- This is chronic nonspecific bacterial inflammation, flowing advantageously with the involvement of the interstitial tissue tissue and cup-making complexes. It is manifested by malaise, blunt pains in the lower back, subfeberbylitis, dysuric symptoms. In the diagnostic process, laboratory studies of urine and blood are carried out, ultrasound kidneys, retrograde pyelography, scintigraphy. The treatment is to comply with the diet and gentle regime, the appointment of antimicrobial therapy, nitrofuran, vitamins, physiotherapy.
MKB-10
N11 Chronic tubuline interlassical nephritis
General
The reasons
The etiological factor causing chronic pyelonephritis is a microbial flora. Preferably it is colibacillary bacteria (parapisal and intestinal wand), enterococci, protea, staphylococci, a blue rod, streptococci and their microbial associations. The L-forms of bacteria formed as a result of ineffective antimicrobial therapy and pH changes of the medium play a special role in the development of the disease. Such microorganisms are distinguished by resistance to therapy, the difficulty of identification, the ability to continue to continue in the intermediate tissue and is activated under the influence of certain conditions.
In most cases, chronic pyelonephritis is preceded by an acute attack. There are cases of combination of pyelonephritis with chronic glomerulonephritis. The chronization of inflammation contributes:
- restained disorders of urine outflow caused by stones in the kidneys, ureter stricture, bubble-ureteral reflux, nephroptosis, prostate adenoma;
- other bacterial processes in the body (urethritis, prostatitis, cystitis, cholecystitis, appendicitis, enterocolitis, tonsillitis, otitis, sinusitis, etc.);
- national general diseases (diabetes mellitus, obesity), the state of chronic immunodeficiency and intoxication.
Young women have an impetus for the development of chronic pyelonephritis, the beginning of sex life, pregnancy or childbirth may appear. In young children, the disease is often associated with congenital anomalies (ureterocele, urinary bubble diverticulas), violating urodynamics.
Classification
Chronic pyelonephritis is characterized by the flow of three stages of inflammation in the renal tissue.
- At the I stage, leukocyte infiltration of the interstitial tissue of the brainstant and the atrophy of the collective channels is found; Renal balls are intact.
- At the stage stage of the inflammatory process, the scar-sclerotic defeat of the interstitation and the tubules is observed, which is accompanied by the death of terminal departments of nephron and squeezing of the tubules. At the same time, hyalineization and incurring of glomers, narrowing or obliteration of blood vessels develop.
- In the ultimate, III stage, the kidney tissue is replaced by the scar, the kidney has a reduced dimensions, it looks wrinkled with a buggy surface.
According to the activity of inflammatory processes in the renal tissue in the development of chronic pyelonephritis, the phases of active inflammation, latent inflammation, remission (clinical recovery) are distinguished. Under the influence of treatment or in its absence, the active phase is replaced by a latent phase, which, in turn, can go to the remission or again into active inflammation. The remission phase is characterized by the lack of clinical signs of disease and changes in urine tests. For clinical development, ether (latent), recurrent, hypertonic, anemic, azotemic forms of pathology are emitted.
Symptoms of chronic pyelonephritis
The latent form of the disease is characterized by poor clinical manifestations. Patients are usually concerned about general malaise, fast fatigue, subfebilitation, headache. Urinary syndrome (dysuria, pain in the lower back, swelling) is usually absent. The symptom of Pasternatsky can be weakly positive. There is a small proteinurium, intermittent leukocyturia, bacteruria. The disorder of the concentration function of the kidneys is manifested by hypoxenuria and polyuria. Some patients can identify minor anemia and moderate hypertension.
A recurrent version of chronic pyelonephritis proceeds wavely with periodic activation and inflammation. The manifestations of this clinical form are the severity and novice pain in the lower back, dysuric disorders, periodic feverish states. In the aggravation phase, a typical acute pyelonephritis clinic is developing. In progression, hypertensive or anemic syndrome may develop. Laboratory, especially in exacerbation, expressed proteinuria, constant leukocyturia, cylindruria and bacteriuria, is determined, sometimes hematuria.
With hypertensive form, the predominant becomes hypertensive syndrome. Arterial hypertension is accompanied by dizziness, headaches, hypertensive crises, sleep disorders, shortness of breath, pain in the heart. Hypertension is often malignant. Urinary syndrome, as a rule, is not expressed or carried by intermittent flow. The anemic of the disease is characterized by the development of hypochromic anemia. Hypertensive syndrome is not expressed, the blade is a non-permanent and meager. The azotemic form combines cases when the disease is detected only at the PPN stage. Clinical and laboratory data of azotemic form are similar to those at Uremia.
Diagnostics
The difficulty of diagnosing chronic pyelonephritis is due to the variety of clinical variants of the disease and its possible latent flow. Diagnostic tactic includes:
- Urine tests. In general analysis of urine, leukocyturia, proteinuria, cylindruria is detected. Investigation of urine according to the method of Addis-Kakovsky is characterized by the predominance of leukocytes over other elements of the blade. Bacteriological sowing of urine contributes to the identification of bacteriuria, identifying pathogens of chronic pyelonephritis and their sensitivity to antimicrobial drugs. To estimate the functional state of the kidneys, Zimnitsky, Rarba, biochemical study of blood and urine is used.
- General blood analysis.In the blood is detected hypochromic anemia, the acceleration of EE, neutrophilic leukocytosis.
- Instrumental research.The degree of violation of kidney functions is specified by holding chromocystoscopy, excretory and retrograde urography, nephrocintigraphy. Reducing the size of the kidneys and structural changes in renal tissue are detected according to the ultrasound, MRI and CT kidney. The instrumental methods objectively indicate a decrease in the size of the kidneys, the deformation of cup-making structures, a decrease in the secretory function of the kidneys.
- Biopsy kidney. In clinically obscure cases of chronic pyelonephritis, the kidney biopsy is shown. Meanwhile, the fence during the biopsy of uncovered renal tissue can give a false-negative result in a morphological study of a bioptat.
In the process of differential diagnosis, the amyloidosis of the kidneys, chronic glomerulonephritis, hypertensive disease, diabetic glomerosclerosis is excluded.
Treatment of chronic pyelonephritis
Patients show compliance with gentle regime with the exception of factors provoking aggravation (supercooling, colds). Adex-willed therapy of all intercurrent diseases, periodic monitoring of urine tests, dynamic observation of the nephron physician is necessary.
Diet
Recommendations for the food diet include the refusal of sharp dishes, spices, coffee, alcoholic beverages, fish and meat Navarov. The diet should be vitamined, with the content of dairy products, vegetable dishes, fruits, boiled fish and meat. On a day it is necessary to use at least 1.5-2 liters of fluids to prevent excessive urine concentration and ensure the washing of urinary tract. With exacerbations of chronic pyelonephritis and, with its hypertensive form, restrictions on the reception of the table salt are superimposed. Cranberry juice, watermelons, pumpkin, melons are useful.
Conservative therapy
The aggravation requires the appointment of antibacterial therapy, taking into account the microbial flora (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) in combination with nitrofurans (furazolidone, nitrofuranstein) or nylidixic acid preparations. Systemic chemotherapy continues until stopping bacteriuria by laboratory results.
In comprehensive drug therapy, vitamins B, A, C; Antihistamines (mebirdroline, Promethazine, chloropiramine). In hypertensive form, hypotensive and antispasmodic preparations are prescribed; With anemian - iron preparations, vitamin B12, folic acid.
