Acute or chronic pyelonephritis. Pyelonephritis - symptoms of acute and chronic forms, treatment and drugs. How to treat pyelonephritis with folk remedies

Pyelonephritis is inflammatory disease one or both kidneys of infectious origin, occurring with obligatory damage to the pyelocaliceal system.

Mostly pathological process localized in the interstitial tissue of the kidney. Depending on the spread of the infectious process, the interstitial tissue is affected primarily (with hematogenous spread of the infection) and secondarily (with an ascending inflammatory process from the pyelocaliceal system).

In some cases, localization inflammatory process only in the interstitial tissue of the kidney, in which case the inflammatory process is called interstitial nephritis.

Pyelonephritis is the most common kidney disease and ranks second among all diseases, second only to acute respiratory infections. The disease is widespread among the adult population and children, proceeds for a long time, in some cases leads to disability. It is very important to know that pyelonephritis and glomerulonephritis are the most common causes development .

Despite the high prevalence of the disease, its diagnosis remains a rather difficult and not always solved problem. Even in specialized hospitals, the correct diagnosis is made in just over 50% of cases.

Pyelonephritis is much more common in women (up to 5 times more often), but in old age it begins to predominate in the male population, which is associated with the development of prostatic hyperplasia.

It should be noted that in the vast majority of cases, pyelonephritis in women of reproductive age develops during pregnancy. Women get sick more often than men, as a result of features anatomical structure urinary tract(shorter urethra). In addition, the prostate gland produces special substances with antimicrobial action.

In childhood, the disease mainly occurs before the age of 3, girls get sick up to 10 times more often than boys.

Etiology and pathogenesis

The main cause of the disease is an infectious agent: bacteria - Escherichia coli (most often), less often - staphylococcus, streptococcus, enterococcus, Proteus vulgaris, etc. The disease is caused either by a mixed flora (the presence of several pathogens is typical for chronic pyelonephritis), or by one pathogen (typical for acute process).

Of great importance in the transition of acute pyelonephritis to chronic are protoplasts and L-forms of bacteria. They appear as a result of antibiotic therapy, microorganisms lose their cell wall during treatment, which can be restored after the end of the course of drug administration, which leads to further proliferation of bacteria. AT recent times the question of the etiological significance of some viruses in the occurrence of pyelonephritis will be raised.

Except external factors leading to the development of the disease, an important role is given to internal chronic infectious processes: caries, inflammation of the ENT organs, chronic cholecystitis, pustular diseases skin, inflammatory diseases of the organs urogenital area(such as cystitis, urethritis, inflammation of the appendages, prostatitis, etc.).

In addition to the hematogenous and urogenous (ascending) routes of infection, a lymphogenous route of spread is possible. But regardless of the method of spread of the infectious agent, an inflammatory process occurs.

Of great importance in the occurrence of pyelonephritis are predisposing factors that lead to impaired urodynamics: congenital malformations urinary organs(stricture of the ureter, etc.), urolithiasis, benign prostatic hyperplasia, etc. In addition, in children and the elderly, a serious role is played by pathological refluxes, especially vesicoureteral. These predisposing factors create favorable conditions for stagnation of urine, the multiplication of microbes in it and the spread of an infectious agent. The onset of the disease is possible when performing invasive methods for examining the genitourinary system (cystoscopy, catheterization, etc.).

Some somatic pathology creates the preconditions for the occurrence of pyelonephritis, liver disease, tuberculosis, diabetes mellitus, hypovitaminosis conditions.

Classification

At present, the classification of pyelonephritis by A. Ya. Pytel is generally recognized in Russia.

1. Downstream:

1) acute pyelonephritis;

2) chronic pyelonephritis.

2. By localization:

1) unilateral pyelonephritis;

2) bilateral pyelonephritis (can be primary and secondary).

3. Due to the occurrence:

1) primary pyelonephritis, which develops without a previous lesion of the genitourinary system;

2) secondary pyelonephritis (occurs several times more often than primary), the occurrence of which is associated with an organic or functional restructuring of the urinary tract, which disrupts the normal outflow of urine. 4. Depending on the ways of occurrence:

1) hematogenous, or descending, pyelonephritis;

2) urogenic, or ascending, pyelonephritis;

3) lymphogenous pyelonephritis.

Acute pyelonephritis

Clinic

The first manifestations of acute pyelonephritis appear after a few days or weeks (on average after 3 weeks) after the attenuation of the focal or systemic infectious process. Acute pyelonephritis is manifested by both local and general symptoms.

There is a classic triad of symptoms characteristic of acute pyelonephritis:

1) increase in body temperature;

2) pain in the lumbar region (symmetrical with a bilateral process);

3) dysuric phenomena.

