Pyelonephritis is one of the most common inflammatory processes kidney disease: approximately 10% of people currently have it or have had it in the past. More often than not, only infectious diseases of the upper and lower sections occur. respiratory system. This disease can appear not only as a complication of any pathology, but also as an independent inflammatory phenomenon.
What is pyelonephritis
Pyelonephritis is an inflammatory process caused by pathogenic microorganisms, as a result of which the pelvis, cups and renal parenchyma are simultaneously or sequentially affected, especially connective tissue the last one. Pure nephritis (inflammation of only the glomeruli) and isolated pyelitis (damage to the pelvicaliceal system) practically never occur in life. The infectious process very quickly passes from the connective (interstitial) tissue to the wall of the pelvis, and from there to the parenchyma. Therefore, it is correct to talk about their common disease - pyelonephritis.
The medulla and cortex make up the parenchyma of the kidney; it is she, along with the cups and pelvis, that becomes inflamed during pyelonephritis
The disease can have an acute or chronic course. This type of bacterial renal inflammation affects 35–45% of all urological patients. Women suffer from pyelonephritis five times more often than men, which is due to the anatomical structure of their urethra: it is short and wide, as a result of which the infection easily penetrates into the bladder and then rises to the kidneys. In most patients, the pathology begins to develop at a young age, often simultaneously with the onset of sexual activity, during pregnancy or after childbirth.
The female urethra is wide and short compared to the male urethra, so infection through it easily rises to the bladder and higher, to the kidneys
First of all, in humans, the connective tissue of the urinary organ is affected, then the nephron tubules, and lastly the glomeruli. The disease in question should be distinguished from interstitial renal inflammation of a different nature, in particular allergic, in which there are no pathological changes in the elements of the organ.
Types of acute pyelonephritis
The clinical picture of acute inflammatory kidney disease depends on the form of its course. So, if pyelonephritis was not preceded by any disease of the urinary organs, then it is primary. As a rule, such patients indicate a history of influenza, ARVI, or tonsillitis in the recent past. Or at the time of contacting a doctor, they have chronic infectious processes (inflammation of the ear, nose or throat, gynecological problems or diseases of the digestive system).
In the case when pyelonephritis has developed against the background of any urological pathology, it is called secondary. For example, such kidney inflammation is promoted by:
- foreign formations in the urinary tract (stones, tumors);
- congenital malformations of the urinary organs;
- difficulty passing urine caused by an obstruction in the urethra, ureters or kidneys;
- neoplasms prostate gland;
- a phenomenon in which biological fluid flows from the bladder back into the ureter (medically called vesicoureteral reflux);
- strictures (narrowing of the ureters and urethra), etc.
Violation of the passage of urine according to the type of vesicoureteral reflux has 5 degrees of severity and contributes to the development of secondary pyelonephritis
So, primary pyelonephritis begins to develop in a healthy kidney, and secondary occurs when the urinary system is painfully altered. The symptoms of the process in both cases will differ markedly: secondary pyelonephritis is characterized by more pronounced local manifestations, which greatly facilitates the diagnosis.
Both primary and secondary inflammation of the kidneys can occur in a simple (serous) or purulent form. The latter is often a complication of the former and includes apostematous nephritis, renal carbuncle and abscess. Approximately every second patient experiences a combination of these purulent phenomena.
The outcome of the acute form of pyelonephritis with adequate and timely treatment There is a complete recovery, and in the absence or insufficiency of therapy, the disease takes a chronic course.
The main clinical signs of acute serous pyelonephritis
The clinical picture of acute pyelonephritis is characterized by a classic triad of symptoms, present in both serous and purulent types:
- Manifestations of general intoxication.
- Painful sensations.
- Disorders of the urinary system.
The clinical signs of this pathology may vary depending on the state of the person’s immune system, his age, gender and the presence concomitant diseases. Primary acute pyelonephritis is characterized by a predominance of general manifestations, and secondary - by local ones.
General intoxication
With pyelonephritis, toxins released by infected kidneys inevitably enter the body. The patient is concerned about the following phenomena:
- weakness;
- nausea, vomiting, sometimes loose stools;
- “jumping” pulse;
- constant thirst;
- dryness of the oral mucosa;
- fever with high temperature (39–40 ° C), accompanied by shaking chills and heavy sweat;
- pain in the head, muscles and joints;
- loss of appetite.
It should be noted that the severity of symptoms of general intoxication is not necessarily and not always directly proportional to the degree of inflammatory changes in the kidneys. In young children and the elderly, weakened by some other pathology of individuals, when their own immunity is clearly insufficient, clinical manifestations pyelonephritis may be weakly expressed, distorted or completely absent. In such patients, kidney inflammation occurs in the manner of a common severe infectious disease or even sepsis. Important: with acute serous inflammation of the kidneys there is no swelling or increased blood pressure, which distinguishes it from hypertension.
Nature of kidney pain
Dull or aching pain in the lower back may appear along with the first rise in temperature or a few days after it. On the side of the inflamed kidney, there is sharp pain in the vertebral-costal angle; the anterior abdominal wall is tense. Pasternatsky's symptom is usually positive - tapping on the patient's back at the level of the 12th rib causes discomfort in the patient.
Pasternatsky's symptom is positive in most types of pyelonephritis - percussion of the affected kidney is sharply painful
The pain syndrome intensifies when walking or other movements, is characterized by varying intensity, and is observed constantly or in the form of attacks. For secondary pyelonephritis, provoked by difficulty in removing urine from the kidney, extremely painful colic is typical. Attacks of the strongest acute pain in the lumbar region are replaced by periods of calm and decline in temperature. But if the obstruction to the outflow of urine persists, after a few hours of apparent relief, the disease begins to attack the person again.
In some complicated forms of acute pyelonephritis, clots of pus can clog the ureter; in these cases, the nature of the sensations can imitate renal colic. Sometimes the pain is so severe that it forces the patient to take a position on his side with his knees tucked to his stomach - the so-called psoas symptom caused by spasm of the lower back muscles.
Sometimes renal colic forces a person to lie on his side with his legs tucked to his stomach; any change in this body position causes severe suffering
It is extremely rare that acute serous pyelonephritis goes away without pain in the kidneys; the person only feels heaviness in the lower back. As a rule, such patients suffer from diabetes or neuropsychiatric disorders.
Urinary disorders
Turbid urine due to a large number of leukocytes, bacteria or admixtures of pus is the main symptom of all types of acute pyelonephritis. Since cystitis is a very common accompaniment of secondary kidney inflammation, the following symptoms are added to the picture of the disease:
- pain and stinging during urination - dysuria;
- increased urge to urinate - pollakiuria;
- copious urine discharge at night - nocturia;
- the presence of blood in the urine - hematuria.
The appearance of blood in the urine is a reason to immediately contact a urologist
Due to the fact that in acute pyelonephritis the patient sweats a lot, the total daily volume of urine excreted is reduced compared to the norm (oliguria). In the secondary type of the disease, signs of urological pathology that provoked kidney inflammation predominate.
How does acute purulent pyelonephritis manifest?
All types of purulent kidney damage have more pronounced clinical symptoms and severe course. They are life-threatening due to their possible complications and require immediate hospitalization of the patient in a urological hospital and intensive care. These forms have their own symptomatic characteristics that differ from those of serous pyelonephritis.
Apostematous nephritis
Apostematous nephritis is purulent inflammation in the kidney parenchyma with the formation of numerous small abscesses (apostemes) in it.
With apostematous nephritis, many pustules appear in the kidney parenchyma
The course of this type of disease is wavy. Simultaneously with the intensification of the most severe symptoms of general intoxication, pain in the lumbar region becomes more active; this state lasts 15–50 minutes. Then the temperature drops, the person sweats profusely, and the pain in the kidney subsides. Seizures may strike the patient several times a day.