SMT therapy, galvanized, electrophoresis, ultrasound, chloride sodium baths, etc. have been particularly well established from physiotherapy techniques, and Ave. In the event of ureodialysis, hemodialysis is required.
Surgery
Far-closed chronic pyelonephritis, not amenable to conservative treatment and accompanied by one-sided shrinking of the kidney, arterial hypertension, is the basis for nephrectomy.
Prediction and prevention
With a latent chronic version of inflammation, patients retain the ability to work for a long time. With other forms, abdication is sharply reduced or lost. The deadlines for the development of chronic renal failure are variable and depend on the clinical version of chronic pyelonephritis, the frequency of exacerbations, the degree of violation of the kidney functions. The death of the patient may occur from Uremia, sharp brain circulation disorders (hemorrhagic and ischemic stroke), heart failure.
Prevention consists in timely and active therapy of acute urinary infections (urethritis, cystitis, acute pyelonephritis), sanations of foci of infection (chronic tonsillitis, hymorite, cholecystitis, etc.); eliminate local disorders of urodynamics (removal of stones, dissection of Stricks, etc.); Correction of immunity.
Protect chronic pyelonephritis With alternating phases of active and latent inflammation and remission. Chronic pyelonephritis does not have such pronounced manifestations as sharp, and in this regard he is much more dangerous.
Usually the disease arises as a result not to the end of the cured acute pyelonephritis. Cases are possible when chronic pyelonephritis proceeds almost asymptomatic. He can reach for months and even for years, gradually destroying the kidneys and withdrawing them. The patient has no symptoms of the disease, well, sometimes a little lumbar lumbar, and he often hurts his head. All this people are written off on the weather or on exercise. Their and oscillations of blood pressure are not fastened. Many are just trying to knock him down on their own, not referring to the doctor.
There are the following forms of chronic pyelonephritis.
By occurrence:
Primary - not related to some
urological disease
Secondary - urinary tract developing on the soil.
On the localization of the inflammatory process:
Unilateral,
Bilateral,
Total - striking all the kidney,
Segmental - affecting part of the kidney.
On the clinical picture:
Latent
Recurrent
Hypertonic
Anemic
Azotemic
Hematuric.
With latent form Chronic pyelonephritis is characterized by an unclear clinical picture - general weakness, headache, quickly tire. High temperature is rare. Disturbance of urination, pain in the lumbar region and swelling, as a rule, are absent, but sometimes manifests itself with the symptom of Pasternatsky. There is a slight amount of protein in the urine, and the number of leukocytes and bacteria changes. In addition, the latent form is usually accompanied by a violation of kidney functions, primarily their concentration ability, which is manifested in strengthening urine formation and in hypoxenuria - low-specific urine isolation.
Patients with a latent form of chronic pyelonephritis can remain able-bodied for a long time. The admission to work is limited only by high arterial hypertension and is completely excluded when it is malignant, as well as with a violation of the nominality of the kidney.
With the recurrent form of chronic pyelonephritis, the alternations of periods of exacerbations and remissions are characteristic. In patients there are constant unpleasant sensations in the area of \u200b\u200bthe lower back, the process of urination is disturbed, and after the chills, the temperature can suddenly increase, signs of acute pyelonephritis appear.
As the recurrent form enhances, the symptoms of certain diseases begin to prevail.
In some cases, hypertensive syndrome can develop with characteristic symptoms for it - headaches, dizziness, disorders, pain in the heart and so on.
In other cases, anemic syndrome becomes the predominant - general weakness, fast fatigue, shortness of breath. In the future, chronic renal failure is developing.
With exacerbation of the disease, pronounced changes occur in the composition of urine - possible proteinuria, leukocyturia, cylindruria, bacteriuria and hematuria. As a rule, the patient in the blood increases ESP and an increase in the number of neutrophils (neutrophilic leukocytosis) occurs.
Hypertensive shape of chronic pyelonephritis It is primarily characterized by the presence of hypertension. Patients are disturbed by dizziness, headaches, as well as pain in the heart, shortness of breath. They appear insomnia and hypertensive crises. Often hypertension is malignant. Violations in the urination usually does not happen.
Anemic form of chronic pyelonephritis It is characteristic of the fact that the symptoms of anemia prevail among signs of illness - a decrease in the number of full-fledged red blood cells. This form of the disease in patients with chronic pyelonephritis is more common, expressed stronger than with other kidney diseases, and wears, as a rule, hypochromic character. Disturbances in the urination are weakly manifested.
To the azotemic form of chronic pyelonephritis There are those cases when the disease declares itself in the form of chronic renal failure. They should be qualified as a continuation of the already existing, but in a timely revealed latent flow of the disease. It is a nitrogenic form that is characteristic of chronic renal failure.
Hematuric shape of chronic pyelonephritis Known by repeating attacks of macrohematuria and resistant microhematuria, which is associated with venous hypertension, which contributes to disruption of the integrity of the vessels of the formalistic kidney zone and the development of formal blood bleeding.
It is usually developing chronic pyelonephritis for 10-15 years and more and ends with wrinkling the kidneys. Wrusting occurs unevenly with the formation of coarse scars on the surface. If only one of the kidneys is wrinkled, then, as a rule, compensatory hypertrophy and hyperfunction of the second kidney is observed. That is, for several weeks, the mass of the remaining kidneys increases, and it assumes the functions of a sick kidney. At the final stage of chronic pyelonephritis, when both organs are amazed, chronic renal failure is developing.
Diagnosis of chronic pyelonephritis
Chronic pyelonephritis is recognized based on:
Anamnese data (medical history),
Existing symptoms
Leukocyturia results - urinary sediment research according to the method of Kakovsky - Addis,
Quantitative detection in the urine of active leukocytes, called Shvegeimer cells - Malina,
Bacteriological analysis of urine
Biopsy kidneys.
To identify chronic pyelonephritis and accurately determine the form of its flowing in time often fails, especially in the conditions of clinics in connection with the variety of clinical manifestations of the disease and with a relatively frequent latent flow.
Also, if the chronic pyelonephritis is suspected, a general blood test is made to determine the residual nitrogen, urea and creatinine in it, the electrolyte composition of blood and urine detects and investigate the functional state of the kidneys.
With the help of the X-ray method, changes in the size of the kidneys, the deformation of their pelvis and cups, the violation of the tone of the upper urinary tract, and radioisotope renography allows you to obtain a graphic image and estimate the functional state of each organ separately.
An additional study method for the diagnosis of chronic pyelonephritis is used intravenous and retrograde pyelography and scanningography, echographic examination of the kidneys, chromocystoscopy.
It is necessary to distinguish chronic pyelonephritis from chronic glomerulonephritis, amyloi-dose, hypertensive disease, diabetic glomerosclerosis.
In contrast to chronic pyelonephritis, chronic glomerulonephritis is characterized by an increased concentration of erythrocytes in the blade, the absence of active leukocytes and the presence of microbes in the urine. The amyloidosis can be recognized by the presence of chronic infection foci, the scarcity of the blade (there are only single leukocytes, erythrocytes and cylinders, sugars are not at all), as well as in the absence of bacterium-uriya and radiological signs of pyelonephritis.
Hypertonic disease More often observed in people's older people, proceeds with hypertensive crises and, more pronounced sclerotic changes of coronary, brain vessels and aorts. In patients with hypertensive disease, there are no characteristic of chronic pyelonephritis of leukocyturia, bacteriuria, a pronounced decrease in the relative density of urine, and with x-ray and radioindication studies, the changes inherent in chronic pyelonephritis are not detected. In diabetic glomerosclerosis, the patient has signs, and other symptoms of diabetic angiopathy are determined - generalized damage to blood vessels.