However, it should be noted that local symptoms will prevail over the general ones with an ascending path of infection and with secondary pyelonephritis. General symptoms prevail in primary pyelonephritis and the hematogenous pathway of the infectious agent

Acute serous pyelonephritis, like any infectious process, most often begins with common symptoms caused by intoxication: a headache appears, body temperature rises to febrile numbers, chills, sweating occur, malaise, significant pain in the joints and muscles appear.

With the development of acute purulent pyelonephritis, the condition of patients is extremely severe, which is explained by bacteremic shock and urosespsis. The temperature rises to very high numbers - up to 40-41 ° C, accompanied by profuse sweating, chills. The severity of the condition is explained by the hectic nature of the temperature curve, which is characterized by temperature fluctuations during the day up to 2°C. Repeated increases in body temperature are due to the formation of new pustules or a solitary abscess in the kidney.

Against the background of general symptoms, local symptoms gradually appear - a characteristic triad of symptoms that can be detected at the onset of the disease, but wear varying degrees expressiveness.

At the beginning of the disease, pain can be not only in the lumbar region, but also in the upper abdomen and is usually not clearly localized. As the disease develops (usually after 1-2 days), the pains take on a clear localization - in the right or left nights (or in both kidneys), the pain usually radiates to groin corresponding hypochondrium, genitals. A feature of the pain is the increase in its intensity at night, when coughing, moving the leg in the hip joint on the corresponding side. In some cases, pain symptoms may be absent at the onset of the disease, and join at the end of the first week of the disease, and sometimes by the end of the second week from the onset of acute pyelonephritis.

Clinical examination reveals positive symptom Pasternatsky, protective tension of the muscles of the anterior abdominal wall on the affected side.

When localized purulent process on the anterior surface of the kidney, the peritoneum may be involved in the pathological process, followed by the development of peritonitis. In some cases, inflammation of the peritoneum is so pronounced that it can simulate a picture of an acute abdomen (acute cholecystitis, acute appendicitis, acute pancreatitis, etc.). In the presence of characteristic changes in the urine, the diagnosis of acute pyelonephritis is simplified.

Diagnostics

At laboratory examination in patients, pronounced leukocytosis (more than 35,000), a shift of the leukocyte formula to the left, a significant increase in ESR - up to 40-70 mm / h are detected. But laboratory manifestations do not always correspond to the severity of the disease: in debilitated patients and in severe cases of the disease, leukocytosis may be absent, in some cases even leukopenia is detected.

The normal protein content in the urine is 0.033 g/l (usually does not exceed more than 1 g/l, reaching in rare cases 2-3 g/l). The appearance of leukocytes in the urine (pyuria) is the most characteristic manifestation of acute pyelonephritis, reaching the entire field of view in severe cases of the disease. Leukocyturia may be absent with complete blockage of the lumen of the ureter by a stone from the side of the affected kidney, as well as with the localization of the pathological process exclusively in the cortical substance of the kidney.

In addition to the above laboratory methods examinations, ultrasound, X-ray methods of examination and angiography are of great importance. Rarely used radioisotope diagnostic methods, CT scan, endoscopic methods examinations.

Ultrasound and X-ray examination methods allow you to establish the number, shape and size of the kidneys, as well as the presence of stones in them.

Excretory urography provides the most valuable information about the structure and function of the kidney. For patients with satisfactory kidney function, it is enough to inject 20 ml of a 60-75% solution of a radiopaque substance (Hayiek, urographin, etc.). Normal contrasting of the pelvis and ureters is determined after 5 minutes.

The first shot is usually taken after 7-10 minutes. The next pictures are taken after 20-30 minutes. Slow progress of the contrast indicates a decrease in kidney function. Lack of contrast indicates a complete cessation of the functioning of the kidney.

Differential Diagnosis

It is necessary to carry out differential diagnosis with those diseases that have similar symptoms and clinical manifestations. In the presence of a severe headache and the appearance of meningeal symptoms, an acute infectious disease can be suspected - meningococcal infection, paratyphoid, typhus or typhoid fever, etc.

With a latent course of acute pyelonephritis, the differential diagnosis should mainly be carried out with another renal pathology- glomerulonephritis.

Flow

The course of acute pyelonephritis depends on many reasons: the age of the sick person, the presence of concomitant pathology and somatic diseases, the condition immune system organism.

Complications

During the course of acute pyelonephritis, the following complications may develop: inflammation of the perirenal tissue (paranephritis), formation of a subdiaphragmatic abscess, hepatorenal syndrome, acute renal failure, bacteremic shock. Much less likely to develop complications such as hypertension and peritonitis.

