The chronic form of pyelonephritis is an inflammatory process that spreads to the kidneys. The disease manifests itself in the form of malaise, pain in the lumbar region and other symptoms.
Pyelonephritis in the chronic form has several stages, each of which is manifested by certain signs. carried out with the help of antimicrobial drugs.
General information about the disease
Chronic pyelonephritis is a nonspecific inflammation of the kidney tissue. As a result of the spread of the pathological process, destruction of the vessels of the organ and is noted.
The chronic form develops against the background of a previously transferred acute pyelonephritis, in which the treatment was carried out incorrectly or was completely absent. In some cases, the pathology may be asymptomatic and many patients do not even notice the presence of the disease. Pyelonephritis can become chronic for several reasons:
- reflux urine;
- inadequate treatment of the acute form;
- violation of urine excretion as a result of narrowing of the urinary tract;
- chronic intoxication.
Chronic pyelonephritis according to ICD-10 has the N11 code and is subdivided, depending on various signs, into several forms.
Statistical data
According to statistics, chronic pyelonephritis is established in 60% of cases of diseases of the genitourinary system with the development of an inflammatory process. In 20%, pathology develops against the background of an acute course.
The disease is established most often in women and girls. This is due to the anatomical structure of the urethra. It is easier for viruses and bacteria to enter the female body through the vagina, from where they enter the kidneys and bladder.
The chronic course differs from the acute one in that the pathological process affects both kidneys, while the organs are not affected in the same way. This form most often proceeds latently, and remissions are replaced by exacerbations.
Etiology of the disease
Pyelonephritis develops as a result of the activation and spread of pathogenic microbes against the background of the influence of various factors. Most often this is an infection with Escherichia coli, streptococci, enterococci and other microorganisms.
Additional causes of kidney inflammation are:
- incorrect treatment;
- , prostate adenoma, urinary reflux and other diseases of the genitourinary system that were not promptly diagnosed and cured;
- multiplication of bacteria that are in the tissues of the kidneys for a long time;
- decreased immunity as a result of prolonged infectious diseases or immunodeficiency states;
- chronic pyelonephritis can be a complication after ARVI, tonsillitis, measles, pneumonia or scarlet fever (children are most susceptible);
- chronic pathologies such as diabetes mellitus, tonsillitis, obesity or bowel dysfunction;
- in women, or during the onset of sexual activity;
- unidentified congenital diseases of the genitourinary system.
Hypothermia and the presence of autoimmune reactions can provoke the development of the pathological process.
Clinical picture
The chronic form of pyelonephritis may be asymptomatic. Signs during the period of remission do not appear. They become pronounced during the exacerbation stage. The main clinical manifestations of pyelonephritis include:
- Intoxication of the body... It is characterized by general weakness, nausea, vomiting, malaise, decreased appetite, and headaches and chills. When diagnosed, pallor of the skin and tachycardia are noted.
- Painful sensations... Localized mainly in the lumbar region.
- Bad urine smell, especially can be observed early in the morning, after sleep.
- Pain when urinating, .
Against the background of chronic pyelonephritis, water-electrolyte disturbances occur, which manifest themselves in the form of dry mouth, cracks on the lips, peeling of the horse cover and constant thirst.
The disease has several stages, each of which is manifested by special symptoms, in the presence of which the doctor can determine the degree of development of the pathology and prescribe the necessary treatment.
- Aggravation... At this stage, the signs are pronounced. Strong pain and intoxication of the body are observed. In a laboratory study of blood, the acceleration of ESR is established. Anemia is also observed. Lack of treatment at this stage leads to the development of renal failure, the diagnosis and treatment of which is difficult.
- Latent... Symptoms are not pronounced. Patients often complain of increased fatigue and constant weakness. In exceptional cases, hyperthermia is noted. Painful sensations in the lumbar region and during urination are practically absent. The ability of the kidneys to concentrate urine against the background of a pathological process decreases, which is reflected in its density. In a laboratory study of urine, the presence of bacteria and leukocytes is established.