Treatment of chronic pyelonephritis
The treatment of chronic pyelonephritis is at least four months. If the disease proceeds without complications, the therapy on the recommendation of the doctor can be reduced.
Every month the patient makes urine analysis and an antibiogram. If the number of leukocytes still exceeds the norm, the drug should be replaced. Sometimes it happens that after a month after the start of treatment, the tests correspond to the norm. But this does not mean that the disease passed and the kidneys are out of danger. There is no case for throwing treatment.
Antibacterial therapy is currently the main method of treating chronic pyelonephritis. Reception of antibiotics is starting only after the causative agent of infection is identified and its sensitivity to medicines is determined. Typically shows antibiotics that suppress the gram-negative flora. The doctor should appoint only those drugs that do not have toxic impact on the kidneys. Treatment passes with regular laboratory control of microflora sensitivity to antibiotic.
A good healing effect with a low probability of relapses and adverse reactions is provided by modern fluorochinolone row antibiotics: Ciprofloxacin, Norfloxacin, Levoflock Sacinfefloxacin; Cefalosnors: cephalexin, cefuroxime, cefenim, semi-synthetic penalty-cyllins with beta-lackamas inhibitors Augmen-Tin, Unzin.
Reception of non-steroidal anti-inflammatory drugs that impede the formation of thromboms in vessels, is also expected to treat chronic pyelonephritis treatment. It may be aspire, Movied, Woltaren, IBU-Profa and others. For improving microcirculation in the kidneys, patients are taken by Kuraltil, Ten-Tal or venorutant, and to activate the renal blood circulation - Urolisan, Cisteneal, Olymetzn, Waroferux.
Immunocorrorizing agents The doctor may appoint a serious course of illness and complications, especially in the people of older age. If the chronic urinary tract infection is detected, peptide bioregulators are prescribed.
To receive antibiotics, especially powerful (the so-called fourth row), did not lead to the intestinal dysbiosis, throughout the course of treatment it is necessary to observe the dairy diet. But if the dysbacteriosis still appeared, then for the restoration of intestinal microflora about a week before the end of the main therapy, it is necessary to start receiving bifidumbexterine. In difficult cases, the doctor may prescribe antifungal drugs.
Preventing the development of chronic pyelonephritis and its complications is possible only with a constant observation of a patient with a urologist. Control tests and research should be done at least three times a year. During this period, the patient at work should have severe physical exercise, supercooling, increased humidity, such people can not work in the night shift. Patients are removed from the records if they have no signs of exacerbation of chronic pyelonephritis for two years.
The diagnosis of "chronic pyelonephritis" is made when 90 days have passed after the start of the disease or there were repeated exacerbations. The pathological process is characterized by a permanent form with manifestations, as well as the disappearance of signs. This article considers the peculiarities of the treatment of chronic pyelonephritis in the weakening of clinical symptoms - remission.
There are full and incomplete disappearance of signs of the disease. In the latter case, part of the symptoms of renal inflamming does not go away due to the unsuccessful selected treatment strategy or the presence of concomitant diseases. In such a situation, we are talking about chronic secondary pyelonephritis.
Inflammation modifies the kidney. Therefore, in the afternoon remission, it is impossible to stop treatment.
Causes of secondar pyelonephritis
The secondary inflammation of the kidneys is distinguished by recurrence and occurs under the influence of the harmful factors listed below:
- Inaccurate diagnosed.
- Incomplete destruction of causative agents of the disease. Premature cessation of antimicrobial reception patient. The appearance of rabbaterials resistant to antibiotics.
- The presence of chronic forms of concomitant diseases.
Treatment
The strategy of treatment with the disappearance of clinical symptoms or partial weakening is different.
Stage of remission
Chronic pyelonephritis in the remission stage does not worry a person. Clinical symptoms disappeared. Indicators of blood components, as well as urins do not go beyond the limits of the norm. However, the occurrence of infectious disease, a cold, disruption of power parameters is capable of resuming the pathological process. Therefore, treatment is not stopped, but are limited to diet and therapy and the use of phytopreparations.
Melon and watermelons are useful for pyelonephritis.
Special nutrition during this period is not required, but the restriction of salty, smoked, sharp, fat, canned products remains in force. It is not recommended to abuse, tobacco, drinks containing caffeine and ethanol. A rich drink is welcomed, as well as eating watery thousands - melons and watermelons.
Decorations of medicinal plants, their preparations in the form of paste, extracts or pills sanitate gymnuts, prevent the reproduction of secondar microflora.
A method of passive renal gymnastics has been developed. It implies an infusion of a diuretic agent, for example, a furosemide, causing a purification polyuria, followed by ensuring a gentle regime, which helps to accelerate the scarring of defects and restoring the filtering function of the kidneys.
Stage of unfinished remission
Chronic pyelonephritis for incomplete remission is a consequence of late treatment of manifest inflammation, the presence of concomitant ailments or congenital pathologies. In this case, it is necessary to prevent aggravation.
Diet and therapy is prohibited by the use of products that are limited when fully remissions. Alternative diets apply alternative diet to prevent renal stones. Originally use products whining urine for 2 ... 3 days comprising bakery, egg and meat food. The necroprifying diet is then used, in which milk, fruits, vegetables occupy a leading position.
The use of plant worstics is not enough. Conduct courses for nitrofurans, antibiotics, sulfonamides, change drugs.
In the treatment of pyelonephritis, nitrofuran antimicrobial drugs are claimed
Conclusion
In chronic pyelonephritis, it is important to keep pathological processes in the phase of weakening clinical symptoms - remission, not allowing exacerbations. The main techniques are diet and therapy and elimination of secondar microflora.
- Infectious inflammatory disease of the kidneys, with predominant localization in a tubula interstacional zone.
Urogdoms face this pathology often, since the incidence is 19 cases per 1000 people. Women are subject to pathology 1.5 times more often than men.
Table of contents:Classification of chronic pyelonephritis
The primary chronic pyelonephritis is distinguished, for its development, the root of microbial flora is considered. No obstacles to urine outflow no.
Secondary chronic pyelonephritis develops against the background of diseases leading to violation of urodynamics:
- anomalies for the development of the structure of the organs of the urogenital system;
- nephloolithiasis;
- narrowing narrowing;
- reflux;
- retroperitoneal sclerosis;
- neurogenic disorders of the bladder under hypotonic type;
- sclerosis of the bladder neck;
- prostate gland hyperplasia and sclerotic changes;
- malignant and benign education.
Pyelonephritis is one-sided and double-sided.
During chronic pyelonephritis, the following phases are distinguished:
- active;
- latent;
- remission;
- clinical recovery.
Symptoms and signs of chronic pyelonephritis
Complaints in chronic pyelonephritis are present during the exacerbation. The patient complains about stupid. Dysuric disorders are not characteristic, but may be present. Of the general symptoms, the following are:
- weakness, apathy;
- reduced performance;
- gravity in the lower back;
- digestible increase in temperature up to 37 - 37.2 degrees.
If the process has complicated by attachment, signs of loss of the functional ability of the kidneys appear.
There are no manifestations in the latent phase or to the phase of remission, and when diagnosis is drawn, laboratory research data is taken into account.
The predisposing factors for the development of chronic pyelonephritis are considered as follows:
- immunodeficiency states;
- in severe;
- infectious diseases;
- gestration;
- diseases of the urogenital tract in history;
- foci of chronic infection (, etc.);
- operations on the urinary system organs.