Forecast

With a timely diagnosis of acute pyelonephritis and adequate treatment, the disease ends in complete recovery in more than 60% of cases. In less than 40% of cases, the disease becomes chronic, resulting in further development of chronic renal failure.

The transition of an acute process into a chronic one may be due to a late diagnosis, inadequate treatment, short courses of treatment, the presence of severe comorbidities, immunodeficiency conditions, increased resistance of the microorganisms that caused inflammation to antibiotic therapy. Except listed factors, a great deal of importance is given to congenital defects development of the genitourinary system.

Treatment

Patients diagnosed with acute pyelonephritis require mandatory hospitalization. Depending on the cause of acute pyelonephritis, a hospital for hospitalization will be determined: with primary pyelonephritis, patients should be hospitalized in the nephrological departments, and with secondary pyelonephritis - in the urological ones. Depending on the severity of the disease, bed rest for a certain period.

The treatment of acute pyelonephritis is complex and includes a specific regimen, a strict diet, mandatory antibiotic therapy, detoxification and restorative therapy. Great importance in the treatment of acute pyelonephritis is attached to the restoration of normal urodynamics.

A diet with a daily calorie content of 2500 kcal, a high content of vitamins, a balanced content of proteins, fats and carbohydrates. Preference should be given to vegetables and fruits, milk and dairy products. Since in acute pyelonephritis there is no fluid retention in the body, it is prescribed plentiful drink, especially at high body temperature, for the purpose of detoxification. The fluid in the body should be introduced in the form of freshly squeezed juices, mineral waters(with a mineralization not higher than 7-10 g / l), rosehip broth, compotes and jelly, cranberry juice.

At serious condition the patient is carried out parenteral administration liquids in the form of glucose solution, sodium chloride solution, rheopolyglucin, polyglucin, neocompensan. Hemodez is not currently used, since its adverse effect on the kidneys has been identified.

The daily volume of fluid received both orally and parenterally can reach 3 liters. Salt intake during the day should not exceed 7-10 g. From the diet, it is necessary to exclude spicy dishes, concentrated fish and meat broths, any alcoholic drinks, coffee, all canned foods and spices, i.e. all foods that irritate the genitourinary system.

Adequate therapy with antibacterial drugs plays a leading role in the treatment of acute pyelonephritis. It is very important to choose the right antibacterial drug, taking into account the sensitivity of the flora to it, which caused the inflammatory process, the dose of the prescribed antibiotic, and the duration of the course of treatment.

If it is impossible to sow the pathogen or determine its sensitivity to an antibacterial drug, it is prescribed antibacterial drugs wide spectrum of activity. The dose of the prescribed antibacterial drug is largely determined by the severity of the course. clinical picture diseases, as well as a combination of antibacterial drugs with drugs of the nitrofuran series, sulfonamides.

It is very important to know about the presence of an adverse effect of an antibacterial drug on the kidneys (nephrotoxicity). After 10 days from the start of antibiotic therapy, it is necessary to re-sow the urine on the flora and determine its sensitivity to antibiotics. This is necessary so that the resistance of the flora to the antibacterial drug used for treatment does not develop.

In some cases, when it is impossible to continue or start treatment with antibacterial drugs, sulfonamides (bactrim, biseptol, urosulfan, etc.) are prescribed. With the joint appointment of sulfonamides and antibiotics, the effectiveness of treatment is significantly increased. A contraindication to the appointment of sulfonamides is renal failure.

On the initial stages acute pyelonephritis is very effective treatment with a combination of an antibacterial drug and a derivative of the nitrofuran series (furagin, furazolidone, etc.), which allows both gram-positive and gram-negative microorganisms to act.

The duration of antibiotic therapy for acute pyelonephritis should be at least 14 days, and in certain cases it can last more than long time- up to 1.5 months. Usually, the abolition of antibacterial drugs falls on the 2-3rd day of normalization of body temperature, improvement of the patient's condition, recovery normal indicators from peripheral blood and urine.

For the treatment of acute pyelonephritis, the following antibacterial drugs are successfully used: penicillin, methicillin, ampiox, ampicillin, oxacillin, etc.

For pyelonephritis caused by Escherichia coli, a combination of chloramphenicol and gentamicin is used.

In the presence of mixed flora, antibacterial drugs with a wide spectrum of action are prescribed (lincomycin, erythromycin, cyprobay, kefzol, tseporin, etc.).

In order not to develop resistance of the microflora to the prescribed antibacterial drugs, the antibiotic is changed to a similar one every 2 weeks. Antibiotics that have a nephrotoxic effect are not recommended (for example, aminoglycosides).