Urine containing bacteria and pus, periodically accumulating in the pelvis, passes from the kidney into the general bloodstream. Jumps in temperature and pulse are nothing more than a violent reaction of the body to the penetration of toxins into the blood. A period of temporary improvement in well-being marks the neutralization of toxins. The cycle then repeats; This explains the wavy nature of apostematous nephritis.
Kidney carbuncle: main signs
A carbuncle is a purulent-necrotic inflammatory process in the cortex of the kidney, characterized by the formation of an infiltrate - a local accumulation of cellular blood particles.
Kidney carbuncle is dangerous due to the opening of an abscess and the development of severe complications
The abscess can open inside the organ - into the pelvis, or outside, into the perinephric tissue. The latter situation is fraught with serious complications - purulent paranephritis and diffuse peritonitis.
There are two varieties clinical course renal carbuncle:
- The picture of the disease resembles that of apostematous nephritis. This type is also characterized by a wave-like course: alternating rise and fall of temperature with a corresponding increase and decrease in pain in the affected kidney.
- Local symptoms are practically invisible, the kidney almost does not hurt. But the pronounced signs of general intoxication listed above prompt doctors to mistakenly hospitalize such patients in infectious diseases or surgery department with suspected pneumonia, influenza or any inflammatory disease abdominal cavity.
Kidney abscess is the most severe and rarest form of acute pyelonephritis. With this disease, a limited melting of the organ tissue is formed, in the place of which a cavity filled with pus is subsequently formed. It is characterized by the same symptoms that are present in apostematous nephritis and kidney carbuncle - general intoxication and pain above the lower back.
The main difference is the temperature reaction: hyperthermia during an abscess is constant, only small fluctuations within one degree are permissible throughout the day. The pain is intense and continuous; a person has a psoas symptom. Extension of the legs is impossible due to severe pain in the lower back on the affected side.
Kidney abscess - the most dangerous species purulent pyelonephritis
Chronic pyelonephritis
Chronic pyelonephritis, like acute one, can be primary or secondary in origin. It occurs in the form of alternating periods of exacerbations and remissions and can have two types:
- Rapidly progressive. The disease often worsens over a long period of time, periods of remission are short-term and practically imperceptible. Pyelonephritis rapidly progresses, eventually leading to chronic renal failure (CRF).
- Recurrent. The disease develops very slowly. Short phases of exacerbation alternate with rather long remissions. With this nature of the disease, there are no clinical signs during the lull period, and pyelonephritis occurs without symptoms. Sometimes the pathology is so subtle that it is discovered by chance during an examination of the patient for some other reason.
Video: pyelonephritis - inflammatory kidney disease
Table: percentage frequency of signs of a rapidly progressive and recurrent type of disease
| Symptoms | Type of chronic pilonephritis | |
| Rapidly progressive | Recurrent | |
| Nausea and vomiting | 34 | 46 |
| Lack of appetite | 58 | 61 |
| Lower back pain | 100 | 100 |
| Hyperthermia more than 37 ºС | 100 | 60 |
| Dysuric phenomena | 100 | 100 |
| Weakness | 71 | 57 |
| Fatigue | 75 | 85 |
| Bloody urine (gross hematuria) | 5 | 8 |
| Chills | 95 | 55 |
| Headache | 27 | 36 |
Symptoms and course of chronic pyelonephritis
Symptoms chronic inflammation kidney symptoms are much less pronounced than in acute cases and depend on the stage of the disease - exacerbation (active phase) or remission (subsiding). The course of the first of them is similar to that of acute serous pyelonephritis. Outside of an exacerbation, the patient usually feels satisfactory. Some patients have the following complaints:
Cloudy urine with flakes - a clear sign urinary system ill health
The listed symptoms are observed infrequently, are mild or may be completely absent, especially in children, the elderly and in patients with metabolic disorders. By clinical signs There are several forms of chronic kidney inflammation.
Table: forms and symptoms of chronic pyelonephritis
| Form of chronic pyelonephritis | Differences from other forms and features | General intoxication | Urological disorders | Edema | Changes in blood pressure | |
| Latent | no complaints | absent | none | none | occasionally positive | none |
| Recurrent | alternation of exacerbations and remissions | sometimes present | clearly visible | sometimes present | positive during exacerbation | there is an increase in blood pressure |
| Hypertensive |
| present | none | none | negative | Blood pressure rises above 140/90 mmHg. Art. |
| Hematuric | repeated relapses of macrohematuria (blood in the urine) and persistent microhematuria (blood in the urine is detected only by laboratory tests) | sometimes present | none | none | negative | venous hypertension |
| Anemic | persistent decrease in hemoglobin and red blood cells in the blood | present | weakly expressed and inconsistent | none | weakly expressed | none |
| Azotemic |
| present | present | sometimes present | positive | there is an increase in blood pressure |
| Tubular |
| present | present | sometimes present | positive | there is a decrease in blood pressure (hypotension) |
Video: acute and chronic pyelonephritis
Pyelonephritis is an inflammatory process with a wide and varied range of manifestations, among which signs of general poisoning of the body, kidney pain and urinary function disorders prevail. Not all characteristic symptoms of the disease are pronounced enough. The disease often occurs in an erased form, making it difficult to diagnose. If pyelonephritis is not recognized and treated in acute stage, then it will inevitably turn into chronic, which in 10–20 years will end with complete shrinkage of the kidneys and insufficiency of their function.
There are many different infectious diseases. One of these is pyelonephritis. This pathology can affect the renal parenchyma and its pyelocaliceal system. The disease is dangerous, especially if there is no timely treatment. For this reason, it is important to know the symptoms of pyelonephritis, methods of diagnosis and methods of treatment.
What is pyelonephritis
One of the most common infectious and inflammatory diseases of the urinary system is what pyelonephritis is. Affects kidney disease. The inflammatory process involves its calyces, pelvis and predominantly interstitial parenchyma tissue. In more advanced stages, the disease affects the blood vessels and glomeruli of the kidneys. In the absence of treatment, the excretory and filtering function of the organ is impaired. Using clinical and morphological data, doctors divided this disease into acute and chronic pyelonephritis.
Chronic
If the cause of kidney inflammation is a congenital kidney abnormality or changes in the urinary system, then the disease itself is chronic. Otherwise it is called obstructive or secondary. What is chronic pyelonephritis? This is the same inflammation of the kidneys, only characterized by a latent course. Due to changes in the urinary system, the outflow of urine is disrupted, as a result of which the infection reaches the kidneys through the ascending route. A typical form of this disease is calculous pyelonephritis, which develops due to kidney stones.
Spicy
According to the pathogenesis, acute pyelonephritis can be determined - which is what this disease is called when microorganisms enter the kidneys in another way - hematogenously, i.e. with blood from other organs where the primary focus of inflammation is located. This is possible with tonsillitis, caries, bronchitis, sinusitis, otitis, cystitis, sore throat and other similar ailments. The inflammation that develops against this background is primary or obstructive. This is the answer to the question of what acute pyelonephritis is.
Classification
The disease is divided into types according to several characteristics. Acute and chronic pyelonephritis - classification according to the nature of the course and severity of symptoms. There are also the following forms of this disease:
- Due to development - primary (acute, or non-obstructive) and secondary (chronic, or obstructive). The first form is a consequence of infections and viruses in other organs, and the second is an abnormality of the kidneys.
- According to the location of inflammation - bilateral and unilateral. In the first case, both kidneys are affected, in the second - only one; the disease can be left- or right-sided.
- The form of kidney inflammation is serous, purulent and necrotic.
Pyelonephritis - causes
This disease occurs more often against the background of severe infectious pathologies that can be caused by fungus, viruses or bacteria. Another reason for the development of inflammation is abnormalities in the development of the kidneys, for example, very small size. There may be other structural abnormalities that cause urine to enter the kidney - stones, bladder overflow, prostate enlargement, obstructed urine outflow. The consequence of such processes is kidney disease - the causes of this pathology can be combined into next list:
- Escherichia coli or Pseudomonas aeruginosa, Proteus, enterococci;
- previous viral or infectious diseases;
- decreased ureteral peristalsis during pregnancy;
- blockage of the urinary tract by a tumor;
- microtraumas received during sexual intercourse;
- crushing of urinary stones;
- use of intrauterine contraceptives;
- hypothermia;
- injuries in the lumbar region;
- pathologies of the endocrine system;
- disregard for rules intimate hygiene;
- surgical intervention on the urinary tract.
