- This is a chronic nonspecific bacterial inflammation, proceeding mainly with the involvement of the interstitial tissue of the kidneys and the calyx-pelvic complexes. It manifests itself as malaise, dull back pain, low-grade fever, dysuric symptoms. In the process of diagnosis, laboratory tests of urine and blood, ultrasound of the kidneys, retrograde pyelography, scintigraphy are carried out. Treatment consists in adhering to a diet and a gentle regimen, prescribing antimicrobial therapy, nitrofurans, vitamins, and physiotherapy.
ICD-10
N11 Chronic tubulointerstitial nephritis
General information
Causes
The etiological factor causing chronic pyelonephritis is the microbial flora. Mostly these are colibacillary bacteria (para-intestinal and Escherichia coli), enterococci, Proteus, staphylococci, Pseudomonas aeruginosa, streptococci and their microbial associations. L-forms of bacteria, which are formed as a result of ineffective antimicrobial therapy and changes in the pH of the environment, play a special role in the development of the disease. Such microorganisms are distinguished by resistance to therapy, difficulty in identification, the ability to persist for a long time in the interstitial tissue and to be activated under the influence of certain conditions.
In most cases, chronic pyelonephritis is preceded by an acute attack. There are cases of a combination of pyelonephritis with chronic glomerulonephritis. Chronization of inflammation is facilitated by:
- unresolved disorders of urine outflow caused by kidney stones, ureteral stricture, vesicoureteral reflux, nephroptosis, prostate adenoma;
- other bacterial processes in the body (urethritis, prostatitis, cystitis, cholecystitis, appendicitis, enterocolitis, tonsillitis, otitis media, sinusitis, etc.);
- general somatic diseases (diabetes mellitus, obesity), states of chronic immunodeficiency and intoxication.
In young women, the impetus for the development of chronic pyelonephritis may be the onset of sexual activity, pregnancy or childbirth. In young children, the disease is often associated with congenital anomalies (ureterocele, bladder diverticula) that impair urodynamics.
Classification
Chronic pyelonephritis is characterized by three stages of inflammation in the renal tissue.
- At stage I, leukocyte infiltration of the interstitial tissue of the medulla and atrophy of the collecting ducts is found; renal glomeruli are intact.
- At stage II of the inflammatory process, there is a cicatricial-sclerotic lesion of the interstitium and tubules, which is accompanied by the death of the terminal sections of the nephrons and compression of the tubules. At the same time, hyalinization and desolation of the glomeruli, narrowing or obliteration of the vessels develop.
- In the final, stage III, renal tissue is replaced by scar tissue, the kidney is reduced in size, looks wrinkled with a bumpy surface.
According to the activity of inflammatory processes in the renal tissue in the development of chronic pyelonephritis, 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 into remission or again into active inflammation. The remission phase is characterized by the absence of clinical signs of the disease and changes in urinalysis. According to clinical development, an erased (latent), recurrent, hypertensive, anemic, azotemic form of pathology is distinguished.
Chronic pyelonephritis symptoms
The latent form of the disease is characterized by poor clinical manifestations. Patients are usually worried about general malaise, fatigue, low-grade fever, headache. Urinary syndrome (dysuria, back pain, edema) is usually absent. Pasternatsky's symptom may be mildly positive. There is a slight proteinuria, intermittent leukocyturia, bacteriuria. Violation of the concentration function of the kidneys is manifested by hypostenuria and polyuria. Some patients may have mild anemia and moderate hypertension.
The recurrent variant of chronic pyelonephritis proceeds in waves with periodic activation and abatement of inflammation. The manifestations of this clinical form are the severity and aching lower back pain, dysuric disorders, and periodic fever. In the exacerbation phase, the clinic of a typical acute pyelonephritis develops. With progression, hypertensive or anemic syndrome may develop. In the laboratory, especially during exacerbation, severe proteinuria, persistent leukocyturia, cylindruria and bacteriuria, and sometimes hematuria, are determined.
In the hypertensive form, the hypertensive syndrome becomes predominant. Arterial hypertension is accompanied by dizziness, headaches, hypertensive crises, sleep disturbances, shortness of breath, pain in the heart. Hypertension is often malignant. Urinary syndrome, as a rule, is not expressed or is intermittent. The anemic variant of the disease is characterized by the development of hypochromic anemia. Hypertensive syndrome is not expressed, urinary syndrome is unstable and meager. In the azotemic form, cases are combined when the disease is detected only at the stage of chronic renal failure. Clinical and laboratory data of the azotemic form are similar to those in uremia.
Diagnostics
The difficulty in diagnosing chronic pyelonephritis is due to the variety of clinical variants of the disease and its possible latent course. Diagnostic tactics include:
- Urine tests. In the general analysis of urine, leukocyturia, proteinuria, cylindruria are detected. The study of urine according to the Addis-Kakovsky method is characterized by the predominance of leukocytes over other elements of the urinary sediment. Bacteriological urine culture helps to identify bacteriuria, identify the causative agents of chronic pyelonephritis and their sensitivity to antimicrobial drugs. To assess the functional state of the kidneys, tests of Zimnitsky, Reberg, biochemical analysis of blood and urine are used.
- General blood analysis. In the blood, hypochromic anemia, accelerated ESR, neutrophilic leukocytosis are found.
- Instrumental research. The degree of renal dysfunction is clarified using chromocystoscopy, excretory and retrograde urography, nephroscintigraphy. A decrease in the size of the kidneys and structural changes in the kidney tissue are detected by ultrasound, MRI and CT of the kidneys. Instrumental methods objectively indicate a decrease in the size of the kidneys, deformation of the pyelocaliceal structures, and a decrease in the secretory function of the kidneys.
- Kidney biopsy. In clinically unclear cases of chronic pyelonephritis, a kidney biopsy is indicated. Meanwhile, the sampling during a biopsy of unaffected renal tissue can give a false negative result in the morphological examination of the biopsy.
In the process of differential diagnosis, renal amyloidosis, chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis are excluded.
Chronic pyelonephritis treatment
Patients are shown adherence to a sparing regimen with the exclusion of factors provoking an exacerbation (hypothermia, colds). Adequate therapy for all intercurrent diseases, periodic monitoring of urine tests, dynamic observation of a nephrologist is required.
Diet
Diet recommendations include avoiding spicy foods, spices, coffee, alcoholic beverages, fish and meat broths. The diet should be fortified, containing dairy products, vegetable dishes, fruits, boiled fish and meat. It is necessary to consume at least 1.5-2 liters of liquid per day in order to prevent excessive concentration of urine and ensure urinary tract lavage. With exacerbations of chronic pyelonephritis and with its hypertensive form, restrictions are imposed on the intake of table salt. Useful cranberry juice, watermelons, pumpkin, melons.
Conservative therapy
Exacerbation requires the appointment of antibacterial therapy taking into account the microbial flora (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) in combination with nitrofurans (furazolidone, nitrofurantoin) or nalidixic acid preparations. Systemic chemotherapy is continued until the bacteriuria has ceased on laboratory results.
In complex drug therapy, vitamins B, A, C are used; antihistamines (mebhydrolin, promethazine, chloropyramine). In hypertensive form, antihypertensive and antispasmodic drugs are prescribed; with anemic - iron preparations, vitamin B12, folic acid.
Of the physiotherapeutic techniques, CMT therapy, galvanization, electrophoresis, ultrasound, sodium chloride baths, etc. have proven themselves especially well. In case of uremia, hemodialysis is required.