Usually, with long courses of antibiotic therapy, antifungal drugs are prescribed - nystatin and others, which is due to a violation of the ratio normal microflora when treated with antibiotics and a drop in local immune defenses.

Antihistamines are also prescribed (suprastin, tavegil, diphenhydramine, etc.), vitamins of group B, vitamins PP, C.

In combination with antibacterial therapy, nalidixic acid preparations are used (blacks, etc.). With a protracted course of the disease, nitroxoline is used, which has a high antimicrobial activity and a fairly wide spectrum of action.

In addition to traditional drugs, uroantiseptics are used. If it is impossible to restore the normal passage of urine, surgery is indicated - decapsulation of the kidney, pyelostomy, in rare cases - nephrectomy.

Prevention

The main point in the prevention of the disease is the rehabilitation of foci chronic infection in the body (from caries to the treatment of infections of the genitourinary system). Since the disease is most common in pregnant women, especially careful monitoring is necessary. The course of the disease is prone to recurrence, therefore, in order to prevent the recurrence of the disease or its transition to a chronic form, repeated courses of antimicrobial therapy with drugs prescribed by a doctor, according to a strict regimen, are necessary.

During treatment with antibacterial drugs, it is necessary to monitor the state of peripheral blood and regularly give urine for analysis to determine the effectiveness of the treatment.

For the duration of treatment and during the recovery period, it is necessary to adhere to a diet.

Chronic pyelonephritis

Chronic pyelonephritis develops as a result of untreated or undiagnosed acute pyelonephritis. The diagnosis of chronic pyelonephritis is made when the course of the disease is more than 2-3 months.

Clinic

The course of chronic pyelonephritis mainly depends on the localization of the inflammatory process (unilateral or bilateral), the state of urodynamics, the presence of concomitant diseases, the severity of inflammatory treatment and the response to antibiotic therapy.

The most pronounced clinical manifestations of chronic pyelonephritis are expressed during the period of exacerbation. During the period of remission of the disease, the clinic is rather worn out.

Symptoms of exacerbation of chronic pyelonephritis very often resemble such symptoms in acute pyelonephritis: a characteristic triad of symptoms appears (an increase in body temperature to febrile numbers, dysuria and pain in the lumbar region appear), as well as general symptoms.

General manifestations are mainly reduced to deterioration, headache, loss of appetite, nausea, vomiting and some other dyspeptic symptoms. Patients may complain of swelling of the eyelids, especially in the morning, pastosity of the face, and pallor of the skin.

During clinical examination, a positive symptom of Pasternatsky is determined.

It is much more difficult to identify the symptoms of chronic pyelonephritis in the stage of remission of the disease, since the clinical symptoms are poorly expressed. Pain in the lumbar region is intermittent, non-intense, the body temperature is normal during the day, in the evening it rises to subfebrile values ​​(37.1 ° C), dysuric phenomena are not expressed.

Urinalysis reveals transient proteinuria, which usually does not exceed 1 g/l, and leukocyturia, which rarely exceeds 10 leukocytes per field of view. Bacteriuria and active leukocytes are rare. In the analysis of peripheral blood, slight leukocytosis, anemia, and slightly increased ESR may be detected.

As a result of a long course of chronic pyelonephritis in patients, working capacity decreases, increased fatigue appears, patients begin to cope with their usual work with difficulty, note constant drowsiness, loss of appetite. As a result of this, weight loss is observed, recurrent quite severe headaches appear.

As the disease progresses skin acquire a grayish-yellow color, become dry, peeling appears. The face becomes puffy and swollen not only in the morning, the tongue is lined brownish coating, dry, lips become dry, cracked, jams appear in the corners of the mouth.

In more than half of the cases of chronic pyelonephritis, arterial hypertension develops, which is symptomatic and can be manifested by significant increases in blood pressure. In some patients, arterial hypertension develops from the first years of the existence of chronic pyelonephritis. The presence of arterial hypertension aggravates the course of the disease, and in some cases comes to the fore, as a result of which an incorrect diagnosis is made.

As arterial hypertension exists, changes appear in the cardiovascular system: hypertrophy and overload of the left heart, especially the left ventricle, may appear signs of angina pectoris. In the future, it is possible to develop circulatory failure due to left ventricular failure, transient cerebrovascular accidents appear. Since arterial hypertension develops against the background of chronic pyelonephritis, the usual symptomatic therapy aimed at lowering blood pressure will not give the desired results.

On the late stages chronic pyelonephritis, polyuria appears (from 2.5 to 7 liters or more per day), as a result of which hyponatremia, hypokalemia may develop, and dry mouth appears. Edema is almost never observed.