Pyelonephritis - symptoms and treatment
With acute inflammation, the temperature rises sharply, often up to 38-39 degrees. Signs of intoxication appear - nausea or vomiting, weakness. Another person begins to go to the toilet frequently, and urination is painful. All this is accompanied by lower back pain, chills and increased sweating. The chronic form manifests itself differently - its symptoms and treatment differ from those characteristic of the acute form. The pain increases gradually, chills and fever appear from time to time. Signs vary depending on the gender and age of the person.
Symptoms in women
The weaker sex is more susceptible to this disease, but only in the first two age periods, i.e. until about 45-50 years old. Everything is explained by the structure of the urethra - it is short and located next to the intestine and genital tract. This increases the risk of developing the disease - symptoms in women are as follows:
- nausea or vomiting;
- poor appetite;
- weakness and high temperature;
- frequent trips to the toilet;
- cloudy or bloody urine and pain when urinating;
- aching in the lower back, worse in cold weather;
- colic and pain in the lower abdomen;
- unusual discharge.
Find out more about what folk remedies include.
The child has
The disease pyelonephritis is often diagnosed in a child - the symptoms are almost the same, but there are some signs that are characteristic only of children. Such a disease can be suspected by a temperature of 39-40 degrees without any features characteristic of a cold. The child is capricious, easily irritated and may complain of a headache. The baby may begin to go to the toilet more often, or, conversely, less often. The color of urine also changes - it becomes cloudy, brownish or red, provided that the child has not consumed any medications or products that contribute to this.
In men
Representatives of the stronger sex are more susceptible to inflammation at the age of 60 years. This is due to the development of tumors or prostate hypertrophy. Symptoms of pyelonephritis in men are very similar to those in women. The first cause for concern is dysuric manifestations, such as frequent urination with pain and pain, urinary incontinence, or even false urges. Other symptoms are as follows:
- elevated temperature;
- headache;
- aching joints and lower back;
- nausea;
- vomit;
- decreased performance;
- surges in blood pressure.
Diagnosis of pyelonephritis
To confirm the diagnosis, a urology specialist prescribes a number of measures. The following tests are indicated for the patient:
- culture and general urine analysis;
- Ultrasound of the kidneys and abdominal cavity;
- computed tomography or x-ray to detect changes in the structure of the affected kidney;
- blood analysis.
No less important is differential diagnosis to determine the chronic form - that this disease can be distinguished from glomerulonephritis, tuberculosis and kidney hypoplasia. In the latter case, an x-ray examination is more often prescribed. Inflammation of the kidney is characterized by wrinkling of the organ, and hypoplasia is characterized by a miniature pelvis and undeformed calyces. In addition to tests, the urologist examines the patient’s medical history to determine whether the disease is acute or chronic.
How to treat pyelonephritis
The first treatment measure is to eliminate the causes that led to the improper outflow of urine. This is done more often surgically– removal of stones, adenomas, urethral plastic surgery or others necessary operations. Then it is carried out antibacterial therapy. Drugs are prescribed taking into account the sensitivity of the microorganisms that cause the disease to them. In general, the methods of treating kidney pyelonephritis depend on the form of the disease, age and gender of the patient.
Treatment regimen
The main drugs in the treatment of kidney inflammation are antibiotic therapy, which are prescribed on the basis of an antibiogram. Before receiving its results, the patient is prescribed broad-spectrum antibiotics for an initial course of 6-8 weeks. This may be Ceftriaxone, Nolitsin or Ampicillin, which can also be prescribed in the form of injections. In addition to antibiotics, the patient is prescribed other medications:
- analgesics to relieve pain;
- Diclofenac or Metamizole to reduce kidney inflammation;
- Furadonin, which normalizes kidney function;
- Phytolysin to restore immunity during remission.
Treatment of the chronic form
Therapy against the chronic form can be carried out at home. The basis is also antibacterial drugs. Along with them, non-steroidal anti-inflammatory drugs are prescribed. They help antibiotics reach the site of kidney damage. Pyelonephritis - it is already known that this disease can be treated with physiotherapy and symptomatic drugs such as Adelphan, Reserpine and Cristepine. They normalize blood pressure during exacerbation. These are the main ways to treat the chronic form.
Acute form
If the diagnosis is confirmed, treatment of acute pyelonephritis in children and adults is carried out in a hospital. Complex therapy immediately includes:
- Bed rest. Its timing is determined depending on the course of the disease.
- Diet. The patient is prescribed a balanced diet with sufficient quantity vitamins and fluids.
- Antibacterial therapy. Includes broad-spectrum antibiotics from the group of cephalosporins or fluoroquinols. The course of treatment should be less than 2 weeks long.
- Antifungal drugs. They are prescribed for prolonged antibacterial therapy. It could be Levorin or Nystatin.
- Antihistamines. Also prescribed for long-term use of antibiotics. Suprastin, Diphenhydramine, Tavegil are most often used.
Treatment in children
The most difficult thing is the treatment of childhood pyelonephritis. The baby will have to take several medications at once – the doctor will tell you what these medications are. Antibiotics will be prescribed, homeopathic medicines, antihistamines. How long does it take to treat pyelonephritis? For full recovery V different cases it takes from 2 to 8 months. At the end of treatment, the child will also be prescribed probiotics for recovery. normal microflora intestines.
Among women
The methods for treating pyelonephritis in women are not particularly different. They are also prescribed antibacterial drugs, bed rest in case of acute form, drink plenty of fluids and diet. Ways to treat pyelonephritis in women include anti-inflammatory and restorative agents, multivitamin complexes and herbal medicines. Among the latter, medicines based on ginseng and eleutherococcus are particularly successful.
Treatment at home
Chronic inflammation can be cured not in the clinic, but at home. Taking antibiotics remains mandatory. Using herbal infusions based on oats, chamomile, plantain, nettle or rosehip will help. The same effect will be obtained from taking herbal medicines Canephron, Fitolysin. Additionally, you need to monitor your fluid intake - at least 1.5-2 liters per day. Under no circumstances should the kidneys be heated. This is the basic advice on how to treat pyelonephritis at home.
Diet for pyelonephritis
Compliance with a special diet is mandatory; it speeds up recovery, even doctors confirm. The diet should not contain spicy foods, alcohol, coffee, canned food, salt and fatty meat broths. Meals should include fermented milk products, compotes, fruits and vegetables, egg white and freshly squeezed juices. Garlic, onions and spices are allowed to be consumed only during the remission stage.
Why is pyelonephritis dangerous?
The disease is dangerous only in the absence of timely and correct treatment. Consequences infectious inflammation kidneys are expressed in pathologies such as apostematous nephritis, abscess or carbuncle of the kidney. In addition, by neglecting treatment, you can start the disease, causing it to become chronic, which is much more difficult to fight.
Video
One of the most common urological diseases of an infectious nature, affecting the pyelocaliceal system and renal parenchyma, is pyelonephritis. This rather dangerous pathology, in the absence of timely, competent treatment, can lead to disruption of the excretory and filtering functions of the organ.
What kind of kidney disease is this, why it is so important to know the first symptoms and consult a doctor in time, and also how to begin treatment for various forms of pyelonephritis, we will consider further in the article.
What is pyelonephritis
Pyelonephritis is an inflammatory disease of the kidneys, characterized by damage to the kidney parenchyma, calyces and renal pelvis.
In most cases, pyelonephritis is caused by the spread of infections from the bladder. Bacteria enter the body from the skin around the urethra. Then they rise from the urethra to the bladder and then enter the kidneys, where pyelonephritis develops.
