Acute pyelonephritis clinic diagnostics treatment. Pyelonephritis: what is it, what is dangerous, symptoms and treatment of pyelonephritis
- This is an inflammatory process that affects the intermediate tissue and the pyelocaliceal system of the kidneys, which has a non-specific nature.
In urological practice, acute pyelonephritis is the most common inflammatory process affecting the kidneys. It may occur in childhood, a favorable condition for which is the immaturity of the urinary system and a high load on it. Adults also do not fall under the exception; women under the age of 40 are more likely to suffer from the disease.
Doctors separate primary and secondary acute pyelonephritis. The primary occurs due to a violation of the outflow of urine from the kidneys themselves, and the secondary is caused by a violation of its passage due to obstruction of the urinary tract.
Pyelonephritis in the acute phase differs from chronic pyelonephritis:
The course of the inflammatory process in acute pyelonephritis is fast, and in chronic it is slow.
Symptoms acute illness pronounced, and chronic signs often lubricated, or absent altogether.
Acute pyelonephritis ends with the recovery of the patient, or the transition to the chronic stage.
Chronic pyelonephritis is characterized by frequent relapses of diseases.
Chronic pyelonephritis is more difficult to treat.
Acute pyelonephritis can affect both one and two kidneys. On average, 1% of the world's population develops pyelonephritis every year. Moreover, it is acute pyelonephritis that accounts for 14% of kidney diseases, and purulent complication occurs in 1/3 of patients.
Symptoms of acute pyelonephritis
Symptoms of acute pyelonephritis depend on the form of the disease and the stage at which it is located.
The initial stage of serous inflammation. The kidney increases in size, tenses up, and the fiber located near the film swells. If the disease is started to be treated at this stage, then acute pyelonephritis will be successfully eliminated.
The stage of acute purulent pyelonephritis is divided in turn into three phases: apostematous pyelonephritis, carbuncle and organ abscess. At the beginning, small pustules form in the cortical layer of the kidney, which, if left untreated, merge and form a carbuncle. In the foci of confluence of carbuncles, the parenchyma of the organ melts and an abscess of kidney tissues develops.
The disease develops very quickly, almost lightning fast. Sometimes it takes a few hours for the patient's condition to become severe, sometimes it worsens in a day.
A person experiences malaise and weakness, the body temperature rises sharply, reaching a mark of 40 ° C.
Sweating increases, headache appears, heartbeat quickens.
The disease is accompanied by a feeling of nausea and vomiting, arthralgia, diarrhea or constipation.
A person experiences pain in the lumbar region, it radiates to the thigh, back, and abdomen. The nature of the pain is either dull or intense.
As a rule, there are no signs of urination disorders.
There is a not too pronounced decrease in daily diuresis, since the patient loses large volumes of water with sweat.
Urine becomes cloudy, it comes from bad smell.
The onset of the disease proceeds according to the type of renal colic, which is associated with urinary tract obstruction.
At the peak of pain, a person's body temperature rises, up to the development of a fever.
When profuse sweating stops, body temperature sometimes drops to critically low levels, sometimes to normal values. The state of health is somewhat normalized.
An attack of colic returns after a few hours if the obstruction of the urinary tract is not eliminated.
There are persistent pains in the lumbar region.
A person suffers from a hectic type of fever (body temperature fluctuations are 3-4 degrees and occur 2-3 times a day).
An increase in temperature is accompanied by chills.
Muscular walls the peritoneum tightens, the same applies to the lumbar muscles.
When the intoxication of the body reaches a peak, clouding of consciousness and the development of delirium are possible.
Symptoms of non-obstructive pyelonephritis in the acute phase are as follows:
Symptoms of secondary pyelonephritis in the acute phase:
Symptoms of purulent pyelonephritis in the acute stage:
The causes of acute pyelonephritis are the penetration of pathogenic microorganisms into the kidney. In 50% of cases, E. coli becomes this agent, in other cases the disease is provoked by Proteus, Pseudomonas aeruginosa, streptococci, staphylococci, viruses and fungi. Modern urological practice indicates a rare detection of only one causative agent of pyelonephritis. Most often, the disease is caused by the association of several microorganisms. Of particular danger are hospital strains of pathogenic agents in terms of the development of inflammation, since they are very difficult to eliminate.
There are two ways in which pathogens can enter the kidney:
Hematogenous route, in which infection occurs through the bloodstream. This is the most rare cause of inflammation of the kidneys, the hematogenous pathway leads to the disease in only 5% of cases. primary foci infections can appear: urinary organs, if they have inflammation (cystitis, adnexitis, prostatitis, etc.), distant organs with sinusitis, bronchitis, caries, tonsillitis, cholecystitis, furunculosis, etc.
The urinogenic route of infection is the most common route of infection to the kidneys. Microorganisms enter them from the lower urinary tract. Another such method of infection is called ascending.
It is worth considering that normally, only the distal urethra can be infected.
In order for the infection to spread further, additional provoking causes or factors are needed, including:
Predominance in the periurethral region and in the area of the perineum of Escherichia coli. This can occur due to intestinal dysbacteriosis, with vaginal dysbiosis in a woman.
Hormonal imbalance.
An increase in the acidic environment of the vagina in women during menopause associated with a lack of estrogen.
Active sex life women and frequent change of sexual partners facilitates the penetration of infection into the bladder.
Ureteral strictures.
Urolithiasis and blockage of the lumen of the ureter, urethral valve by a stone.
Prostate adenoma and prostate cancer.
Neurogenic bladder.
Hypothermia.
Pregnancy.
Diabetes.
Hypovitaminosis and overwork.
The likelihood of acute pyelonephritis increases significantly with a combination of several causes, which happens most often.
Complications and consequences of acute pyelonephritis
title="(!LANG:>Complications and consequences of acute pyelonephritis" style="margin-right:25px;">!}Complications and consequences of acute pyelonephritis can be very serious and pose a threat to the life and health of the patient.
The danger may be:
-
bacterial shock.
Paranephritis.
Apostematous pyelonephritis.
Kidney carbuncle.
Kidney abscess.
Pyonephrosis of renal tissues with their purulent fusion.
Acute kidney failure.
Diagnosis of acute pyelonephritis
Diagnosis of acute pyelonephritis most often does not cause difficulties for a nephrologist. This is primarily due to the presence of clear symptoms of the disease.
Often these patients have a history of chronic diseases or acute purulent inflammation. The clinical picture in acute pyelonephritis is always accompanied by an increase in body temperature to high values and parallel pain in the lumbar region, mostly one-sided. Patients complain of difficulty urinating and changes in the smell and color of urine. It acquires a reddish tint, turbidity is visible in it.
Laboratory tests detect the presence of protein and bacteria in the urine. To determine the type of causative agent of the infection, a bacterial urine culture will be required.
It is also necessary to donate blood for a general analysis. An increase in ESR and leukocytosis will indicate acute pyelonephritis. Identification of the causative agent of infection is possible with the performance of specialized tests.
Survey urography indicates that one kidney is increasing in volume compared to the other.
Excretory urography indicates a pronounced limitation of the mobility of the affected organ, which is noticeable during the orthoprobe. If the patient has apostematous pyelonephritis, then on the part of inflammation, the excretory function noticeably decreases, which can be seen during a diagnostic study. A carbuncle or abscess will be indicated by swelling of the contour of the kidney, deformation of the pelvis and calyces as a result of compression.
To assess the structural changes in the kidneys that caused pyelonephritis, it is advisable to perform an ultrasound scan. To assess the concentration capabilities of organs, the Zimnitsky test is used, which will require urine collection.
CT is a method that allows you to exclude or confirm the presence of urolithiasis, as well as to identify possible anatomical abnormalities in the structure of organs.
Treatment of acute pyelonephritis
Non-drug treatment is essential for the patient's recovery. It comes down to maintaining sufficient daily diuresis. To do this, the patient must drink liquid in a volume of 2 to 2.5 liters.
To replenish water reserves, you can use fortified decoctions in the form of fruit drinks, which have antiseptic effects. These are cranberries, lingonberries and rose hips. In addition, the use of diuretics is shown.
However, only a doctor can recommend drinking plenty of water, since it is contraindicated in heart and lung failure, at arterial hypertension. If the patient suffers from disorders carbohydrate metabolism, then the liquid consumed should not contain sugar.