Surgery
Far advanced chronic pyelonephritis, not amenable to conservative treatment and accompanied by unilateral renal wrinkling, arterial hypertension, is the basis for nephrectomy.
Forecast and prevention
With a latent chronic variant of inflammation, patients remain able to work for a long time. In other forms, the ability to work is sharply reduced or lost. The timing of the development of chronic renal failure is variable and depends on the clinical variant of chronic pyelonephritis, the frequency of exacerbations, and the degree of renal dysfunction. The death of a patient can occur from uremia, acute disorders of cerebral circulation (hemorrhagic and ischemic stroke), heart failure.
Prevention consists in timely and active treatment of acute urinary infections (urethritis, cystitis, acute pyelonephritis), sanitation of foci of infection (chronic tonsillitis, sinusitis, cholecystitis, etc.); elimination of local disorders of urodynamics (removal of stones, dissection of strictures, etc.); correction of immunity.
Leaks chronic pyelonephritis with alternating phases of active and latent inflammation and remission. Chronic pyelonephritis does not have such pronounced manifestations as acute, and in this regard, it is much more dangerous.
Usually, the disease occurs as a result of not fully cured acute pyelonephritis. There are cases when chronic pyelonephritis is almost asymptomatic. It can drag on for months or even years, gradually destroying the kidneys and incapacitating them. The patient has no symptoms of the disease, well, sometimes the lower back aches a little, and often the head hurts for a long time. People attribute all this to the weather or physical activity. They are not alarmed by fluctuations in blood pressure. Many simply try to bring it down on their own, without going to the doctor.
There are the following forms of chronic pyelonephritis.
By occurrence:
Primary - not associated with any
urological disease
Secondary - developing on the basis of lesions of the urinary tract.
By localization of the inflammatory process:
Unilateral,
Bilateral,
Total - affecting the entire kidney,
Segmental - affecting part of the kidney.
According to the clinical picture:
Latent,
Recurrent
Hypertensive
Anemic
Azotemicheskaya,
Hematuric.
With a latent form chronic pyelonephritis is characterized by an unclear clinical picture - general weakness, headache, quickly get tired. High fever is rare. Violation of urination, pain in the lumbar region and edema, as a rule, are absent, but sometimes Pasternatsky's symptom appears. There is a small amount of protein in the urine, and the number of leukocytes and bacteria changes. In addition, the latent form is usually accompanied by impaired renal function, primarily their concentration ability, which manifests itself in increased urine formation and hypostenuria - urine excretion with a low specific gravity.
Patients with a latent form of chronic pyelonephritis can remain able to work for a long time. The admission to work is limited only by high arterial hypertension and is completely excluded in case of its malignant course, as well as in violation of the nitrogen-excreting function of the kidneys.
With a recurrent form of chronic pyelonephritis, alternating periods of exacerbations and remissions are characteristic. Patients have constant discomfort in the lumbar region, the process of urination is disrupted, and after a chill, the temperature may suddenly rise, signs of acute pyelonephritis appear.
As the recurrent form intensifies, symptoms of certain diseases begin to prevail.
In some cases, hypertensive syndrome may develop with its characteristic symptoms - headaches, dizziness, disturbances, pain in the region of the heart, etc.
In other cases, anemic syndrome becomes predominant - general weakness, fatigue, shortness of breath. In the future, chronic renal failure develops.
With an exacerbation of the disease, pronounced changes in the composition of urine occur - proteinuria, leukocyturia, cylindruria, bacteriuria and hematuria are possible. As a rule, in the patient's blood, ESR increases and the number of neutrophils increases (neutrophilic leukocytosis).
Hypertensive form of chronic pyelonephritis characterized primarily by the presence of hypertension. Patients are worried about dizziness, headaches, as well as pain in the heart, shortness of breath. They have insomnia and hypertensive crises. Hypertension is often malignant. Violations in urination usually do not occur.
Anemic form of chronic pyelonephritis characterized by the fact that symptoms of anemia prevail among the symptoms of the disease - a decrease in the number of full-fledged red blood cells. This form of the disease in patients with chronic pyelonephritis occurs more often, is more pronounced than in other kidney diseases, and is usually hypochromic in nature. Disturbances in urination are weak.
To the azotemic form of chronic pyelonephritis include those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of the already existing, but not timely detected latent course of the disease. It is the azotemic form that is characteristic of chronic renal failure.
Hematuric form of chronic pyelonephritis known for repeated attacks of macrohematuria and persistent microhematuria, which is associated with venous hypertension, which contributes to the disruption of the integrity of the vessels of the fornic zone of the kidney and the development of fornical bleeding.
Chronic pyelonephritis usually develops for 10-15 years or more and ends with wrinkling of the kidneys. Shrinkage occurs unevenly with the formation of rough scars on the surface. If only one of the kidneys shrinks, then, as a rule, compensatory hypertrophy and hyperfunction of the second kidney is observed. That is, within a few weeks, the mass of the remaining kidney increases, and it takes over the functions of the diseased kidney. At the final stage of chronic pyelonephritis, when both organs are affected, chronic renal failure develops.
DIAGNOSTICS OF CHRONIC PYELONEPHRITIS
Chronic pyelonephritis is recognized on the basis of:
Anamnesis data (medical history),
Existing symptoms
The results of leukocyturia - studies of urinary sediment according to the Kakovsky-Addis method,
Quantitative detection of active leukocytes in urine, called Steenheimer-Malbin cells,
Bacteriological analysis of urine,
Kidney biopsy.
It is often not possible to identify chronic pyelonephritis and accurately determine the form of its course in time, especially in a polyclinic due to the variety of clinical manifestations of the disease and with a relatively frequent latent course.
Also, if chronic pyelonephritis is suspected, a general blood test is done to determine the residual nitrogen, urea and creatinine in it, the electrolyte composition of blood and urine is detected, and the functional state of the kidneys is examined.
Using the X-ray method, changes in the size of the kidneys, deformation of their pelvis and calyxes, violation of the tone of the upper urinary tract are established, and radioisotope renography allows you to obtain a graphic image and evaluate the functional state of each organ separately.
An additional research method for the diagnosis of chronic pyelonephritis is used intravenous and retrograde pyelography and scannography, ultrasound examination of the kidneys, chromocystoscopy.
It is necessary to distinguish chronic pyelonephritis from chronic glomerulonephritis, amyloidose, hypertension, diabetic glomerulonephritis.
In contrast to chronic pyelonephritis, chronic glomerulonephritis is characterized by an increased concentration of red blood cells in the urinary sediment, the absence of active leukocytes and the presence of microbes in the urine. Amyloidosis can be recognized by the presence of foci of chronic infection, scarcity of urinary sediment (there are only single leukocytes, erythrocytes and casts, no sugar at all), as well as by the absence of bacteriuria and radiological signs of pyelonephritis.
Hypertonic disease more often observed in older people, proceeds with hypertensive crises and, more pronounced sclerotic changes in the coronary, cerebral vessels and aorta. Patients with essential hypertension do not have leukocyturia, bacteriuria, a pronounced decrease in the relative density of urine, characteristic of chronic pyelonephritis, and changes inherent in chronic pyelonephritis are not revealed in X-ray and radiographic studies. With diabetic glomerulosclerosis, the patient has signs, as well as other symptoms of diabetic angiopathy - generalized damage to the blood vessels.