Hemorrhagic syndrome may also appear due to changes in the composition of the blood, damage nervous system in the form of polyneuritis, there may be pain in the bones.

For the timely diagnosis of "chronic pyelonephritis" it is necessary to carefully examine the patient and collect an anamnesis.

Diagnostics

From the anamnesis, it is possible to reveal information about past diseases of the genitourinary system in the past (such as renal colic, urethritis, cystitis, etc.), which could become determining factors in the development of chronic pyelonephritis.

In the latent course of chronic pyelonephritis, an important place in the diagnosis of the disease is given to laboratory and instrumental methods of examination.

Most characteristic changes, indicating in favor of chronic pyelonephritis, are changes in the urine: proteinuria - from 0.033 g / l to values ​​\u200b\u200bnot exceeding 1 g / l, the number of leukocytes is 5-15 in the field of view, rarely rising to 50-100, sometimes in the urine you can find single granular or hyaline cylinders. In some cases, with a latent course of chronic pyelonephritis, even with repeated analyzes leukocyturia and proteinuria may not be detected.

This fact makes it necessary to analyze urine in dynamics, resorting to the Nechiporenko test, the Addis-Kakovsky test, determining the number of active leukocytes and the degree of bacteriuria.

The presence of leukocyturia, if more than 10% of all leukocytes are active leukocytes, speaks in favor of pyelonephritis. Active leukocytes (Sternheimer-Malbin cells) can also form at low urinary osmotic pressure (below 200 mosm/L), which is often seen in pyelonephritis.

With an increase in the osmolarity of urine, active leukocytes again turn into ordinary leukocytes.

Of great importance in chronic pyelonephritis, namely its latent course, are provocative tests that allow you to activate the current inflammatory process latently (for example, prednisolone provocative test).

Bacteriuria is most often found during an exacerbation of the disease, amounting to more than 105 microbial bodies in 1 ml of urine.

The presence of physiological (false) bacteriuria does not always lead to the development of pyelonephritis, however, some scientists believe that it is necessary to conduct a course of treatment until complete urine sterility is achieved. This is done to prevent the development of pyelonephritis.

In chronic pyelonephritis, hematuria is possible, which most often manifests itself in the form of microhematuria. Gross hematuria may be due to fornic bleeding or urolithiasis.

If all of the above methods of examination do not allow to make a correct diagnosis of the disease with confidence, a puncture biopsy of the kidney is used, which allows you to clarify the diagnosis of pyelonephritis in 7-8 out of 10 cases. This is due to the fact that in pyelonephritis the inflammatory process has a focal location, therefore, if a needle enters healthy kidney tissue, it can give negative results in the presence of pyelonephritis.

Differential Diagnosis

The main diseases with which it is necessary to diagnose chronic pyelonephritis are kidney damage in diabetes mellitus (diabetic glomerulosclerosis), chronic pyelonephritis, hypertension and renal amyloidosis.

The latent form of chronic pyelonephritis can be simulated by the initial stage of renal amyloidosis. But unlike chronic pyelonephritis, with amyloidosis of the kidneys, bacteriuria and leukocyturia are absent, active leukocytes are not detected, and the concentration function of the kidneys remains at a normal level.

Treatment

The main points in the treatment of the disease are the same as in acute pyelonephritis: diet, adequate antibiotic therapy, adherence to the regimen. Hospitalization in a hospital is carried out with an exacerbation of the disease.

It should be noted that it is necessary to limit the amount of fluid consumed in cases of arterial hypertension and in the presence of a disturbed normal outflow of urine. In the presence of arterial hypertension, it is necessary to limit the intake of table salt to 4-5 g per day. If anemia is detected, foods containing a large number of iron (apples, pomegranates, black currants, strawberries, etc.). In more severe cases, iron medications are prescribed, such as ferrum-lek, as well as vitamin B 12, folic acid, sometimes a transfusion of red blood cells or whole blood.

Regardless of the stage of pyelonephritis, a large positive influence vegetables, fruits and berries (melon, watermelon, pumpkin) have a diuretic effect, due to which the urinary tract is cleansed of small stones, microbes, mucus, etc.

Antibacterial drugs are prescribed at the initial stages of the disease in adequate dosages, for a long course. In the treatment of chronic pyelonephritis, the same antibacterial drugs are used as in the treatment of acute pyelonephritis. It should be noted that if there is sclerotic changes in the renal tissue, which develop in the later stages of the disease, it is not possible to achieve the required concentration of the antibacterial drug in the kidneys even when using high dosages.

