What is kidney pyelonephritis and how is it treated. Pyelonephritis - symptoms of acute and chronic forms, treatment and medications

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

Treatment of chronic pyelonephritis

Chronic pyelonephritis- a chronic nonspecific infectious-inflammatory process with predominant and initial damage to the interstitial tissue, pyelocaliceal system and renal tubules with subsequent involvement of the glomeruli and renal vessels.

Treatment program for chronic pyelonephritis.
1.
2.
3. (restoration of urine outflow and anti-infective therapy).
4.
5.
6.
7. .
8.
9.
10.
11.
12. .
13. Treatment of chronic renal failure (CRF).

1. Mode

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

Indications for hospitalization of the patient are:

• severe exacerbation diseases;
• development of difficult-to-correct arterial hypertension;
• progression of chronic renal failure;
• disturbance of urodynamics, requiring restoration of urine passage;
• clarification of the functional state of the kidneys;
• o development of an expert solution.

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

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

3. Etiological treatment

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

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

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

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

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

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

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

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

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

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

3.1. Antibiotics

Table 1. Antibiotics for the treatment of chronic pyelonephritis

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

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

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

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

3.1.4. Monobactam preparations
Monobactams (monocyclic beta-lactams) have a powerful bactericidal effect against gram-negative flora and are highly resistant to the action of penicillinases (beta-lactamases). Drugs in this group include aztreonam (azactam).

3.1.5. Aminoglycoside preparations
Aminoglycosides have a powerful and faster bactericidal effect than beta-lactam antibiotics and have a wide antimicrobial spectrum (gram-positive, gram-negative flora, Pseudomonas aeruginosa). You should be aware of the possible nephrotoxic effect of aminoglycosides.

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

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

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

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

3.2. Sulfonamides

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

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

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

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

3.3. Quinolones

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

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

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

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

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

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

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

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

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

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

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

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

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

3.4. Nitrofuran compounds

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

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

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

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

3.5. Quinolines (8-hydroxyquinoline derivatives)

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

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

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

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

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

• antibiotics, the use of which is possible in normal doses: dicloxacillin, erythromycin, chloramphenicol, oleandomycin;
• antibiotics, the dose of which is reduced by 30% when the urea content in the blood increases by more than 2.5 times compared to the norm: penicillin, ampicillin, oxacillin, methicillin; these drugs are not nephrotoxic, but in chronic renal failure they accumulate and cause side effects;
• antibacterial drugs, the use of which in chronic renal failure requires mandatory dose adjustment and administration intervals: gentamicin, carbenicillin, streptomycin, kanamycin, biseptol;
• antibacterial agents, the use of which is not recommended for severe chronic renal failure: tetracyclines (except doxycycline), nitrofurans, nevigramon.

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

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

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

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

4. Use of NSAIDs

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

5.Improving renal blood flow

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

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

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

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

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

6. Functional passive kidney exercises

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

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

Negative reactions, which can occur during passive kidney exercises:

• long-term use of the method can lead to depletion of the reserve capacity of the kidneys, which is manifested by a deterioration in their function;
• uncontrolled passive kidney exercises can lead to water and electrolyte imbalance;
• Passive kidney exercises are contraindicated if there is a violation of the passage of urine from the upper urinary tract.

7. Herbal medicine

In the complex therapy of chronic pyelonephritis they use medicines, having anti-inflammatory, diuretic, and with the development of hematuria - hemostatic effect ( table 2).

Table 2. Medicinal plants used for chronic pyelonephritis

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

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

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

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

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

Collection No. 1

Collection No. 2

Collection No. 3

In case of exacerbation of chronic pyelonephritis, accompanied by an alkaline reaction, it is advisable to use the following collection:

Collection No. 4

The following collection is recommended as maintenance antibiotic therapy:

Collection No. 5

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

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

Collection No. 6(for Bath)

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

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

• multivitamin complexes;
• adaptogens (tincture of ginseng, Chinese magnolia vine, 30-40 drops 3 times a day) during the entire period of treatment of an exacerbation;
• methyluracil 1 g 4 times a day for 15 days.

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

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

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

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

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

9. Physiotherapeutic treatment

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

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

10. Symptomatic treatment

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

11. Spa treatment

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

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

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

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

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

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

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

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

12. Planned anti-relapse treatment

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

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

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

Pyelonephritis occurs as a result of the spread of infection from Bladder. The sudden development of the inflammatory process is associated with an acute course. Symptoms such as pain in the lumbar region, increased body temperature up to 40 degrees, general malaise, and frequent urination appear. In the absence of proper treatment, the disease becomes chronic.

If you suspect pyelonephritis, immediately consult a doctor who will prescribe a course of therapy. This will allow you to stop the spread of infection in the body in time.

Causes of pyelonephritis

The disease is typical for women and men. The specifics differ in two cases: women are prone to infection in reproductive age, and men suffer from chronic pyelonephritis associated with age-related health problems.

Sources of infection are:

• reverse flow of contaminated urine;
• blood;
• lymph from infectious foci in neighboring organs or intestines.