TREATMENT OF CHRONIC PYELONEPHRITIS
The treatment for chronic pyelonephritis is at least four months. If the disease proceeds without complications, therapy can be shortened on the recommendation of a doctor.
Every month the patient is given a urine test and an antibiogram. If the white blood cell count is still higher than normal, the drug should be replaced. Sometimes it happens that within a month after the start of treatment, the tests are normal. But this does not mean at all that the disease has passed and the kidneys are out of danger. In no case should you quit treatment.
Antibiotic therapy is currently the main treatment for chronic pyelonephritis. Taking antibiotics is started only after the causative agent of the infection has been identified and its sensitivity to drugs has been determined. Antibiotics are usually indicated that suppress gram-negative flora. The doctor should prescribe only those drugs that do not have a toxic effect on the kidneys. Treatment takes place with regular laboratory monitoring of the sensitivity of the microflora to the antibiotic.
A good therapeutic effect with a low probability of relapses and side reactions is provided by modern antibiotics of the fluoroquinolone series: ciprofloxacin, norfloxacin, levoflox-sacinpefloxacin; cephalosnorins: cephalexin, cefuroxime, cephenime, semi-synthetic penicillins with beta-lactamase inhibitors augmentin, unazine.
The use of non-steroidal anti-inflammatory drugs that prevent the formation of blood clots in the vessels is also suggested for the complex treatment of chronic pyelonephritis. It can be aspirin, movalis, voltaren, ibu-profen and others. To improve microcirculation in the kidneys, patients take courantil, tren-tal or venoruton, and to activate the renal circulation - urolisan, cystenal, olimetzn, uroflux.
The doctor can prescribe immunocorrective agents in case of severe disease and complications, especially in the elderly. If a chronic urinary tract infection is detected, peptide bioregulators are prescribed.
So that taking antibiotics, especially powerful ones (the so-called fourth row), does not lead to intestinal dysbiosis, a fermented milk diet must be followed throughout the course of treatment. But if dysbiosis nevertheless appeared, then to restore the intestinal microflora about a week before the end of the main therapy, it is necessary to start taking bifidumbecterin. In difficult cases, your doctor may prescribe antifungal medications.
Prevention of the development of chronic pyelonephritis and its complications is possible only with constant supervision of the patient by a urologist. Control tests and studies should be done at least three times a year. During this period, the patient at work should not have heavy physical activity, hypothermia, high humidity, such people should not work the night shift. Patients are removed from the register if they have no signs of exacerbation of chronic pyelonephritis within two years.
The diagnosis "Chronic pyelonephritis" is made when 90 days have passed since the onset of the disease or there have been repeated exacerbations. The pathological process is characterized by a permanent form with manifestations, as well as the disappearance of signs. This article examines the features of the treatment of chronic pyelonephritis with the weakening of clinical symptoms - remission.
Distinguish between complete and incomplete disappearance of signs of the disease. In the latter case, part of the symptoms of renal inflammation does not go away due to an unsuccessfully chosen treatment strategy or the presence of concomitant diseases. In such a situation, we are talking about chronic secondary pyelonephritis.
The inflammation changes the kidney. Therefore, with the onset of remission, treatment cannot be stopped.
Causes of secondary pyelonephritis
Secondary inflammation of the kidneys is characterized by a tendency to relapse and occurs under the influence of the following harmful factors:
- Inaccurate diagnosis.
- Incomplete destruction of pathogens. Premature discontinuation of antimicrobial agents by the patient. The emergence of antibiotic-resistant bacterial races.
- The presence of chronic forms of concomitant diseases.
Treatment
The treatment strategy for the disappearance of clinical symptoms or partial relief is different.
Remission stage
Chronic pyelonephritis in remission does not bother a person. The clinical symptoms disappeared. Indicators of blood components, as well as urine, do not go beyond the normal limits. However, the occurrence of an infectious disease, a cold, a violation of nutritional parameters can resume the pathological process. Therefore, the treatment is not stopped, but is limited to diet therapy and the use of herbal remedies.
Melons and watermelons are good for pyelonephritis.
Special nutrition during this period is not required, but the restriction of salty, smoked, spicy, fatty, canned foods remains in force. It is not recommended to abuse tobacco, drinks containing caffeine and ethanol. Drinking plenty of fluids is encouraged, as well as eating watery gourds - melons and watermelons.
Decoctions of medicinal plants, their preparations in the form of a paste, extracts or pills sanitize the urinary tract, prevent the reproduction of the secondary microflora.
The method of passive renal gymnastics has been developed. It involves the infusion of a diuretic, for example, Furosemide, which causes cleansing polyuria, followed by a gentle regimen, which helps to accelerate scarring of defects and restore the filtering function of the kidneys.
Incomplete remission stage
Chronic pyelonephritis with incomplete remission is a consequence of delayed treatment of manifest inflammation, the presence of concomitant ailments or congenital pathologies. In this case, it is necessary to prevent exacerbation.
Diet therapy seems to prohibit the use of foods that are limited in case of complete remission. Alternative diets are used to prevent the formation of kidney stones. Initially, products are used that acidify urine for 2 ... 3 days, containing bakery, egg and meat foods. Then an alkalizing diet is used, in which milk, fruits, and vegetables take the leading position.
The use of herbal uroseptics is not enough. They conduct courses of treatment with nitrofurans, antibiotics, sulfonamides, changing drugs.
Nitrofuran antimicrobial drugs are in demand in the treatment of pyelonephritis
Conclusion
In chronic pyelonephritis, it is important to keep pathological processes in the phase of weakening of clinical symptoms - remission, avoiding exacerbations. The main techniques are diet therapy and the elimination of secondary microflora.
- infectious and inflammatory kidney disease, with a predominant localization in the tubulointerstitial zone.
Urologists are often faced with this pathology, 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
Primary chronic pyelonephritis is distinguished, for its development, the primary cause is the defeat of the microbial flora. There are no obstacles to the outflow of urine.
Secondary chronic pyelonephritis develops against the background of diseases leading to impaired urodynamics:
- anomalies in the development of the structure of the organs of the genitourinary system;
- nephrourolithiasis;
- narrowing of the ureter;
- reflux;
- retroperitoneal sclerosis;
- hypotonic neurogenic disorders of the bladder;
- sclerosis of the bladder neck;
- hyperplasia of the prostate and sclerotic changes;
- malignant and benign formations.
Pyelonephritis is unilateral and bilateral.
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 an exacerbation. The patient complains of being blunt. Dysuric disorders are uncommon but may be present. Of the general symptoms, the following are noted:
- weakness, apathy;
- decreased performance;
- heaviness in the lower back;
- an unreasonable rise in temperature to 37 - 37.2 degrees.
If the process is complicated by accession, then there are signs of loss of the functional ability of the kidneys.
In the latent phase or in the remission phase, there are no manifestations, and when making a diagnosis, laboratory data are taken into account.
The following are considered predisposing factors for the development of chronic pyelonephritis:
- immunodeficiency states;
- in severe form;
- infectious diseases;
- gestation;
- history of diseases of the urogenital tract;
- foci of chronic infection (, etc.);
- operations on the organs of the urinary system.
Physical examination reveals pain on palpation of the kidney / kidneys, a positive symptom of tapping in the lumbar region. With a long-standing process, there may be polyuria (an increase in the daily amount of urine).
With secondary chronic pyelonephritis against the background of kidney abnormalities, an increase in blood pressure is often noted.