When treating with antibacterial drugs, it is very important to take into account the acidity of urine: certain antibiotics (erythromycin, gentamicin) have the maximum therapeutic effect in an alkaline urine reaction - at pH = 7.5-8.0. To achieve this pH of urine, patients are prescribed a milk-vegetarian diet, it is recommended to use alkaline mineral waters, you need to take weak solutions. baking soda. Other antibiotics (tetracyclines, cephalosporins, etc.) are active in acidic and alkaline urine reactions - over a wide range (pH = 2.0-9.0). The antibiotics that are most active in the acidic environment of urine (pH = 5.0-5.5) include ampicillin and nitroxoline.

In severe cases of the disease, it is recommended to combine the intake of antibacterial drugs with each other and with nalidixic acid preparations, nitrofuran derivatives, and sulfonamides. Highly wide application in the treatment of infectious diseases of the kidneys received gentamicin, which has a broad antimicrobial effect and more than 90% of which is excreted by the kidneys unchanged.

Indicators for the abolition of antibiotic therapy is the normalization of body temperature for 3 days, the normalization of peripheral blood and urine. However, given the fact that the disease is prone to relapse, it is necessary to carry out many months of anti-relapse therapy prescribed by the doctor.

Apart from drug therapy, good effect observed when using decoctions, infusions and tinctures medicinal herbs and plants that have an antiseptic and diuretic effect (cranberry, rosehip, lingonberry leaf, horsetail grass, St. John's wort herb, birch leaves, etc.).

To prevent the development of side effects allergic reactions in the treatment of antibacterial drugs, antihistamines are prescribed (suprastin, tavegil, diphenhydramine, pipolfen, etc.).

For the treatment of arterial hypertension, antihypertensive drugs are prescribed (dopegit, adelfan, andipal, clonidine, etc.), which are often combined with diuretic drugs (furosemide, triampur, etc.). To normalize cardiac activity, in some cases, cardiac glycosides (digoxin, corglicon, strophanthin, etc.) are prescribed.

In some cases, in order to improve the efficiency of the conservative therapy have to resort to surgical interventions(for example, to restore the normal outflow of urine, stones are removed, benign prostatic hyperplasia is operated on).

Sanatorium-and-spa treatment in the treatment of chronic pyelonephritis occupies a very important place. Sanatorium treatment is especially indicated for patients with secondary pyelonephritis after surgical removal stones to prevent their recurrence. Studies have shown that the course of treatment in the sanatoriums of Zheleznovodsk, Truskavets and other resorts allows achieving stable remission (stones in the urinary system do not form for a whole year even without special drug therapy).

Sanatorium treatment is not indicated for all patients: it is contraindicated for patients in the acute stage of the disease or during exacerbation chronic process, in the presence of arterial hypertension of III degree and above, the presence of phenomena of renal failure, pronounced anemia.

Prevention

Most important preventive measure consists in the timely detection and adequate treatment of acute pyelonephritis in order to prevent the transition of the process into a chronic one. In addition, it is necessary to sanitize all foci of chronic infection, treat intercurrent diseases, properly employ such patients, and eliminate diseases that contribute to the development of pyelonephritis.

Proper employment is to limit the work associated with large physical activity, with hypothermia and overheating, psycho-emotional overload, as well as work in the initial shift.

After stopping the exacerbation of the chronic process, it is necessary to follow the above diet and conduct anti-relapse therapy.

Clinical examination of patients with acute and chronic pyelonephritis

After recovery, persons who have had acute pyelonephritis should be registered with a dispensary, from which they are removed no earlier than 1 year later, under the condition normal tests urine and no bacteriuria. While on dispensary observation for acute pyelonephritis, patients pass urine in the first 2 months with a frequency of 1 time in 2 weeks, then - 1 time in 1 month during the year.

While maintaining changes in urine, patients are observed for 3 years. If there is no effect from the treatment, patients are transferred to the group with chronic pyelonephritis. If an exacerbation of the disease is detected, hospitalization is mandatory. With an inactive course of chronic pyelonephritis, urinalysis is performed at intervals of 1 time in 6 months.

If symptoms of chronic renal failure are detected, the time interval between periods of dispensary examination is reduced. It is very important to monitor the state of blood pressure (it is highly desirable to measure blood pressure twice a day - in the morning, while lying in bed, and in the evening, before going to bed), glomerular filtration rate, indicators of the relative density of urine (Zimnitsky test). It is important to assess the condition of the fundus during examinations by an ophthalmologist, as well as to assess the dynamics of the increase in nitrogenous wastes (creatinine, urea, etc.) in the blood serum. Depending on the progression of chronic renal failure and its stage, studies are carried out once every 1-3 months.

• The difference between chronic pyelonephritis and acute
• Therapeutic measures
• The nuances of the treatment of kidney folk remedies

Treatment of pyelonephritis with folk remedies is the most affordable and gentle method of treatment.

