Pyelonephritis in pregnancy - Causes, symptoms and treatment. MF.
Pyelonephritis is a kidney disease characterized by inflammation of the interstitial tissue of the kidneys, followed by damage to the calyx and pelvis. When pregnancy is most often affected by the right kidney. In general, pyelonephritis develops in about 7% of pregnant women and calls it scientifically "gestational pyelonephritis", that is, pyelonephritis, developed during pregnancy. Given that gestational pyelonephritis can lead to serious complications in pregnancy - this is a particularly urgent problem.
What is the cause of the disease? Why pyelonephritis most often develops during pregnancy? The main reason for the development of gestational pyelonephritis is mechanical. During pregnancy, the uterus gradually increases in size, "squeezing" the neighboring organs, including the ureters - the excretory ducts of the kidneys, which remove urine from the kidneys. Thus, urine can not normally pass through the ureters. For the same reason, pyelonephritis often occurs in the second half of pregnancy, when the size of the uterus is maximal.
Another important factor contributing to the development of gestational pyelonephritis is hormonal changes during pregnancy. The change in the ratio of hormones in the body, mainly estrogens and progesterone, leads to a worsening of the peristalsis of the ureters and as a result - the progress of urine becomes more difficult.
Thus, all these physiological causes lead to stagnation of urine in the renal pelvis, which is a favorable background for the reproduction of pathological microorganisms - E. coli, staphylococci, streptrococcus and so on. All this leads to the development of an infectious inflammatory process in the kidneys, that is, pyelonephritis.
Most of all to gestational pyelonephritis are pregnant women who once had been ill with pyelonephritis or cystitis. In addition, provoking factors include reduced immunity, hypothermia and sedentary lifestyle.
As a rule, the main symptoms of the disease make themselves felt, starting from 22-24 weeks of pregnancy. How pronounced are the symptoms of the disease, depends primarily on the form of pyelonephritis-acute or chronic.
In acute form of pyelonephritis, the condition of the pregnant woman deteriorates sharply - the temperature rises, weakness, lethargy, chills, severe headaches, muscle pain, nausea, vomiting, loss of appetite.
The appearance of pain in the lumbar region is characteristic. Depending on which kidney is affected, the pain may be on the right or left in the lower back. With bilateral pyelonephritis, that is, if both kidneys are affected, the pain will be from both sides.
The chronic form of pyelonephritis is not very pronounced. Dull uncomfortable pain in the nasal region, weakness, lethargy, headache.
Given the painful nature of pyelonephritis, with self-diagnosis it is often confused with the threat of miscarriage. In any case, even with minor symptoms, the pregnant woman should immediately contact her obstetrician-gynecologist and tell in detail about her complaints.
For the diagnosis, the doctor prescribes a number of laboratory and instrumental studies:
- a general blood test helps to identify inflammatory changes-elevated levels of leukocytes, ESR;with pronounced pyelonephritis, the level of hemoglobin decreases;
- biochemical blood test( possibly a rise in the level of urea and creatinine);
- general urinalysis;Urinalysis by Nechiporenko and by Zimnitsky. In pyelonephritis, protein and leukocytes are detected in urine tests, possibly also a small amount of blood;
- bacteriological study of urine-make for an accurate determination of the causative agent of infection and its sensitivity to antibiotics;
- renal ultrasound - the affected kidney will be enlarged with a modified structure;
- consultation of the nephrologist;
- chromoscystoscopy is an instrumental method of examining the kidneys and upper urinary tract to detect the extent of urinary passage disorder;
- catheterization of the ureters - perform both with a diagnostic( reveal the degree of violation of the passage of urine), and with a therapeutic purpose. The research is carried out under the supervision of ultrasound.
The scope of diagnostic studies in each case is determined exclusively by the obstetrician-gynecologist after examination of the pregnant woman. In acute pyelonephritis and with exacerbation of the chronic form of the disease, the pregnant woman is sent for treatment and observation to the hospital.
Treatment in a hospital is carried out together with nephrologists. The first thing that the treatment of pyelonephritis begins with is the restoration of the disturbed passage of urine. For this purpose, "positional therapy" is carried out. Pregnant put on the opposite side of the diseased kidney in a bent knee-elbow position. The foot end of the bed is raised. This position contributes to the rejection of the pregnant uterus and pressure on the ureters decreases. If within 24 hours the situation does not improve, based on the ultrasound, catheterization of the ureter of the affected kidney under the supervision of ultrasound. In most cases, such manipulations lead to a positive effect.