Laboratory and instrumental examination methods
You can use decoctions of diuretic and anti-inflammatory herbs:
Sanatorium treatment in Pyatigorsk, Truskavets, Essentuki, Zheleznovodsk is possible only during the period of remission.
If a patient has chronic pyelonephritis accompanied by an increase in blood pressure, then salt is limited to 5-6 g / day. Liquids can be drunk up to 1000 ml.
With nephrogenic hypertension supported by chronic pyelonephritis, ACE inhibitors are prescribed, since an increase in pressure is associated with an increase in renin in the blood.
In case of intolerance due to side effects, angiotensin II receptor antagonists are used.
Management of patients with exacerbation of chronic pyelonephritis with some concomitant pathology
If the patient has a concomitant disease with diabetes mellitus, then aminopenicillins and ciprofloxacins are used.
For patients with chronic renal failure, drugs with a hepatic or dual route of excretion are selected:
- Pefloxacin;
- Ceftriaxone;
- Cefoperazone.
A competent choice of antibacterial drugs ensures the safety of use and simplifies the selection of the dosage.
Patients with chronic renal failure are not prescribed aminoglycosides and glycopeptides, due to their nephrotoxicity.
In patients and persons suffering from drug addiction, the causative agent of pyelonephritis may be uncharacteristic. Preference is given to fluoroquinolones (levofloxacin), aminoglycosides and cephalosporins, since they are not metabolized in the body and are excreted by the kidneys.
Exclusion from the cephalosporin group:
- Cefatoxime;
- Cefoperazone;
- Ceftriaxone.
Exacerbation of chronic pyelonephritis associated with resistant hospital strains of bacteria is extremely rare. This may be a complication of medical procedures or a history of inadequate antibiotic use.
In these cases, Ceftazidimi and Amikacin are used.
Cefazidime is prescribed as the only antibiotic or in combination with Amikacin.
Carbapenems are considered reserve drugs (with the exception of ertapenem).
Surgery
The indications for surgery are all violations of the outflow of urine.
If chronic pyelonephritis is complicated by the formation of an apostem or a carbuncle of the kidney, an operation is performed in the volume of decapsulation, followed by the installation of a nephrostomy drainage.
In the most advanced cases, they resort to nephrectomy.
Chronic pyelonephritis is inflammation in the kidneys, which, as a rule, is concomitant with any obstructive pathology in the urinary tract, but may be the result of improper therapy for acute pyelonephritis.
The most important reasons for the transition of acute inflammation to the chronic phase:
Timely undiagnosed and uncorrected disturbance of urodynamics in nephrolithiasis, urinary tract stricture, prostate adenoma, vesicoureteral reflux, nephroptosis, etc.
Improper treatment, including too short a course.
Lack of systematic long-term follow-up.
The formation of resistant forms of bacteria that can persist asymptomatically in the renal tissue in an inactive state, and the progression of pathogenic microflora against the background of a decrease in the immune system.
Chronic severe extragenital pathology (diabetes mellitus, systemic diseases, HIV infection, caries, tonsillitis, tumor pathology.
All types of immunodeficiency pathologies.
Injuries and operations on the organs of the genitourinary system.
Where does chronic pyelonephritis come from in children?
Chronic pyelonephritis sometimes begins in childhood, more often in girls, who are more susceptible to the inflammatory process due to anatomical features.
The chronization of the process is preceded by an attack of acute pyelonephritis.
During or immediately after acute infectious and viral diseases (flu, tonsillitis, acute respiratory viral infections, pneumonia, otitis media), a new exacerbation of inflammation in the kidneys occurs, which is disguised as these diseases, especially in childhood, and remains unnoticed (chronic latent pyelonephritis). The weakening of the body is aggravated by infectious processes and inadequate antibiotic therapy.
In the future, such a child is doomed to the undulating course of the pathological process, where the stage of remission will be replaced by the stage of exacerbation.
Chronic pyelonephritis in children often develops against the background of postoperative conditions for plasty of the pelvic-ureteric segment due to stricture. Parents should work out a common position with the doctor, be sure to go through an ultrasound scan with the baby, get tested, not violate the principles of nutrition for pyelonephritis, avoid hypothermia, strengthen the immune system, and monitor the daily routine. In this case, with timely performed plastic surgery, it is possible that remission will be stable, and there will be no exacerbations.
The clinical course of chronic pyelonephritis
ICD code - 10 N 11.8
Chronic pyelonephritis for years can proceed without any pronounced symptoms, in the form of smoldering inflammation in the interstitial renal tissue. The manifestations of chronic pyelonephritis depend on the activity, degree and stage of inflammation in the kidneys.
Classification of pyelonephritis
Chronic pyelonephritis is unilateral and bilateral, in remission or exacerbation. Even chronic pyelonephritis is assessed by the preservation or loss of the functional ability of the kidneys: with or without impaired function.
An important criterion is the assessment of changes in the analysis of urine.
Distinguish between laboratory remission, incomplete laboratory remission and active process.
Etiology of pyelonephritis
Pyelonephritis is caused by:
1. Intestinal Escherichia,
2. Enterococcus,
3. Protect,
4. Staphylococci,
5. Streptococci
6. L-forms of bacteria (recurrence of pyelonephritis),
7. Mycoplasma,
8. Leptospira,
9. Mushrooms.
In 1/3 of patients with acute pyelonephritis and in 2/3 of patients with chronic pyelonephritis microflora is mixed. In 30% of cases, the pathogen is not sown - this does not exclude an infectious process.
Diagnostics of the chronic pyelonephritis
In diagnostics, a competent and fully collected anamnesis is a significant help.
The patient is carefully questioned about diseases of the urogenital tract organs in childhood, the date of the last exacerbation is found out, what medications were taken, what concomitant diseases are.
In women, they find out what changes were during pregnancy on the part of the genitourinary system, whether there were episodes of chronic cystitis.
In men with chronic pyelonephritis, attention should be paid to the severity in the lumbar region, to find out about injuries of the urethra, bladder, and the condition of the prostate gland.
Abnormalities in the development of the kidneys and urinary tract,
uronephrolithiasis,
prolapse of the kidney,
MKB and others.
Signs and symptoms of chronic pyelonephritis
There is no pronounced symptomatology in the chronization of the process in the kidneys, unless we are talking about an exacerbation. Nevertheless, it is necessary to pay attention to the following non-specific symptoms:
Pulling back pain
weakness, apathy,
lack of appetite and weight loss,
the likely appearance of morning puffiness in the eyelid area,
excessive dry skin and brittle nails,
dysuric disorders
temperature rise in the evening.
If these signs appear, make an appointment with your doctor immediately.
What happens in the analyzes for chronic pyelonephritis
Pyuria is the first diagnostic sign of chronic inflammation in the kidneys (an increased number of leukocytes in the urine). Periodically, protein is found in the urine (proteinuria).
Note that it is impossible to judge the stage of inflammation only by the presence of leukocyturia. First you need to make sure of the source of pyuria.
In men, leukocytes can enter the urine with concomitant inflammation in the prostate or urethra, in women - in the bladder or vagina. Therefore, it will be reasonable to conduct a 2-glass test, which will help to clarify where the leukocytes came from in the urine.
One should not be limited to one general urine analysis, it is necessary to prescribe a Nechiporenko test, since in chronic inflammation in the clinical analysis of urine pathology was not found, and there are leukocytes in the Nechiporenko sample, which is a confirmation of inflammation and requires antibacterial therapy.