Drug treatment of acute pyelonephritis
If the patient does not have signs indicating urinary tract obstruction, then he is urgently prescribed antibiotic therapy. Its duration can be from 5 days to two weeks. It is preferable to start treatment with parenteral antibiotics. When the symptoms of the acute phase of the disease are stopped, antibacterial drugs take inside.
Modern antibacterial agents include:
Fluoroquinolones, which have bactericidal properties. These drugs include: Levofloxacin, Sparfloxacin, Moxifloxacin, Ciprofloxacin, Ciprinol, Ofloxacin, Pefloxacin, Lomefloxacin. These drugs are not used to treat pregnant women, while breastfeeding, it is not recommended to prescribe them to children and adolescents during a period of active growth.
Drugs from the group of beta-lactams are common aminopenicillins, such as: Amoxicillin and Ampicillin. The therapeutic effect is observed in relation to Escherichia coli, Proteus, enterococci. However, bacteria often develop resistance to drugs of this group and therefore they are recommended to be prescribed for the treatment of pyelonephritis in pregnant women. For all other patients, protected penicillins are used: Amoxiclav, Flemoklav Solutab and Sultamicillin. If pyelonephritis occurs in a complicated form, then carboxypenicillins are used: Ticarcillin, Carbenicillin, and ureidopenicillins: Piperacillin, Azlocillin.
Cephalosporins, which are more often than other drugs used by specialists to get rid of pyelonephritis. These can be: Cefazolin, Cefuroxime, Cefalexin, Cephradin, Cefixime, Ceftibuten, Ceftriaxone, Cefotaxime, Cefoperazone, Cefepime.
For the treatment of severe nosocomial forms of pyelonephritis, as well as for serious complications of the disease, aminoglycosides are prescribed: Netilmicin, Gentamicin, Tobramycin, Amikacin.
In addition to antibiotics, doctors also use other antimicrobials, which continue to be taken even after the abolition of antibacterial drugs. These are nitrofurans: Furazidin, Nitrofurantoin, combined antimicrobial agents: Co-trixomazole, 8-hydroxyquinolines: Nitroxoline. They affect the activity of microbes, effects on the acidity of urine.
Surgical treatment of acute pyelonephritis
When to use antibacterial agents and other drugs is ineffective, and it is also not possible to restore the patency of the upper urinary tract with the help of a catheter, surgery is necessary. It is indicated when the patient's condition worsens. Operate most often purulent forms of the disease: apostemes and carbuncles of the kidney.
The nature of the operation often remains open until the moment of its execution, the issue is resolved when visualizing the extent of the involvement of the kidney in the pathological process. Its main goal is to prevent the further development of the purulent-inflammatory course of the disease in the kidney, to prevent the transition of the disease to a healthy organ, and to restore the normal outflow of urine.
Physiotherapy for the treatment of acute pyelonephritis
As physiotherapy, methods such as: CMW-therapy, UHF and electrophoresis are used.
It is important to pay attention to the nutritional features of the patient with a predominance of easily digestible protein foods.
Diet for acute pyelonephritis implies compliance with strict rules. Thanks to her, it is possible to stop pain syndrome, adjust the acidity of urine. Drinking should be plentiful and at the time of the peak of the disease be at least 2 liters.
When acute symptoms will decline, you should switch to a plant-milk diet. Salt in the diet of the patient is limited. It can be consumed no more than 6 g per day, and in complicated forms of the disease it is completely excluded from the diet.
Be sure to have vegetables and fruits with a diuretic effect on the patient's table: zucchini, melons, watermelons, cucumbers.
At the stage of recovery, meat products and fish are gradually returned to the patient's menu. First courses must be vegetarian. Nutrition should be fractional, and food processing methods should be gentle.
Education: A diploma in the specialty "Andrology" was obtained after completing a residency at the Department of Endoscopic Urology of the RMAPE in the Urological Center of the Central Clinical Hospital No. 1 of Russian Railways (2007). Postgraduate studies were completed here in 2010.
Kidney diseases are increasingly common in medical practice. They can develop for many reasons. This includes the wrong way of life, inflammatory diseases neighboring organs, infection of the genitourinary system, and so on. This article will focus on such a pathology as acute pyelonephritis. The symptoms and treatment of the disease are well known and described. In this article, we will find out the features of the correction of this pathology. It is also worth mentioning what is acute in children.
Common Kidney Diseases
The inflammatory process in the shell of the organ and the pyelocaliceal system is called pyelonephritis. This pathology can take various forms. On the this moment the following manifestations are known to medicine:
- acute and treatment will be described below);
- chronic inflammation (often has no manifestations);
- acute pathology (asymptomatic course of the disease, followed by the addition of symptoms).
All these forms bring a lot of discomfort to a person. That is why it is so important to diagnose in time and prescribe the right treatment. Otherwise, the patient may face serious complications that will lead to hospitalization and surgery.
Acute pyelonephritis
The symptoms and treatment of this disease can be different. When prescribing therapy, it is imperative to take into account the patient's complaints. In some cases, the pathology develops from an already existing disease. In this case, it is necessary to treat not only the inflammatory process, but also its cause.
Pathology develops mainly due to the multiplication of bacteria. These include microorganisms of Escherichia coli, Proteus, Pseudomonas aeruginosa, enterococci, staphylococci, and so on. Less commonly, pathology develops due to viral damage to the organ.
Pathology most often develops due to bacteria entering the kidney from neighboring organs. Less commonly, a patient has a so-called ascending acute pyelonephritis. Symptoms and treatment are somewhat different. In this case, pathogenic microorganisms penetrate through the urethra into the bladder and only then affect the renal system.
Signs of the disease
Depending on what acute pyelonephritis has symptoms, appropriate treatment is prescribed. Remember that the correction should not be carried out independently. Only a qualified specialist will be able to choose the right drugs and their regimen.
Symptoms of pathology can be different. Most often, a high temperature rises and there is pain in the peritoneum. However, these symptoms may be conditional and do not always indicate an acute inflammatory process in the kidney. Consider the main signs of pathology.
Fever, or hyperthermia
Acute pyelonephritis is often manifested by fever. In this case, the person does not feel other signs of a cold.
The patient begins to chill, sweating increases. In some cases, seizures or delusions may occur. If such acute pyelonephritis in children has symptoms, and treatment is not carried out immediately, the consequences can be dire. In children, these conditions can be especially dangerous. Elderly people are also at risk.
pain symptom
Acute pyelonephritis (symptoms) often begins with pain. Subfebrile temperature is maintained. Unpleasant sensations can be pressing, bursting or pulling. However, more often they are sharp with backaches.
Also, the pain can be girdle and affect the lower abdomen. In some cases, acute pyelonephritis has symptoms in women in the form of cutting sensations during urination and immediately after it. This may indicate the accession of cystitis. In this case, we are talking about an ascending pathology.
General deterioration in well-being
Pathology is often manifested by general malaise. In this case, the patient's digestion is disturbed. Most often, nausea and loss of appetite are observed. In more severe situations, diarrhea and vomiting may join.
Also rises arterial pressure, which in itself leads to the addition of headaches, tinnitus. Sometimes the patient may lose consciousness. This condition is especially dangerous for pregnant women and young children. What are the symptoms of acute pyelonephritis in infants?
Signs of pathology in children
Often, kids can't talk about what's bothering them. In this case, parents will have to guess on the coffee grounds. Pathology in newborns and infants is manifested by severe anxiety, crying. Also, when the temperature rises, parents do not show signs of a cold. The baby presses her legs to her tummy and cries angrily. Outwardly, this manifestation is similar to ordinary colic, but unlike gas formation, pyelonephritis does not go away on its own. At the same time, over time, the condition of the baby only worsens.
How to diagnose pathology?
If there is a suspicion of acute and treatment should be related. Several methods are used for diagnosis.
- Questioning and inspection. This method cannot provide reliable information about the disease. The doctor examines the patient and learns about the symptoms that bother him. During palpation, the pain may increase. This indirectly indicates pathology.
- ultrasound. This method is more accurate. During the study, the specialist examines the walls of the organ and determines the degree of expansion of the pelvicalyceal system. The data obtained may indicate a disease.
