonephritis” 2009 pp. 92-98
7. Razukas V.G., Speichene Danute M.L. "Diffuse glomerulonephritis" -2009. pp. 27-29
8. Ryabova I.S. "Nephrotic Syndrome" Ed. Medicine - 2008 S. 90
9. Mukhin N. A., Tareeva I. E. "Diagnosis and treatment of kidney diseases." -2007 pp. 57-63
10. Tkach I. S. " Acute glomerulonephritis. Symptoms, forms of the disease, methods of diagnosis and treatment, diet. Analysis of urine and blood in glomerulonephritis. - 2010 pp. 34-38
11. Tatareva I.E. "Nephrology" Ed. Medicine - 2010 pp. 256-259
12. Tareeva. M. "Clinical nephrology: In 2 volumes" - 2009. pp. 38-59
13. Shilov E.M., Krasnova T.N., “Immunosuppressive therapy for glomerulonephritis” - 2007 S. 80
14. Chizh A. S. "Treatment of acute and chronic glomerulonephritis: Method" Ed. Medicine - 2011 pp. 25-37
15. Shulutko B.I. "Glomerulonephritis. Internal Diseases, Ed. Shulutko B.I. - 2008 S. 334 - 363.
According to numerous scientific studies, the modern treatment of symptoms of pyelonephritis in women with folk remedies is an excellent alternative to some synthetic drugs and allows you to achieve good results in the treatment of the disease, especially if used in combination with the classical scheme for stopping the inflammatory process in the kidneys. Healing fees You can make your own or buy already ready-made formulations in pharmacies. In any case, doctors do not deny the effectiveness of folk remedies in the fight against pyelonephritis and often recommend them to their patients as adjuvant therapy to the main treatment.
- Causes of the disease in women
- How the disease manifests itself
- Features of treatment
- Most Popular folk recipes that help in the treatment of pyelonephritis
- How to prevent relapses?
Causes of the disease in women
Pyelonephritis is an inflammatory pathology, predominantly of infectious origin, affecting the main structure of the urinary system, namely the pelvis-calyx apparatus. This ailment occurs as a result of a pathological violation of the passage of urine, which provokes its reflux together with the microflora from the bladder back into the renal tubule system, or as a result of infection of the renal tissue by microorganisms penetrating its thickness in an ascending way. Among the most common causative agents of pyelonephritis in women, viruses are isolated, coli, Klebsiella, fungal cultures of the genus Candida, staphylococci and the like.
The main provoking factors of the disease are:
- general hypothermia of the body;
- lumbar injuries;
- congenital anomalies of the kidneys and ureters;
- nephroptosis;
- nephrolithiasis (the presence of stones in the kidneys);
- a sharp weakening of the immune system;
- venereal and nonspecific infections of the female genital organs;
- transferred surgical interventions on the organs of the genitourinary sphere;
- poor-quality bladder catheterization;
- an increase in the size of the uterus, including the state of pregnancy;
- hyperglycemia;
- deficiency of vitamin compounds;
- the presence of persistent foci of infection in the body.
If you believe official statistics, pyelonephritis in women is diagnosed several times more often than in the representatives of the stronger sex. This is due to the peculiarities of the structure of the female genitourinary sphere and hormonal changes characteristic of pregnancy, as well as menopause.
How the disease manifests itself
The course of pyelonephritis, depending on the form of the disease, may be accompanied by a number of painful manifestations or be asymptomatic. With pyelonephritis, which is acute, patients will have sharp expressions of the classic symptoms of the disease:
- severe pain syndrome in the lumbar region of a aching character;
- headache;
- a sharp increase in temperature and chills;
- weakness, malaise and loss of working capacity;
- nausea and repeated vomiting;
- frequent urge to urinate;
- the appearance in the urine of impurities of protein, pus and uniform elements;
- increase in pressure.
Often, signs of cystitis join acute pyelonephritis. At this time, a sick woman complains of false urges to urination, turbidity and darkening of urine, which acquires a specific fishy smell, cramps during urination, the presence of fresh blood in the urine and copious discharge from the vagina.
Unlike the acute variant of the pathology, a chronic ailment has a less pronounced clinical picture or can be completely asymptomatic. The presence of such a disease in a woman makes it possible to suspect a urinalysis, where single erythrocytes, many leukocytes and bacteria, protein in high concentrations and cylindrical epithelium will be determined.
