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