Kidney pyelonephritis is caused by the following reasons:

• untreated cystitis and hypothermia;
• disturbance of the outflow of urine, which is associated with the presence of stones or narrowing of the ureters;
• decreased immunity and inflammation;
• diabetes and overwork;
• presence of catheters or urinals;
• congenital pathologies of the urinary tract;
• ureteral injuries during operations;
• hormonal disorders and chemotherapy;
• polycystic disease

Pyelonephritis in women is associated with the onset of sexual activity. Girls violate hygiene rules and things happen hormonal disbalance. Acute pyelonephritis, in the absence of specialist intervention, becomes chronic.

Patients often stop taking medications when signs of inflammation subside. But the pathogens of the disease remain in the body. Decreased immunity and a new inflammatory process provoke the manifestation of the disease.

Pyelonephritis, the causes of which affect different systems body, associated with activation of pathogens:

• coli;
• chlamydia;
• bacterial microorganisms Proteus and Klebsiella;
• Staphylococcus aureus;
• salmonella;
• mycoplasma.

Identifying the cause of the disease and the causative agent is important for constructing the correct treatment regimen. Self-medication is unacceptable - it can cause complications.

Signs and symptoms of pyelonephritis

Signs of the disease appear from a few hours after the infection occurs to several days. It depends on the level of immunity.

The symptoms of the disease differ between acute and chronic forms. The age of the patient even plays a role. Pyelonephritis in men is associated with inflammatory diseases of the genital area.

Diagnosis of pyelonephritis

When making a diagnosis, pay attention to appearance, presence of temperature, patient’s blood pressure. The survey reveals the presence concomitant diseases. For example, cystitis and pyelonephritis often occur together.

• The temperature with pyelonephritis rises to 39 degrees.
• Blood pressure rises.
• The abdomen is palpated.

Measures to identify the disease include 2 types of diagnostics: laboratory and instrumental. The first group is the study of biological fluids.

Tests for pyelonephritis include:

• study of creatinine levels in urine. The amount of a substance shows how well the blood purification level corresponds normal indicators(normal in men is from 71 to 106 µmol/l, in women - from 36 to 90 µmol/l);
• urine culture to identify the pathogen;
• blood culture when infection spreads;
• blood analysis;
• urine test to detect the presence of infection.

Instrumental diagnostics include:

• ultrasound examination for detection of abscesses, stones and causes of urinary retention, congenital defects of the urinary tract;
• survey urography, which allows you to determine the presence of X-ray positive stones, identify the contours and position of the kidney;
• computed tomography if ultrasound examination is insufficient;
• gynecological examination, as venereal diseases may masquerade as pyelonephritis;
• radionuclide diagnostics.

Treatment of pyelonephritis

Treatment of pyelonephritis is carried out comprehensively. It includes:

• antibacterial treatment;
• elimination of the cause of obstruction of urine outflow;
• anti-inflammatory, detoxification therapy;
• herbal medicine;
• diet.

For pyelonephritis, this is the basis of treatment, allowing to extinguish the activity of the pathogen. The course of therapy lasts two weeks. Medicines are administered orally and intravenously. This depends on the degree of development of the disease. Three groups of drugs are used:

• semisynthetic penicillins;
• antibiotics of the aminoglycoside group;
• antibiotics-cephalosporins.

Treatment of pyelonephritis includes drugs that improve microcirculatory processes. They improve urine flow. To eliminate inflammation, non-steroidal anti-inflammatory drugs (Nimesulide, Paracetamol) are prescribed.

Kidney pyelonephritis is inflammatory disease occurring in acute or chronic form. An infectious and inflammatory process develops in the kidney parenchyma and the pyelocaliceal system.

What is kidney inflammation, what gives impetus to the inflammatory process? Everything about organ inflammation and treatment options in each specific case can be learned through diagnostics and medical specialists.

Symptoms

People with weakened immune systems are most susceptible to disease.

How does the disease manifest itself? Symptoms of pyelonephritis and patient complaints vary and depend on the person’s age.

A symptom of the sluggish latent period of the disease is the inflammatory process. Signs of pyelonephritis in adults are divided into local and general. At the first signs you should seek medical help.

Pathology can manifest itself with the following symptoms:

• Malaise;
• Fever, increased body temperature to 39;
• The appearance of nausea and vomiting;
• Pain in the lumbar region, radiating to the iliac fossa or suprapubic region;
• Confusion;
• Frequent, painful urination;
• Blood in the urine;
• Cloudy urine with a pungent odor.

Impaired urination, discomfort when urinating, frequent lower back pain may be serious signals diseases.

The disease is often accompanied by diuretic disorders. Night diuresis predominates over daytime diuresis.
An acute form of kidney inflammation manifests itself:

• High fever, chills;
• Heavy sweating;
• Pain from the diseased organ;
• On days 3-5, upon palpation, you can notice that the affected kidney is enlarged;
• The appearance of pus in the urine on the third day;
• Headache, joint pain.

Symptoms of chronic pyelonephritis are not clearly visible. Among characteristic features in this case the following are observed:

• Frequent urination;
• Unpleasant urine odor;
• Constant It's a dull pain in the lumbar region.

In later stages, kidney disease manifests itself:

• Dry mouth;
• Heartburn;
• Belching;
• Swelling of the face.

Nausea, severe pain, swelling of the face and legs, blood pressure above normal - all this can be serious signs running chronic process.

Pyelonephritis in children and infants is often confused with ARVI or a cold, which complicates diagnosis and treatment. The sooner the symptoms appear, an examination is carried out and treatment is prescribed, the sooner the problem can be solved.

