Pyelonephritis - Causes, symptoms and treatment. MF.

Pyelonephritis is a disease of the kidneys of an inflammatory nature, which under adverse conditions is caused by a number of microorganisms.

Pyelonephritis is dangerous because it often proceeds asymptomatically without disturbing the person's well-being, therefore some patients treat their problem lightly. The most frequent of the non-specific inflammatory diseases of "upper urinary tract" , which constitute about 2/3 of all urological diseases, is acute and chronic pyelonephritis.

By its course, pyelonephritis can be acute and chronic.

Acute pyelonephritis often begins suddenly, the temperature rises sharply to 39-40 ° C, weakness, headache, profuse sweating, nausea and vomiting are possible. Simultaneously with the temperature there are pains in the lower back, usually on the one hand. The pain is blunt, but the intensity may be different. Urination with uncomplicated form of pyelonephritis is not disrupted. In the first days of the disease, the content of nitrogenous slags in the blood can increase. In urine - pus, erythrocytes, protein, a large number of bacteria. Symptom Pasternatskogo( effleurage in the lumbar region), as a rule, is positive.

Chronic pyelonephritis , as a rule, is a consequence of an incomplete acute pyelonephritis , when it was possible to remove acute inflammation, but neither managed to completely destroy all pathogens in the kidney nor restore the normal outflow of urine from the kidney. Chronic pyelonephritis is often found when examining urine or measuring blood pressure. There are complaints of general weakness, headache, lack of appetite, rapid urination, can constantly disturb the patient with blunt aching pain in the lower back, especially in damp, cold weather. Skin pale, dry. With the development of the disease, the specific gravity of urine decreases, hypertension is often detected. The progression of bilateral pyelonephritis results in renal failure. In addition, chronic pyelonephritis becomes aggravated from time to time, and then the patient has all the signs of an acute process.

Causes of pyelonephritis

Pyelonephritis may be a person of any age, but more often they are sick:

• children under 7 years of age who have the disease associated with anatomical developmental features;
• girls and women 18-30 years old, whose appearance of pyelonephritis is associated with the onset of sexual activity, with pregnancy or childbirth;
• are elderly men suffering from prostatic adenoma.

In addition to the above, one of the most common causes of pyelonephritis is urolithiasis and frequent attacks of renal colic.

With all these diseases and conditions, the outflow of urine from the kidney is broken, which makes it possible to multiply in it microorganisms.

Also contributing to the development of pyelonephritis are factors such as lower overall immunity of the body, diabetes mellitus, chronic inflammatory diseases.

Frequent hypothermia, lack of control over the kidneys( by general analysis of urine, if necessary - by blood analysis) can lead to impaired renal function due to severe inflammation. Especially often there is pyelonephritis in the presence of salts or stones in the kidneys, so if you find on ultrasound of salts or stones, even with asymptomatic flow, requires special treatment. Sometimes( more often in women) the disease begins with acute cystitis.

Symptoms of pyelonephritis

With bilateral acute pyelonephritis, there are often signs of kidney failure. Acute pyelonephritis can be complicated by parainfrit, the formation of pustules in the kidney( apostematous pyelonephritis), carbuncle or kidney abscess, necrosis of the renal papillae, which is an indication for surgical intervention.

Pionephrosis - is the terminal stage of purulent-destructive pyelonephritis .Pinephrotic kidney is an organ that has undergone purulent fusion, consisting of isotonic cavities filled with pus, urine and tissue degradation products.

Diagnosis of pyelonephritis

Even judging by the listed symptoms, it is not difficult to diagnose pyelonephritis, as the complaints of patients are quite typical.

With the help of urine analysis, bacteria are detected, the number of leukocytes and protein increases. Special test kits make it possible to identify bacteria that caused inflammation in the urinary tract.

An important role in diagnosis is played by a history of a recent acute acute purulent process or the presence of chronic diseases. Characteristic combination of fever with frequent and painful urination, pain in the lumbar region and with changes in the urine. On the review radiograph, one of the kidneys in the volume is found to be enlarged, with excretory urography - a sharp restriction of the mobility of the affected kidney during breathing, the absence or later appearance of the shadow of the urinary tract on the side of the lesion. The compression of cups and pelvis, amputation of one or more cups indicate the presence of carbuncle.

Treatment of pyelonephritis

In the case of primary acute pyelonephritis, in most cases, treatment is conservative, the patient should be hospitalized with an inpatient.

The main curative measure is the effect of the causative agent of the disease with antibiotics and chemical antibacterial drugs in accordance with the data of the antibiogram, detoxification and iteration increasing immunity in the presence of immunodeficiency.

For acute pyelonephritis , treatment should begin with the most effective antibiotics and chemical antibacterials, to which the urine microflora is sensitive, in order to eliminate the inflammatory process in the kidney as soon as possible, preventing the transition of its inflammatory-destructive form.

For secondary acute pyelonephritis , treatment should begin with the restoration of urine massage from the kidney, which is fundamental.

Treatment of chronic pyelonephritis is basically the same as acute, but longer and more time consuming.

For chronic pyelonephritis treatment should provide for the following main measures:

1. elimination of causes that caused a violation of the passage of urine or renal circulation, especially the venous circulation;
2. administration of antibacterial agents or chemotherapeutic agents with the consideration of antibiogram data;
3. increases the body's immune reactivity.

Urine flow recovery is achieved primarily by the use of a particular type of surgical intervention( removal of adenoma of the prostate gland, stones of the urine and urinary tract, nephropexia in nephroptosis, urethra plastic or the ureteral ureteral segment, etc.).Often after these surgical interventions it is possible to obtain relatively stable remission of the disease relatively easily and without prolonged antibacterial treatment. Without a sufficiently well-restored urine massage, the use of antibacterial drugs usually does not have a long-term remission of the disease.

Antibiotics and their antibacterial drugs should be given in terms of the sensitivity of the microflora of the patient's urine to antibacterial drugs. Antibiogram preparations with a wide spectrum of action are prescribed for the receipt of these antibiograms. Treatment for chronic pyelonephritis is systematic and prolonged( at least 1 year).The initial continuous course of antibacterial treatment is 6-8 weeks, since during this time it is necessary to suppress the infectious agent in the kidney and resolve the purulent inflammatory process in it without complications to prevent the formation of scar connective tissue. In the presence of chronic renal failure, the appointment of nephrotoxic antibacterial drugs should be carried out under the constant control of their pharmacokinetics( concentration in the blood and urine).With a decrease in the parameters of the humoral and cellular links of immunity, various drugs are used to enhance immunity.

Once the patient has reached the stage of remission of the disease, antibiotic treatment should be continued with intermittent courses. The timing of interruptions in antibacterial treatment is established depending on the degree of kidney damage and on the time of onset of the first signs of exacerbation of the disease, i.e., the appearance of symptoms of the latent phase of the inflammatory process.

Sanatorium treatment for patients with chronic pyelonephritis is performed in Truskavets, Zheleznovodsk, Jermuk, Sairme idr. It should be remembered that only strictly successive treatment of patients with cystic pyelonephritis inpatient, polyclinic and in the resort gives good results. Due to this, patients suffering from cirrhosis pyelonephritis, the phlegmatic phase of inflammation, should continue antibacterial treatment of the spa's conditions in accordance with the scheme recommended by the attending physician who observes the patient for a long time.

In addition, one of the main rules in the treatment of this disease is the regular intake of "renal" herbs.