With a physical examination, pain during the palpation of the kidney / kidneys, a positive symptom of the tendering in the zealnist area is revealed. With a long existing process, polyuria may be (increasing the daily amount of urine).
In secondary chronic pyelonephritis against the background of kidney anomalies, an increase in blood pressure is often noted.
Laboratory and instrumental examination methods
You can use risks of diuretic and anti-inflammatory herbs:
Sanatorium - resort treatment in Pyatigorsk, Truskavets, Essentuki, Zheleznovodsk is possible only during remission.
If a patient has chronic pyelonephritis accompanied by an increase in blood pressure, then limit the salt to 5-6 g / day. Liquids can be drunk up to 1000 ml.
With nephrogenous hypertension supported by chronic pyelonephritis, ACE inhibitors are prescribed, since the increase in pressure is associated with an increase in renin in the blood.
With intolerance due to side effects, antagonists of angiotensin II receptors are used.
Patient management tactics when aggravating chronic pyelonephritis with some concomitant pathology
If the patient has diabetes a concomitant disease, then use aminopenicillins and ciprofloxacins.
For patients with CPN, preparations are selected with a hepatic or double by removing:
- Ploksacin;
- Ceftriaxone;
- Cefoperasazon.
A competent selection of antibacterial drugs ensures safety and simplifies the selection of dosage.
Patients with CPN do not prescribe aminoglycosides and glycopeptides, in view of their nephrotoxicity.
In patients and persons who suffer from drug addiction, pyelonephritis causative agent may be uncharacter. Preference is given to fluoroquinolones (levofloxacin), aminoglycosides and cephalosporins, as they are not metabolized in the body and are derived by the kidneys.
Exception from the Cephalosporins group:
- Cefatoxim;
- Cefoperazone;
- Ceftriaxone.
The aggravation of chronic pyelonephritis associated with the resistant hospital strains of bacteria is extremely rare. This may be a complication of medical manipulations or an inadequate intake of antibiotics in history.
In these cases, use ceftazidimi and amikacin.
Cephazidim is prescribed as a single antibiotic, or in combination with amikacin.
Reserve preparations are considered carbapenes (an exception - Ertapenem).
Surgery
The indication to the operation serve all violations of urine outflows.
If chronic pyelonephritis is complicated by the formation of the kidney to the appearance or carbuncle, there is an operation in the amount of decapsulation, followed by the installation of nephrostomic drainage.
In the most neglected cases resort to nephrectomy.
Chronic pyelonephritis - kidney inflammation, which, as a rule, is a concomitant of any obstructive pathology in the urinary tract, but may be a consequence of incorrect therapy of acute pyelonephritis.
The most important reasons for the transition of acute inflammation in the chronic phase are:
On time is not a diagnosed and non-corrected violation of urodynamics in nephrolithiasis, stricture of urinary tract, prostate adenome, vesicuretheral reflux, nephroptosis, etc.
Incorrect treatment, including too short.
Lack of systematic long-term observation.
The formation of stable forms of bacteria capable of asymptomatic to persist in renal tissue in an inactive state, and the progression of pathogenic microflora on the background of a decrease in the work of the immune system.
Chronic heavy extragnenital pathology (diabetes, systemic diseases, HIV - infection, caries, tonsillitis, tumor pathology.
All types of immunodeficient pathologies.
Injuries and operations on the organs of the urinary sphere.
Where is chronic pyelonephritis in children
Chronic pyelonephritis sometimes begins in childhood, more often in girls who are more susceptible to an inflammatory process due to anatomical features.
The process chronic is preceded by an attack of acute pyelonephritis.
During or immediately after acute infectious and viral diseases (influenza, angina, ORVI, pneumonia, Otita) there is a new exacerbation of the inflammation in the kidneys, which is masked for these diseases, especially in childhood, and remains unnoticed (chronic latent pyelonephritis). The weakening of the body is exacerbated by infectious processes and inadequate antibacterial therapy.
In the future, such a child is doomed to the waveway course of the pathological process, where the remission stage will be replaced by the stage of exacerbation.
Chronic pyelonephritis in children is often developing against the background of postoperative states over the plastics of the laughter-ureteral segment due to stricture. Parents should develop a single position with a doctor, be sure to pass with the baby ultrasound, pass tests, not violate the power principles for pyelonephritis, avoid hypoints, strengthen the immune system, follow the execution of the routine of the day. In this case, with a timely manifold plastic, it is possible that remission will be a rack, and there will be no exacerbations.
Clinical course of chronic pyelonephritis
Code on the ICD - 10 N 11.8
Chronic pyelonephritis for years can occur without any pronounced symptomatics, in the form of smoldering inflammation in interstitial renal tissue. The manifestations of chronic pyelonephritis are depending on the activity, degree and stage of inflammation in the kidneys.
Pyelonephritis classification
Chronic pyelonephritis is one-sided and double-sided, in the stage of remission or exacerbation. Another chronic pyelonephritis is estimated to preserve or lose the functional ability of the kidneys: with impaired function or without.
An important criterion is considered to assess changes in urine analysis.
There are laboratory remission, incomplete laboratory remission and an active process.
Etiology pyelonephritis
Pyelonephritis causes:
1. Intestinal Escherichia,
2. Enterococcus,
3. Drive,
4. Staphilococci,
5. Streptococci
6. L-forms of bacteria (recurrence of pyelonephritis),
7. Mycoplasma,
8. Leptospira,
9. Mushrooms.
In 1/3 patients with acute pyelonephritis and in 2/3 patients with chronic pyelonephritis microflora is mixed. In 30% of cases, the causative agent is not sewn - this does not exclude the infectious process.
Diagnosis of chronic pyelonephritis
In diagnosis, considerable help represents competently and fully assembled anamnesis.
The patient carefully asks for diseases of the urogenital tract in childhood, find out the date of the last exacerbation, which medicines were taken, what are the concomitant diseases.
Women find out what changes were during pregnancy by the urogenital system, there was no episodes of chronic cystitis.
In men in chronic pyelonephritis, you should pay attention to the severity in the zone area, find out about the injuries of the urethra, bladder, the condition of the prostate gland.
Anomalies for the development of kidneys and urinary tract,
Uronhephrolithiasis,
kidney omission
ICD and others.
Signs and symptoms of chronic pyelonephritis
There is no pronounced symptoms when chronizing the process in the kidneys, if only we are talking about exacerbation. Nevertheless, it is necessary to pay attention to the following non-specific symptoms:
Pulling back pain
Weakness, apathy,
Lack of appetite and reduced body weight,
The likely appearance of the morning swelling in the field of the eyelids,
excessive dry skin and nail fragility,
Dysuric disorders,
Increase the temperature in the evening clock.
When these signs appear, immediately sign up for the doctor's consultation.
What happens in analyzes in chronic pyelonephritis
Piura - the first diagnostic sign of chronic inflammation in the kidneys (increased number of leukocytes in the urine). Periodically in the urine detect protein (proteinuria).
Note that only by the presence of leukocyturia, it is impossible to judge the stage of inflammation. First you need to make sure the source of the pyuria.
In men, leukocytes in the urine can fall when concomitant inflammation in the prostate or urethra, in women in the bladder or vagina. Therefore, there will be a 2-hubbed sample, which will help clarify where leukocytes in the urine came from.