- Laboratory research. These include general blood and urine tests, as well as biochemistry. Often, if a pathology is suspected, bacterial urine culture is performed. Based on the results, it is possible to determine the microorganisms present and to identify their sensitivity to certain antibiotics.
- Radiography. This manipulation is performed much less frequently. However, it can give an accurate picture of the condition of the kidneys. During the diagnosis, a contrast solution is used, which is injected into the kidney. After that, the image of the organ is displayed on
Acute pyelonephritis: treatment at home
This pathology is mainly treated in the walls of the hospital. However, many patients refuse hospitalization for various reasons. It must be remembered that this can lead to the development of complications.
- Most often it implies such a pathology as acute pyelonephritis, antibiotic treatment. However, before prescribing drugs, it is necessary to carry out laboratory research. Otherwise, you can only aggravate your situation. With improper use of antibacterial drugs, bacterial resistance to the antimicrobial agent develops and decreases immune defense person.
- It is also described in some detail by the healthy lifestyle magazine. There are indicated folk remedies for correction. Some of them can be quite useful. However, you should not take risks without the participation of a doctor to carry out such manipulations.
- Be sure to be associated with a disease such as acute pyelonephritis, symptoms and treatment. Diet and certain regimen are additional methods corrections. They will help to alleviate the patient's condition and speed up recovery.
Let us consider in detail what acute pyelonephritis treatment has at home.
The use of antimicrobial drugs
Quite often, it is carried out with a disease such as acute pyelonephritis, treatment. At the same time, a preliminary analysis for the sensitivity of microorganisms is not performed. Such a correction may not be very effective and lead to more advanced pathology.
The most correct appointment will be a recommendation given after a preliminary analysis. At the same time, the sensitivity of certain bacteria to certain medicines is clarified. Most often, doctors prescribe the following medications: Ofloxacin, Norfloxacin, Ciprofloxacin, Amoxicillin and others.
In most cases, the effect of drugs is noticeable already one week after treatment. Within a month of such therapy, complete recovery occurs. However, doctors strongly recommend continuing treatment for up to two months. Long-term exposure allows you to destroy all pathological microorganisms and prevent the transition of the disease into a chronic form.
Use of immunomodulators
This should not be done on your own. Such a correction is always combined with the use of strong medicines. Acute pyelonephritis cannot be cured with immunostimulating drugs alone.
Immunomodulators allow you to quickly cope with the pathology and improve the condition of the body after prolonged use of antibiotics. These means include the following: "Interferon", "Fiferon", "Likopid", "Canephron", "Isoprinosine", "Decaris", "Prodigeosan" and so on. Correction can be carried out for quite a long time (up to several months). In this case, one medication is replaced by another for a more effective action.
The use of diuretics in the treatment of pathology
Often, medicines that have a diuretic effect are used to correct the pathology. Most often, these are teas from medicinal herbs, for example: "Brusniver", "Kidney tea" and so on.
You can also use solutions and capsule forms of drugs. Most often it is Cyston, Canephron and others. It is worth noting that these medicines can be used during pregnancy. However, before that, it is still worth getting expert advice.
Surgical treatment of pyelonephritis
In more advanced situations, apply surgical intervention. It is produced under general anesthesia and can be of two types: organ-preserving or organ-carrying. In the first case, the affected kidney is decapsulated. At the same time, the walls of the organ are dissected and purulent and pathological formations are removed. The doctor tries to preserve healthy tissues as much as possible and not disturb the blood flow in them. The prognosis of such treatment is usually favorable. At the same time, it is necessary to comply with the prescription data for the patient.
Complete is performed when it is not possible to leave the organ. In this case, donor material can be used. However, there is no guarantee that it will take root. A person can live quite normally with one kidney. In this case, it will be necessary to control the state of the body more carefully.
Therapeutic exercises for illness
You can treat pyelonephritis at home with the help of special exercises. Most often they are prescribed to expectant mothers. After all, it is this group of women that is prone to the development of the inflammatory process due to high blood pressure uterus on organs.
Doctors recommend several times a day to take a knee-elbow position. This allows you to facilitate the work of the kidneys and reduce pressure on them. Also, if you have unilateral acute pyelonephritis, then you should lie down and sleep only on the opposite side. Thus, you can avoid increased pressure on the diseased organ and improve the outflow of urine from it.
Diet for acute pyelonephritis
For the treatment of acute pyelonephritis, a diet and appropriate regimen can be applied. Most often, doctors recommend that you observe complete rest during an illness. Especially if there are symptoms such as high fever, increased pressure, weakness and chills.
The diet also implies a large intake of fluids. The patient needs to increase the amount of fluid consumed to two or even three liters per day. Such an impact will be positive only if the outflow of urine is not disturbed. In addition to plain clean water, you can drink cranberry and lingonberry fruit drinks. Such drinks perfectly cleanse the urinary tract from pathogenic microbes.
Compliance with the diet involves the rejection of smoked and salty. Such products contribute to fluid retention in the body. This can only make the situation worse. At the time of exacerbation of the disease, it is recommended to completely eliminate salt from your diet.
It is also necessary to exclude sweets, bakery products and any allergens from the menu. It is strictly forbidden to eat tomatoes in any form, tomato. Give up alcohol. Meat and fatty broths should be excluded from the patient's diet. What can you eat with acute pyelonephritis?
Prefer easy vegetable soups and steam products. Eat small meals, but more often. Between each meal, drink several glasses of water and the above fruit drinks. Avoid coffee and strong tea. These drinks can only aggravate the condition by a large increase in blood pressure.
The use of herbs: folk methods of correction
Treating acute pyelonephritis with herbs is quite dangerous. However, many patients resort to this method.
Remember that some herbs may be contraindicated for a particular patient. That is why before using them, you should still contact the doctors to obtain permission for such treatment.
Summing up and conclusion of the article
You now have much knowledge about such a disease as acute pyelonephritis (symptoms, treatment with herbs and other methods). Remember that pathology is quite dangerous and can lead to serious complications. That is why her treatment should be carried out within the walls of the hospital, and not engage in self-appointment. The disease is especially dangerous for young children and the elderly. To prescribe the right appointments, you should first undergo an examination. A catheter is used for urinary obstruction.
Monitor the condition of your kidneys. If one of the symptoms appears, do not delay the time, contact the specialists! Only in this case is it likely that the pathology will not turn into a more serious form. Good health to you!
- What is acute pyelonephritis
- Symptoms of acute pyelonephritis
- Treatment of acute pyelonephritis
What is acute pyelonephritis
Acute pyelonephritis can be primary (less often) and secondary (much more often). In the vast majority, one kidney is affected. Bilateral acute pyelonephritis is much less common than unilateral.
Pathogenesis (what happens?) during Acute pyelonephritis
Morphologically, both primary and secondary acute pyelonephritis can occur as a serous (more often) and gynoic (less often) inflammatory process with its predominant localization in the interstitial tissue.
In acute serous pyelonephritis, the kidney is enlarged, dark red. Due to the increase in intrarenal pressure during the dissection of the fibrous capsule, the kidney tissue protrudes (prolapses). Histologically, numerous perivascular infiltrates are found in the interstitial tissue.
Serous pyelonephritis is characterized by foci and polymorphism of the lesion: foci of inflammatory infiltration alternate with areas of unchanged (healthy) renal tissue. There is also swelling of the interstitial tissue with compression of the renal tubules. In most cases, there are phenomena of paranephritis, swelling of the perirenal tissue. With timely active treatment and a favorable course of the disease, it is possible to achieve a reverse development of the inflammatory process. In other cases, serous pyelonephritis becomes purulent with a more severe clinical picture and course.
Acute purulent pyelonephritis morphologically manifests itself in the form of pustular (apostematous) nephritis, solitary abscess and carbuncle of the kidney. In the case of penetration of the infection by the urogenous route, significant changes are observed in the pelvis and cups: their mucous membrane is hyperemic, the cavities are enlarged, and pus is contained in the lumen. Often there is necrosis of the papillae of the pyramids. Foci of purulent inflammation can merge with each other and lead to the destruction of the pyramids. In the future, the cortical substance of the kidney is also involved in the pathological process with the development of small abscesses (pustules) in it - apostematous nephritis.