In the clinical analysis of blood, hemoglobin is sometimes reduced. Leukocytosis and ESR - signs of acute inflammation - are not typical for a chronic process.
In 25% of patients with a long-term disease, the level of urea and creatinine in the blood is higher than normal.
Zimnitsky's test may indirectly indicate the loss of the functional ability of the kidneys.
The urine is collected every 3 hours in a separate container. Estimate the quantity and specific gravity
There are special tests to confirm the diagnosis of chronic pyelonephritis, however, in modern nephrology, when many instrumental research methods are available, they are not often used.
The patient is given a single dose of Pyrogenal or Prednisolone. It is believed that these drugs will provoke the release of active leukocytes and Sternheimer-Malbin cells.
Instrumental diagnostics of chronic inflammation in the kidneys
Chronic pyelonephritis is diagnosed by the following methods:
X-ray examination of the kidneys: intravenous and infusion urography. Pyelonephritis is characterized by an increase in the renal-cortical index (> 4), as well as a decrease in the thickness of the renal parenchyma at the poles (Hodson's symptom).
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 contrast highlighting.
Changes in the architectonics of the kidneys.
Expansion of the pelvis.
Hodson's symptom (if the cups of a healthy kidney are located along a symmetrical line, then during chronicity the distance between the cups and the contour of the kidney is different and the line connecting them is incorrect).
With a standard picture of pyelonephritis, a decrease in the size of one of the kidneys, an increase in the density of the shadow and the vertical axis, at the site of the affected kidney, are visualized.
Excretory urography is a method for diagnosing chronic inflammation in the upper urinary tract. X-ray signs of pathology are diverse, and the asymmetry of changes depends on the ratio of areas of inflammation and areas of sclerosis.
Retrograde pyelography is less commonly used because there is a possibility of a hospital-acquired infection of the kidneys.
Chronic pyelonephritis is characterized by gradual atrophy of the renal parenchyma, which can be more accurately determined using 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 assess changes during therapy over time.
Dynamic scintigraphy determines the quantity and quality of the functional renal parenchyma in chronic inflammation.
The method is more accurate in comparison with excretory urography, since sometimes there is no renal dysfunction on urograms, and dynamic scintigraphy gives a clear picture of the presence of changes.
Signs of chronic pyelonephritis on ultrasound
Signs of hydronephrotic transformation
Ultrasound of the kidneys is a non-invasive painless method of examination, when performing the study, the expansion of the renal cavities and the diffusely heterogeneous structure of the parenchyma are visible. Ultrasound helps distinguish a hypoplastic kidney from a sclerotically wrinkled kidney and diagnose many other urological pathologies.
Differential diagnosis
The differential diagnosis is carried out with urogenital tuberculosis, congenital reduced kidney and chronic glomerulonephritis.
For the tuberculous process in the kidneys, the predominance of leukocytes in the urine over microhematuria is typical. The patient is subject to examination by the urologist of the anti-tuberculosis dispensary, where he will undergo a urine test for Mycobacterium tuberculosis and excretory urography.
In the differential diagnosis of pyelonephritis and glomerulonephritis, a clarifying answer can be obtained with a careful history taking and urine examination.
Below are the main signs - the differences between pyelonephritis and glomerulonephritis.
A hypoplastic (reduced in size) kidney has clear contours, no deformation of internal cavities, and a characteristic tissue density.
Pay attention to the absence of urological diseases in the anamnesis, if there was no urological pathology, then there are more data for hypoplasia.
Features of the treatment of chronic inflammation in the kidneys
Treatment of chronic pyelonephritis in remission does not require antibiotics. To be sure that there is no inflammation, undergo an ultrasound scan, pass urine for a general analysis and a Nechiporenko test. If urine culture for growth flora does not give, as if remission. In this case, seasonal preventive therapy with uroseptics (spring - autumn) is sufficient, 10 days each and the intake of herbal remedies.
When pyelonephritis has a continuously recurrent course and is complicated by any, suppressing immunity, concomitant pathology, antibiotics are needed. In this case, with each repeated exacerbation of the disease, urine culture is performed to verify the pathogen (s) and antibiotic sensitivity.
If possible, you should definitely check the state of the immune system, and, based on the results, choose the necessary immunopreparations.
Periodic intake of herbal diuretics helps to remove pathogenic microorganisms from the organs of the urinary system and has an anti-inflammatory effect.
Don't forget about proper nutrition.
During the period of remission, treatment with mineral waters is indicated: Zheleznovodsk, Truskavets.
Chronic pyelonephritis prognosis
In chronic pyelonephritis, the prognosis for life depends on a number of factors:
Unilateral or bilateral defeat.
There are any complications of pyelonephritis (chronic renal failure, nephroangiosclerosis, secondarily - a wrinkled kidney).
How quickly the disease progresses.
How long ago the diagnosis was made.
The presence of concomitant urological pathology (nephrolithiasis, large prostate adenoma with symptoms of bladder outlet obstruction, renal cysts).
Does the patient follow all the doctor's recommendations.
Whether the patient is planning a pregnancy with existing chronic kidney inflammation.
How deeply the process has spread.
What is the patient's lifestyle.
Secondary chronic pyelonephritis more often leads to the addition of chronic renal failure.
In any case, the development of complications of chronic pyelonephritis can be prevented by correct behavior and competent preventive measures.
Home treatment
Let us make a reservation that with an exacerbation of chronic pyelonephritis, all appointments are made by the doctor, it is very dangerous to treat an acute process in the kidneys only with herbs. As a preventive measure, taking herbal preparations will promote remission.
So what can you do at home.
Dill seeds
2 tablespoons of dry dill seeds pour 400 ml of water, simmer over low heat for 25 minutes.
Take 100 ml 3 times a day - 10 days of each month, for a long time.
Herbal collection
Ingredients:
2 tablespoons chopped strawberry leaf
1 tablespoon chamomile
1 tablespoon horsetail
1 tablespoon dill seeds
Pour the herbal mixture with 500 ml of water, boil for 25 minutes, strain, add up to 500 ml of boiling water, cool and take 2/3 cup 3 times a day for a course of 14 days.
It is known that the inflammatory process is supported by tissue malnutrition (ischemia). To improve microcirculation, you can use the following recipe.
Tincture of chestnuts with vodka
Take 5 fresh chestnuts, grind them, pour 250 ml of vodka, seal the container tightly and remove for 14 days in a dark cool place, shake the tincture every 3 days.
Strain through a sieve, take 15 drops 3 times a day for 10 days.
Store in a cool place.
Cranberry juice on lingonberry leaves with honey
Prepare a decoction from the crushed lingonberry leaves at the rate of 1 tablespoon per 200 ml of water, cool to a temperature of about 80-90 C.
Crush the cranberries with a wooden mortar, add honey to taste and pour over the lingonberry leaf broth.
You can take it in the form of a drink, sometimes it is worth interrupting for 20 days so that there is no addiction.
genitalhealth.ru
Reasons for education
Like any disease, chronic pyelonephritis has its beginning and is due to:
- metabolic disorders in the body, hypovitaminosis;
- low immunity protection;
- overwork, fatigue, systematic lack of sleep;
- hypothermia of the body;
- defeat by infections;
- the anatomical structure of the body;
- prostate adenoma or hormonal disruptions (changes occur during pregnancy, childbirth, deprivation of virginity, androgen deficiency);
- congenital anomalies (typical for a child).