One general analysis of urine should not be limited, it is not necessary to appoint a sample of Nechiporenko, since in chronic inflammation in clinical analysis of the urine of pathology, and non-bonded leukocytes are in trial, which is the confirmation of inflammation and requires antibacterial therapy.
In clinical analysis of blood, sometimes reduced hemoglobin. Leukocytosis and soe - signs of acute inflammation - not typical for the chronic process.
In 25% of patients, with a long-flowing disease, the level of urea and creatinine in the blood above the norm.
Zimnitsky's sample can indirectly indicate the loss of the functional ability of the kidneys.
Urine collected every 3 hours in a separate container. Rate quantity and specific weight
There are special tests to confirm the diagnosis of chronic pyelonephritis, however, in modern nephrology, when in the availability of many instrumental research methods, they do not apply often.
The patient is introduced once pyrogenal or prednisone. It is believed that these drugs will provoke the yield of active leukocytes and Stergeemer cells - Malina.
Instrumental diagnosis of chronic kidney inflammation
Chronic pyelonephritis is diagnosed by the following methods:
X-ray surveys of the kidneys: intravenous and infusion urography. Characteristic for pyelonephritis is an increase in the renal cortical index (\u003e 4), as well as a decrease in the thickness of the kidney parenchyma on the poles (symptom of Khodson).
Radioisotope methods (renography, dynamic computer scintigraphy),
Ultrasound methods.
The main X-ray signs of chronic pyelonephritis:
Changing the size and contours of the kidneys.
Slow down the separation.
Changes in kidney architectonics.
Expansion of lochs.
Symptom Khodson (if a cup of healthy kidneys is located on a symmetrical line, then when chronic, the distance between the cups and the kidney circuits is different and the incorrect interpretation).
With a standard picture of pyelonephritis, a decrease in the size of one of the kidneys is visualized, an increase in the density of the shadow and the vertical axis, in the place of affected kidney.
Excretory Urography Method for the diagnosis of chronic inflammation in WMP. Radiographic signs of pathology are distinguished by variety, and the asymmetry of changes depends on the relationship of the areas of inflammation and sections of the sclerosis.
Retrograde pyroid is less common, since there is a chance of infection of the kidneys in hospital infection.
For chronic pyelonephritis, a gradual atrophy of the renal parenchyma is characterized, which is more accurately determined by the renal cortical index.
To clarify the state of the kidneys, radioisotope renography is used, the method allows you to clarify the function of each kidney separately and evaluate changes on the background of therapy in the dynamics.
Dynamic scintigraphy determines the quantity and quality of the kidney functional parenchyma during chronic inflammation.
The method is more accurate, compared with an excretory urography, since sometimes there are no kidney functions in the dynamic scintigraphy, and dynamic scintigraphy gives a clear picture of the presence of changes.
Signs of chronic pyelonephritis on ultrasound
Signs of hydronephortic transformation
Ultrasound of the kidneys is a non-invasive painless examination method, when the study is performed, the expansion of the kidney cavities and the diffuse-inhomogeneous structure of the parenchyma can be seen. Ultrasound helps to distinguish the hypoplaced kidney from sclerotically wrinkled and diagnose many other urological pathology.
Differential diagnosis
The diphyderage is carried out with a urinary tuberculosis congenital reduced kidney and chronic glomerulonephritis.
For the tuberculosis process in the kidneys, the predominance of leukocytes in the urine above the microhematuria is typically. The patient is subject to a survey at the urologist of the anti-tuberculous dispensary, where he performs urine analysis on mycobacterium tuberculosis and an excretory urography.
In the differential diagnosis of pyelonephritis and glomerulonephritis, the clarifying answer can be obtained with a thorough collection of anamnesis and urine study.
Below are the main signs - the differences of pyelonephritis from glomerulonephritis.
The hypoplascent (reduced in size) of the kidney has clear contours, the absence of deformation of the internal cavities, the characteristic density of the tissue.
Pay attention to the absence of urological diseases in history, if there was no urological pathology, then more hypoplasia data.
Features of the treatment of chronic inflammation in the kidneys
Treatment of chronic pyelonephritis in the remission stage does not require the use of antibiotics. To be sure that there are no inflammations, go through the ultrasound, hand over the urine for a general analysis and sample is notchiporenko. If urine sowing on the growth flora will not give, exactly remission. In this case, enough seasonal preventive treatment with Wrospectors (Spring - Autumn), 10 days and admission of phytopreparations.
When the pyelonephritis has a continuously recurrent flow and is complicated by any depressing immunity, concomitant pathology, antibiotics are needed. In this case, with each re-exacerbation of the disease, sowing urine to verify the pathogen (pathogens) and the sensitivity to the antibiotic is performed.
If it is possible, it is necessary to check the state of the immune system, and by results, select the desired immunopreparations.
Periodic reception of plant diuretics contributes to the removal of pathogenic microorganisms from the urinary system organs and has an anti-inflammatory effect.
Do not forget about proper nutrition.
During the remission, the treatment of mineral waters is shown: Zheleznovodsk, Truskavets.
Forecast of chronic pyelonephritis
In chronic pyelonephritis, the forecast for life depends on a number of factors:
One-sided defeat or bilateral.
There are any complications of pyelonephritis (CPN, nephroangiosclerosis, secondary - wrinkled kidney).
How quickly progresses the disease.
How long ago the diagnosis is set.
The presence of concomitant urological pathology (nephrolithiasis, a large prostate adenoma with symptoms of infraweestic obstruction, kidney cysts).
Does the patient perform all the recommendations of the doctor.
Whether a patient is planned to pregnancy with existing chronic inflammation of the kidneys.
How deeply spread the process.
What way of life is a patient.
Secondary chronic pyelonephritis more often leads to the attachment of CPN.
In any case, the correct behavior and competent preventive measures, the development of complications of chronic pyelonephritis can be prevented.
Treatment at home
We will alleviate that with the exacerbation of chronic pyelonephritis, all appointments make a doctor, treat a sharp process in the kidneys only by herbs is very dangerous. In preventive purposes, remissions will contribute to the reception of herbal fees.
So, what can be done at home.
Dill seeds
2 tablespoons of dry dill seeds pour 400 ml of water, tomorrow 25 minutes on slow heat.
Take 100 ml 3 times a day - 10 days of each month, long.
Herbal collection
Ingredients:
2 tablespoons of ground strawberry leaf,
1 tablespoon chamomile,
1 tablespoon of horsetail,
1 tablespoon of dill seeds.
Pour a herbal mixture of 500 ml of water, boil 25 minutes, strain, add to 500 ml of boiling water, cool and take 2/3 cups 3 times a day for 14 days.
It is known that the inflammatory process is supported by a tissue nutrition (ischemia). To improve microclosion, you can use the following recipe.
Chestnuts on vodka
Take 5 fresh chestnuts, grind them, pour 250 ml vodka, tightly clog and remove for 14 days in a dark cool place, once every 3 days the tincture shake.
Strain through the sieve, take 15 drops 3 times a day 10 days.
Store in a cool place.
Cranberry Morse on cruising leaves with honey
From the crushed leaf brystry workers to prepare a decoction at the rate of 1 tablespoon of 200 ml of water, cool to a temperature of about 80-90 C.
The cranberry is crowned with a wooden mortar, add honey to taste and pour the decoction from the lingonberry sheet.
You can take in the form of a drink, sometimes it is worth interrupted for 20 days so that there is no addiction.
genitalHealth.ru.