With a hematogenous route of infection, multiple pustules ranging in size from a pinhead to a pea are first formed in the cortex, and then in the medulla of the kidney. At first they are in the interstitium, then they affect the tubules and finally the glomeruli. Pustules can be located in the form of single small abscesses or in groups. When removing the fibrous capsule, superficially located pustules are opened. Pas section they are visible in the cortex and in the medulla. The kidney is enlarged, dark cherry in color, the perirenal tissue is sharply edematous. Changes in the pelvis and cups are usually less pronounced than in urogenic purulent pyelonephritis. Merging with each other, small pustules form a larger abscess - a solitary abscess.
Kidney carbuncle is a large abscess (from a lentil grain to the size of a chicken egg), consisting of several or many small pustules that merge with each other. Outwardly, it resembles a carbuncle of the skin, by analogy with which it got its name. Sometimes it can be combined with apostematous nephritis; more often it is unilateral and solitary. The simultaneous development of carbuncles in both kidneys is rare (about 5% of cases). As with other forms of acute purulent pyelonephritis, purulent paranephritis may develop.
The considered variants of acute purulent pyelonephritis are different stages of the same purulent-inflammatory process. In addition, microscopically detected expansion of the tubules and collecting ducts, in the interstitial tissue - leukocyte (sometimes massive) infiltrates, in place of which, with a favorable course of the disease, scar tissue develops. When recovering from acute pyelonephritis, wrinkling of the kidney does not occur, since the development of cicatricial changes due to the death of renal tissue is not diffuse, but focal in nature.
Symptoms of acute pyelonephritis
The initial clinical manifestations of primary acute pyelonephritis usually occur after a few days or weeks (on average, after 2-4 weeks) after the attenuation of a focal infection (tonsillitis, exacerbation of chronic tonsillitis, mastitis, osteomyelitis, furunculosis, etc.).
The disease is characterized by general and local symptoms. With primary purulent pyelonephritis and the hematogenous route of infection, the general symptoms of the disease are more pronounced, and with secondary pyelonephritis and the urogenic route of infection, local symptoms come to the fore. In typical cases, a triad of symptoms is characteristic: chills followed by fever, dysuric phenomena and pain in the lumbar region (on both sides - with bilateral and on one side - with unilateral pyelonephritis).
Acute pyelonephritis often begins with general symptoms due to intoxication: headache, weakness, general malaise, muscle and joint pain, chills with fever and subsequent profuse sweating. The severity of these clinical manifestations is different.
Purulent pyelonephritis is much more severe than serous, sometimes in the form of urosepsis and bacteremic shock. Chills are amazing, followed by an increase in temperature to 39-40 ° C, sometimes up to 41 ° C. After 1-2 hours, profuse sweat appears and the temperature short term decreases. Chills with a sharp rise in temperature and profuse sweating are repeated daily, several times a day. Purulent pyelonephritis is characterized by a hectic-type temperature with daily fluctuations of up to 1-2 ° or more, but it can also remain persistently elevated. Repeated hectic temperature increase at certain intervals is due to the appearance of new pustules (in patients with apostematous pyelonephritis) or the formation of a new solitary abscess.
In the blood, there is a pronounced leukocytosis (up to 30-40 thousand or more) with a neutrophilic shift leukocyte formula to the left, an increase in ESR to 40-80 mm/h or more. However, a clear dependence of changes in the peripheral blood on the severity of clinical manifestations is not always observed: in severe cases of the disease, as well as in debilitated patients, leukocytosis may be moderate, insignificant or absent, and sometimes even leukopenia is noted.
Local symptoms of acute pyelonephritis (pain in the lumbar region, dysuric phenomena, changes in the urine) do not always occur at the onset of the disease and may have varying degrees of severity.
At the onset of the disease, pain in the lumbar region or in the upper abdomen is of uncertain nature and localization. Only after 2-3 days they take a clear localization in the region of the right or left kidney, often with irradiation to the right or left hypochondrium, to the inguinal region, to the genitals; aggravated at night, by coughing, by moving the corresponding leg. In some patients, in the first days of the disease, pain may be absent altogether and appear only after 3-5 days, and sometimes after 10-14 days. A positive symptom of Pasternatsky is noted, although not always, as well as soreness and protective tension of the abdominal muscles on the side of the affected kidney.
If the abscess is localized on the anterior surface of the kidney, the peritoneum may be involved in the inflammatory process with the development of peritoneal symptoms. In such cases severe pain in combination with symptoms of peritoneal irritation often lead to an erroneous diagnosis of appendicitis, acute cholecystitis, pancreatitis, perforated gastric ulcer and other diseases, especially if there are no dysuric phenomena and pathological changes in the urine, as is often the case in the first days of the disease. With frequent and painful urination, the diagnosis of pyelonephritis is simplified.
The most important laboratory signs of acute pyelonephritis are proteinuria, leukocyturia, and significant (true) bacteriuria, especially if they are found simultaneously. Proteinuria in the vast majority of cases does not exceed 1.0 g / l (from traces to 0.033-0.099-1.0 g / l) and is represented mainly by albumins, less often by p-globulins. Sometimes it reaches 2-3 g / l, but may be absent. Leukocyturia (pyuria) - most feature pyelonephritis; it often reaches significant severity (leukocytes cover all fields of view or are found in clusters) and may be absent only if the inflammatory process is localized only in the cortical substance of the kidney or if the ureter is obstructed (blockage by a stone) in case of unilateral lesion. Sometimes it is transient. Often there is erythrocyturia, mainly in the form of microhematuria, less often - macrohematuria (with necrosis of the renal papillae, calculous pyelonephritis). The severe course of the disease is also accompanied by cylindruria (granular and waxy cylinders).
Bacteriuria is found in most cases, however, like leukocyturia, it is intermittent in nature, so repeated urine tests for microflora are important. To confirm pyelonephritis, only the presence of true bacteriuria matters, that is, at least 50-100 thousand microbial bodies in 1 ml of urine.
Impaired kidney function with an increase in blood levels of urea, creatinine, sometimes to a large extent, is possible (in about 1/3 of patients) with severe bilateral kidney damage, in rare cases and to a small extent - in patients with unilateral pyelonephritis.
Severe forms of pyelonephritis, especially bilateral, lead to liver damage and the development of hepatorenal syndrome with a violation of protein-forming, neutralizing, pigmentary (with the development of jaundice), prothrombin-forming and its other functions.
The course of acute pyelonephritis has some features depending on the age of the patient (in children, adults, the elderly and the elderly). The disease proceeds especially hard in patients weakened by previous chronic diseases, in particular diabetes mellitus.
Acute pyelonephritis can be complicated by paranephritis, subdiaphragmatic abscess, necrosis of the papillae of the kidneys with the development of acute renal failure, bacteremic shock, hepatorenal syndrome, less often - peritonitis and arterial hypertension.
With early recognition, timely and active treatment, acute pyelonephritis ends in recovery in about 60% of cases. In other cases, it acquires a chronic course with the development of chronic renal failure. They impede the final recovery and contribute to the transition of acute pyelonephritis to chronic late-started, insufficiently active and early-terminated treatment; microflora resistance to antimicrobials; the presence of anomalies in the development of the urinary tract and kidneys, as well as stones and other causes that disrupt the passage of urine; concomitant intercurrent diseases, often chronic, weakening the body's defenses, and some other factors.
Diagnosis of acute pyelonephritis
Ultrasound, X-ray urological, radioisotope, endoscopic studies, and in some cases, renal angiography, are essential in the diagnosis of acute pyelonephritis. CT scan. So, with the help of ultrasound and plain X-ray urography, it is possible to establish the location, size, shape of the kidneys, the presence of stones and their localization. Excretory urography provides more valuable information about the state of the structure and function of the kidneys. If the excretory function of the diseased kidney is impaired, the pelvis and ureters on this side are filled with a contrast agent less intensively or their contrasting occurs with a delay, and if the kidney does not function, then they are not detected at all (symptom of "silent kidney"). Excretory urography also allows you to detect stones that are not visible on the survey urogram, as well as various anomalies in the development of the kidneys and urinary tract, pyelectasis, signs of dyskinesia of the cups and ureters, to judge the degree of patency of the latter. With carbuncle of the kidney or severe inflammatory infiltration of the interstitial tissue, deformity of the pelvis, narrowing, and sometimes amputation of one or more cups is determined.