Pyelonephritis can be an independent disease, but more often it complicates the course of various diseases ( urolithiasis, prostate adenoma, diseases of the female genital organs, tumors genitourinary system, ) or occurs as a postoperative complication.
Classification
Kidney pyelonephritis is classified:
- Due to development - primary (acute, or non-obstructive) and secondary (chronic, or obstructive). The first form is a consequence of infections and viruses in other organs, and the second is an abnormality of the kidneys.
- According to the location of inflammation - bilateral and unilateral. In the first case, both kidneys are affected, in the second - only one; the disease can be left- or right-sided.
- The form of kidney inflammation is serous, purulent and necrotic.
Highlight:
- Acute pyelonephritis is caused by the entry of a large number of microorganisms into the kidneys, as well as when the body’s protective properties are weakened ( weak immunity, transferred colds, overwork, stress, poor nutrition). The inflammatory process is pronounced. Most often it is diagnosed in pregnant women, whose bodies are especially vulnerable.
- What is chronic pyelonephritis? This is the same inflammation of the kidneys, only characterized by a latent course. Due to changes in the urinary system, the outflow of urine is disrupted, as a result of which the infection reaches the kidneys through the ascending route.
By flow phases:
- Active inflammation is characterized by symptoms: increased temperature, pressure, abdominal and lower back pain, frequent urination, swelling;
- Latent inflammation is characterized by the absence of any symptoms and, accordingly, the patient’s complaints. However, pathologies are visible in urine analysis;
- Remission - there are no pathologies in the urine or symptoms.
Causes
With pyelonephritis, as we have already indicated, the kidneys are affected, and this result is mainly caused by exposure to bacteria. Microorganisms, once in the renal pelvis or in it itself by urinogenic or hematogenous routes, settle in the interstitial tissue of the kidney, as well as in the tissue of the renal sinus.
The disease can occur at any age. Most often, pyelonephritis develops:
- in children under 7 years of age (the likelihood of pyelonephritis increases due to the characteristics of anatomical development);
- in young women aged 18-30 years (the occurrence of pyelonephritis is associated with the onset of sexual activity, pregnancy and childbirth);
- in elderly men (with urinary tract obstruction due to the development of prostate adenoma).
Any organic or functional reasons obstructing the normal flow of urine increases the likelihood of developing the disease. Pyelonephritis often appears in patients with urolithiasis.
The most common cause of urinary tract inflammation is:
- Coli bacterium (Escherichia coli), or enterococcus.
- Less commonly, other gram-negative bacteria can provoke a nonspecific inflammatory process.
- Often, patients are found to have combined or multidrug-resistant forms of infection (the latter are the result of uncontrolled and unsystematic antibacterial treatment).
Routes of infection:
- Ascending (from the rectum or foci of chronic inflammation located in the urogenital organs);
- Hematogenous (implemented through the blood). In this situation, the source of infection can be any distant focus located outside urinary tract.
For the occurrence of pyelonephritis, the penetration of microflora into the kidney is not enough. For this, in addition, predisposing factors are necessary, among which the main ones are:
- violation of the outflow of urine from the kidney;
- disorders of blood and lymph circulation in the organ.
However, it is believed that in some cases highly pathogenic microorganisms can cause acute pyelonephritis in intact kidneys in the absence of any predisposing causes.
Factors that will help bacteria develop in paired organs:
- Lack of vitamins;
- Reduced immunity;
- Chronic stress and overwork;
- Weakness;
- Kidney disease or genetic predisposition to rapid damage to paired organs.
Symptoms of pyelonephritis in adults
Symptoms of pyelonephritis can vary depending on a person's age and may include the following:
- Malaise;
- Fever and/or chills, especially in the case of acute pyelonephritis;
- Nausea and vomiting;
- Pain in the side under the lower ribs, in the back, radiating to the iliac fossa and suprapubic region;
- Confusion;
- Frequent, painful urination;
- Blood in the urine (hematuria);
- Cloudy urine with a pungent odor.
Pyelonephritis is often accompanied by dysuric disorders, manifested in the form of frequent or painful urination, urine separation in small portions, and a predominance of nighttime diuresis over daytime.
Symptoms of acute form of kidney pyelonephritis
In this form, pyelonephritis occurs in combination with symptoms such as:
- high temperature, chills. Patients experience increased sweating.
- The kidney on the affected side hurts.
- On the 3-5th day of the manifestation of the disease, by palpation it can be determined that the affected kidney is in an enlarged state, in addition, it is still painful.
- Also, by the third day, pus is detected in the urine (which is designated by the medical term pyuria).
- The appearance of chills and fever is accompanied by headache, joint pain.
- In parallel with these symptoms, there is an increase in pain in the lumbar region, mainly this pain still manifests itself on the side on which the kidney is affected.
Signs of chronic pyelonephritis
The symptoms of the chronic form of kidney disease are very conditional and the course does not have pronounced signs. Often the inflammatory process in everyday life is perceived as a respiratory infection:
- muscle weakness and headache;
- febrile temperature.
However, besides these characteristic features disease, the patient experiences frequent urination, with the appearance of an unpleasant smell of urine. In the lumbar region, a person feels a constant aching pain and feels the urge to urinate frequently.
Late general symptoms of chronic pyelonephritis are:
- dryness of the oral mucosa (slight and intermittent at first)
- discomfort in the adrenal region
- heartburn
- belching
- psychological passivity
- puffiness of the face
- pallor of the skin.
All this can serve as manifestations of chronic renal failure and are characteristic of bilateral kidney damage, excretion of up to 2-3 liters of urine per day or more.
Complications
Serious complications of pyelonephritis include:
- renal failure;
- paranephritis;
- and bacterial shock;
- kidney carbuncle.
Any of these diseases has serious consequences for the body.
All of the above symptoms and signs urological disease must have an adequate medical assessment. You should not endure and hope that everything will work out on its own, and you should not engage in independent treatment without first being examined by a medical professional.
Diagnostics
Diagnosis of inflammation of the pelvis and renal parenchyma, as usual, begins with general examination after collecting patient complaints. Instrumental and laboratory studies that provide a complete picture of what is happening are becoming mandatory.
Laboratory methods include:
- General clinical analysis urine: when urinary sediment is cultured on a glass slide, an increase in the number of leukocytes and bacteria in the field of view is detected. Urine should normally be acidic in nature, but with infectious pathology it becomes alkaline;
- General clinical blood test: all signs of an inflammatory process appear in the peripheral blood, the erythrocyte sedimentation rate increases and the number of leukocytes in the field of view increases significantly.
Laboratory indicators:
- a blood test reveals an increase with a shift of the formula to the left, accelerated ESR;
- the urine is cloudy with mucus and flakes, and sometimes has an unpleasant odor. A small amount of protein, a significant number of leukocytes and single red blood cells are found in it.
- urine cultures determine true bacteriuria - the number of microbial bodies in a milliliter of urine is >100 thousand.
- the Nechiporenko test reveals the predominance of leukocytes in the middle portion of urine over red blood cells.
- in the chronic process, changes in biochemical tests are observed: an increase in creatinine and urea.
Among instrumental methods studies are prescribed:
- Ultrasound of the kidneys and abdominal cavity;
- computed tomography or x-ray to detect changes in the structure of the affected kidney.
Treatment of kidney pyelonephritis
Kidney pyelonephritis should be treated comprehensively, including medications and physiotherapeutic methods. Complete treatment for kidney disease contributes to the patient’s speedy recovery from infectious pathology.
Medications
Target drug treatment is aimed not only at destruction of infectious agents and relief of symptomatic signs, but also to restore vital important functions body while the disease pyelonephritis progressed.