Folk methods, tested on more than one generation, do not have so many side effects how many pharmaceuticals. From many recipes traditional medicine It is always possible to choose the one that fits optimally.

But we must remember: traditional medicine is used only when diagnosed with chronic pyelonephritis. Cases of acute pyelonephritis stop only medications, and quite often in a hospital setting.

Acute pyelonephritis occurs when pathogenic flora invades the renal parenchyma. It is characterized by an increase in temperature painful sensations in the lumbar region, an increase or decrease in the amount of urine excreted, a change in its color to dark. The disease is easy to diagnose by the results of urine tests - they show leukocytosis.

Chronic pyelonephritis does not have such a characteristic clinical picture. Its symptoms:

• a slight increase in temperature within 37.0 - 37.6ºС;
• aching pain in the lumbar region;
• a slight excess of leukocytes in the analysis of urine;
• an increase or decrease in the number of urination and volume of fluid released.

Exacerbation of the disease occurs:

• with hypothermia;
• when the state of the body changes, for example, pregnancy;
• in violation of the diet.

Chronic pyelonephritis often presents as comorbidity against the background of other infectious and systemic diseases.

The condition requires mandatory treatment. The sluggish form of pyelonephritis can provoke the occurrence kidney failure.

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Therapeutic measures

How to treat pyelonephritis in the acute stage? The necessary therapy is selected only by the attending physician. Self-medication is dangerous to health.

General measures used to relieve the acute process are as follows:

1. Anti-inflammatory drugs are prescribed - antibacterial drugs.
2. Pain relievers, analgesics and antispasmodics are connected.
3. In some cases, for example, when the ureters are blocked by pus or stones, surgical intervention is used.

Medicines at the first stage are most often injected.

Removal of acute symptoms, which occurs within 2-4 days, does not mean that the disease has receded. Pathogenic flora cannot leave the body so quickly. If we neglect therapeutic measures at this stage, then in the future it will be necessary to treat chronic pyelonephritis.

Pharmaceuticals it is undesirable to take for a long time. They have many adverse effects on the body. For example, they inhibit the beneficial intestinal flora, cause dysbacteriosis. Therefore, it is rational at this stage to begin the therapeutic effect of folk remedies for pyelonephritis.

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Remedies from the arsenal of traditional medicine for kidney diseases

One of the most popular means bearberry is used to flush out pathogenic flora from the body. This herb is more commonly referred to as bear ears.

Brew the infusion in the following way.

1. 30 g of herbal raw materials are poured into 1 liter of boiling water.
2. Insist in a thermos or in a glass container insulated with a towel for about half an hour.
3. Filter.

Drink 3 times daily, 150 - 200 ml at a time.

No less often used decoction of corn stigmas. It is brewed in the same proportion as bearberry infusion. Just before insisting, the “brewing” must be boiled.

For the treatment of kidneys, it is good to use honey therapy.

Algorithm for the manufacture of "medicine":

1. In the evening, a handful of berries - viburnum, wild rose, sea buckthorn, pour 500 ml of water and insist in a half-liter thermos.
2. In the morning, add a tablespoon of natural honey to the tincture.
3. Drink 3 times a day, like tea, after meals.

Such a remedy not only flushes pathogens from the urinary system, but also fortifies the body, increases overall immunity.

Pyelonephritis is a nonspecific infectious inflammatory disease of the kidneys that affects the renal parenchyma (mainly interstitial tissue), pelvis and calyces. The outcome of pyelonephritis is usually nephrosclerosis.

Prevalence

The incidence of acute pyelonephritis is 15.7 cases per 100,000 population per year, the prevalence of chronic pyelonephritis is 18 per 1,000 population. The incidence of pyelonephritis has 3 age-related peaks associated with sex.

Early childhood(up to 3 years). A significant predominance of the disease among girls (8:1) is noted.

Active reproductive age (18-35 years), the predominance of women over men remains (average 7:1).

Elderly and old age; from the age of 60, the ratio of sick men and women levels off, and after 70 years, men are more likely to suffer from pyelonephritis, which is associated with the development of hypertrophic and tumor processes of the prostate gland, leading to impaired urodynamics.

The predominance of the incidence of girls and women in the first two age periods is due to both the anatomical and physiological characteristics of the urethra (short, proximity of the genital tract and rectum), and the characteristics of the hormonal status, which changes during pregnancy and leads to dilation, hypotension and dyskinesia of the urinary tract. The development of such changes is also facilitated by the use of oral contraceptives.

CLASSIFICATIONS

By localization, one- and two-sided pyelonephritis is distinguished.