Ascending pyelography is used in extreme cases, if other methods do not allow to clarify the nature and degree of structural and functional disorders of the affected kidney and decide on the need for surgical intervention.
Radioisotope renography provides valuable information about a unilateral or bilateral lesion, as judged by the state of the function of the left or right kidney, determined in turn by the nature and severity of the renogram segments (flattening of the curve, decrease in the secretory and excretory segments). In acute pyelonephritis, which arose for the first time, these changes are expressed to a slight or moderate degree.
The renal scan also helps to identify structural and functional disorders of the kidneys, since neohydrin is well absorbed only by functioning tissue. However, radioisotope diagnostic methods are only of auxiliary importance, since the detected changes in the structure and function of the kidneys are not strictly specific for acute pyelonephritis. These methods can be considered as a valuable addition to radiological, in particular to excretory urography.
Endoscopic methods of instrumental research (cystoscopy, chromocystoscopy), as well as retrograde (ascending) pyelography, are carried out in exceptional cases in the acute period of the disease, since even with the most careful observance of aseptic rules, an aggravation of the inflammatory process is possible. They are resorted to when other methods are not enough to clarify the diagnosis or when catheterization of the ureter is necessary as a therapeutic measure (to restore its patency in case of obstruction with calculi, mucus, etc.), and also when the issue of surgical intervention is decided in the absence of effect from conservative treatment.
Chromocystoscopy reveals a decrease or absence of the function of the kidney affected by the inflammatory process, which is determined by the time the paint appears from the mouths of the ureters, the intensity of the jet and the color of the urine, or by the absence of urine output from the mouth of one of the ureters. In addition, catheterization of the ureters makes it possible to obtain separate urine from both kidneys and conduct its study. Identification and elimination of the cause that prevents the normal passage of urine helps to increase the effectiveness of antibiotic therapy for pyelonephritis.
acute pyelonephritis must be differentiated from diseases that proceed in the same way as pyelonephritis, with symptoms of general intoxication, high fever, and a severe general condition. If acute pyelonephritis with such a clinical picture is accompanied by severe headache and meningeal symptoms, it is mistakenly regarded, especially in the absence of local symptoms, as an acute infectious disease (typhoid and typhoid fever, paratyphoid fever, meningococcal infection, etc.), which gives rise to erroneous hospitalization such patients to the infectious diseases hospital. Great difficulties arise when differential diagnosis between acute pyelonephritis and sepsis, since kidney damage can be one of the local manifestations of sepsis. At the same time, acute purulent pyelonephritis itself can serve as a source of infection and cause sepsis. Therefore, in the absence of other foci of infection, it should be thought that the clinic of sepsis is due to acute pyelonephritis.
Sometimes acute pyelonephritis can occur with a picture acute abdomen, peritoneal symptoms, local pain simulating acute cholecystitis, pancreatitis, appendicitis, perforated gastric ulcer and duodenum and other acute diseases of the abdominal organs, which often serves as a reason for referring such patients to surgical departments and carrying out unnecessary surgical interventions.
In the latent course of acute pyelonephritis, there are difficulties in differential diagnosis with acute or chronic glomerulonephritis (see glomerulonephritis), manifested only by an isolated urinary syndrome. The correct diagnosis of acute pyelonephritis is possible only after the exclusion of these diseases, for which it is necessary to know the clinical symptoms and diagnosis of the latter well.
Treatment of acute pyelonephritis
Patients with pyelonephritis are prescribed complex treatment, which includes a regimen, diet, antibacterial, restorative and detoxifying agents, as well as measures aimed at eliminating the causes that prevent the normal passage of urine.
Patients with acute pyelonephritis need mandatory hospitalization: in urological departments - with secondary, especially purulent, and in nephrological (therapeutic) departments - with primary serous pyelonephritis. The terms of bed rest prescribed in the hospital depend on the severity of clinical manifestations and the characteristics of the course of the disease.
The diet should be varied with a sufficient content of proteins, fats and carbohydrates, highly fortified, with a total daily calorie content of up to 2000-2500 kcal on average. Easily digestible food is recommended - milk and dairy products, cereals, vegetable and fruit purees, white bread.
Since, unlike glomerulonephritis, acute pyelonephritis usually does not cause fluid retention in the body and there are no edema, significant restrictions on fluid and salt intake are not required. On the contrary, in order to detoxify high temperature and severe general condition, additional administration of fluid is recommended, including parenterally in the form of various solutions (intravenously drip gemodez, neocompensan, reopoliglyukin, polyglucin, glucose, isotonic sodium chloride solution, etc.). On average, the total amount of parenterally administered and/or ingested liquid during the day can be up to 2.5-3.0 liters, preferably in the form of various fresh natural juices, compotes, jelly, rosehip broth, tea, mineral waters (essentuki, Borjomi, Berezovskaya, etc.). Some clinicians (A. Ya. Pytel, 1972, 1977) consider it expedient to prescribe to patients, especially those with fever, cranberry juice, which contains a large amount of sodium benzoate, which is converted in the liver under the influence of glycine into hippuric acid. The latter, excreted by the kidneys, has a bactericidal effect on the microflora of the kidneys and urinary tract, thus enhancing the effect of antibiotics and other antimicrobial agents. The daily amount of table salt is 6-10 g.
From the diet it is necessary to exclude spicy dishes, meat broths, canned food, coffee, alcoholic beverages, various flavoring seasonings (pepper, mustard, onion, horseradish, etc.), irritating the urinary tract and kidneys.
Crucial in the treatment of acute pyelonephritis belongs to antimicrobial agents. The main rule of antibiotic therapy is the appointment of optimal (or maximum) doses, early onset and sufficient duration, compliance with the antibiotic and the sensitivity of the urine microflora to it. If the sensitivity of the microflora cannot be determined, treatment is carried out with antibiotics with a wide spectrum of antimicrobial activity. The dose of the antibiotic should correspond to the severity of the clinical manifestations of the disease and its course. In severe forms of pyelonephritis, maximum doses of antibiotics are prescribed, often in combination with sulfonamides or nitrofuran preparations. When choosing an antibiotic, it is also necessary to take into account the possibility of its nephrotoxic action and the individual sensitivity of the patient's body to it. Since in the course of treatment a change in microflora may occur or its resistance to the prescribed antibiotic develops, it is necessary to repeat urine cultures (every 10-14 days) for microflora and determine its sensitivity to antibiotics.
Antibacterial therapy should be carried out for at least 2 weeks, and more often 4-6 weeks or more: until complete normalization of body temperature, peripheral blood, persistent disappearance of proteinuria, leukocyturia and bacteriuria) determined by repeated multiple urine tests. Siroko used penicillin in daily dose 4-6 million units (in severe cases - up to 8-12 million units or more), semi-synthetic preparations of the penicillin series - oxacillin, ampicillin, methicillin, ampiox, etc. In colibacillary infection, levomycetin succinate is effective (0.5 g 3 times a day). day intramuscularly or intravenously), gentamicin or garamycin (40-80 mg 3 times a day parenterally). With a mixed and antibiotic-resistant microflora, erythromycin, tseporin, kefzol, cyprobay, tarivid, lincomycin, ristomycin, rondomycin, vibramycin and other antibacterial drugs with a wide spectrum of antimicrobial action are prescribed in optimal doses. In severe cases resort to intravenous administration antibiotics in optimal, and in the absence of effect - in maximum doses. In this case, it is necessary to take into account the possibility of nephrotoxic and ototoxic effects of some antibiotics, especially aminoglycosides. Due to the possibility of microbial resistance to antibiotics, it is advisable to change them after 10-14 days, which is especially important in the absence of conditions for examining urine for microflora and its sensitivity to antibiotics.
At long-term treatment antibiotics should be prescribed antifungal drugs - nystatin, levorin, as well as vitamins (B1, B6, B12, C, P, PP, etc.) and antihistamines(diphenhydramine, pipolfen, suprastin, tavegil, etc.). In mild cases of the disease, and also if it is impossible to carry out or continue antibiotic treatment (due to their intolerance or fungal complications), sulfonamides are indicated - etazol, urosulfan, sulfadimethoxin, biseptol, bactrim and others in usual doses. According to available data, urosulfan is most active in staphylococcal and colibacillary infections, and etazol - in streptococcal infections. Contraindication to the appointment of these drugs - the presence of symptoms of renal and hepatic insufficiency. In combination with antibiotics, they significantly increase the therapeutic effect.