Preparations:
- Antibiotics. During an exacerbation, you cannot do without them, but it is optimal if a doctor prescribes them, even better if at the same time he explains how to collect and where to donate urine for culture for microflora and sensitivity to antibiotics. Most often used in outpatient practice:
- protected penicillins (Augmentin),
- 2nd generation cephalosporins (Ceftibuten, Cefuroxime),
- fluoroquinolones (Ciprofloxacin, Norfloxacin, Ofloxacin)
- nitrofurans (Furadonin, Furamag), as well as Palin, Biseptol and Nitroxoline.
- Diuretics: prescribed for chronic pyelonephritis (to remove excess water from the body and possible swelling), in acute cases are not prescribed. Furosemide 1 tablet 1 time per week.
- Immunomodulators: increase the body’s reactivity in case of illness, and to prevent exacerbation of chronic pyelonephritis.
- Timalin, intramuscularly 10-20 mg once a day, 5 days;
- T-activin, intramuscularly 100 mcg once a day, 5 days;
- Multivitamins (Duovit, 1 tablet 1 time a day), Ginseng tincture - 30 drops 3 times a day, are also used to increase immunity.
- Nonsteroidal anti-inflammatory drugs(Voltaren), have an anti-inflammatory effect. Voltaren orally, 0.25 g 3 times a day, after meals.
Treatment of chronic pyelonephritis is carried out according to the same principles as the therapy of the acute process, but is longer and more labor-intensive. Therapy for chronic pyelonephritis includes the following therapeutic measures:
- elimination of the causes that led to difficulty in the outflow of urine or caused disturbances in the renal circulation;
- antibacterial therapy (treatment is prescribed taking into account the sensitivity of microorganisms);
- normalization of general immunity.
The goal of treatment during an exacerbation is to achieve complete clinical and laboratory remission. Sometimes even 6 weeks of antibiotic treatment does not give the desired result. In these cases, a scheme is practiced where, for six months, an antibacterial drug is prescribed every month for 10 days (each time a different one, but taking into account the spectrum of sensitivity), and the rest of the time - diuretic herbs.
Surgery
Surgical intervention is prescribed if, during conservative treatment, the patient's condition remains severe or worsens. Usually, surgical correction carried out when purulent (apostemotic) pyelonephritis, abscess or carbuncle of the kidney is detected.
During the operation, the surgeon restores the lumen of the ureter, excises inflammatory tissue and installs drains for the outflow of purulent fluid. If the kidney parenchyma is significantly destroyed, an operation is performed - nephrectomy.
Diet and proper nutrition
The goal of the diet for pyelonephritis is
- sparing kidney function, creating optimal conditions for their work,
- normalization of metabolism not only in the kidneys, but also in other internal organs,
- lowering blood pressure,
- reduction of swelling,
- maximum removal of salts, nitrogenous substances and toxins from the body.
According to the table of treatment tables according to Pevzner, the diet for pyelonephritis corresponds to table No. 7.
General characteristics of treatment table No. 7- this is a slight restriction of proteins, while fats and carbohydrates correspond physiological standards. In addition, the diet should be fortified.
Products that need to be limited or, if possible, eliminated during the treatment period:
- broths and soups based on rich meat and fish broth – we are talking about the so-called “first” broths;
- first courses of legumes;
- salted and smoked fish;
- any fatty varieties of river and sea fish;
- caviar of any fish;
- seafood;
- fatty meats;
- lard and interior fat;
- bread with added salt;
- any flour products with added salt;
- mushrooms of any kind and prepared in any way;
- strong tea and coffee;
- chocolate;
- confectionery products (pastry and cakes);
- sorrel and spinach;
- radish and radish;
- onion and garlic;
- sausages and sausages – boiled, smoked, fried and baked;
- any smoked products;
- sharp and fatty cheeses;
- canned meat and fish;
- marinades and pickles;
- high fat sour cream.
Allowed foods:
- Lean meats, poultry and fish. Despite the fact that fried foods are acceptable, it is recommended to boil and steam, stew and bake without salt and spices.
- As for drinks, it is recommended to drink more green tea, various fruit drinks, compotes, herbal teas and decoctions.
- Low-fat soups, preferably with a vegetarian vegetable base.
- The most preferred vegetables for this diet are pumpkin, potatoes, and zucchini.
- Cereals should be avoided, but buckwheat and oatmeal are acceptable and useful for this disease.
- It is recommended to eat bread without adding salt; it is not recommended to eat fresh bread right away. It is advised to make toast out of bread and dry it in the oven. Pancakes and pancakes are also allowed.
- For pyelonephritis, dairy products are allowed if they are low-fat or low-fat.
- Fruits can be eaten in any quantity; they are useful for the inflammatory process of the kidneys.
Following a diet for pyelonephritis facilitates the work of diseased kidneys and reduces the load on all organs of the urinary system.
Folk remedies
Before use folk remedies from pyelonephritis, be sure to consult your doctor, because There may be individual contraindications for use.
- Pour 10 grams of the mixture (prepared from lingonberry leaves, coltsfoot, strawberries, cornflower flowers, forest speedwell grass, nettles and flax seeds) with boiling water (0.5 liters) and place in a thermos for 9 hours. You need to consume 1/2 cup at least 3 times a day.
- Pumpkin juice is especially popular, which has a strong anti-inflammatory effect during pyelonephritis. From the vegetable you can cook yourself a medicinal porridge for breakfast or steam it, as well as in the oven.
- Corn silk– ripe corn hairs – as a diuretic for high blood pressure. In addition, the plant has an antispasmodic effect, which will eliminate pain during the inflammatory process in the kidneys and other parts of the body, however, if blood clots form in the patient’s blood too often, then corn silk will have to be abandoned.
- The plant is dried and crushed.
- Pour 1 dessert spoon of hairs with 1 glass of boiling water.
- Simmer for 20 minutes.
- Leave for 40 minutes.
- Take 2 tbsp. decoction every 3 hours.
- Collection for kidney pyelonephritis: 50 g each – horsetail, strawberries (berries) and rose hips; 30 g each – nettle (leaves), plantain, lingonberry and bearberry; 20 g each - hops, juniper and birch leaves. Mix the entire medicinal composition and add 500 ml of water. Bring the entire medicinal mass to a boil. Then strain and consume 0.5 cups 3 times a day.
Prevention
- visit a urologist (once every 3-4 months);
- timely treatment of urological and gynecological diseases;
- consume large amounts of fluid to normalize urine flow;
- avoid hypothermia;
- lead healthy image life;
- adhere to a balanced diet;
- do not abuse protein foods;
- for men - monitor the condition of the urinary system, especially if there have been urological ailments in the past;
- if there is a urge to urinate, do not delay the process;
- observe the rules of personal hygiene.
Kidney pyelonephritis is a serious disease that must be treated when the first signs appear to avoid complications. Be sure to get diagnosed by a nephrologist or urologist 1-2 times a year.
Pyelonephritis is an infectious inflammatory disease of the kidneys that occurs when pathogenic bacteria spread from the lower parts of the urinary system. In most cases, the causative agent of pyelonephritis is Escherichia coli (E. Coli), which large quantities sown in patients' urine.
This is a very serious disease, accompanied by severe pain and significantly worsens the patient’s well-being. Pyelonephritis is easier to prevent than to cure.
Pyelonephritis is part of a group of diseases collectively called “urinary tract infection.” With improper antibacterial treatment of infectious diseases of the lower parts of the urinary system, bacteria begin to multiply and gradually move to higher parts, eventually reaching the kidneys and causing symptoms of pyelonephritis.
Facts and statistics
- Every year in the United States, an average of 1 person out of every 7 thousand people falls ill with pyelonephritis. 192 thousand of them are undergoing inpatient treatment in specialized departments of hospitals and clinics.
- Women suffer from pyelonephritis 4-5 times more often than men. Acute pyelonephritis occurs more often in women who are sexually active.
- In 95% of patients, treatment of pyelonephritis gives a positive result within the first 48 hours.
- In childhood, pyelonephritis develops in approximately 3% of girls and 1% of boys. 17% of them develop cicatricial changes in the renal parenchyma, and 10-20% develop hypertension.