Pathogenesis

Ways of infection

Allocate urogenic and hematogenous ways of infection. In acute pyelonephritis, as well as in men, the hematogenous route of infection predominates, in chronic pyelonephritis, and also in women, the urogenic route of infection.

Factors contributing to the development of pyelonephritis

Obstruction of the urinary tract(including during catheterization).

Neurogenic bladder dysfunction(at diabetes, injuries and diseases of the spinal cord, multiple sclerosis). Urinary retention in neurogenic dysfunction requires re-catheterization of the bladder, which is accompanied by an additional risk of infection.

sexual activity. In young women, the penetration of bacteria into the bladder is facilitated by massaging the urethra and contraction of the muscles of the urogenital diaphragm during intercourse.

Pregnancy. Pyelonephritis is found in 3-8% of pregnant women (in 70% - unilateral, more often on the right, in 30% - bilateral). During the first pregnancy, pyelonephritis usually begins at the 4th month of pregnancy, during the second - at the 6-7th month. Pregnant pyelonephritis develops due to a decrease in the tone and peristalsis of the ureters and functional insufficiency of the vesicoureteral valves. There is a change in the hemodynamics of the kidney: cortical renal blood flow decreases, phlebostasis develops in the medullary zone. The compression of the ureters by the enlarged uterus also plays a role, especially with an anatomically narrow pelvis, polyhydramnios, and a large fetus.

By the nature of the flow: acute and chronic pyelonephritis. chronic pyelonephritis in last years considered as chronic tubulo-interstitial nephritis of bacterial origin (see Chapter 35 "Tubulo-interstitial nephritis").

By form: obstructive and non-obstructive pyelonephritis.

ETIOLOGY

Infectious causative agents: gram-negative bacteria of the intestinal group Escherichia coli (75%), Proteus mirabilis (10-15%), types Enterococcus, Enterobacter. Less commonly found species Klebsiella, Staphylococcus, as well as Candida albicans. Discuss the role Ureaplasma urealyticum, Mycoplasma hominis.

If pyelonephritis is a variant of nosocomial infection, the most common pathogens are Escherichia coli, kinds Klebsiella, Proteus, Staphylococcus aureus, Candida. Staphylococcus aureus usually found in purulent lesions of the kidneys due to hematogenous spread of infection.

In 22% of patients, associations of bacteria with the participation of coli. In 15% of patients with conventional urine cultures, it is not possible to isolate the pathogen, which does not always indicate a remission of the disease, but is associated with the transformation of bacteria into peculiar forms devoid of a cell wall (L-form). Unstable L-forms at favorable conditions can undergo reverse transformation and support the inflammatory process.

Vesicoureteral reflux. It is usually noted in children with anatomical defects in the urinary tract or in recurrent urinary tract infections. In the latter case, it disappears as the child grows up.

Pathogenesis of arterial hypertension in chronic pyelonephritis

Infiltration of the interstitial tissue of the kidneys leads to a violation of intrarenal hemodynamics, an increase in renin secretion. The resolution of the inflammatory process contributes to the regression of arterial hypertension. At the same time, sclerotic processes in the kidneys, especially in the area of ​​the vascular pedicle (pedunculitis), create the prerequisites for fixing arterial hypertension.

- an infectious inflammatory disease in which the renal pelvis, calyces and parenchyma of the kidney are involved in the pathological process. First of all, the interstitial tissue of the kidney is affected.

Pyelonephritis- the most frequent urological disease may be acute or chronic. There are primary pyelonephritis (occurring in a healthy kidney) and secondary (which is a complication of another disease of the kidney and urinary tract).

Prevalence

Pyelonephritis is the most common disease of the kidneys and urinary tract, ranking second after acute respiratory infection. Sometimes patients are unaware of the existence of the disease. Most often, pyelonephritis is diagnosed in women, on average 5 to 10 times more often than in men. The peak of the disease in a woman falls on childhood, the time of onset of sexual activity and pregnancy. In men, pyelonephritis is more often detected in old age with violations of urodynamics (in particular, with prostate adenoma).

Etiology

Pyelonephritis can be caused by any microorganism. The most common pathogens are Escherichia coli, staphylococci, streptococci, enterococci. The causative agent enters the kidney by the hematogenous route (through the blood) from the focus of infection (tonsillitis, furunculosis, pneumonia, infected wounds etc.), or along the ureter from the lower urinary tract in violation of the outflow of urine from the kidney.

Laboratory and instrumental diagnostics

Mandatory for the examination of patients is:

1. Bacteriological examination of urine

Urine culture - urine is sown on a nutrient medium, and after some time, under a microscope, the growth of a certain type of bacteria that caused inflammation is detected