Nitrofuran derivatives - furagin, furadonin, furazolidone, etc. - also have a broad spectrum of antimicrobial action. It is very important that both gram-negative and gram-positive microflora are sensitive to them, and microbial resistance to them is less pronounced than antibiotics and rarely develops. Assign them inside at 0.1-0.15 g 3-4 times a day for 8-10 days, and if necessary to enhance the therapeutic effect, and intravenously. In order to prevent dyspeptic phenomena, these drugs, like some antibiotics (for example, levomycetin), can be administered in suppositories. They are most effective in combination with antibiotics, especially in initial stage acute pyelonephritis.
In the treatment of acute pyelonephritis, nalidixic acid preparations (negrams, negramon) are also used at a dose of 0.1-1.0 g 4 times a day for up to 10-14 days, to which gram-negative microflora, in particular E. coli, is usually sensitive. The combination of Nevigramone with antibiotics is more effective. However, drugs in this group are more often used as maintenance therapy after the elimination of the main manifestations of the disease.
Siroko is used, especially for prolonged pyelonephritis, 5-NOC (nitroxoline), which has a wide spectrum of action and high antimicrobial activity. Almost all bacteria that can cause pyelonephritis are sensitive to it.
The drug is well absorbed when taken orally (at a dose of 0.1 g 4 times a day), enters the blood relatively quickly, is excreted from the body only by the kidneys, so it quickly creates a high concentration in the urine. In addition, it usually does not give serious side effects (headache, rarely allergic skin rashes) and is well tolerated by patients throughout the course of treatment (2-4 weeks).
In case of individual intolerance to antibiotics, sulfanilamide and other drugs or resistance to them, salol and urotropin (40% solution of 5-10 ml intravenously) can be used.
However, in some cases with secondary pyelonephritis, even early and actively carried out antibiotic therapy, as well as a combination of antibiotics with other drugs (nitrofurans, sulfonamides, 5-NOC) is ineffective or not effective enough if the causes that disrupt the normal passage of urine are not eliminated. In such cases, the elimination of obstacles to the movement of urine is of paramount importance in the complex therapy of acute pyelonephritis. With obstruction of the upper urinary tract, catheterization of the ureters can be effective, with the help of which it is sometimes possible to eliminate the obstruction to the flow of urine (calculus, mucus clots, etc.). If it is not possible to restore urodynamics, and the patient's condition remains severe, the success of treatment can only be ensured by urgent surgical intervention. The operation is often resorted to with a solitary abscess, carbuncle of the kidney, apostematous nephritis (pyelostomy, decapsulation, opening of pustules, dissection of the carbuncle and, according to strict indications, nephrectomy).
Prevention of acute pyelonephritis
In the prevention of acute pyelonephritis, as well as acute glomerulonephritis, great importance has conservative or surgical sanitation of foci of streptococcal infection, as well as the treatment of infections of the bladder and urinary tract.
It is necessary to systematically monitor and examine pregnant women in the antenatal clinic for the timely detection of the pathology that has arisen in the kidneys and the adoption of urgent measures to eliminate it. Urine is recommended to be examined not only during pregnancy, but also after childbirth, since kidney disease that began during pregnancy can be latent, without clinical manifestations, and then after a few years lead to the development of chronic renal failure.
Due to the high frequency of relapses of acute pyelonephritis and in order to prevent its transition to chronic, it is necessary to conduct repeated courses of antimicrobial therapy in a hospital or on a long-term basis (at least 6 months). In this case, it is recommended to alternate antibiotics with sulfonamides, including prolonged action, nitrofurans, nalidixic acid preparations, 5-NOC, etc.
One of the proposed schemes for prolonged treatment of acute pyelonephritis is as follows (G. Mazhdrakov, 1980). Initially, chloramphenicol is prescribed at 2.0 g per day for 7-10 days, then sulfa drugs(urosulfan, etazol, sulfadimethoxin, biseptol, bactrim, etc.) in usual doses for 10-12 days, then nalidixic acid preparations (negrams, nevigramon) 1 tablet 4 times a day for a period of 10-14 days and nitrofurans (furadonin, furadantin, furagin, etc.) 0.1 g 3 times a day for 8-10 days and finally 5-NOC 1 tablet 4 times for 10-14 days. After the course of therapy, urine is examined for the degree of bacteriuria, leukocyturia, proteinuria. While maintaining bacteriuria (more than 50-100 thousand microbial bodies in 1 ml of urine), leukocyturia and proteinuria, a similar course of treatment is repeated, but only 10-14 days of each month for 6-12 months. If possible, it is necessary to determine the microflora of urine and its sensitivity to a particular group of drugs (antibiotics, nitrofurans, etc.) and, depending on this, prescribe the appropriate drug. When conducting such long, repeated courses of treatment, one should take into account the individual sensitivity of each patient to the prescribed medications and the possibility of developing allergic reactions or pathological changes in peripheral blood (leukopenia, agranulocytosis, etc.).
In Ulan-Ude, a man with suspected coronavirus was admitted to the infectious diseases hospital. The blood materials taken for research were sent to Novosibirsk, since such tests are not performed in Ulan-Ude. The results of the research will be ready on the evening of January 27th.
14.01.2020
At a working meeting in the government of St. Petersburg, it was decided to actively develop a program for the prevention of HIV infection. One of the points is: testing for HIV infection up to 24% of the population in 2020.
14.11.2019
Experts agree that it is necessary to draw public attention to the problems cardiovascular diseases. Some of them are rare, progressive and difficult to diagnose. These include, for example, transthyretin amyloid cardiomyopathy.
Ophthalmology is one of the most dynamically developing areas of medicine. Every year, technologies and procedures appear that make it possible to obtain results that seemed unattainable 5-10 years ago. For example, in early XXI centuries, the treatment of age-related farsightedness was impossible. The most an elderly patient could count on was...
Almost 5% of all malignant tumors constitute sarcomas. They are characterized by high aggressiveness, rapid hematogenous spread and a tendency to relapse after treatment. Some sarcomas develop for years without showing anything ...
Viruses not only hover in the air, but can also get on handrails, seats and other surfaces, while maintaining their activity. Therefore, when traveling or in public places, it is advisable not only to exclude communication with other people, but also to avoid ...
Return good vision and forever say goodbye to glasses and contact lenses - the dream of many people. Now it can be made a reality quickly and safely. New opportunities for laser vision correction are opened by a completely non-contact Femto-LASIK technique.
Acute pyelonephritis is an infectious and inflammatory process that affects the parenchyma of the kidneys and the pyelocaliceal system. The causative agents of the pathology are the bacteria Proteus, Escherichia coli, Klebsiella, Pseudomonas. Pathology is most common in women, accounting for 14% of all kidney diseases.
In the classification of acute pyelonephritis, two of its main varieties are presented: primary and secondary (due to pathologies of the upper urinary tract). There are also three forms of the disease: serous, purulent, necrotic papillitis. Purulent acute pyelonephritis can develop as apostematous pyelonephritis, kidney abscess, kidney carbuncle.
Causes of acute pyelonephritis
Provoke the appearance of acute pyelonephritis can microorganisms that live both in the body and in environment. To date, the following pathogens have been identified: Proteus (Proteus), E. coli (Escherichia coli), Enterococcus (Enterococcus), Staphylococcus (Staphylococcus), Pseudomonas aeruginosa.
Bacteria enter the kidney in the following ways:
- ascending - the focus of inflammation is in the large intestine, lower urinary tract or female genital organs;
- hematogenous - acute inflammation outside the urinary tract (furuncle, mastitis, carbuncle and other diseases) becomes the trigger of the disease.
There are also a number of predisposing factors: overwork, dehydration, diabetes, hypothermia, hypovitaminosis, respiratory infections. At risk are people with hemodynamic and urodynamic problems in the urinary tract and kidney.
Stages of acute pyelonephritis
The disease proceeds in serous and purulent stages. At the same time, the disease passes into the purulent stage if it is treated for a long time or incorrectly.
serous stage
At this stage of pyelonephritis, there is a significant increase in the kidney, as well as the acquisition of a dark red hue. Kidney tissue protrudes noticeably, and perivascular infiltrates appear in the interstitial tissue. The affected kidney is characterized by polymorphism and foci, when the foci of inflammation are replaced by completely healthy and unchanged tissues. If you start the treatment of acute pyelonephritis on time, it is quite possible to reverse the inflammatory process and prevent possible complications.