Symptoms and treatment of pyelonephritis is a subject of discussion in many medical forums, especially when it comes to the inflammatory process that occurred during pregnancy. In women in position, this disease is diagnosed with a frequency of 1 to 5% of the total number of cases. An increase in the risk of developing pathology coincides with the second half of pregnancy. It is very difficult for expectant mothers to endure this kind of ailment, as they suffer from lower back pain, general malaise and nausea appear, body temperature rises, and so on. Every sixth pregnant woman with pyelonephritis is at risk of sepsis, and every fourth is diagnosed with complex forms of anemia.
Why is it important to treat pyelonephritis? In addition to pathological symptoms, the disease is dangerous for the woman's body due to the high risk of developing complications of the disease, among which are:
- the formation of a purulent abscess at the site of the focus of infection;
- kidney failure;
- sepsis;
- kidney emphysema.
Features of treatment
Treatment of pyelonephritis should be comprehensive. Apart from traditional therapy, doctors prescribe various kinds of folk remedies to patients, recommend adjusting the diet and point out the importance of physiotherapy. With the help of such treatment, it is currently possible to completely overcome the disease, prevent the occurrence of its complications and the spread of infection throughout the body.
Therapy for inflammation of the pelvic-calyx apparatus in women is based on a number of general rules, which allow patients to quickly get rid of the disease and prevent its recurrence:
- hypothermia of the body should not be allowed, especially in the cold season;
- it is necessary for the entire period of treatment to abandon salty foods and bad habits, in particular, from drinking alcohol;
- when symptoms of any form of the disease appear, it is necessary to without fail observe bed rest;
- a woman should maintain an adequate drinking regimen (at least 2 liters of fluid per day), which will allow pathogenic microorganisms to be removed from the body faster.
A significant condition for recovery is the appointment of antibacterial and antimicrobial drugs, as well as antispasmodics, non-steroidal anti-inflammatory forms and diuretic drugs.
An important role in the treatment of the disease is given to the treatment of symptoms of pyelonephritis in women with folk remedies. Herbal preparations have anti-inflammatory, antibacterial, and mild diuretic effects, allowing the kidneys to quickly recover from the disease and effectively prevent relapses of the disease.
The most popular folk recipes that help in the treatment of pyelonephritis
For cooking effective remedy from inflammation of the urinary tract, you need 200 g of onion, 20 g of dry crushed rosemary leaves and a teaspoon of May honey. All these ingredients should be mixed, pour 500 ml of red wine and stand for at least 3 weeks. It is recommended to shake the mixture periodically. Before use, the finished medicine should be filtered and taken 50 ml three times a day before the main meals.
Take about 100 g of carrot seeds and pour them with boiling water in the amount of a liter. Keep the infusion for about 8-10 hours, remove plant impurities and consume 150 ml before each meal, but at least four times a day. The tool perfectly copes with the symptoms of chronic pyelonephritis, which is accompanied by swelling, as well as a decrease daily diuresis urine. The infusion increases the concentration properties of the kidneys and perfectly cleanses the blood.
Grind about 20 g of dried bearberry leaves and pour a glass of boiling water. Place the resulting mixture on water bath by covering with a lid. Stand for 30 minutes, cool, strain thoroughly. Dilute the finished concentrated broth with cold boiled water, bringing its amount to 200 ml. Take 50 ml 3-4 times a day, regardless of meals. Bearberry based remedy is great natural antiseptic, which, in addition, has a pronounced diuretic and restorative effect, eliminates inflammatory foci and stimulates filtration, which ensures its effectiveness in the treatment of microbial processes in the kidneys and urinary tract.
To prepare the infusion you will need:
- lemon balm - 4 parts;
- leaves of cross grass or white mistletoe - 4 parts;
- sedum flowers - 3 parts;
- dill seeds - 2 parts.
All of these components should be mixed. Pour a tablespoon of the collection with hot water, insist in a thermos and drink 100-150 ml three times a day. Such a medicine is recommended to be used for two months, followed by a break. The course of treatment must be repeated twice a year. Infusion from the collection perfectly helps with pyelonephritis with chronic course associated with arterial hypertension. It allows you to prevent relapses and restore damaged areas of soft tissues.
You will need:
- horsetail grass - 10 parts;
- asparagus root - 6 parts;
- leaves and fruits of wild strawberries - 6 parts;
- nettle leaves - 4 parts;
- leafy shoots of plantain - 4 parts;
- rose hips - 4 parts;
- initial grass - 2 parts;
- rhizome of horse sorrel - 2 parts;
- parsley - 1 part.