The causes of pyelonephritis can be a large set of factors that cannot be foreseen in advance. It is recommended to periodically undergo an examination, take a urine test, especially at a time when there is a risk of pyelonephritis.
Disease classification
Depending on a number of factors, chronic pyelonephritis can be classified in different ways. Given the causes of the formation of the disease, pyelonephritis is primary, secondary, obstructive, non-obstructive. Based on the location of the infection, pyelonephritis can be unilateral or bilateral. According to the stage of the inflammatory process, it is divided into active, latent, in remission. By severity, it is categorized into uncomplicated and complicated pyelonephritis. All these factors, their presence or absence, allow to determine the degree of the disease, as well as to choose the optimal treatment for adults and children.
Symptoms of pyelonephritis
The severity of the disease depends on the form of its course. Therefore, the symptoms of pyelonephritis are characterized in different ways. Pyelonephritis makes itself felt suddenly accompanied by:
- pulling, aching pain in the back;
- an increase in body temperature;
- sleep disturbance;
- a change in the color of urine, its smell, transparency;
- the appearance of edema, renal pressure;
- urinary syndrome.
When diagnosing pyelonephritis, symptoms are divided into local (latent, recurrent) and general (early, late). Each of the forms has its own indicators, characteristics, types, manifestations.
Latent
This form has mild symptoms. It is accompanied by a low (37 °) body temperature, headache. Waist pain, swelling may be absent. The condition can lead to the occurrence of anemia, hypertension. The malaise is accompanied by excessive urination, speaks of impaired renal function.
Anemic
In this case, the number of red cells in the blood sharply decreases, which provokes anemia. With a lack of a special substance that the kidneys produce, a violation of hemoglobin synthesis begins to occur. In this case, general symptoms may be mild, which will complicate self-diagnosis, a laboratory examination will be required. The anemic form of the disease is common in people with pyelonephritis.
Hypertensive
The work of the kidneys directly depends on the level of pressure necessary for vital activity. If the blood flow of the kidneys is disturbed, a hormone called renin begins to be released into the body in increased doses, mixed with other components and hormones. Subsequently, there is a narrowing of the vessels of the kidneys, blood circulation is disturbed, and in the end result, pressure destabilization. In chronic pyelonephritis, the kidney tissues are destroyed, they are depleted, and there is a serious violation in the structure of the organs. Because of this, depressive substances cease to be produced, arterial hypertension begins. Symptoms in hypertensive form are expressed in headaches, shortness of breath, dizziness, pain in the heart.
Azotemic
The latent course of the disease is poorly expressed, it is not always possible to quickly determine the causes and, as a result, diagnose the disease. If you ignore the course of the disease when the first symptoms appear, then the risk of complications is high. The azotemic form of the disease implies a stage when the process of renal failure occurs. The reason is the inability of the kidneys to remove 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.
Recurrent form
This is a repetition, when, after the process of inflammation subsides, the weakening of symptoms, an exacerbation occurs again. It can be more pronounced, stronger, accompanied by a feverish state. This condition is classified as secondary pyelonephritis.
Diagnosing kidney disease
It is quite difficult to identify the presence of a disease, and even without obvious signs and suspicions. To determine pyelonephritis, carry out the following:
- general urine analysis;
- biochemical analyzes of blood and urine;
- Kidney ultrasound, magnetic resonance imaging, X-ray studies.
Changes to blood test results
In the presence of a disease, uniform changes in blood elements occur. Such deviations make it possible to diagnose the disease, to identify the degree of complication or development. When analyzing blood, the level of hemoglobin, the number of erythrocytes, their sedimentation rate, hematocrit (the ratio of red cells to plasma volume) are examined. If a person suffers from pyelonephritis, then the results will show a decrease in the number of blood cells, hemoglobin, hematocrit. The ESR indicator begins to increase in inverse proportion.
The general analysis shows the number, characteristics of specific cells, therefore, a biochemical blood test is prescribed to study the biologically significant components of the plasma.
Changing the properties of urine
Accurate data on the presence of the disease can be obtained from the study of urine analysis. Indicators of urine in men and women are different, varying from 0 to 6. Deviation indicates the course of the inflammatory process. Color is an important indicator. In chronic pyelonephritis, it reaches a yellow, orange or red hue. A lack of protein in the urine is a good indicator, and an increase indicates a disease. Also, with pyelonephritis, the number of leukocytes increases, the epithelium is minimized, salt is formed in the urine, the level of the cylinders rises, they become granular.
Special laboratory tests
These tests include a complete blood count and urine test. Urine is examined according to the Nicheporenko and Zimnitsky method. The test results show the predominance of leukocytes over erythrocytes, and also allow you to determine the density of urine.
Bacteriological research
This group of examinations includes bacteriological culture and enzyme-linked immunosorbent assays. The study of the culture allows you to identify microorganisms in the urine that caused the inflammation. The examination identifies the main causative agent of the disease, which makes it possible to prescribe the correct treatment. The results of enzyme-linked immunosorbent assays supplement the information of bacteriological culture, help to more accurately identify the cause of the infection.
Instrumental research
For an accurate diagnosis, stage of the disease, determination of the state of the kidneys, and other dependent organs, studies are carried out using special medical equipment.
Ultrasound procedure
With the help of the apparatus and sound waves, you can see the work of the kidneys on the screen. During ultrasound, the state of the organs, the presence of lesions, wrinkling, compaction of the pelvis, cups, and deformation of the kidneys are visible. During the procedure, the diagnostician makes some measurements, notes the time indicators during work, and, if necessary, takes pictures with the help of the apparatus. In the future, the attending physician, thanks to the images, the data, determines the degree of chronic pyelonephritis and prescribes the appropriate treatment.
X-ray
Provides three methods of examination: plain radiography, excretory urography, computed tomography. Each of the procedures has its own goal of studying the condition of the kidneys. Depending on the initial indicators, a specific type of radiography is assigned.
Magnetic resonance imaging
Effective and one of the most expensive procedures for examining the body. With the help of an electromagnetic pulse, the atoms in the tissues of the organs react, and the sensor reads the information, which is converted into a finished image. In chronic pyelonephritis, MRI can allow examining a cyst, the formation of new kidney diseases, and examining blood vessels and tissues.
Renal angiography
Allows you to study blood vessels in the kidneys. Depending on the stage of the disease, changes occur in the vascular system. Initially, the number of small vessels decreases, leading to their complete disappearance. At the second stage, the kidney begins to shrink, reduce its size. At the last stage, the organ is wrinkled as much as possible, the vessels are deformed, and their number is reduced significantly. Thus, angiography allows you to investigate, to determine the state of the kidneys with pyelonephritis.
Differential diagnosis
When making a diagnosis, pyelonephritis is differentiated from other diseases, such as hypertension, diabetic and chronic glomerulonephritis, and renal amyloidosis. In some indicators, these diseases resemble pyelonephritis, so the doctor needs the patient's medical history, the results of all tests to determine an error-free diagnosis.
The doctor always prescribes complex treatment, because chronic pyelonephritis is characterized by unpredictability in the process of its development, course. The diet must be followed, it is necessary to adhere to the recommendations, prohibitions in nutrition. Compulsory adherence to the treatment regimen, timely administration of medications, injections. Weakening of immunity can cause inhibition of treatment or its ineffectiveness, therefore, you need to protect yourself from colds, prevent hypothermia of the body.