Purulent stage
Clinical signs of acute pyelonephritis at the purulent stage of its development are pustular nephritis, solitary abscess and carbuncle of the kidney. If the causative agent of the infection has entered the body by the urogenic route, then the patient may have changes in the cups and pelvis: hyperemic mucous membrane, expansion of the cavities, the presence of pus in the lumen. Often, disparate inflammatory foci merge together and destroy the pyramids. The more aggravated the pathology, the higher the risk of the following varieties:
- Apostematous nephritis. At this stage of purulent pyelonephritis, small pustules appear in the cortical and medulla of the kidney. They can be located both in the form of groups and single abscesses.
- Solitary abscess. The disease passes to this stage if small pustules merge together and create a large group.
- Kidney carbuncle. This is a large abscess, which consists of many small ones. Often combined with apostematous nephritis, usually localized only in one kidney.
Symptoms of acute pyelonephritis
Clinical signs of acute pyelonephritis depend on the stage of the pathology, its form and the specifics of the course. For example, the serous stage of the disease is much easier than the purulent, which is accompanied by severe symptoms.
Primary acute pyelonephritis
Symptoms of acute pyelonephritis are fever, back pain, the presence of bacteria and white blood cells in the urine. Patients go to the doctor with complaints of chills, headache, nausea, vomiting, malaise, severe sweating, dull pain in the hypochondrium and lower back.
In primary pyelonephritis in patients in the evening, the temperature rises to 40 degrees, and in the morning it drops to 38. The disease is usually not accompanied by any urination disorders. However, the volume of urine due to increased sweating is significantly reduced. Prolonged lack of treatment can provoke the transition of pathology into a chronic form. Serious health complications such as urolithiasis disease, chronic renal failure, hypertension, pyonephrosis.
Secondary acute pyelonephritis
For secondary pyelonephritis, more pronounced symptoms are characteristic, which are mainly due to a violation of the process of excretion of urine from the body. This disease usually develops against the background of urolithiasis, prostate adenoma, pathologies of the urinary tract.
If the disease was provoked by kidney stones, in this case it is accompanied by renal colic - an attack of pain in the lower back. Then the patient's health gradually worsens: general weakness occurs, thirst, tachycardia, and headache appear.
Separately, it is worth mentioning the symptoms of purulent forms of pathology, which usually occur in the process of complication of secondary pyelonephritis. Clinical manifestations of serous and purulent pyelonephritis are lower back pain, excessive tension of the abdominal muscles, fever, chills, delirium and confusion.
Diagnosis of acute pyelonephritis
- General analysis of urine: carried out to identify deviations in its composition from the norm. However, using this analysis, it is impossible to confirm the diagnosis, since abnormalities in the urine can indicate a variety of diseases. To obtain accurate results on the composition of urine, the patient must collect it correctly: first, perform the toilet of the genital organs, and then collect urine in a dry dish (you can store it for no more than 2 hours). The following indicators may indicate acute pyelonephritis: elevated level leukocytes; the presence of glucose, protein and bacteria in the urine (above 100,000 per ml); alkaline urine.
- Urinalysis according to Nechiporenko. The presence of pyelonephritis in a patient is indicated by an increase in the level of erythrocytes and leukocytes, as well as the appearance of cylinders in it, which are normally absent.
- Bacteriological examination of urine. Usually this analysis is prescribed if antibiotic treatment has not given the desired effect. For this purpose, the doctor conducts a urine culture to identify the causative agent of inflammation. Having found the bacterium that provoked the disease, the doctor can select an antibiotic as accurately as possible to eliminate it.
- excretory urography. One of the most reliable ways to detect pyelonephritis in a patient. This diagnostic method allows visualization urinary tract, detect their blockage by a tumor or stone, and also determine its level.
- Ultrasound of the kidneys. With the help of ultrasound, it is possible to detect the size of the kidneys, in particular the reduction of the kidney affected by inflammation, to identify stones or tumors in the urinary tract, to find out if the pyelocaliceal system has been deformed.
- CT and MRI of the kidneys. Both of these procedures are important in the diagnosis of pyelonephritis, as they provide reliable information about the purulent form of its course. A CT scan is also performed in order to detect whether the inflammation has affected neighboring organs.
- Plain urography - is necessary to assess the size of the kidneys and change their contour with complications such as carbuncle or abscess.
- Selective renal angiography is an auxiliary technique that is used solely to clarify the diagnosis.
Treatment of acute pyelonephritis
The goal of treating acute pyelonephritis is to eliminate the cause that caused inflammation in the kidney, relieve the symptoms of the disease, and detoxify. Doctors select a treatment regimen in such a way that it remains possible to save the kidney, and also to prevent recurrence of the disease. The patient is treated in a hospital under the supervision of a nephrologist and urologist.
The first problem that the doctor must solve is the normalization of the outflow of urine from the kidney affected by inflammation. If the obturation is not removed within a day, this will lead to a serious disruption of the kidneys and can provoke chronic pyelonephritis.
Antibacterial therapy is important in the treatment of pathology, which should be started as soon as possible. Since in pyelonephritis the inflammatory process affects the interstitial tissue of the kidney, the main task of treating the pathology is to create the optimal concentration of antibiotics in the tissue. Tactics drug therapy provides for the appointment of drugs to destroy pathogens of inflammation and drugs for accumulation in tissues.
To treat the disease, the doctor may prescribe the following antibiotics:
- penicillins (Augmentin, Amoxicillin);
- aminoglycosides (Tobramycin, Gentamicin);
- cephalosporins (ceftriaxone, cefuroxime);
- tetracyclines (doxycycline);
- quinolones (Nitroxoline).
- sulfonamides (Urosulfan);
- chloramphenicol (chloramphenicol).
- nitrofurans (Furagin).
Antibacterial therapy should last at least 2 weeks. The doctor decides to stop it based on the results of repeated tests, normalization of body temperature and improvement in the patient's health. If the patient takes antibiotics for a long time, taking vitamins, antihistamines and antifungal drugs is indicated.
Drug treatment of the disease also involves the appointment of the following groups of drugs:
- immunomodulators (T-activin, Timalin) - increase the reactivity of the body, prevent the development of chronic pyelonephritis;
- multivitamins (tincture of ginseng, Duovit) - used to increase immunity;
- non-steroidal anti-inflammatory drugs (Voltaren) - eliminates inflammation in the body.
Drug treatment of pyelonephritis in the most difficult cases may be ineffective. This forces the doctor to resort to ureteral catheterization to restore normal urodynamics. If this method was not effective, an operation is prescribed. Indications for surgical intervention are complications of pyelonephritis: solitary abscess, carbuncle of the kidney, apostematous nephritis.
Forecast and prevention of acute pyelonephritis
During treatment, the patient must adhere to a diet. First of all, he should significantly reduce the amount of table salt, spices, seasonings, coffee, alcohol. It is recommended to drink plenty of liquid per day - about two liters. Patients over 16 years of age should preferably drink at least two liters per day. It is advisable to drink compotes, natural juices, kissels, teas, mineral water, cranberry juice, rosehip broth.
It is worth giving up spicy, fried, rich, fatty foods. In particular, you should not eat fresh bakery products, replacing them with three-day-old products. The patient's diet should be dairy and vegetable, include foods high in vitamins. Since the human immune system is weakened during an exacerbation of inflammation, it is recommended to abandon allergen products for a while.
In the prevention of the disease, not only diet food, but also timely treatment of urinary tract infections, sanitation (surgical or medical) of foci of infection, the causative agent of which was streptococcus. Since relapses of pyelonephritis occur very often, the patient after completion of treatment should periodically undergo courses of antimicrobial therapy.
Preventive treatment of pathology can be carried out both on an outpatient basis and in a hospital. For effective treatment courses of therapy should be long. Therefore, the doctor must take into account the patient's sensitivity to a particular medication, as well as the risk of an allergic reaction.
Pyelonephritis is an acute or chronic kidney disease that develops as a result of exposure to the kidney of some causes (factors) that lead to inflammation of one of its structures, called the pyelocaliceal system (the structure of the kidney in which urine is accumulated and excreted) and adjacent to this structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.