A spoonful of the collection should be steamed in two glasses of boiling water and simmer in a water bath for about 25-30 minutes. Drink the finished medicine before meals in small sips. The remedy helps well with inflammation of the renal pelvis, allows you to quickly drive out urine, remove sand from the kidneys and normalize their filtration function. The course of therapy is 4-6 months with mandatory repetition.
Three tablespoons of chicory pour 0.5 liters of boiling water and insist in a thermos for 2-3 hours. After the specified time has elapsed, strain the resulting composition and consume 200 ml three times a day. This tool perfectly copes with inflammation of the urinary tract, has an antimicrobial and diuretic effect, is a natural antispasmodic, which allows you to quickly stop the pain.
About 10 g of corn silk should be poured into a glass. After that, insist, strain and consume two tablespoons of the finished infusion 6-8 times a day. Brewed stigmas of corn have a strong anti-edematous effect, which allows them to be used in the edematous-hypertensive form of pyelonephritis. Together with the remedy, it is recommended to carry out a salt-free diet in combination with limited fluid intake.
Take equal amounts of St. John's wort, flowers of small-leaved linden, lemon balm and chamomile. Pour a tablespoon of the resulting composition with a glass of boiling water and insist for several minutes until a steep infusion is obtained. Take a glass finished product overnight for 1-2 months.
How to prevent relapses?
A number of recommendations will help prevent the development of inflammation in the kidneys, as well as seasonal exacerbations of a chronic process, including:
- compliance with the rules of personal hygiene;
- avoiding hypothermia of the body;
- timely rehabilitation of chronic foci of infection;
- treatment of colitis, cholecystitis and the like;
- active struggle with violations of normal defecation;
- rational diet with salt restriction;
- getting rid of the habit of holding urine;
- refusal to drink alcohol;
- normalization of an adequate drinking regime with daily use liquids in the amount of 2-3 liters;
- regular examinations by a nephrologist.
Pyelonephritis is one of the ailments that can significantly affect a woman's life expectancy. That is why the first symptoms of the disease should not be ignored. At the onset of symptoms pathological process in the kidneys, you should immediately contact a specialist and take measures to eliminate the manifestations of inflammation.
Causes of kidney fibrosis and the possibility of its treatment
Retroperitoneal fibrosis is a chronic inflammatory process in the fibro-fatty tissue of the retroperitoneal space. This condition causes damage to the kidneys, obstruction of the ureters and diseases of the pelvic organs. Pathology is most often diagnosed in men aged 30–60 years, patients complain of pain in the lower back and groin, increased blood pressure, impaired urination. In 30% of patients, a tumor-like formation in the pelvic region is palpated. How kidney fibrosis manifests itself, what it is and what complications can develop, the nephrologist explains in detail.
Clinical picture
The severity of symptoms depends on the stage of the disease and the rate of spread of the pathological process.
In most cases, the first signs of the disease appear after 2 months from the onset of connective tissue growth, but sometimes the disease progresses within 2–10 years.
In the initial stages, kidney fibrosis causes dull, implicit pain in the lower back, side. Discomfort sensations are constantly present, often the pain “shoots” in the groin, genitals, inner surface hips. Patients note an increase in blood pressure, general weakness, and a rapid loss of working capacity. The pain is unilateral or bilateral. About a third of patients find tumors in the abdomen because they are easily palpable.
As the disease progresses, the ureters, aorta, and inferior vena cava are compressed. The volume of urine excreted decreases or complete anuria occurs with symptoms of general intoxication of the body. Violation of the process of urination leads to inflammation of the kidney (pyelonephritis), damage to the pelvis (hydronephrosis), the formation of stones and chronic renal failure.
If only one kidney is affected, then the second one compensates for the work of the affected organ.
Additionally, patients complain of symptoms hypertension: edema lower extremities, headache, blurred vision and hearing, nausea. Blood pressure levels rise due to an increase in the volume of circulating blood, which the kidneys cannot filter efficiently. Swelling appears on the face, most often under the eyes, on the hands and feet. When pressed on the skin, a noticeable dent from the fingers remains.
Symptoms of uremia in renal fibrosis:
- nausea, vomiting;
- dizziness, confusion;
- dryness, itching of the skin;
- smell of ammonia from the mouth;
- convulsions;
- violation of the menstrual cycle in women;
- impotence, oligospermia in men.