The identified symptoms and diagnostic results determine the treatment of the disease.

Causes

What causes pyelonephritis? The source of the disease is most often an infection caused by microorganisms. The classification is based on the pathogenesis of the disease.

The main causes of pyelonephritis are well known. The etiology of pyelonephritis and pathogenesis are associated with the penetration of pathogenic microorganisms along with the bloodstream into the vascular system of the renal glomeruli. The main pathogen is Escherichia coli, as well as staphylococcus, streptococcus and enterococcus. The etiological factor causing the chronic process is microbial flora.

The development of pathology occurs when:

• System anomalies;
• Chronic kidney disease;
• The presence of stones in the organ;
• Exacerbations during pregnancy;
• Adenoma or prostate cancer in men;
• Diabetes mellitus of the first or second type;
• Gout;
• Severe hypothermia of organs;
• Long-term use of antibiotics;
• Protracted infectious diseases of other organ systems.

The exact causes of the disease are determined by a nephrologist.

The most significant risk factors for pyelonephritis are reflux at various levels.

The psychosomatics of kidney diseases has also been studied quite well. It is important to understand why the inflammatory process in the kidneys can be dangerous. Each new exacerbation of pyelonephritis involves more and more new areas of kidney tissue in the inflammatory process.

Classification

The most common renal pathologies are urolithiasis disease, nephropathy, pyelonephritis, glomerulonephritis.

There is no unified classification of such processes. Most criteria describe the types of pyelonephritis and the nature of the inflammatory process. The most common is the classification according to N. A. Lopatkin.

1. Hematogenous. The infection is carried by blood to the kidneys from other organs;
2. Urogenic or ascending. The penetration of bacteria into the kidney tissue occurs from the urinary tract.

According to the nature of the disease, pyelonephritis is classified into acute and chronic. The acute form has a short period with pronounced symptoms and requires hospitalization. More often, patients are diagnosed with a right-sided acute inflammatory process than a unilateral left one. The acute period always begins with serous inflammation. The acute serous period is the initial stage of the disease.

The chronic form can last a long time. There is a classification of chronic pyelonephritis according to the activity of the inflammatory process in the kidney.

About 1% of people with kidney infections develop xanthogranulomatous pyelonephritis, a rare aggressive lesion of the reticular connective tissue with destruction of the parenchyma that results from chronic inflammation.

A rare form of acute purulent kidney disease - emphysematous pyelonephritis - severe, life-threatening a disease characterized by the presence of renal parenchymal and perirenal infection caused by gas-forming microorganisms.

Diagnostics

Diagnostics acute inflammation kidney problems usually do not cause problems. The symptoms of this disease are well known. The results of blood and urine tests in this case are abnormal. Multiple white blood cells usually appear as a sign of an inflammatory process.

Diagnosis of urinary system diseases includes:

• Complete blood test;
• General urine analysis;
• Blood chemistry;
• Bacterial culture of urine.

First of all, the color of the urine is assessed. The smell of urine is of particular importance. Bacteriological tests of urine identify the causative agent of the disease.

To determine a more accurate cause of the disease, the following procedures are performed:

• Ultrasonography;
• X-ray (without contrast or contrast urography);
• CT and MRI.

Differential diagnosis of acute and chronic pathology is carried out with several diseases. There is a special table that presents distinctive features every pathology.

The diagnosis will determine which doctor treats this disease and what appropriate treatment will be prescribed by the specialist.

Special forms of diagnostics corresponding to different types pyelonephritis does not exist. Even xanthogranulomatous pyelonephritis can be recognized and detected using ultrasound. Emphysematous is diagnosed based on X-ray examination of the urinary tract and bacteriological examination of urine.

The results of the examination will enable the doctor to make the correct diagnosis.

Treatment

The clinical picture of pyelonephritis can vary from latent, erased, asymptomatic forms to manifest forms, including urosepsis.

An attack of renal colic can begin suddenly. Inflammation of the kidneys may be accompanied by microhematuria or hematuria, which is defined as blood in the urine.

Treatment of acute pyelonephritis is carried out with antibiotics. Antibacterial therapy treatment is prescribed only by a doctor. Treatment is started with antibiotics and chemical antibacterial drugs, which must be prescribed taking into account the sensitivity of the urine microflora. Often in such cases Amoxicillin with clavulanic acid, Suprax, Tsiprolet are used. Flemoxin Solutab is used to treat children and pregnant women.

In difficult cases, the drug Levofloxacin and Ceftriaxone are used. Analgesics - painkillers, non-steroidal anti-inflammatory, antispasmodic medications - help relieve symptoms. The most effective medicine Norbactin is considered for cystitis and pyelonephritis.

The standard of treatment and how many days sick leave lasts for pyelonephritis are known. A certificate of incapacity for work is issued to the patient for the time he is in the hospital - from 5 to 10 days.

How to cure chronic pyelonephritis

The disease must be treated comprehensively. The choice of treatment will depend on the stage, form and severity of the pathology. Manifestation syndromes are carefully studied.

Treatment of a chronic process in both the right and left kidneys takes quite a long time. For this purpose, various anti-infective drugs are used - uroantiseptics. One of the most commonly used uroseptics is Nitroxoline. The cleansing function of the kidneys is activated by the drug Fitolysin.