The definition of "Pyelonephritis" comes from the Greek words ( pyelos- translates as, pelvis, and nephros-bud). Inflammation of the structures of the kidney occurs in turn or simultaneously, it depends on the cause of the developed pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 39 0 C, nausea, vomiting, urination disorder), when it proper treatment after 10-20 days, the patient recovers completely.
Chronic pyelonephritis is characterized by exacerbations (most often in the cold season), and remissions (subsidence of symptoms). Its symptoms are mild, most often, it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, abnormalities of the urinary system, prostate adenoma, and others).
Women, especially young and middle-aged women, get sick more often than males, approximately in a ratio of 6: 1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men are more likely to develop pyelonephritis at an older age, this is most often associated with the presence of prostate adenoma. Children also get sick, more often at an early age (up to 5-7 years), compared with older children, this is due to the low resistance of the body to various infections.
Kidney Anatomy
The kidney is an organ of the urinary system involved in the removal of excess water from the blood and products secreted by body tissues that were formed as a result of metabolism (urea, creatinine, medications, toxic substances, etc.). The kidneys remove urine from the body, further along the urinary tract (ureters, bladder, urethra), it is excreted into the environment.The kidney is paired organ, bean-shaped, dark brown, located in the lumbar region, on the sides of the spine.
The mass of one kidney is 120 - 200 g. The tissue of each of the kidneys consists of a medulla (in the form of pyramids) located in the center, and a cortical located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyxes (average 2-4 in one kidney). In the future, the large renal calyces pass into one large renal pelvis (a cavity in the kidney, funnel-shaped), which, in turn, passes into the next organ of the urinary system, which is called the ureter. From the ureter, urine enters the bladder (a reservoir for collecting urine), and from it through the urethra out.
Inflammatory processes in the calyces and pelvis of the kidney are called pyelonephritis.
Causes and risk factors in the development of pyelonephritis
| Features of the urinary tract | |
| R develop as a result of exposure to the fetus during pregnancy of adverse factors (smoking, alcohol, drugs) or hereditary factors (hereditary nephropathy, resulting from a mutation of the gene responsible for the development of the urinary system). Congenital anomalies leading to the development of pyelonephritis include the following malformations: narrowing of the ureter, underdeveloped kidney (small size), lowered kidney (located in the pelvic region). The presence of at least one of the above defects leads to stagnation of urine in the renal pelvis, and a violation of its excretion into the ureter, this is a favorable environment for the development of infection and further inflammation of the structures where urine has accumulated. |
| In women, compared to men, the urethra is shorter and larger in diameter, so sexually transmitted infections easily enter the urinary tract, rising to the level of the kidney, causing inflammation. |
| Hormonal changes in the body during pregnancy | |
| The pregnancy hormone, progesterone, has the ability to reduce the tone of the muscles of the genitourinary system, this ability has a positive effect (prevention of miscarriages) and a negative effect (violation of urine outflow). The development of pyelonephritis during pregnancy is a disturbed outflow of urine (a favorable environment for the reproduction of infection), which develops as a result of hormonal changes, and compression of the enlarged (during pregnancy) uterus of the ureter. | |
| reduced immunity | |
The task of the immune system is to eliminate all substances and microorganisms alien to our body, as a result of a decrease in the body's resistance to infections, pyelonephritis may develop.
|
|
| chronic diseases genitourinary system | |
| lead to a violation of the excretion of urine and its stagnation; |
| (inflammation of the bladder), in case of ineffective treatment or its absence, the infection spreads along the urinary tract upwards (to the kidney), and its further inflammation. | |
| Infections such as chlamydia, trichomoniasis, when penetrating through the urethra, enter the urinary system, including the kidney. |
| Chronic amygdalitis, bronchitis, intestinal infections, furunculosis and others infectious diseases are a risk factor for the development of pyelonephritis . In the presence of a chronic focus of infection, its causative agent (staphylococcus, E. coli, Pseudomonas aeruginosa, Candida and others) can enter the kidneys with the blood stream. |
Symptoms of pyelonephritis
- burning and pain during urination, due to inflammation in the urinary tract;
- the need to urinate more often than usual, in small portions;
- beer-colored urine (dark and cloudy), is the result of the presence of a large number of bacteria in the urine,
- foul-smelling urine
- often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).
- Pasternatsky's symptom is positive - with a light blow with the edge of the palm on the lumbar region, pain appears.
- Edema, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appear on the face (under the eyes), legs, or other parts of the body. Edema appears in the morning, soft pasty consistency, symmetrical (on the left and right sides of the body of the same size).
Diagnosis of pyelonephritis
General urine analysis - indicates abnormalities in the composition of the urine, but does not confirm the diagnosis of pyelonephritis, since any of the abnormalities may be present in other kidney diseases.Proper collection of urine: in the morning, the toilet of the external genitalia is performed, only after that the morning, first portion of urine is collected in a clean, dry dish (a special plastic cup with a lid). The collected urine can be stored for no more than 1.5-2 hours.
Indicators general analysis urine for pyelonephritis:
- High level of leukocytes (normal in men 0-3 leukocytes in the field of view, in women up to 0-6);
- Bacteria in urine >100,000 per ml; the excreted urine is normal, it must be sterile, but hygienic conditions are often not observed during its collection, therefore, the presence of bacteria up to 100,000 is allowed;
- Urine density
- Ph urine - alkaline (normally acidic);
- The presence of protein, glucose (normally they are absent).
Urinalysis according to Nechiporenko:
- Leukocytes are increased (normal up to 2000/ml);
- Erythrocytes are increased (normal up to 1000/ml);
- The presence of cylinders (they are normally absent).
Ultrasound of the kidneys: is the most reliable method to determine the presence of pyelonephritis. Determines the different sizes of the kidneys, a decrease in the size of the affected kidney, deformation of the pelvicalyceal system, the detection of a stone or tumor, if any.
Excretory urography, is also a reliable method for detecting pyelonephritis, but compared to ultrasound, you can visualize the urinary tract (ureter, bladder), and if there is a blockage (stone, tumor), determine its level.
CT scan, is the method of choice, using this method it is possible to assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)
Treatment of pyelonephritis
Medical treatment of pyelonephritis
- antibiotics, are prescribed for pyelonephritis, according to the results of bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.
Antibiotics and antiseptics in the treatment of pyelonephritis:
- Penicillins(Amoxicillin, Augmentin). Amoxicillin inside, 0.5 g 3 times a day;
- Cephalosporins(Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
- Aminoglycosides(Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg / kg 2 times a day;
- Tetracyclines (Doxycycline, orally 0.1 g 2 times a day);
- Levomycetin group(Chloramphenicol, orally 0.5 g 4 times a day).
- Sulfonamides(Urosulfan, inside 1 g 4 times a day);
- Nitrofurans(Furagin, inside 0.2 g 3 times a day);
- Quinolones(Nitroxoline, inside 0.1 g 4 times a day).
- Diuretic drugs: are prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and are not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
- Immunomodulators: increase the reactivity of the body during the disease, and to prevent exacerbation of chronic pyelonephritis.
- Timalin, intramuscularly 10-20 mg 1 time per day, 5 days;
- T-activin, intramuscularly, 100 mcg once a day, 5 days;
- Multivitamins , (Duovit, 1 tablet 1 time per day) Ginseng tincture - 30 drops 3 times a day are also used to improve immunity.
- Non-steroidal anti-inflammatory drugs (Voltaren), have an anti-inflammatory effect. Voltaren inside, 0.25 g 3 times a day, after meals.
- To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantyl, 0.025 g 3 times a day.
Phytotherapy for pyelonephritis
Herbal medicine for pyelonephritis is used as an addition to drug treatment, or to prevent exacerbation in chronic pyelonephritis, and is best used under medical supervision.Cranberry juice, has an antimicrobial effect, drink 1 glass 3 times a day.
A decoction of Bearberry, has an antimicrobial effect, take 2 tablespoons 5 times a day.
Boil 200 g of oats in one liter of milk, drink ¼ cup 3 times a day.
Kidney collection No. 1: A decoction of the mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.
Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, cowberry. Finely grind all these herbs, pour 2 tablespoons of water and boil for 20 minutes, take half a cup 4 times a day.