With the development of pyelonephritis, body temperature rises, urolithiasis (stones) can cause renal colic, the appearance of hematuria (blood in the urine). Uremia leads to stagnation of blood, against the background of which pulmonary edema develops, microflora and intestinal function are disturbed.
Fibrolipomatosis of the kidneys is characterized by venous hypertension - the cause of its development is compression of the inferior vena cava by a fibrous neoplasm. Patients have symptoms varicose veins veins of the lower extremities, varicocele.
Causes of the disease
Scientists have not been able to fully figure out the etiology of kidney fibrosis, but they distinguish a complex of provoking factors that can cause pathology:
- chronic liver diseases;
- mechanical injuries of the abdominal cavity;
- poisoning with toxic substances, drugs;
- diseases of the digestive tract;
- infections of the genitourinary system;
- spinal tuberculosis;
- autoimmune diseases;
- conducting radiation and chemotherapy;
- cancerous tumors;
- long-term or uncontrolled use of ergotamine drugs, Metisergide.
It is possible to accurately determine the cause of kidney fibrosis only in 2/3 of patients, in other cases the disease is recognized as idiopathic.
Pathogenesis
The pathological process of sclerosis begins to develop from the periphery, localized in the retroperitoneal fatty tissue, which is located around the iliac vessels at their intersection with the ureter. As the lipomatosis progresses, it reaches the hilum of the kidney. First, one organ is affected, then the fibrous neoplasm can spread to the second (30%).
In the active period of the disease, compression of the ureter occurs, making it difficult to excrete urine. The process is complicated by inflammation of the kidney parenchyma, damage to the pelvis, sinuses, leads to chronic renal failure and gradual atrophy of the urinary organ. With compression of fatty tissue on the large intestine, intestinal obstruction may occur.
fibrolipomatosis renal sinuses(pedunculitis) develops with a sclerotic change in the cellular tissue of the kidney gate and along the vascular pedicle. Pathological refluxes occur, that is, urine is thrown into the interstitial tissue, penetrates into the veins and lymphatic vessels draining the kidney.
When fibrosis spreads to the vena cava and arteries supplying the pelvic organs, thrombosis develops, which can lead to ischemia, cause intense pelvic pain, oliguria, anuria, and an increase in the concentration of urea in the blood. Non-permanent symptoms include a change in the patient's skin color up to jaundice, swelling of the legs, dyspeptic disorders. With complete occlusion of the vessel, death occurs.
Diagnostic examination
In the early stages, fibrosis may be mild, characteristic changes are observed in the study of the composition of urine, protein is found in it. A blood test reveals an increase in ESR and the level of α-globulins. With uremia and renal failure in the blood, high concentration urea, creatinine.
To assess the condition of the kidneys, their excretory channels, radiography, excretory urography, ultrasound, computed tomography. Ultrasound of the iliac vessels with contrast confirms the expansion of the lumen of the kidney, obstruction of the ureter.
Since the primary cause of fibrosis may be chronic illness other internal organs, it is necessary to conduct an additional examination and check whether their main functions are violated. A highly informative diagnostic method is a laparoscopic examination of the abdominal cavity and a biopsy of the lumbar region. During the histology of the obtained biopsy, a large number of fibrin cells in adipose tissue are detected.
Fibroma of the kidney is differentiated from oncological tumors, tuberculous lesions of the urinary system, pancreatic cysts with atypical localization.
Methods of treatment
Drug therapy is prescribed in the initial stages of the disease, when there are no symptoms of compression of the ureter, intestines or blood vessels. Patients are recommended non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants. Conducted if necessary symptomatic treatment antibiotics, antipyretics, antihypertensive tablets.
In the active stage, it is not advisable to treat fibrosis with drugs; surgical intervention is indicated for patients.
The doctor excised sclerosed fatty tissue, which allows you to increase the lumen of the compressed organ (ureterolysis). Sometimes, in order to restore the normal flow of urine or blood, plastic surgery, the introduction of a stent, is required. If obstruction of both ureters has occurred, and there is no way to restore the passage of urine, a nephrostomy (artificial opening) is placed that goes to the anterior wall of the abdominal cavity.
When kidney fibroma completely disrupts the functioning of the organ, its atrophy and wrinkling occurs, partial or complete nephrectomy is indicated. Such an operation is performed only if the second kidney is working normally. With multiple strictures, at a severe stage of hydronephrosis, the ureter is replaced with an intestinal segment.