Drug therapy
For the treatment of pyelonephritis, antibiotics, uroseptics, antimicrobial drugs are prescribed. When prescribing, the doctor is guided by the results of analyzes, examinations, and takes into account the source of the inflammatory process. Depending on this, he selects a set of medicines, the category of which may include penicillin, cephalosporin, oxyquinoline, quinol, sulfanilamide drugs, nitrofunars. Chronic pyelonephritis for women and men is treated in the same way, there are no sex characteristics, and antibiotics with similar properties should be used for children, but with recommendations for the child. Self-selection is prohibited, the appointment is carried out only by specialists.
The duration of treatment is from two weeks to a month, and after that a course of therapy is determined in order to exclude a relapse. Therefore, it is recommended that you always have medicines on hand, which, if necessary, will help prevent an exacerbation and start therapy on time.
Surgical intervention
Sometimes it is impossible to cure with medicines, but on the contrary, the formation of purulent foci begins. Then an operation is performed, which pursues the goal of eliminating purulent formations. In severe cases, doctors may remove the affected kidney. There are several types of 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 can be accompanied by complications, both during the operation and in the postoperative period. There are also contraindications to surgery, such as cardiovascular disease. Surgical methods are an extreme measure, it will be prescribed only after a thorough, complete examination and study of the medical history.
Other effective treatments
It is advisable to include the use of folk remedies for the treatment of pyelonephritis and rest in sanatoriums among such methods. Traditional medicine is not able to lead to a complete recovery and cure of the kidneys, but it is very effective between taking medications and courses of therapy.
Home treatment
The use of diuretics, renal herbal preparations based on bearberry, black currant, horsetail, wild rose, juniper, and flax seeds will be effective. They have excellent antiseptic and diuretic properties. A powerful bactericidal effect is possessed by cranberries, from which fruit drinks are made, 0.5-1 liters of drink per day are taken. In addition to the fruit drink, you need to take methionine, which plays the role of an amino acid, affecting the synthesis of biological components of the body. In addition, such a tandem is capable of neutralizing toxic compounds. And all this is necessarily accompanied by a diet, spicy dishes, canned products are excluded from the diet. Drinking more water is recommended.
Prophylaxis
Preventive measures include a whole range of measures:
- timely treatment;
- periodic examination, testing, visiting the attending physician;
- elimination of infectious foci in the body;
- therapy of cystitis, prostatitis, epididymitis until complete recovery;
- during pregnancy, control over the appearance of pathogenic bacteria in the urine;
- extraction of stones (if necessary, through surgery);
- maintaining personal hygiene;
- the use of vitamins, trace elements, sufficient water;
- antibacterial protection.
Proper nutrition is the key to health, regardless of the presence or absence of diseases. A diet for chronic pyelonephritis is necessary, because the kidneys are directly involved in metabolism. In addition, the dietary menu will speed up the process of eliminating pathologies. Therefore, it is worth excluding spicy, fatty, spicy, salty foods. Dairy products, fruits, berries are recommended, as well as drinking at least 2 liters of clean water per day.
Drugs that improve renal blood flow
As prescribed by the doctor, it is necessary to take drugs that improve renal blood flow, such as trental, courantil, escuzan, troxveazin.
Forecast
Only timeliness, correctness of the diagnosis, the appointment of effective treatment will lead to recovery. Complications occur when metamorphosis occurs in the kidney. Depending on the stage of pyelonephritis, its complexity of treatment, the duration of diagnosis depends on the onset of remission or its absence. The prognosis also depends on the rate of progression of pyelonephritis, the presence of urological pathologies, pregnancy, as well as the patient's lifestyle, his desire to be treated. Thus, there are many factors that are responsible for the development of the disease or recovery and depend on the medical professionals as well as the patient himself.
Video about chronic pyelonephritis:
pochku.ru
Symptoms and forms of chronic pyelonephritis
The mechanism of occurrence of pyelonephritis is based on the throwing of urine affected by bacteria into the pelvis. Inflammation begins, advancing from the walls of the pelvis to the medulla and cortex of the kidneys. The disease is characterized by flaccid symptoms or their complete absence.
The picture of symptoms can vary significantly from patient to patient. This is due to the presence of some form of pyelonephritis.
In the latent form, there are no specific symptoms, but minor manifestations of the following signs are observed:
- Fatigue,
- Dull pain in the side and lower back (Pasternatsky's symptom),
- Slight rise in temperature
- Headache,
- General malaise.
Sometimes the clinic is also characterized by a slight increase in blood pressure, mild anemia.
Urinalysis shows periodic sedimentation of leukocytes and bacteria.
The anemic form has already pronounced symptoms:
- tingling sensation in the region of the heart,
- dyspnea,
- pallor of the skin
- severe weakness.
The hypertensive form is characterized by arterial hypertension.
To the previous ailments are added:
- dizziness,
- insomnia,
- hypertensive crises,
- stitching pains in the heart.
The azothermic form of pyelonephritis is a disease that manifests itself already with the onset of chronic renal failure. In fact, it is an untreated latent form.
Recurrent form - phases of relapse and remission, which replace each other depending on the conditions of a person's stay.
Symptoms of this form:
- Temperature increase,
- Chills,
- Lower back discomfort
- Frequent urge to use the toilet
- Pain when urinating.
The period of exacerbation is nothing more than acute pyelonephritis. With the development of a recurrent form, hypertensive or anemic syndrome often occurs.
By the nature of the 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 incorrect therapy, is replaced by a latent state, which flows either into remission or back into the inflammatory process.
Remission is a clinical recovery, when the patient is not tormented by signs of pyelonephritis, and urine tests show no changes.
The length of the remission period depends on the therapy and the patient's lifestyle.
Causes of the disease
The first cause of chronic pyelonephritis is microorganisms that enter the active stage due to improper hygiene, improper intake of antibacterial agents, with changes in the pH environment.
The disease is caused by the most common types of bacteria:
- Proteus,
- Colibacillus,
- Staphylococci and streptococci,
- Enterococci,
- Pseudomonas aeruginosa and others.
L-types of microorganisms also affect the onset of the disease, because they can persist for a long time in human tissues and enter the kidneys with blood.
Chronic pyelonephritis can be a consequence of existing diseases:
- Urolithiasis disease,
- BPH,
- Cystitis,
- Diabetes,
- Gout,
- Obesity,
- Cholecystitis,
- Appendicitis and others.
The onset of the disease in women can be caused by pregnancy and childbirth, sex life.
Medical procedures - cystoscopy, catheterization, anesthesia and others - also often provoke the onset of the disease.
Children suffer from chronic pyelonephritis due to congenital abnormalities - ureterocele, bladder diverticula.
Http://feedmed.ru/bolezni/mochevydelitelnoj-sistemy/hronicheskiy-pielonefrit.html
Diagnostics of the primary and secondary pyelonephritis
Diagnosis is somewhat difficult, since the course of the disease is very weak. Only a detailed questioning about the symptoms and laboratory tests help to establish the correct diagnosis.
To make a diagnosis, the following diagnostic methods are used:
- General analysis of urine and blood,
- Bacteriological culture,
- Blood chemistry,
- Kidney biopsy.
For diagnostic purposes, pyelography and renography are performed. The patient is also given catheterization to determine the amount of protein and enzymes in the blood precipitated.