To treat this disease you can and should use folk remedies. Herbs significantly help in the therapy process, providing anti-inflammatory, uroseptic, and diuretic effects. The most popular means for inflammation in the kidneys, there are leaves and berries of lingonberry, leaves and buds of birch, cornflower, bearberry. Rosehip is used to strengthen the immune system.

Homeopathy improves all kidney functions.

During the recovery period and to prevent the disease, procedures are prescribed by a physiotherapist to increase the body's defenses. Physiotherapy and immunostimulation are carried out. Rehabilitation for pyelonephritis, restoration of the body and treatment chronic disease can happen at home.

Xanthogranulomatous

Xanthogranulomatous pyelonephritis is most often treated only with surgery. Another disease associated with kidney inflammation is glamic nephritis, which, despite the seriousness of the disease, is usually treated with supportive care. The difference between glomerulonephritis and pyelonephritis is that the pathological phenomena gradually spread and affect the calyces and pelvis of the kidneys.

Spicy

Treatment for acute kidney pyelonephritis takes place mainly in a hospital. This is dictated by the need for constant monitoring of the patient, monitoring his condition, taking multiple tests and monitoring the dynamics of the disease. This difficult work is performed by nurses.

To begin the nursing process of caring for a patient, it is necessary to ask the patient or his relatives about the problem, medical history, past illnesses, and conduct an objective study - this will allow nurse assess the patient's physical and mental condition.

Literate nursing care– a great help for the patient and speeding up the healing process. The nursing process includes the execution of certain actions:

• Follow the instructions of the attending physician;
• Collect patient tests in a timely manner;
• Monitor the patient’s compliance with the diet prescribed by the doctor;
• Maintain thermal conditions in the ward;
• Monitor compliance with bed rest;
• Provide emotional support to the patient;
• Monitor the patient’s condition and, if necessary, provide first aid;
• Promptly notify the doctor about the patient's condition.

There is no clear answer to the question whether chronic pyelonephritis can be completely cured. Which doctor treats this disease?

How to treat pyelonephritis in each specific case can be found out at an appointment with a doctor, after carrying out the appropriate diagnosis. Kidney disease in men and women is treated by a nephrologist, urologist, a therapist is also directly involved in this process, and in children - by a pediatrician.

Louise Hay explains kidney disease in the field of psychosomatics. For treatment renal pathologies It is recommended to pay attention to this point of view.

Is pyelonephritis congenital?

Structural features genitourinary system in a newborn they can be provocateurs of pyelonephritis.

Dr. Komarovsky warns that pyelonephritis in newborns and infants up to one year old is dangerous with complications, so diagnosis and treatment should be carried out as quickly as possible.

Are the concepts compatible: pyelonephritis and the army? Do people with chronic pyelonephritis join the army? It all depends on the course of the disease. Even a doctor’s conclusion about the presence of such a diagnosis does not guarantee exemption from military service. A decision on the eligibility of a conscript will be made in accordance with the conditions prescribed in the Schedule of Sicknesses.

An important point in the treatment of kidney inflammation is diet. If the disease is only in initial stage, to treat it, you can try a decoction of oats in combination with the diet prescribed by your doctor. Oats can also be brewed to prevent disease. Oatmeal infusions also strengthen the body's immunity. In order to avoid the onset of the disease, prevent progression and speed up treatment, doctors usually prescribe massage for pyelonephritis and exercise therapy.

Is it possible to go to the bathhouse with pyelonephritis to improve the health of the body?

But bathhouses and saunas are not always indicated in such a situation. You should consult your doctor on this issue.

It is possible to get rid of the inflammatory process in the kidneys with timely examination and treatment, as well as following an appropriate diet and a healthy lifestyle. Complications in this case can lead to serious consequences. One of these complications, although quite rare, is xanthogranulomatous pyelonephritis. As a result of complications, hypertension and diseases of other organs and systems may appear.

Diet

What can you eat if you have pyelonephritis? The acute period of the disease, chronic, xanthogranulomatous and emphysematous pyelonephritis require a special diet.

If you have inflammatory kidney disease, you need to drink plenty of fluids. Mineral water, which must be drunk according to a certain scheme, must be present in the diet. You need to eat right, lead healthy image life. The diet is usually agreed upon with the attending physician, but, as a rule, fatty, spicy, and fried foods are excluded from the diet. Salt consumption should be kept to a minimum.

Diet for pyelonephritis is an important direction in the treatment of the disease, as it helps reduce the load on the affected kidneys and replenish the body with important vitamins and minerals, which is necessary measure in the process of increasing immunity.

Complications

Frequent exacerbations of the disease do not pass without leaving a trace, and the disease recurs again and again, moving into the chronic phase, causing complications to appear.

In the absence of timely treatment for pyelonephritis, the disease can lead to serious complications.

The destruction of kidney tissue caused by inflammation can not only aggravate the functioning of the organ, but also make it absolutely impossible. Serious consequences of pyelonephritis are xanthogranulomatous, emphysematous pyelonephritis and renal failure. Complications affect all organs and systems of the body.

Pyelonephritis is an infectious inflammatory disease of the kidneys that occurs when pathogenic bacteria spread from lower sections urinary system. In most cases, the causative agent of pyelonephritis is Escherichia coli (E. Coli), which is sown in large quantities in patients' urine.