Causes of Education
Like any disease, chronic pyelonephritis has its beginning and is due to:
- metabolic disorders in the body, hypovitaminosis;
- low immunity security;
- overwork, fatigue, systematic lack of sleep;
- supercooling the body;
- defeat infections;
- anatomical body structure;
- adenomes of prostate or hormonal failures (changes occur during pregnancy, childbirth, deprivation of virginity, androgenic failure);
- congenital anomalies (characteristic of a child).
The causes of pyelonephritis can be a large set of factors, which are not possible in advance. It is recommended to periodically undergo a survey, donate urine analysis, especially at a time when there is a risk of pyelonephritis.
Classification of the disease
Depending on a number of factors, chronic pyelonephritis can be qualified in different ways. Given the reasons for the formation of the disease, pyelonephritis is primary, secondary, obstructive, unstructive. Based on the location of the infection, the pyelonephritis can be one-sided or bilateral. At the stage of flowing the inflammatory process, it is divided into active, latent, in the remission. According to the severity, it is categorized to uncomplicated and complicated pyelonephritis. All these factors, their presence or absence allows you to determine the degree of the disease, as well as choose the optimal treatment for adults and children.
Symptoms for pyelonephritis
The severity of the disease depends on the form of its flow. Therefore, the symptoms of pyelonephritis is characterized in different ways. Pyelonephritis makes itself felt suddenly accompanied by:
- pulling, novel pain in the field of the back;
- increasing body temperature;
- sleep violation;
- by changing the color of urine, its smell, transparency;
- the appearance of edema, renal pressures;
- urea syndrome.
When diagnosing pyelonephritis, symptoms are divided into local (latent, recurrent) and general (early, late). Each of the forms has its own indicators, features, types, manifestations.
Latent
This form has low-rise symptoms. Accompanied by low (37 °) body temperature, headache. Wrong pain, swelling may be absent. The state can lead to anemia, hypertensive disease. Awildness is accompanied by excessive urine, indicates a violation of the kidneys.
Anemic
In this case, the number of red blood in the blood is dramatically reduced, which provokes anemia. With a lack of a special substance that the kidneys produce, a violation of hemoglobin synthesis begins to occur. Common symptoms can be weakly expressed, which makes it difficult to independent diagnostics, a laboratory survey will be required. The anemic form of the disease is common in people suffering from pyelonephritis.
Hypertonic
The work of the kidneys is directly dependent on the pressure level necessary for life. If the kidney bleeding is violated, the hormone called Rhenin begins to be thrown into the body with elevated doses, mixed with other components and hormones. Subsequently, the narrowing of the kidney vessels occurs, blood circulation is disturbed, and ultimately the result destabilization of pressure. In chronic pyelonephritis, the kidney tissues are destroyed, their exhaustion, there is a serious violation in the structure of the organs. Because of this, depressive substances are ceased to be produced, arterial hypertension begins. Symptoms with hypertonic form are expressed in headaches, sandwood, dizziness, pain in the heart.
Azotemic
The latent flow of the disease is weak, it does not always allow to quickly determine the causes and, as a result, diagnose the disease. If there is no attention to the flow of the disease when the first symptoms appear, then the risk of complications. Azotemic form of the disease implies stage when the renal failure process occurs. The cause becomes the inability of kidneys to carry out toxic substances from the body, the metabolism is disturbed. The presence of renal failure is characterized by an increase in creatine, which will be seen from the results of the analysis.
Recurient form
This is repeated when after sinking the process of inflammation, weakening symptoms, the exacerbation occurs. It can be pronounced brighter, stronger, accompanied by a feverish state. This condition qualifies as a secondary pyelonephritis.
Diagnosing a kidney disease
To identify the presence of the disease, and even without explicit signs and suspicion is quite difficult. To determine pyelonephritis, the following is carried out:
- general urine analysis;
- biochemical blood and urine tests;
- Ultrasound kidneys, magnetic resonance tomography, radiological studies.
Change blood test results
In the presence of the disease, uniform changes in blood elements occur. Such deviations make it possible to prejudice the disease, identify the degree of complication or development. When analyzing the blood, the level of hemoglobin, the number of erythrocytes, their sedimentation rate, hematocrit (the ratio of red cells to the plasma volume) is investigated. If a person is sick with pyelonephritis, then the results will show a decrease in the number of blood cells, hemoglobin, hematocrit. In return proportionally begins to increase the SE indicator.
The overall analysis shows the number, characteristics of specific cells, therefore, to study biologically significant components of plasma, a biochemical blood test is prescribed.
Changes in urin properties
The exact data on the presence of the disease can be exploring urine analysis. Urin indicators in men and women differ, range from 0 to 6. Deviation speaks of the flow of the inflammatory process. Color is an important indicator. In chronic pyelonephritis, it reaches a yellow, orange or red shade. The absence of protein in the urine is a good indicator, and its increase indicates the disease. Also, the pyelonephritis increases the number of leukocytes, the epithelium is minimized, the salt in the urine is formed, the level of cylinders increases, they become grainy.
Special laboratory research
These studies include a general analysis of blood and urine. Urina is examined according to the method of Nitrechenko and Zimnitsky. The results of the analyzes show the predominance of leukocytes above the erythrocytes, and also allow to determine the density of urine.
Bacteriological research
This group of surveys includes bacteriological sowing and immunoassay samples. Studying seeding allows you to identify microorganisms in Urin, which caused inflammation. The survey identifies the main causative agent of the disease, which makes it possible to appoint proper treatment. The results of immuno-immimensional samples complement the information of bacteriological sowing, help to more accurate the cause of infection.
Instrumental research
For accurate formulation of the diagnosis, the stage of the disease, determining the state of the kidneys, other dependent bodies, research is carried out using special medical equipment.
Ultrasound procedure
With the help of the device and sound waves you can see the work of the kidneys on the screen. During the ultrasound, the state of the organs, the presence of the wonder, wrinkling, the seal of pelvis, cups, the deformation of the kidneys. Diagnostician Diagnostic Diagnostic Makes Some Measures, notes time indicators during operation, it takes pictures with the help of the device. In the future, the attending physician due to the pictures, the data determines the degree of chronic pyelonephritis and assigns the appropriate treatment.
Radiography
Provides three ways to conduct a survey: Review X-ray, excretory urography, computed tomography. Each of the procedures pursues its goals to study the renal status. Depending on the initial indicators, a specific type of radiography is prescribed.
Magnetic resonance tomography
Effective and one of the most expensive body examination procedures. Using the electromagnetic pulse, atoms in organ tissues react, and the sensor reads the information that is converted to the finished image. In chronic pyelonephritis, MRI may allow us to study the cyst, the formation of new kidney diseases, conduct a survey of blood vessels, tissues.
Renal angiography
Allows you to study vessels in the kidneys. Depending on the stage of the disease, changes occur in the vessel system. Initially, the number of small vessels is reduced, leading them to a complete disappearance. The second stage begins wrinkling the kidneys, reduce its size. At the last stage, the organ is maximally curly, the vessels are deformed, and their number is reduced at times. Thus, angiography allows you to investigate, determine in what condition the kidneys are located during pyelonephritis.
Differential diagnosis
When diagnosing diagnosis, pyelonephritis is carried out with other diseases such as hypertension, diabetic and chronic glomerulonephritis, kidney amyloidosis. With some indicators, these diseases resemble pyelonephritis, so the doctor needs the history of the patient's disease, the results of all analyzes to determine the unmistakable diagnosis.