But if there is no result, resort to percutaneous puncture nephrostomy( drain urine from the kidney with a catheter, which is injected directly into the affected kidney).In rare complicated cases with purulent pyelonephritis, when the condition threatens the life of the mother and fetus, the kidneys are decapsulated( the fibrous capsule of the affected kidney is removed) or nephrectomy( the kidney is removed).In parallel, the question of the appropriateness of maintaining pregnancy is being decided. In most cases, pregnancy has to be interrupted, given the high probability of development of purulent-septic complications.
Medication for pyelonephritis is mandatory. The main group of drugs that is most effective for the treatment of pyelonephritis are antibiotics. At pregnancy, the doctor has to treat very carefully with the selection of any antibacterial drugs, because the antibiotic should be not only effective, but also safe for the fetus. Preference is given to antibiotics of the penicillin series( Ampicillin, Oxacillin), cephalosporins( Tseporin, Suprex), aminoglycosides( Netilmetin) and macrolides( Erythromycin).Strictly contraindicated in pregnancy antibiotics streptomycin and tetracycline. In any case, the specific medicine the doctor will be able to appoint only after determining the type of pathogen and its sensitivity to antibiotics. The course of antibiotic treatment is no more than 10-14 days.
To intensify the effect of the antibiotic in parallel, antimicrobial drugs( 5-NOC) are prescribed. Also, infusion therapy is carried out( Hemodez, Lactosol).All pregnant women, regardless of the form of pyelonephritis, are prescribed antispasmodics( No-shpa, Baralgin), desensitizing drugs( Diazolin, Tavegil, Suprastin), sedative tinctures of motherwort or valerian, vitamins of group B, C and PP.
In chronic pyelonephritis, there is no need to be hospitalized if the urinalysis is normal. Pregnant women give general recommendations regarding lifestyle and nutrition.
For a quick recovery during an exacerbation, a pregnant woman should adhere to bed rest. Outside the exacerbation of chronic pyelonephritis, on the contrary, one should lead a mobile lifestyle. It is necessary to exclude from the diet spicy, fried, smoked and salted food. It is useful to drink natural fruit drinks, in particular, berry juice, compotes, juices. It is also recommended to drink teas with a diuretic effect and diuretic renal phytogens, which are sold in pharmacies.
For lovers of traditional medicine, there is also an effective phytopreparation that can be used in combination with the main treatment of pyelonephritis during an exacerbation phase or as a prophylaxis of the disease. It is called Kanefron N. The drug has anti-inflammatory, antispasmodic and diuretic effect. If there are no allergic reactions, then during pregnancy it can be used for a long time.
Complications of pyelonephritis in pregnancy:
- intrauterine infection of the fetus;
- miscarriages;
- intrauterine fetal death;
- premature delivery;
- development of gestosis-complication of pregnancy, which leads to increased arterial pressure, edema and proteinuria;
- renal failure in a pregnant woman, development of severe purulent-septic complications, which can lead to the death of both mother and fetus.
Prevention of pyelonephritis:
- a flexible lifestyle during pregnancy-frequent walking, walking at least 30 minutes a day;
- in the presence of chronic diseases of the urinary system in the past - compliance with a special diet number 7 throughout pregnancy;
- regular emptying of the bladder( at least once every 3-4 hours) during pregnancy;
- consumption of liquid not less than 2 liters per day( provided there is no edema!).
Questions and answers.
1. Is it possible to give birth, if gestational pyelonephritis was detected during pregnancy?
- It is possible, pyelonephritis is not an indication for cesarean section.
2. Have made ultrasound of the kidneys. We diagnosed pyelonephritis. The doctor appointed Kanefron and Augmentin. Can I even take Augmentin-is it dangerous for the fetus?
- Augmentin is a rather toxic preparation for pregnant women, it is usually not prescribed. In any case, this issue should be discussed with your doctor after receiving the results of a bacteriological study of urine.
3. Can I cure pyelonephritis with Kanefron?
- It is impossible, Kanefron is used only in combination with the main treatment.
4. I have several times worsened during pregnancy with pyelonephritis. What do you recommend not to resort more to antibiotics?
- Drink more fluids if there is no swelling, and more often empty the bladder. Drink Kanefron if the doctor recommends.
5. I have found a small protein in the urine, but there are no white blood cells or blood. What is it, pyelonephritis?
- Such an analysis is not entirely informative, it may be gestosis. You need to pass a urine test for Nechiporenko and Zimnitsky.
6. I was diagnosed with chronic pyelonephritis as a child. Can I get pregnant and give birth?
- If there is no kidney failure - you can.
7. I have a sharp increase in pressure on the background of chronic pyelonephritis. What to do?
- Urgently go to the gynecologist and go to the hospital.
8. I have found erythrocytes in urine. The doctor insists that I go to the hospital. But is it necessary?
- With hematuria and other changes in the urine - hospitalization is mandatory.
Obstetrician-gynecologist, Ph. D.Christina Frambos