This is a very serious disease, accompanied by severe painful sensations and significantly worsening the patient's well-being. Pyelonephritis is easier to prevent than to cure.

Pyelonephritis is part of a group of diseases collectively called “urinary tract infection.” With improper antibacterial treatment of infectious diseases of the lower parts of the urinary system, bacteria begin to multiply and gradually move to higher parts, eventually reaching the kidneys and causing symptoms of pyelonephritis.

Facts and statistics

• Every year in the United States, an average of 1 person out of every 7 thousand people falls ill with pyelonephritis. 192 thousand of them are undergoing inpatient treatment in specialized departments of hospitals and clinics.
• Women suffer from pyelonephritis 4-5 times more often than men. Acute pyelonephritis occurs more often in women who are sexually active.
• In 95% of patients, treatment of pyelonephritis gives a positive result within the first 48 hours.
• In childhood, pyelonephritis develops in approximately 3% of girls and 1% of boys. 17% of them develop cicatricial changes in the renal parenchyma, and 10-20% develop hypertension.
• Plain water can significantly improve the condition of a patient with pyelonephritis. Drink plenty of fluids maintains normal fluid balance, and also provides “dilution” of the blood and helps remove more bacteria and their toxins. This occurs due to frequent urination in response to increased fluid intake.
• Although even slight movement can cause severe pain with pyelonephritis, it is important to urinate as often as possible. Although the patient feels discomfort during urination, this the only way get rid of the causative agent of the disease - bacteria are eliminated from the body only with urine. Uncontrolled growth of microorganisms will worsen the condition, causing sepsis (blood poisoning) and can even cause the death of the patient.
• Cranberry juice is considered a good helper in the fight against pyelonephritis. You can drink the juice at pure form or diluted with water (see). In this case, you should completely avoid drinking alcohol, sweet carbonated drinks and coffee.

Risk factors

Risk factors for developing pyelonephritis include:

• Congenital anomalies of the kidneys, bladder and urethra;
• AIDS;
• Diabetes;
• Age (risk increases as you get older);
• Diseases of the prostate gland, accompanied by an increase in its size;
• Kidney stone disease;
• Spinal cord injury;
• Bladder catheterization;
• Surgical interventions on the urinary system;
• Uterine prolapse.

Causes of pyelonephritis

Ascending route of infection

Pyelonephritis is caused by bacteria. They enter the urinary system through the urethra and then spread to the bladder. The pathogen then moves to higher structures, ultimately penetrating the kidneys. More than 90% of cases of pyelonephritis are caused by Escherichia coli, a bacterium that multiplies in the intestines and enters the urethra from the anus during bowel movements. This explains the increased incidence among women (due to the anatomical proximity of the anus, external genitalia and urethra).

Ascending infection is the most common cause of acute pyelonephritis. This explains the high incidence among women. Due to the anatomically short urethra and the structural features of the external genitalia, the intestinal flora in women is contaminated groin area and vagina, then rapidly spreading upward into the bladder and higher.

Except coli Among the causative agents of pyelonephritis are:

• Staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
• Klebsiella pneumoniae;
• Proteus (Proteus mirabilis);
• Enterococcus;
• Pseudomonas aeruginosa;
• Enterobacter species;
• Pathogenic fungi.

Less common routes of migration of infectious agents into the kidneys include hematogenous and lymphogenous. Microbes can also be introduced during instrumental manipulations, for example, with catheters. With the latter option, the most likely causative agents of pyelonephritis are Klebsiella, Proteus and Pseudomonas aeruginosa.

Vesiculourethral reflux

Vesiculourethral reflux is characterized by a violation of the outflow of urine through the ureters to the bladder and partial reflux of it back into the renal pelvis. If the disease is not diagnosed in the early stages, stagnation of urine leads to the growth of pathogenic microorganisms that are thrown into the kidney and cause its inflammation.

Frequent repeated attacks of acute pyelonephritis in children cause severe damage to the kidneys, which can result in scarring. This is a rare complication, occurring mainly in children under 5 years of age. However, cases of the development of cicatricial changes after pyelonephritis in children at puberty have been described.

The increased tendency to cicatricial changes in the kidneys in children is explained by the following factors:

• Reflux in children occurs at much lower pressure than in adults;
• Reduced resistance of the body's immune system against bacterial infections during the first year of life;
• Complexity early diagnosis pyelonephritis in infancy.

In 20 - 50% of children under 6 years of age with pyelonephritis, vesiculourethral reflux is diagnosed. Among adults, this figure is 4%.

In 12% of patients on hemodialysis, irreversible kidney damage developed due to pyelonephritis in early childhood.

Other causes of pyelonephritis are rare. In some cases, inflammation does not develop upward from the bladder, but directly when the pathogen enters the kidneys from other organs through the blood vessels.

The likelihood of infection increases if the ureter is blocked by a stone or an enlarged prostate obstructs urine output. The inability to remove urine leads to stagnation and the proliferation of bacteria in it.

Symptoms of pyelonephritis

The most common symptoms of acute pyelonephritis include:

• Fever, chills
• Nausea, vomiting
• General weakness, fatigue
• Dull aching pain in the side on the affected side or in the lower back of a girdling nature
• Minor swelling

Additional nonspecific symptoms pyelonephritis, characterizing the course of the inflammatory disease:

• Fever;
• Cardiopalmus.