Table of contents
Pyelonephritis- a nonspecific infectious and inflammatory disease of the kidneys, in which the renal pelvis, calyces and parenchyma of the kidneys are involved in the process. Currently, pyelonephritis is the most common kidney disease in all age groups. Women different ages suffer from pyelonephritis 5 times more often than men. More high incidence in women, it is due to the anatomical and physiological characteristics of the female body. Women have three critical period when the incidence is highest: early childhood, onset of sexual activity and pregnancy. In men, the incidence of pyelonephritis increases in old age, when problems with urination appear, caused by damage to the prostate gland.
Allocate acute and chronic pyelonephritis. Most often, the disease occurs against the background of other pathological changes in the urinary tract, such as urolithiasis, anomaly in the development of the kidneys, pathological mobility of the kidneys, as well as against the background of various diseases that cause a violation of the outflow of urine. Such pyelonephritis is called secondary or complicated. In primary or uncomplicated pyelonephritis, the inflammatory process begins in the intact kidney. Pyelonephritis can be caused by microorganisms living in the human body (endogenous flora) or in the external environment (exogenous flora). An infectious agent can enter the kidney both ascending through the urethra and bladder, and hematogenously from other foci of infection (inflammation of the tonsils, infected wounds, etc.)
Clinical picture:
Acute pyelonephritis is the most severe. As a rule, the disease begins acutely, there is a high temperature (up to 40), chills, sweating, general malaise, pain in the lumbar region, thirst, urination disorders, the appearance of cloudy sediment in the urine. Joining headache, nausea, vomiting indicate a rapidly growing intoxication. Exacerbation of chronic pyelonephritis is manifested by similar symptoms, but the clinical picture is less bright. The temperature, as a rule, is subfebrile (up to 38), it can be normal, the pain syndrome is characterized by the appearance of dull, aching pains in the lumbar region, urination disorders are mild or absent.
When symptoms of acute pyelonephritis appear, it is necessary to consult a doctor as soon as possible, since the outcome of treatment depends on the timeliness of diagnosis and the appointment of adequate therapy. Do not underestimate the severity of the disease and self-medicate. Delay can be fraught with serious complications, up to the loss of a kidney and a threat to the life of the patient. Treatment should be carried out in a hospital, under the supervision of a qualified urologist. If acute pyelonephritis occurs with severe clinical symptoms, which, as a rule, makes the patient consult a doctor, then chronic pyelonephritis can be asymptomatic and manifests itself only with periodic changes in the urine test. In addition, patients often attribute minor nagging pains in the lumbar region to the manifestation of osteochondrosis of the spine and do not go to the urologist, and therefore chronic pyelonephritis is diagnosed when complications appear, which greatly worsens the prognosis of the disease. Therefore, when pain occurs in the lateral sections of the back in the lumbar region, it is necessary to contact a urologist and undergo a comprehensive urological examination.
Diagnostics pyelonephritis includes laboratory methods studies, bacteriological examination of urine to detect pathogenic microflora and determine sensitivity to antibacterial drugs, ultrasound and X-ray examination of the urinary tract, endoscopic diagnostic methods are possible, but bypassing the acute period.
Treatment pyelonephritis is complex and is carried out in the following areas:
- antibacterial therapy, if possible, taking into account the properties of the identified pathogen
- Elimination of the causes that cause a violation of the outflow of urine
- Sanitation of foci of infection
- immunocorrection
- symptomatic therapy
With the development purulent inflammation in the kidney, urinary tract obstruction often necessitates emergency surgery.
It should be noted the importance of timely and optimal prescription of antibiotic therapy. Many patients, knowing that they have pyelonephritis, when symptoms of exacerbation appear, on their own begin taking antibacterial drugs that they were once prescribed, after taking a few tablets, feeling better, stop taking them. This approach to treatment is extremely dangerous, since inadequate therapy in terms of composition or timing leads to the emergence of antibiotic-resistant strains of microorganisms, which greatly complicates further treatment.
Prevention pyelonephritis includes both medical and social aspects. Early diagnosis and timely treatment urological diseases, urination disorders and anomalies in the development of the urinary system, hygienic measures during sexual life in women, exclusion of diseases of the genital area, sanitation oral cavity condition of the upper respiratory tract.
Patients with diagnosed pyelonephritis (chronic or acute) need to be monitored by a urologist on an outpatient basis.
