Chronic pyelonephritis: symptoms, causes and treatment

Chronic pyelonephritis is an inflammatory lesion of calyxes and kidneys, which is caused by various microorganisms.

This disease accounts for approximately 50% of all nephrologic patients.

Anatomico-physiological features of the urinary system in women are accompanied by the fact that they have a disease registered more often.

Causes of chronic pyelonephritis

The main reason that leads to the development of chronic pyelonephritis is the infection of the kidney tissue, which can occur in various ways.

These are the following:

1. 1) Ascending, in which microorganisms penetrate from the lower parts of the genitourinary organs
   
2. 2) Hematogenous - microbes are transported with blood flow from foci of chronic infection( diseases of ENT organs, dental diseases)
   
3. 3) Lymphogenous infection inthe renal parenchyma penetrates the lymphatic pathways.

From the etiological point of view, chronic pyelonephritis is classified into two main types:

1. 1) Primary that develops in the healthy kidney
   
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2. 2) Secondary, which is preceded by damage to the renal parenchyma, as well as disturbance of the processes of urodynamics( normal urine outflow).

main causative microorganisms which lead to the development of this disease are as follows:

• coli
  
• 
  
• Klebsiella Proteus enterobacter
  
• 
  
• enterococci
  
• staphylococci streptococci
  
• 
  
• Pseudomonas aeruginosa
  
• certain types of anaerobic bacteria and others.

The probability of infection with these bacteria increases under certain conditions. These are predisposing factors, which include:

1. 1) Sexuality management, which can be accompanied by the development of infections of the genitals
   
2. 2) Pregnancy( in this case we are talking about hormonal changes, compression of the urinary organs by a growing large uterus, etc.)
   
3. 3) Violation of normal urinary outflow, including urinary retention for various social reasons
   
4. 4) Disturbance of innervation of the bladder, which leads to overflow and urine congestion
   
5. 5) Urine incontinence andfrom the bladder to the ureters( vesicoureteral reflux)
   
6. 6) Weighed heredity, which manifests itself in some features of the structure of the genitourinary system.

Symptoms of chronic pyelonephritis

In the clinical course of chronic pyelonephritis, two main stages are distinguished:

1. 1) The period of exacerbation of
   
2. 2) The period of remission, which occurs almost asymptomatically.

The main symptoms, as well as the complaints that patients present with this disease, are as follows:

• pains in the lumbar region that can give to the inguinal region and lower extremity
  
• rapid urination
  
• the appearance of nocturnal diuresis( the number of night visits of the toilet is 3 or more times,which is not a norm option)
  
• urine becomes turbid, can acquire a pathological odor
  
• slight increase in body temperature, including with the appearance of chills
  
• weakness
  
• notmotivated fatigue
  
• reduced performance
  
• headache
  
• change in appetite, etc.

An objective examination performed by a physician also reveals certain signs that indicate chronic pyelonephritis. These include:

• weight loss
  
• dryness of the skin and its peeling
  
• slight puffiness of the face( pastog under the eyes)
  
• pain during palpation and tapping in the lumbar region.

Read also, the symptoms of acute pyelonephritis.

Classification

The clinical course of chronic pyelonephritis can occur in one of the following options. This determines some difficulties in the diagnostic process.

So, the main types of the disease are:

1. 1) Latent form, in which the clinical symptoms are little expressed, and the diagnosis can be established only by laboratory methods of the study
   
2. 2) Recurrent form - the periods of remission are often replaced by exacerbations with the steady progression of the pathological process
   
3. 3) Hypertensive form, which is characterized by early development of malignant hypertension
   
4. 4) Anemic form manifested by reduced numbertion of hemoglobin. Its development is due to the fact that the erythropoietin necessary for the formation of red blood cells
   
5. is synthesized in the kidneys 5) The septic form in which each exacerbation is accompanied by high fever, chills and increased weakness
   
6. 6) Gematuristic form -more typical for glomerulonephritis( for pyelonephritis the most characteristic increase in leukocytes).

Diagnosis of chronic pyelonephritis

Diagnosis of chronic pyelonephritis is also based on the conduct of additional research methods. They include both laboratory and instrumental tests.

The most informative are the following:

1. 1) Clinical urinalysis in which the increased protein and leukocyte counts are determined
   
2. 2) Urine analysis by Nechiporenko - determines the increase in the level of leukocytes
   
3. 3) Biochemical blood test that identifies certain deviations in case of prolonged existencepyelonephritis( creatinine increase, protein reduction, and electrolyte disturbances are determined)
   
4. 4) Urine bacteriology with sensitivity determination of isolated microorganismsnisms antibiotic
   
5. 5) Ultrasonography, which reveals concrements in the urinary
   
6. 6) X-ray examination system organs.

Complications of chronic pyelonephritis

Long-standing pyelonephritis can lead to various complications, which include the following:

• secondary hypertension of renal origin that does not respond to traditional antihypertensive therapy
  
• Secondarily wrinkled kidney
  
• water-electrolyte disorders with the ensuing consequences( primarily,this is a violation of the heart rate)
  
• chronic renal failure.

Treatment of chronic pyelonephritis

Treatment of chronic pyelonephritis is conservative. It consists in the following:

1. 1) Dietary food( eliminates spicy food, fried and smoked dishes, normalizes the diet regime)
   
2. 2) Antibiotics given their sensitivity
   
3. 3) Anti-inflammatory drugs
   
4. 4) Pain medications
   
5. 5) Antiaggregants that normalize microcirculation
   
6. 6) Antipyretics.

Antibacterial therapy is of great importance in relieving the exacerbation of chronic pyelonephritis. It is administered taking into account the most common pathogens that are associated with this disease. After receiving the results of bacteriological examination of urine, it is possible to correct the prescribed antibiotics.

The main antibiotics that are indicated for chronic pyelonephritis are the following:

• fluoroquinolones
  
• protected penicillins
  
• cephalosporins.

Synthetic or plant uroantiseptics can be used to increase the effectiveness of antibacterial therapy. They allow to accelerate the death of pathogenic microorganisms and prevent another relapse of the disease.

During the remission period, physiotherapeutic procedures can be used. They have a complex positive effect on the course of the chronic pathological process, reducing the likelihood of its aggravation and the development of complications.

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