In the chronic course of pyelonephritis, manifestations of the disease can occur in more mild form, but persist for a long time. In this case, the blood test is calm, there are leukocytes in the urine, but there may be no bacteriuria. During remission, there are no symptoms, blood and urine tests are normal.

Every third patient with pyelonephritis has associated symptoms infections of the lower urinary system (,):

• Stitching or burning;
• The appearance of blood in the urine;
• Strong, frequent urge to urinate, even with an empty bladder;
• Change in urine color (dark, cloudy). Sometimes - with a characteristic unpleasant “fishy” smell.

Tests for pyelonephritis

• A blood test shows signs of inflammation (increased leukocytes, accelerated ESR).
• Urine tests reveal a significant number of bacteria (more than 10 to 5 degrees CFU), more than 4000 leukocytes in the Nechiporenko sample, hematuria varying degrees, protein up to 1 g per liter, the specific gravity of urine decreases.
• IN biochemical analysis blood there may be an increase in creatinine, urea, potassium. The growth of the latter indicates the formation of renal failure.
• When visualizing the kidneys on ultrasound, the affected organ is enlarged in volume, its parenchyma thickens and becomes denser, and an expansion of the renal pelvis system is observed.

Complications

The risk of complications increases in pregnant women, as well as in patients with diabetes. Complications of acute pyelonephritis can include:

• Kidney abscess (formation of a cavity filled with pus);
• Kidney failure;
• Sepsis (blood poisoning) when pathogenic bacteria enter the bloodstream.

Pyelonephritis and sepsis

Unfortunately, pyelonephritis is not always easy to treat, often due to errors during diagnosis. In some cases, the disease becomes severe even before seeing a doctor. The risk groups in this case are people with spinal injuries (paralyzed, who do not feel pain in the lower back), as well as the mute, who cannot independently complain if their condition worsens.

Untimely treatment or its absence leads to the progression of the disease, the growth of bacteria and their penetration into the bloodstream with the development of sepsis. This condition is also called blood poisoning. This is a serious complication, often resulting in the death of the patient.

Patients with pyelonephritis should not die, since this is not a serious disease that can be quickly and effectively treated with antibacterial drugs. But if the disease is complicated by sepsis or, in the terminal stage, septic shock, then the risk of death increases sharply. According to world statistics, every third patient with sepsis dies in the world. Among those who managed to cope with this condition, many remain disabled, since during treatment the affected organ is removed.

Famous people with pyelonephritis complicated by sepsis:

• Marianna Bridie Costa - Brazilian model

Born June 18, 1988. She died on January 24, 2009 from sepsis that developed against the background of pyelonephritis. Treatment included amputations of both arms in an attempt to stop the progression of the disease. Death occurred 4 days after the operation.

• Etta James - singer, four-time Grammy winner

• Jean-Paul II - Pope

Born May 18, 1920. He died on April 2, 2005 from sepsis, the cause of which was pyelonephritis.

Emphysematous pyelonephritis

Emphysematous pyelonephritis is a severe complication of acute pyelonephritis with a high mortality rate (43%). Risk factors for development this complication are diabetes mellitus or blockage of the upper urinary system. The main symptom is the accumulation of gas in the kidney tissues, which leads to their necrosis and the development of renal failure.

Pyelonephritis in pregnant women

The incidence of bacteriuria during pregnancy is 4-7%. Pyelonephritis develops in approximately 30% of pregnant women from this group (1-4% of the total number of pregnant women). Most often, symptoms of pyelonephritis appear in the second trimester. Among the complications of pyelonephritis in pregnant women are:

• Anemia (23% of cases);
• Sepsis (17%);
• Renal failure (2%);
• Premature birth (rare).

An increased incidence of asymptomatic bacteriuria in pregnant women is observed among representatives of a low socioeconomic class, as well as in multiparous women.

Treatment of pyelonephritis

In cases where acute pyelonephritis occurs or chronic pyelonephritis worsens, high temperature, decreased blood pressure ( blood pressure), severe pain a suppurative process or a disturbance in the outflow of urine may develop - treatment may require surgical intervention. Also, in cases where taking tablet forms of antibiotics is accompanied by vomiting, nausea, or increasing intoxication, hospitalization of the patient is indicated. In other cases, the doctor may prescribe treatment at home.

For a disease such as pyelonephritis, symptoms and treatment, both symptomatic and antibacterial, are closely related. Symptomatic treatment includes:

• Bed rest for the first few days (duvet rest), that is, horizontal position and warmth.
• Non-steroidal anti-inflammatory drugs to achieve an analgesic effect and reduce body temperature (metamizole,);
• Drink plenty of fluids.

In case of chronic pyelonephritis, both during remission and during exacerbation, wet cold should be avoided - this is the worst enemy of weak kidneys. It is also advisable to lie down in the middle of the day for at least 30 minutes and avoid infrequent emptying of the bladder.

Antibacterial treatment of pyelonephritis in adults

Typically, the antibiotic is first prescribed empirically for 5-7 days, and then it can be changed based on the results of bacterial culture.