A physical treatment is always appointed by a complex treatment, because chronic pyelonephritis is distinguished by unpredictability in the process of its development, flowing. The diet must be observed, it is necessary to adhere to the recommendations, prohibitions for nutrition. Mandatory compliance with the treatment regime, timely reception of drugs, injections. The weakening of immunity can cause braking treatment or ineffectiveness, so it needs to protect itself from the cold, prevent the body undercooling.
Medical therapy
Antibiotics, urges, antimicrobial drugs are prescribed for the treatment of pyelonephritis. When appointing the doctor is guided by the results of analyzes, surveys, takes into account the source of the inflammatory process. Depending on this, a complex of medicines is selecting, in the category of which may include penicillin, cephalosporin, oxychinoline, chinol, sulfonilahine preparations, nitrofunara. Female and men's chronic pyelonephritis are treated equally, there is no features on sexual sign, and for children you should use antibiotics with similar properties, but with recommendations for the child. An independent choice is prohibited, the appointment is carried out only by specialists.
The term of treatment is from two weeks to a month, and after the course of therapy is determined to exclude recurrence. Therefore, it is recommended to always have medicines at hand, which, if necessary, contribute to the prevention of exacerbation and start therapy on time.
Surgical intervention
Sometimes to cure medications does not work, and on the opposite the formation of purulent foci begins. Then an operation is carried out, which pursues the purpose of eliminating purulent formations. With severe cases, doctors can remove the affected kidney. There are several ways to surgical procedures:
- decapsulation;
- pyelostomy;
- opening and excision of purulent necrotic foci;
- nephrectomy.
Regardless of the type of operation, surgical intervention is a complex procedure that may be accompanied by complications, both in the process of operation and in the postoperative period. There are also contraindications for operations, such as cardiovascular diseases. Surgical methods of extreme measure, it will be appointed only after a thorough, complete examination and study of the history of the disease.
Other effective methods of treatment
In such ways, it is advisable to attribute the use of folk treatments for pyelonephritis and rest in sanatoriums. Folk medicine is not able to lead to complete recovery and cure of the kidneys, but is very effective between medicines and course therapy.
Treatment at home
Effective will be the use of diuretic tools, renal herbal fees based on the basis of Tokhanyanka, black currant, wildcroy, rosehip, juniper, flax seeds. They have excellent antiseptic, diuretic properties. The cranberries from which Morse is being made are made by a powerful bactericidal action, 0.5-1 liter beverage per day is taken. Additionally, they need to take methionine to the guide drink, which plays the role of amino acid, affecting the synthesis of biological components of the body. In addition, such a tandem is able to neutralize toxic compounds. And all this is necessarily accompanied by a diet, excluded sharp dishes from the diet, preserved cooking products. It is recommended to use water more.
Prevention
Preventive measures provide for a whole range of activities:
- timely treatment;
- periodic examination, testing, visiting the attending physician;
- elimination of infectious foci in the body;
- therapy of cystitis, prostatitis, epididiment to complete recovery;
- during pregnancy control over the appearance of pathogenic bacteria in the urine;
- extraction of stones (if necessary through surgical intervention);
- maintenance of personal hygiene;
- use of vitamins, trace elements, sufficient water;
- antibacterial protection.
Proper nutrition is a security deposit, regardless of the presence or absence of diseases. Diet with chronic pyelonephritis is necessary because the kidneys directly participate in the metabolism. In addition, the dietary menu will speed up the process of eliminating pathologies. Therefore, it is worth excluding sharp, oily, spicy, salty food. Dairy products, fruits, berries, as well as use of at least 2 liters of pure water per day are recommended.
Means that improve renal blood flow
For the appointment of a doctor, it is necessary to take funds that improve renal blood flow, such as Trental, Kuraltil, Eskusan, Trokezine.
Forecast
Only timeliness, the correctness of the diagnosis, the appointment of effective treatment will lead to recovery. Complications occur in the occurrence of metamorphosis in the kidney. Depending on the pyelonephritis stage, its complexity of treatment, the duration of the diagnosis depends on the offensive of remission or the lack of such. The forecast also depends on the rate of progression of pyelonephritis, the presence of urological pathologies, pregnancy, as well as the lifestyle of the patient, his desire to be treated. Thus, there are many factors that are responsible for the development of the disease or recovery and dependent on health workers as well as the patient himself.
Video about chronic pyelonephritis:
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Symptoms and shapes of chronic pyelonephritis
The mechanism of the occurrence of pyelonephritis is based on the injury of urine affected by bacteria. The inflammation begins, moving on the walls of the pelvis to the brain and cortical substance of the kidneys. The disease characterize the sluggish symptoms or their complete absence.
In different patients, the picture of symptoms can differ significantly. This is explained by the presence of a form of pyelonephritis.
With latent form, there are no specific symptoms, but there are minor manifestations of the following signs:
- Fatigue,
- Dumb pains in the side and lower back (Symptom of Pasternatsky),
- A slight increase in temperature
- Headache,
- General malaise.
Sometimes the clinic is characterized by a minor increase in pressure, weak anemia.
The urine analysis shows the periodic sedimentation of leukocytes and bacteria.
An anemic form has already pronounced symptoms:
- feeling of tingling in the heart of the heart
- dyspnea,
- skin pallor
- pronounced weakness.
Hypertensive form is characterized by arterial hypertension.
Previous findings added:
- dizziness,
- insomnia,
- hypertensive crises
- cheering pain in the heart.
Azothermic form of pyelonephritis is a disease that is manifested already upon the occurrence of chronic renal failure. In fact, it is not a roaming latent form.
The recurrent form - the recurrent phases and remission, which replace each other depending on the conditions of the person's stay.
Symptoms of this form:
- Temperature increase,
- Chills,
- Discomfort in the lower back
- Frequent urge to the toilet,
- Pain when urination.
The exacerbation period is nothing more than acute pyelonephritis. When developing a recurrent form, hypertensive or anemic syndrome often occurs.
By the nature of inflammation, the disease is divided into the following phases:
- Active inflammation
- Latent inflammation
- Remission.
Inflammation in the active phase in the absence of proper treatment or with improper therapy is replaced by a latent state, which flows either into remission or back to the inflammatory process.
Remissions - clinical recovery, when the patient does not torment signs of pyelonephritis, and urine tests do not give any changes.
The duration of the remission period depends on therapy and the lifestyle of the patient.
Causes of disease
The first cause of chronic pyelonephritis is microorganisms that come to the active stage due to incorrect hygiene, incorrectly receiving antibacterial agents, with changes in the pH environment.
The disease causes the most common types of bacteria:
- Proteus,
- Intestinal wand
- Staphylococci and streptococci,
- Enterococci
- Sinnaya wand and others.
L-types of phleganisms also affect the occurrence of the disease, because they can remain for a long time in human tissues and get into the kidney.
Chronic pyelonephritis can be a consequence of the existing diseases:
- Urolithiasis disease,
- BPH,
- Cystitis,
- Diabetes,
- Gout,
- Obesity,
- Cholecystitis,
- Apandicitis and others.
The beginning of the disease in women can cause pregnancy and childbirth, sex life.
Medical procedures - cystoscopy, catheterization, anesthesia and others - also often provoke the beginning of the disease.
Children suffer from chronic pyelonephritis due to congenital pathologies - ureterocele, urinary bubble diverticulus.
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Diagnostics of primary and secondary pyelonephritis
The diagnosis is characterized by some difficulty, since the course of the disease is very weak. Only a detailed question of symptoms and laboratory studies help to establish the correct diagnosis.