These methods allow you to establish the primary or secondary nature of pyelonephritis.
Primary develops in people who first complain of kidney problems.
The causes of the secondary manifestation of the disease are the same factors as in primary pyelonephritis.
Video on this topic
Disease treatment principles
Treatment requires a long time, following all the prescriptions of a specialist, adherence to proper nutrition.
The best result will bring a comprehensive treatment, ranging from eliminating the causes of the disease and ending with lifestyle changes.
The complex of therapeutic measures includes:
- Compliance with the regime,
- Diet,
- Taking antibacterial agents,
- Phytotherapy,
- Immunomodulatory therapy,
- Physiotherapy,
- Symptomatic treatment,
- Visit to the sanatorium,
- Routine treatment to avoid relapse.
Since the disease is bacterial, taking antibiotics becomes mandatory and vital. The doctor prescribes antibiotics based on the analyzes received, which reveal the sensitivity of microbes to certain drugs.
Antibiotic therapy involves taking penicillins:
- amoxicillin,
- methicillin,
- oxacillin,
Depending on the sensitivity of bacteria to antibiotics, cephalosporin drugs may be prescribed:
- cefazolin,
- ceftriaxone,
- cephalexin.
Sulfonamides are prescribed as additional antimicrobial agents:
- urolesan,
- groseptol,
- lidaprim.
With the anemic form of pyelonephritis, iron intake is indicated, and the hypertensive type of the disease requires the intake of antihypertensive drugs and antispasmodics.
After basic antimicrobial therapy, long-term relapse treatment is carried out with variable use of different antibiotics.
Surgical treatment of the disease is carried out in the case of:
- violation of the outflow of urine,
- reflux into the ureter from the bladder,
- the presence of kidney stones,
- adenoma of the prostate.
To speed up recovery and prevent relapse, patients are shown physiotherapy methods of treatment:
- electrophoresis,
- galvanization,
- sodium baths.
Healing diet food
Diet plays a large role in maintaining kidney function.
Medical nutrition implies compliance with the rules:
- Refusal of spicy, fried, pickled food, coffee, broths, alcohol;
- It is allowed to eat dairy products, cereals, stewed vegetables, fruits, lean meat, fish;
- During the day, you should drink 2 liters of water and other liquids (tea, compote, mineral water). During relapse, fluid intake should be reduced;
- In case of hypertensive form, the use of salt in food should be reduced, or salt should be abandoned altogether;
- Shown are diuretic products - melon, pumpkin.
Sometimes, alternate adherence to diets of different specifics is prescribed. For example, for several days the patient consumes acidifying food - meat, bread products. The next few days, he uses alkaline foods - vegetables, fruits, milk.
Medical nutrition should be coordinated with the attending physician, who, if necessary, makes his own adjustments to the diet.
Complications of chronic pyelonephritis
Negligence towards yourself during chronic pyelonephritis is fraught with complications.
Lack of treatment causes replacement of healthy kidney tissue with coarse connective tissue, as a result of which the organs cannot fully perform their functions.
It is important to prevent chronic bilateral pyelonephritis, as in this case, renal failure occurs.
A very dangerous complication is pyonephrosis, when the kidney is filled with thick pus.
Secondary hypertension is another complication that is difficult to treat. With a strong weakening of the body, sepsis is possible.
Chronic pyelonephritis is always easier to prevent than to cure. After all, preventive measures are quite simple - regular medical examination and control, avoidance of contact with cold surfaces, a sensitive attitude towards oneself.
If the diagnosis of chronic pyelonephritis is made, the prognosis of cure is very favorable - every 5 patient gets rid of the disease completely with proper complex treatment.
feedmed.ru
Therapy of the disease is aimed, first of all, at eliminating the main cause - the infectious pathogen. After laboratory determination of antibiotic sensitivity, the doctor prescribes antibiotic therapy using an agent from the following groups:
- Penicillins - antibiotics of this group have a wide spectrum of action, as well as low nephrotoxicity - they do not have a damaging effect on the kidneys.
- Fluoroquinolones - this group of antibacterial drugs is also characterized by a minimal effect on the kidneys, they are very effective against bacteria that provoke diseases of the urinary system, but their use is sharply limited in relation to children and women during pregnancy. They have the side effect of increasing photosensitivity and should not be accompanied by visits to the beach or solarium.
- Cephalosporins of the new generation are quite effective in the treatment of chronic pyelonephritis, but they are more often produced in a form intended for intramuscular administration, therefore, therapy is accompanied by a visit to a treatment room or is carried out in a hospital setting.
- Sulfonamides are effective in therapy only if laboratory diagnostics have confirmed the sensitivity of bacteria to this type of drugs.
- Oxyquinolines are also effective in combating diseases of the urinary tract of an infectious nature and are often used in urological practice.
- Nitrofurans have a high percentage of effectiveness, but side effects are quite pronounced, which explains their less frequent use.
Antibacterial treatment lasts up to 14 days, after which the treatment should be monitored - to retake the prescribed tests.
In the presence of appropriate indications, antispasmodics can be used for a better outflow of urine and pain relief, as well as antiplatelet agents and anticoagulants.
To improve renal blood flow, antiplatelet agents and medications that improve venous outflow are prescribed.
Physiotherapy, magnetotherapy, electrophoresis - these procedures significantly complement the effectiveness of the main treatment and are indicated for chronic pyelonephritis to achieve stable remission.
In the presence of concomitant diseases, additional symptomatic therapy or drugs are prescribed to correct the disorders caused by pyelonephritis. For example, in the presence of anemia, the doctor prescribes iron preparations, with high blood pressure - antihypertensive drugs. Antipyretics and other medications may also be prescribed as needed.
In addition, the doctor may prescribe additional drugs that enhance the effect of the main treatment. Often used herbal medicine for diseases such as chronic pyelonephritis. Herbal treatment should not accompany the acute stages of the disease, and the dosage and frequency of taking infusions is prescribed strictly by a specialist. Unlike the main medicines, phyto-teas are prescribed in a course of several months, and are also used for prophylaxis. Herbs that have a healing effect on kidney disease include:
- bearberry;
- lingonberry (has a diuretic effect, is effective for edema);
- blueberries;
- birch leaf;
- licorice;
- field horsetail;
- corn silk, etc.
In addition to the main method of taking infusions, there is also a method of taking baths with herbs - chamomile, St. John's wort, parsley - these herbs have an antiseptic effect.
Therapy must also be accompanied by a number of recommendations on the drinking regimen and diet. If high blood pressure and edema are not observed, the amount of non-carbonated liquid consumed can be increased to 3 liters per day. If the above symptoms are present, the volume can be 2 liters. You can use juices, fruit drinks, water, herbal teas.
As for the diet, you should avoid drinking coffee, spicy, salty, overly seasoned foods. The daily salt intake is 6 grams. It is important to eat food that has the correct ratio of fats, carbohydrates, and proteins. It is desirable to take fermented milk products - fermented baked milk, yogurt, bifidokefir - in addition to their positive effect on treatment, they are also designed to restore the functioning of the gastrointestinal tract, disturbed by the intake of antibiotics, and help avoid dysbiosis. Allowed the use of lean beef, chicken, rabbit, eggs, as well as lean boiled fish, cereals, vegetables. In general, the diet is aimed at ensuring that the body receives easily digestible food, this contributes to a speedy recovery and increased resistance to harmful effects.
www.medcentrservis.ru