Treatment of pyelonephritis with antibiotics is carried out with drugs from the fluoroquinolone group, ampicillin in combination with beta-lactamase inhibitors, as well as cephalosporins (drugs of choice in children). The convenience of cephalosporins of 3–4 generations (ceftriaxone, cefotaxime) is that therapeutic doses are administered no more than 2 times a day. Due to high resistance (40%), ampicillin is used less and less. The duration of the course is 7–14 days, depending on the severity of the disease and the effect of the treatment.

Due to the retention of high concentration after absorption from the intestine, ciprofoloxacin can be used in tablet form. Intravenous antibiotic administration is indicated only for nausea and vomiting.

If the patient's condition does not improve 48-72 hours after the start of treatment, it is necessary to perform a computed tomography scan of the abdominal cavity to exclude an abscess and. You will also need to conduct a repeated bacteriological analysis of urine to determine the sensitivity of the pathogen to antibiotics.

In some cases, after a course of antibacterial therapy, repeated treatment with an antibiotic of a different group may be necessary. Treatment of chronic pyelonephritis involves prescribing long courses of treatment antibacterial drugs. The main problem in treating diseases caused by bacteria is the development of antibiotic resistance.

In the case where the symptoms characterizing pyelonephritis were quickly identified and treatment was started in a timely manner, for most patients the prognosis remains positive. The patient is considered healthy if the pathogen is not detected in the urine within a year after discharge.

Weekly course of ciprofloxacin - effective therapy pyelonephritis

Studies have shown that a seven-day course of the antibacterial drug ciprofloxacin is as effective as a 14-day course of drugs from the fluoroquinolone group. One study involved two subgroups of 73 and 83 women with acute pyelonephritis treated with ciprofloxacion (7 days) and fluoroquinolone (14 days). The results showed that in both groups the effectiveness of treatment was 96-97%. Moreover, in the group treated with fluoroquinolone, 5 patients developed symptoms of candidiasis, while in the other group no such symptoms were detected.

Antibacterial therapy of pyelonephritis in children

Treatment begins with intravenous administration of antibacterial drugs. After achieving a positive effect and reducing the temperature, it is possible to switch to tablet forms of cephalosporin drugs:

• Ceftriaxone;
• Cefepin;
• Cefixime.

Treatment of mild forms can initially be carried out with tablet preparations.

Treatment of pyelonephritis of fungal etiology

Antifungal treatment is carried out with Fluconazole or Amphotericin (see). In this case, it is mandatory to control the removal of fungal compounds using radiopaque urography, computed tomography or retrograde pyelography. Pyelonephritis, caused by pathogenic fungi and accompanied by blockage of the urinary tract, is treated surgically with the application of a nephrostomy. This method ensures the normalization of urine outflow and allows the administration of antifungal drugs directly to the site of infection.

Nephrectomy

The issue of nephrectomy (kidney removal) is considered if developed sepsis cannot be treated conservative treatment. This operation is especially indicated for patients with increasing renal failure.

Herbal medicine for pyelonephritis

If available, of course, medicinal herbs will call allergic reaction, That's why herbal teas Can be used if you are not prone to allergies. Many plants, in addition to the antiseptic effect, have a number of positive action, have diuretic, anti-inflammatory properties:

• reduce swelling - bearberry, horsetail, see.
• urinary tract spasms - orthosiphon, oats
• reduce bleeding - ,
• Ciprofloxacin 0.5-0.75 twice daily and Norfloxacin 400 mg twice daily remain relevant only for previously untreated patients.

2nd line antibiotics (alternative) – Amoxicillin with clavulanic acid (625 mg) 3 times a day. If sensitivity is culture-proven, Ceftibuten 400 mg once daily can be used.

In case of severe pyelonephritis requiring hospitalization, therapy in a hospital is carried out with carbopenems (Ertapenem, Miranem) intramuscularly or intravenously. After the patient has been observed for three days normal temperature, therapy can be continued with oral medications. Levofloxacin and Amikacin are becoming alternatives to carbopenems.

Pyelonephritis in pregnant women is no longer treated with amoxicillin, but, regardless of gestational age, the following drugs are prescribed:

• Cefibutene 400 mg once daily or
• Cefixime 400 mg once daily or
• Cefatoxime 3-8 g per day in 3-4 injections intramuscularly or intravenously or
• Ceftriaxone 1-2 g per day once intramuscularly or intravenously.

Pyelonephritis is one of the most common infectious diseases of the kidneys, accompanied by the development of an inflammatory process in the pelvis, calyces or parenchyma of the organ. It can occur independently or as a concomitant complication against the background of other pathologies (nephrolithiasis, glomerulonephritis, etc.).

The causative agents of infection are most often pathogenic or opportunistic gram-negative microorganisms that can enter the kidneys in various ways. Timely consultation with a doctor and adequate therapy reduce the risk of developing possible complications and the transition of the pathology to a chronic form. The incidence rate is about 1% among adults and 0.5% among children. In more than half of the clinical cases, kidney pyelonephritis is detected in young and middle-aged women.

Causes

The main reason for the development of pyelonephritis is the appearance of potential pathogens of infectious diseases in the kidneys. These can be microorganisms that constantly live in the body or come from outside.