For diagnosis, the following diagnostic methods use:
- General analysis of urine and blood,
- Bacteriological sowing
- Blood chemistry,
- Biopsy kidney.
Diagnostic purposes are carried out pyelography, renography. The patient also prescribe catheterization to determine the amount of protein and blood enzymes falling into the sediment.
These methods allow you to establish the primary or secondary character of pyelonephritis.
Primary develops in people who first complain about kidney problems.
The causes of the secondary manifestation of the disease are the same factors as for primary pyelonephritis.
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Principles of disease treatment
Treatment requires a long time, fulfillment of all prescriptions of the specialist, compliance with the right nutrition.
The best result will bring comprehensive treatment, ranging from eliminating the causes causing a disease and ending with a change in lifestyle.
The complex of medical events includes:
- Regime compliance
- Diet,
- Reception of antibacterial agents
- Phytotherapy,
- Immunomodulatory therapy,
- Physiotherapy,
- Symptomatic treatment
- Sanatorium visit
- Planned treatment for avoiding relapses.
Since the disease is bacterial, the reception of antibiotics becomes mandatory and vital. The doctor prescribes antibiotics based on the obtained analyzes, where the sensitivity of the microbes is detected to any drugs.
Antibacterial therapy implies the reception of penicillins:
- amoxicillin,
- meticillin,
- oxacillin,
Depending on the sensitivity of bacteria to antibiotics, drugs of cephalosporinic row can be assigned:
- cefasoline
- ceftriaxone,
- cefalexin.
Sulfanimamides are prescribed as additional antimicrobial agents:
- uriassian
- grosptol,
- lidaprim.
With anemic form of pyelonephritis, an iron intake is shown, and the hypertensive type of illness requires the reception of hypotensive tools and spasmolitics.
After the main antimicrobial therapy, a long treatment is carried out against recurrence with variable use of different antibiotics.
Operational treatment of the disease is carried out in the case of:
- violation of urine outflow,
- reflux to the ureter from the bladder,
- the presence of stones in the kidneys,
- prostate adenomes.
To accelerate the recovery and prevention of recurrence, physiotherapy treatment methods are shown:
- electrophoresis,
- galvanization,
- sodium baths.
Therapeutic diet nutrition
The diet plays a big role in maintaining kidney functions.
Therapeutic nutrition implies compliance with the rules:
- Rejection of acute, fried, pickled food, coffee, broths, alcohol;
- It is allowed to eat dairy products, cereal, stew vegetables, fruits, lean meat, fish;
- During the day, 2 liters of water and other liquid (tea, compote, mineral water) should be drunk. During recurrence, the reception of liquids should be reduced;
- With hypertensive form, it is necessary to reduce the use of salt in food, or to abandon the salt at all;
- A diuretic products are shown - melon, pumpkin.
Sometimes an alternate compliance with different diets is applied. For example, a few days the patient uses acidifying food - meat, bread products. The next few days use alkaline products - vegetables, fruits, milk.
Therapeutic nutrition should be coordinated with the attending physician, which, if necessary, makes its own adjustments to the diet.
Complications of chronic pyelonephritis
The negligence attitude towards itself during chronic pyelonephritis is fraught with complications.
The absence of treatment causes the replacement of healthy kidney tissues with coarse coupling, as a result of which the organs cannot fully fulfill their functions.
It is important to prevent chronic bilateral pyelonephritis, since in this case the renal failure occurs.
Pionephrosis is considered a very dangerous complication when the kidney is filled with thick pus.
Secondary hypertension is another complication that is quite difficult to treat. With a strong weakening of the body, sepsis is possible.
To warn chronic pyelonephritis is always easier than to treat. After all, preventive measures are pretty simple - regular medical examination and control, avoiding contact with cold surfaces, sensitive attitude towards himself.
If the diagnosis of chronic pyelonephritis is supplied, the cure forecast is very favorable - each 5 patient with a competent complex treatment from the illness is completely eliminated.
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The treatment of the disease is directed primarily to eliminate the main cause - infectious pathogen. After laboratory determination of sensitivity to antibiotics, the doctor prescribes antibacterial therapy using the means from the following groups:
- Penicillins - the antibiotics of this group have a wide range of action, as well as low-endoxy - they do not affect the kidney.
- Fluoroquinolones - this group of antibacterial drugs is also characterized by minimal impact on the kidneys, they are very effective in relation to bacteria provoking urinary system diseases, but their use is dramatically limited to children and women during pregnancy. They have a side effect - an increase in photosensitivity, and their reception can not be accompanied by visits to the beach and to the solarium.
- The cephalosporins of the new generation are quite effective in the treatment of chronic pyelonephritis, but they are more often produced in the form intended for intramuscular administration, so therapy is accompanied by a procedural office or carried out in a hospital.
- Sulfanimamides are effective in therapy only if the laboratory diagnostics confirmed the sensitivity of the bacteria to this type of preparations.
- Oxykinolines are also an effective means in the fight against urinary tract diseases of an infectious nature and are often used in urological practices.
- Nitrofurans have a high percentage of efficiency, but rather pronounced side effects, which explains their more rare application.
Antibacterial treatment lasts up to 14 days, after which treatment should be conducted - to revoke the assigned analyzes.
In the presence of appropriate indications, antispasmodics can be applied to better urine outflows and pain syndrome, as well as disaggregants and anticoagulants.
Antiagregants and improving venous outflows are prescribed to improve renal blood flow.
Physiotherapy, magnetotherapy, electrophoresis - these procedures are significantly complemented by the effectiveness of the main treatment and are shown in chronic pyelonephritis to achieve a stealing remission.
In the presence of concomitant diseases, additional symptomatic therapy or drugs are appointed, designed to adjust disruption caused by pyelonephritis. For example, if anemia, a doctor prescribes iron preparations, with high arterial pressure - hypotensive means. Antipyretic and other drugs can also be appointed.
In addition, the doctor can be appointed additional preparations that increase the action of the main treatment. It is often used phytotherapy of such a disease as chronic pyelonephritis. Treatment of herbs should not accompany the acute stages of the disease, and the dosage and frequency of intakes are prescribed by a strictly expert. Unlike major drugs, phytosborg is prescribed by a course of several months, and also apply to prevention. To herbs having a therapeutic effect on kidney diseases include:
- tolokhanka;
- a lingonberry (has a diuretic effect, effective at edema);
- blueberries;
- birch leaf;
- licorice;
- field Horsetail;
- corn storks and others.
In addition to the main method of admission of infusions, there is also a method of taking a bath with herbs - chamomile, St. John's wort, parsley - these herbs have an antiseptic effect.
Therapy also must be accompanied by a number of recommendations for drinking regime and diet. In the event that high blood pressure and edema is observed, the number of non-carbonated fluid consumed can be increased to 3 liters per day. If the above symptoms are there, the volume can be 2 liters. You can use juices, frost, water, herbal teas.
As for the diet, the use of coffee, sharp, salt, too seasoned dishes should be avoided. The daily rate of salt is 6 grams. It is important to eat food having the right ratio of fats, carbohydrates, proteins. It is desirable to receive fermented milk products - ryuzhki, yogurt, bifoxifier - besides its positive effect on treatment, they are also designed to restore the operation of the gastrointestinal tract, impaired by taking antibiotics, and avoid dysbacteriosis. The use of low-fat beef, chicken, rabbit, eggs, as well as low-fat boiled fish, croup, vegetables are allowed. In general, the diet is aimed at ensuring that the body gets easily-friendly food, it contributes to the speedy recovery and increase the resistance to detrimental effects.
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