- Plain water can significantly improve the condition of a patient with pyelonephritis. Drinking plenty of fluids maintains normal fluid balance and also dilutes the blood and helps eliminate more bacteria and their toxins. This happens due to frequent urination in response to increased fluid intake.
- Although even slight movement can cause severe pain with pyelonephritis, it is important to urinate as often as possible. Although the patient feels discomfort during urination, this is the only way to get rid of the causative agent of the disease - bacteria are removed from the body only with urine. Uncontrolled growth of microorganisms will worsen the condition, causing sepsis (blood poisoning) and can even cause the death of the patient.
- Cranberry juice is considered a good helper in the fight against pyelonephritis. The juice can be drunk pure or diluted with water (see). In this case, you should completely avoid drinking alcohol, sweet carbonated drinks and coffee.
Risk factors
Risk factors for developing pyelonephritis include:
- Congenital anomalies of the kidneys, bladder and urethra;
- AIDS;
- Diabetes;
- Age (risk increases as you get older);
- Diseases of the prostate gland, accompanied by an increase in its size;
- Kidney stone disease;
- Spinal cord injury;
- Bladder catheterization;
- Surgical interventions on the urinary system;
- Uterine prolapse.
Causes of pyelonephritis
Ascending route of infection
Pyelonephritis is caused by bacteria. They enter the urinary system through the urethra and then spread to the bladder. The pathogen then moves to higher structures, ultimately penetrating the kidneys. More than 90% of cases of pyelonephritis are caused by Escherichia coli, a bacterium that multiplies in the intestines and enters the urethra from the anus during bowel movements. This explains the increased incidence among women (due to the anatomical proximity of the anus, external genitalia and urethra).
Ascending infection is the most common cause of acute pyelonephritis. This explains the high incidence among women. Due to the anatomically short urethra and the structural features of the external genitalia, the intestinal flora in women is contaminated groin area and vagina, then rapidly spreading upward into the bladder and higher.
In addition to E. coli, among the causative agents of pyelonephritis there are:
- Staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
- Klebsiella pneumoniae;
- Proteus (Proteus mirabilis);
- Enterococcus;
- Pseudomonas aeruginosa;
- Enterobacter species;
- Pathogenic fungi.
Less common routes of migration of infectious agents into the kidneys include hematogenous and lymphogenous. Microbes can also be introduced during instrumental manipulations, for example, with catheters. With the latter option, the most likely causative agents of pyelonephritis are Klebsiella, Proteus and Pseudomonas aeruginosa.
Vesiculourethral reflux
Vesiculourethral reflux is characterized by a violation of the outflow of urine through the ureters to the bladder and partial reflux of it back into the renal pelvis. If the disease is not diagnosed on early stages, stagnation of urine leads to growth pathogenic microorganisms, which are thrown into the kidney and cause its inflammation.
Frequent repeated attacks of acute pyelonephritis in children cause severe damage to the kidneys, which can result in scarring. This rare complication, occurring mainly in children under 5 years of age. However, cases of the development of cicatricial changes after pyelonephritis in children at puberty have been described.
The increased tendency to cicatricial changes in the kidneys in children is explained by the following factors:
- Reflux in children occurs at much lower pressure than in adults;
- Reduced resistance of the body's immune system against bacterial infections during the first year of life;
- Complexity early diagnosis pyelonephritis in infancy.
In 20 - 50% of children under 6 years of age with pyelonephritis, vesiculourethral reflux is diagnosed. Among adults, this figure is 4%.
In 12% of patients on hemodialysis, irreversible kidney damage developed due to pyelonephritis in early childhood.
Other causes of pyelonephritis are rare. In some cases, inflammation does not develop upward from the bladder, but directly when the pathogen enters the kidneys from other organs through the blood vessels.
The likelihood of infection increases if the ureter is blocked by a stone or an enlarged prostate obstructs urine output. The inability to remove urine leads to stagnation and the proliferation of bacteria in it.
Symptoms of pyelonephritis
The most common symptoms of acute pyelonephritis include:
- Fever, chills
- Nausea, vomiting
- General weakness, fatigue
- Dumb It's a dull pain in the side on the affected side or in the lower back of a encircling nature
- Minor swelling
Additional nonspecific symptoms pyelonephritis, characterizing the course of the inflammatory disease:
- Fever;
- Cardiopalmus.
In the chronic course of pyelonephritis, manifestations of the disease can occur in more mild form, but persist for a long time. In this case, the blood test is calm, there are leukocytes in the urine, but there may be no bacteriuria. During remission, there are no symptoms, blood and urine tests are normal.
Every third patient with pyelonephritis has concomitant symptoms of infection of the lower urinary system (,):
- Stitching or burning;
- The appearance of blood in the urine;
- Strong, frequent urge to urinate, even with an empty bladder;
- Change in urine color (dark, cloudy). Sometimes - with a characteristic unpleasant “fishy” smell.
Tests for pyelonephritis
- A blood test shows signs of inflammation (increased leukocytes, accelerated ESR).
- Urine tests reveal a significant number of bacteria (more than 10 to 5 CFU), more than 4000 leukocytes in the Nechiporenko test, hematuria of varying degrees, protein up to 1 g per liter, the specific gravity of urine decreases.
- IN biochemical analysis blood there may be an increase in creatinine, urea, potassium. The growth of the latter indicates the formation of renal failure.
- When visualizing the kidneys on ultrasound, the affected organ is enlarged in volume, its parenchyma thickens and becomes denser, and an expansion of the renal pelvis system is observed.
Complications
The risk of complications increases in pregnant women, as well as in patients with diabetes. Complications of acute pyelonephritis can include:
- Kidney abscess (formation of a cavity filled with pus);
- Kidney failure;
- Sepsis (blood poisoning) when pathogenic bacteria enter the bloodstream.
Pyelonephritis and sepsis
Unfortunately, pyelonephritis is not always easy to treat, often due to errors during diagnosis. In some cases, the disease progresses to severe form even before seeing a doctor. The risk groups in this case are people with spinal injuries (paralyzed, who do not feel pain in the lower back), as well as the mute, who cannot independently complain if their condition worsens.
Untimely treatment or its absence leads to the progression of the disease, the growth of bacteria and their penetration into the bloodstream with the development of sepsis. This condition is also called blood poisoning. This severe complication, often ending in the death of the patient.
Patients with pyelonephritis should not die, since this is not a serious disease that can be quickly and effectively treated with antibacterial drugs. But if the disease is complicated by sepsis or, in the terminal stage, septic shock, then the risk of death increases sharply. According to world statistics, every third patient with sepsis dies in the world. Among those who managed to cope with this condition, many remain disabled, since during treatment the affected organ is removed.
Famous people with pyelonephritis complicated by sepsis:
- Marianna Bridie Costa - Brazilian model
Born June 18, 1988. She died on January 24, 2009 from sepsis that developed against the background of pyelonephritis. Treatment included amputations of both arms in an attempt to stop the progression of the disease. Death occurred 4 days after the operation.
- Etta James - singer, four-time Grammy winner
- Jean-Paul II - Pope
Born May 18, 1920. He died on April 2, 2005 from sepsis, the cause of which was pyelonephritis.
Emphysematous pyelonephritis
Emphysematous pyelonephritis is a severe complication of acute pyelonephritis with high frequency deaths (43%). Risk factors for the development of this complication are diabetes or blockage upper sections urinary system. The main symptom is the accumulation of gas in the kidney tissues, which leads to their necrosis and the development of renal failure.
Pyelonephritis in pregnant women
The incidence of bacteriuria during pregnancy is 4-7%. Pyelonephritis develops in approximately 30% of pregnant women from this group (1-4% of total number pregnant women). Most often, symptoms of pyelonephritis appear in the second trimester. Among the complications of pyelonephritis in pregnant women are:
- Anemia (23% of cases);
- Sepsis (17%);
- Renal failure (2%);
- Premature birth (rare).