There are three ways infection can enter the kidneys:

• Hematogenous. Infectious agents enter the kidneys with the blood when there are foci of acute or chronic inflammation in the body. For example, sinusitis, tonsillitis, furunculosis, osteomyelitis, influenza, tonsillitis, etc.;
• Lymphogenic. Pathogenic microorganisms enter the kidney from the nearest organs affected by infection (intestines, genitals, etc.) through the lymph flow;
• Urinogenic. The pathogen enters the organ from the lower parts of the urinary system - the bladder or ureters. This mechanism of infection occurs when the patient has vesicoureteral reflux (return of urine from the bladder into the ureters).

Among the most frequently detected pathogens of pyelonephritis during bacterial culture of urine, the following microorganisms are present:

• Enterococci;
• Paraintestinal coli;
• Pseudomonas aeruginosa;
• Proteas;
• Streptococci;
• Klebsiella;
• Staphylococci.

In approximately 20% of cases, patients with pyelonephritis have a mixed pathogenic microflora, rather than one specific pathogen. With a long course of the disease, there are cases of fungal infection.

Escherichia coli is the most common causative agent of pyelonephritis

Important: Penetration of a potential pathogen into the kidney does not always lead to pyelonephritis. In addition, the body must have favorable conditions for active growth, vital activity and reproduction of the infectious agent.

For the development of pyelonephritis, reasons are necessary that promote reproduction and active life in the kidneys pathogenic microflora. These include the following conditions:

• disturbance of urodynamics due to nephroptosis, kidney dystopia, the presence of stones in the organs of the urinary system and other factors;
• hypovitaminosis;
• decreased immunity;
• hypothermia;
• pathologies of the endocrine system (for example, diabetes mellitus);
• frequent nervous stress;
• chronic inflammatory diseases;
• weakness, overwork.

An increased risk of developing kidney pyelonephritis is observed in children under 6 years of age, which is explained by the structural features of the urinary tract and an incompletely formed immune system. Quite often, the disease is detected in women during pregnancy against the background of reduced immunity, compression and weakening of the tone of the urinary tract. Also at risk are men over 60 years of age suffering from prostatitis, urethritis or prostate adenoma.

Types of disease

In medical practice, there are several principles for classifying the disease. Based on the localization of the inflammatory process, unilateral and bilateral pyelonephritis is distinguished. Taking into account etiological factors There are primary (in the absence of any kidney pathologies and urodynamic disorders) and secondary forms of the disease. Depending on the presence of obstructions in the urinary tract, kidney disease pyelonephritis can be obstructive or non-obstructive. The most commonly used classification of pyelonephritis is based on the nature of its course. According to this criterion, acute and chronic forms of the disease are distinguished.

Acute pyelonephritis

Acute pyelonephritis can occur in two variants - serous and purulent. In this case, the inflammatory process is localized mainly in the interstitial tissue.

With serous pyelonephritis, the organ increases in size and acquires a dark red color. Multiple infiltrates are formed in the interstitial tissue, alternating with healthy renal tissue. There is swelling of the interstitial tissue, accompanied by compression of the renal tubules. In some cases, inflammation and swelling of the perirenal fatty tissue is also noted. With timely and adequate treatment, the disease reverses. In severe cases, serous pyelonephritis can become purulent.

Purulent pyelonephritis is characterized by the presence in the interstitial tissue of a large number of pustules of various sizes. Small pustules can join together to form a carbuncle - a large abscess. When the ulcers spontaneously open, the pus enters the renal pelvis and is excreted along with the urine. During recovery, connective tissue forms at the site of the ulcers, forming scars. The degree of involvement of certain parts of the organ in the inflammatory process depends on the route of infection. With the urinogenic route, more pronounced changes are observed in the pelvis and calyx, and with the hematogenous route of infection, the cortex is primarily affected.

Chronic pyelonephritis

Chronic pyelonephritis of the kidneys is most often the result of undertreated acute form diseases. The inflammatory process covers separate areas kidneys in the lower or upper pole. The course of chronic pyelonephritis is characterized by alternating periods of remission and exacerbations. With each exacerbation, new areas of renal tissue are involved in the inflammatory process. As the disease progresses, there is a dysfunction of the glomeruli and tubules, which is fraught with the development of renal failure

Against the background of chronic pyelonephritis, the development of nephrogenic arterial hypertension is often noted. In the final stage of the disease, patients present with a shriveled kidney, scarring, and replacement of tubules connective tissue. The prognosis of the disease depends on its duration, the activity of the inflammatory process and the number of exacerbations.

Important: The diagnosis of chronic pyelonephritis is made if clinical and laboratory signs are observed for more than one year.

Prevention methods

Prevention of pyelonephritis is not complicated, but, nevertheless, it allows you to reduce the risk of the disease and its severe consequences. It includes the following steps:

• timely treatment of any infectious diseases;
• drinking at least 1.5 liters of fluid per day for the normal functioning of the urinary system;
• timely (without long delays) emptying the bladder;
• daily observance of personal hygiene rules.

Also, to prevent the occurrence of the disease, it is important to avoid hypothermia, as it often becomes a provoking factor for the spread of infection.

Maintaining physical fitness, avoiding bad habits, a balanced healthy diet that includes everything essential vitamins, macro- and microelements, help strengthen the body as a whole and increase its resistance to various diseases, including with pyelonephritis.

People who are predisposed to developing the disease need to be regularly monitored by a nephrologist and undergo urine tests to assess kidney function and promptly identify any abnormalities.

Advice: Prevention of pyelonephritis should begin from the very beginning. early age, since children under six years of age are at risk.