An increased incidence of asymptomatic bacteriuria in pregnant women is observed among representatives of a low socioeconomic class, as well as in multiparous women.
Treatment of pyelonephritis
In cases where acute pyelonephritis occurs or chronic pyelonephritis worsens with high fever, decreased blood pressure (blood pressure), severe pain A suppurative process or a violation of the outflow of urine may develop - treatment may require surgical intervention. Also, in cases where taking tablet forms of antibiotics is accompanied by vomiting, nausea, or increasing intoxication, hospitalization of the patient is indicated. In other cases, the doctor may prescribe treatment at home.
For a disease such as pyelonephritis, symptoms and treatment, both symptomatic and antibacterial, are closely related. Symptomatic treatment includes:
- Bed rest for the first few days (duvet rest), that is, horizontal position and warmth.
- Non-steroidal anti-inflammatory drugs to achieve an analgesic effect and reduce body temperature (metamizole,);
- Drink plenty of fluids.
In case of chronic pyelonephritis, both during remission and during exacerbation, wet cold should be avoided - this is the worst enemy of weak kidneys. It is also advisable to lie down in the middle of the day for at least 30 minutes and avoid infrequent emptying of the bladder.
Antibacterial treatment of pyelonephritis in adults
Typically, the antibiotic is first prescribed empirically for 5-7 days, and then it can be changed based on the results of bacterial culture.
Treatment of pyelonephritis with antibiotics is carried out with drugs from the fluoroquinolone group, ampicillin in combination with beta-lactamase inhibitors, as well as cephalosporins (drugs of choice in children). The convenience of cephalosporins of 3–4 generations (ceftriaxone, cefotaxime) is that therapeutic doses are administered no more than 2 times a day. Due to high resistance (40%), ampicillin is used less and less. The duration of the course is 7–14 days, depending on the severity of the disease and the effect of the treatment.
Due to the retention of high concentration after absorption from the intestine, ciprofoloxacin can be used in tablet form. Intravenous antibiotic administration is indicated only for nausea and vomiting.
If the patient's condition does not improve 48-72 hours after the start of treatment, it is necessary to perform a computed tomography scan of the abdominal cavity to exclude an abscess and. You will also need to conduct a repeated bacteriological analysis of urine to determine the sensitivity of the pathogen to antibiotics.
In some cases, after a course of antibacterial therapy, repeated treatment with an antibiotic of a different group may be necessary. Treatment of chronic pyelonephritis involves prescribing long courses of antibacterial drugs. The main problem in treating diseases caused by bacteria is the development of antibiotic resistance.
In the case where the symptoms characterizing pyelonephritis were quickly identified and treatment was started in a timely manner, for most patients the prognosis remains positive. The patient is considered healthy if the pathogen is not detected in the urine within a year after discharge.
Weekly course of ciprofloxacin – effective therapy pyelonephritis
Studies have shown that a seven-day course of the antibacterial drug ciprofloxacin is as effective as a 14-day course of drugs from the fluoroquinolone group. One study involved two subgroups of 73 and 83 women with acute pyelonephritis who received treatment with ciprofloxacion (7 days) and fluoroquinolone (14 days). The results showed that in both groups the effectiveness of treatment was 96-97%. Moreover, in the group treated with fluoroquinolone, 5 patients developed symptoms of candidiasis, while in the other group no such symptoms were detected.
Antibacterial therapy of pyelonephritis in children
Treatment begins with intravenous administration antibacterial drugs. After achieving a positive effect and reducing the temperature, it is possible to switch to tablet forms of cephalosporin drugs:
- Ceftriaxone;
- Cefepin;
- Cefixime.
Treatment of mild forms can initially be carried out with tablet preparations.
Treatment of pyelonephritis of fungal etiology
Antifungal treatment is carried out with Fluconazole or Amphotericin (see). In this case, it is mandatory to control the removal of fungal compounds using radiopaque urography, computed tomography or retrograde pyelography. Pyelonephritis, caused by pathogenic fungi and accompanied by blockage of the urinary tract, is treated surgically with the application of a nephrostomy. This method ensures the normalization of urine outflow and allows the introduction antifungal drugs directly to the site of infection.
Nephrectomy
The issue of nephrectomy (kidney removal) is considered if developed sepsis cannot be treated conservative treatment. This operation is especially indicated for patients with increasing renal failure.
Herbal medicine for pyelonephritis
If present, naturally, medicinal herbs will cause an allergic reaction, so herbal teas Can be used if you are not prone to allergies. Many plants, in addition to the antiseptic effect, have a number of positive effects, have diuretic and anti-inflammatory properties:
- reduce swelling - bearberry, horsetail, see.
- urinary tract spasms - orthosiphon, oats
- reduce bleeding - ,
- Ciprofloxacin 0.5-0.75 twice daily and Norfloxacin 400 mg twice daily remain relevant only for previously untreated patients.
- Cefibutene 400 mg once daily or
- Cefixime 400 mg once daily or
- Cefatoxime 3-8 g per day in 3-4 injections intramuscularly or intravenously or
- Ceftriaxone 1-2 g per day once intramuscularly or intravenously.
In nephrology and urological practice Doctors often encounter such a disease as. According to statistics, the disease occurs in 20% of the population of different age categories. Treatment of pyelonephritis is a long and labor-intensive process, therefore, when diagnosing this disease, patients need not only to take medications for a long time, but also to follow a diet and refuse bad habits. Medicines for pyelonephritis will help not only eliminate the symptoms of the disease, but also influence the very cause of its development.
Pyelonephritis, refers to infectious pathologies acute or chronic course. The disease can affect either one or both kidneys, causing very serious diseases. It develops as a result of the penetration of pathogenic pathogens into the lower parts of the genitourinary system, which multiply quite quickly, move through the canals of the genitourinary system, reach the kidneys, after which they provoke an inflammatory process.
Pyelonephritis is included in the group of diseases of the urinary system, the treatment of which should be carried out under the supervision of a doctor and only after the results of laboratory and instrumental diagnostics.
Drug treatment of pyelonephritis is aimed at suppressing and destroying pathogenic pathogens, therefore the first drugs for symptomatic treatment will act as antimicrobial and antibacterial agents. The treatment regimen for pyelonephritis always consists of taking several medications with different mechanisms of action, which will help not only suppress the aggressiveness of pathogenic bacteria, but also improve the functioning of the kidneys and urinary system as a whole. In order to successfully cure pyelonephritis, it is important not only to recognize the disease in time, but also to identify and eliminate its main cause.
A disease such as pyelonephritis develops as a result of pathogenic flora entering the genitourinary system. The causative agents of infection are often intestinal microorganisms - Escherichia coli, enterococci, Proteus, staphylococci, streptococci and other bacteria, which can remain in the body for a long time, show their aggressiveness against the background of a number of factors, or penetrate from the external environment.
The disease is diagnosed in women much more often than in men. The reason for this is anatomical structure organs of the genitourinary system. The following factors can be a trigger for the development of pyelonephritis:
- Hypothermia of the body.
- Decreased immunity.
- Concomitant diseases of the genitourinary system.
- Frequent stress, nervous tension.
- Failure to comply with personal hygiene rules.
- Gynecological manipulations.
- Bladder catheterization.
One of the causes of pyelonephritis is nervous tension and stress.
During the development of the inflammatory reaction in the kidneys, the outflow of urine through the ureter is disrupted, which causes an increase in intrapelvic pressure, disruption of capillary blood flow, and tissue hypoxia. Such pathological changes significantly disrupt kidney function and may have unpleasant consequences.
Pyelonephritis is a fairly complex disease, so many people wonder whether pyelonephritis can be cured?
How to recognize the symptoms of pyelonephritis?
The first symptoms of pyelonephritis may appear several hours after contact with a pathogenic pathogen or after a few days. They can be expressed or erased and directly depend on the degree of the disease, its stage, accompanying symptoms sick. A characteristic symptom The disease is considered to be pain in the lumbar region, which can radiate to the back and lower abdomen. The nature of the pain syndrome can have different intensity.
With pyelonephritis, patients complain of the following symptoms:
- Pain when urinating.
- Copious and frequent urination.
- Cloudy urine mixed with pus or blood.
- Elevated leukocytes in the blood test.
- Increase in body temperature to 39 degrees.
- Fever.
- Nausea, urge to vomit.
The clinical picture of the disease is more pronounced in the acute period. In the chronic form of the disease, the symptoms are less pronounced, and the disease itself can be diagnosed accidentally after testing. For kidney pyelonephritis, the doctor prescribes a series of tests, studies the clinic, and then prescribes therapeutic therapy.
Principle of drug treatment
Treatment of pyelonephritis in adults, as well as in children, consists of a whole complex therapeutic measures aimed at suppressing infection and its spread to other parts of the urinary system. Features of therapeutic therapy depend on the patient’s age and the degree of damage to the structures of the genitourinary system.
In order to cope with the disease, the doctor prescribes several drugs that not only eliminate pathogenic flora, but also restore kidney function. How to treat pyelonephritis and how to prevent its possible complications is determined by the attending physician after determining the nature of the disease.
Considering that this disease is infectious in nature, before prescribing treatment for pyelonephritis, it is important to determine the strain of the pathogen and select drugs to which the pathogen remains sensitive.
If the nature of the disease is not clear, doctors prescribe antimicrobial drugs that can suppress the aggressive flora. In addition to antibacterial drugs, the patient also takes other medications to relieve pain, improve kidney function, and reduce the risk of exacerbations and complications.
Complex therapy for pyelonephritis often includes the following groups of drugs:
- antibiotics;
- diuretics;
- immunomodulators;
- antihistamines;
- antispasmodics;
- anti-inflammatory drugs;
- vitamin therapy, immunotherapy;
- herbal medicines.
The main thing in the treatment process is antibiotics, which can eliminate bacteria, relieve inflammation, thereby stopping the disease. Antibacterial therapy consists of taking antimicrobial drugs. The acute period of the disease always requires the use of anti-inflammatory, analgesic and antipyretic drugs, which should be taken for 3 to 7 days. Medicines based on herbs, which are well tolerated and interact ideally with antibiotics and other symptomatic drugs, can improve the functioning of the urinary system.
An important place in the treatment of pyelonephritis is occupied by pathogenetic treatment, which is aimed at the mechanisms of development of the disease itself, restoring general health, and reducing the risk of complications after the disease.
Statistics show that in approximately 20% of people suffering from pyelonephritis, the disease takes on a chronic form, which is characterized by periods of remission and exacerbation. In the acute period, the doctor will always prescribe antibacterial drugs, and during remission - preventive treatment which will reduce the frequency of exacerbations.
The acute form of pyelonephritis must be treated in a hospital setting, where the disease will be constantly monitored. With minor inflammation and satisfactory condition of the patient, the treatment process can be carried out on an outpatient basis. Treatment at home must necessarily include taking certain medications, following a diet and all the doctor’s recommendations.
In general, treatment for pyelonephritis lasts at least 2 weeks, so if after several days of treatment the patient feels much better, you need to complete the full treatment course, this will help reduce the risk of the disease becoming chronic.
Antibacterial therapy is considered the main thing in the treatment of pyelonephritis, but the choice of drug directly depends on the type of pathogen and the age of the patient. Doctors often use medications to treat the symptoms of pyelonephritis with the highest possible effectiveness. Therefore, patients must strictly adhere to the recommended doses, course, and frequency of taking them.
Nitrofurans
A common group of drugs used for the treatment of the urinary system are nitrofurans, which have a broad antimicrobial effect against gram-positive and gram-negative bacteria. Taking such medications allows you to suppress the aggressiveness of staphylococci, streptococci, trichomonas, E. coli and other microbes.
Representatives of this group:
- Furagin.
- Furadonin
- Furazolidone.
- Furamag.
The active components of such drugs quickly penetrate the site of inflammation, block and destroy the cell membranes of pathogenic pathogens, thereby stopping their reproduction. Basically, such drugs are prescribed for the treatment of chronic pyelonephritis. General contraindications to their use include children under 3 months of age, pregnancy and lactation. The course of treatment and dose are determined by the doctor for each patient.
Group representatives:
- Norfloxacin (Nolitsin).
- Ciprofloxacin (Ciprinol, Tsiprolet).
- Ofloxacin.
- Lomefloxacin (Lomflox).
Taking any medication from the group of fluoroquinolones can influence bacterial cells and disrupt their life cycle. Most often, these medications are used when other medications are ineffective. Taking any medicine from this group can only be prescribed by a doctor after identifying the pathogenic pathogen.
Sulfonamides
A group of drugs used to treat diseases of the genitourinary system caused by pathogenic bacteria. Sulfonamides are often used in combination with nitrofurans, which improves the efficiency and quality of treatment.
This group includes the following representatives:
- Biseptol.
- Urosulfan.
- Nitroxoline.
In the last few years, they have been used quite rarely in the treatment of pyelonephritis, because most of pathogenic bacteria are resistant to such drugs, so taking them may not bring the desired therapeutic effect.
Phosphonic acid derivatives
The only drug from this group is Monural, which has persistent antimicrobial properties and helps to quickly neutralize bacterial flora. The medicine is well tolerated and can be prescribed to children and even pregnant women.
The basis of the drug Monural is fosfomycin, which is a broad-spectrum antibiotic. As practice shows, the effect after taking this drug can occur within 1 to 2 days. You can take the medicine only as prescribed by a urologist or nephrologist and only after making a final diagnosis.
Penicillins or cephalosporins
To relieve the symptoms of pyelonephritis, treatment often includes taking medications from the penicillin or cephalosporin group. Taking such medications allows you to suppress and destroy pathogenic flora.
These include:
- Amoxiclav.
- Augmentin.
- Amoxicycline.
- Cefazolin.
- Ceftriaxone.
- Emsef.
The treatment course with penicillin or cephalosporin drugs can take from 5 to 10 days. Such drugs are produced in different forms: tablets, suspension for children, or in ampoules for intramuscular or intravenous administration. Penicillins, as well as cephalosporins, can cause allergies, so before taking them you need to conduct a sensitivity test.
Natural preparations
Particularly popular are natural uroantiseptics for pyelonephritis, which contain healing herbs. Such drugs are prescribed in combination with other drugs, including synthetic antibiotics. Preparations based on extracts medicinal plants have pronounced antiseptic and diuretic properties.
- Urolesan;
- Phytolysin;
- Cyston.
The advantage of such drugs is considered to be good tolerability, lack of side effects even with prolonged use. Uroseptics are considered ineffective for purulent pyelonephritis. Medicines from this group are prescribed for outpatient treatment or prevention of kidney and urinary system diseases.
Other drugs for the treatment of pyelonephritis
In addition to the main drugs for pyelonephritis, treatment includes the use symptomatic therapy, which will eliminate certain symptoms of the disease and improve the general condition of the patient.
Non-steroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Nimesulide, Voltaren, Movalis and others. Taking such medications allows you to relieve pain, normalize body temperature, and reduce the inflammatory process.
Probiotics – Linex, Laktovit, Ecoflor, Hilak forte. Used in combination with antibiotics and antimicrobials, protect the intestinal mucosa from dysbacteriosis.
Diuretics (diuretics) – Lasix, Furagin. They stimulate the outflow of urine from the renal tubules, thereby eliminating the occurrence of stagnant processes and reducing the risk of stone formation in the kidneys.
Complex therapy for pyelonephritis often includes taking drugs to stimulate the immune system, or vitamin therapy.
It is important to understand that self-medication of inflammatory processes in the urinary system is not worthwhile. Only a nephrologist or urologist knows how to cure pyelonephritis and eliminate all possible risks of its complications. It is known that preventing the development of pyelonephritis is much easier than treating it, so if a person monitors his health and seeks medical help on time, the risks are minimized.
Loading...