- Remission... There are no symptoms at this stage. The disease does not show any signs, which complicates the diagnosis. During the laboratory study of urine, a slight deviation from normal values may be established. When exposed to negative factors, the stage of remission turns into an exacerbation stage, the symptoms acquire an aggressive course, the patient needs medical attention.
Disease classification
On the basis of ICD-10, the types and forms of chronic pyelonephritis are determined by various factors. Allocate:
- Primary chronic form... Pathology develops on a healthy organ, the pathological process affects both kidneys.
- Secondary chronic form... It is a complication of another pathology. It is at first one-sided, then the inflammation affects the second kidney.
A certain group of scientists prefers to divide pyelonephritis into out-of-hospital form and nosocomial, when the patient requires hospitalization. Depending on the localization of the pathological process, there are:
- One-sided.
- Double-sided.
According to the severity of the disease, it should be divided into:
- Complicated when other pathologies join.
- Uncomplicated, without concomitant diseases.
A separate group includes pyelonephritis, which occurs with renal failure. Most often, complicated forms.
Treatment methods
Diagnosis and therapy are complicated by the fact that the disease does not show symptoms in the remission stage. Each patient with chronic pyelonephritis requires an individual approach and comprehensive treatment. First of all, to relieve symptoms during the exacerbation stage, drugs are prescribed to relieve symptoms and destroy pathological microorganisms.
When establishing a chronic form of pyelonephritis, the following groups are assigned:
- Cephalosporins. Kefzol, Cefepim or Tseporin;
- Semi-synthetic penicillins. "Amoxiclav", "Ampicillin" or "Oxacillin" are broad-spectrum antibiotics that help to destroy the microorganisms that caused the development of the disease;
- "Negro", the drug belongs to the group of nilidixic acids;
- in severe cases, "Tobramycin", "Gentamicin" or "Kanamycin" are prescribed.
As antioxidants used ascorbic acid, "Selenium", "Tocopherol". in the chronic form of pyelonephritis, they are prescribed for up to eight weeks. In the case of a severe course of the exacerbation stage, antibacterial drugs are administered intravenously, which helps to achieve greater efficiency and quick results. One of the most modern remedies for pyelonephritis is "5-NOK". It helps to quickly stop symptoms and relieve inflammation.
The patient should limit the consumption of fatty foods, salty and spicy foods, and also observe the drinking regime prescribed by the doctor.
Traditional methods
Treatment of pathology can occur after the relief of the exacerbation stage and only after consultation with the attending physician. The following recipes are the most effective:
- White acacia tea... Brew like regular tea. Consume half a glass for 10 days.
- Bean decoction... A glass of beans, chop, pour a liter of boiling water, put on fire and bring to a boil. Take daily for 7 days in a row.
- Heather infusion... Pour two tablespoons of dried herbs with two glasses of boiling water and leave for an hour. Then strain and drink in large sips.
With pyelonephritis, baths with the addition of tincture of pine branches are also useful. In this case, the water temperature should not be less than 35 degrees. The duration of the bath is no more than 15 minutes. The course of treatment is 15 procedures.
Disease prevention
To avoid the development of inflammation in the kidney tissue should be observed. Experts recommend:
- avoid hypothermia;
- eat properly;
- strengthen immunity;
- timely treat infectious diseases.
The chronic form is dangerous because it may not manifest itself for a long time. The disease is established when diagnosing other pathologies. In case of symptoms, you should consult a doctor, since the acute form always develops into a chronic one, which is difficult to treat.
The kidneys, due to their location, are prone to easy formation of inflammatory processes. The most common pathology of this kind is acute pyelonephritis.
In this disease, the inflammatory process covers. The disease occurs in children and adults, more often in women.
General information
Pyelonephritis is an acute kidney disease caused by nonspecific microbial flora.
The pathological process also captures the system of cups and pelvis. Usually both kidneys are affected at the same time.
The incidence of acute pyelonephritis reaches 16 cases per 100,000 population per year. There are three age groups most at risk of the disease:
- children under three years old, girls get sick eight times more often than boys;
- adults aged 18-35, women get sick seven times more often;
- people over 60 years old, men and women get sick equally often.
The prevalence of morbidity in women is due to anatomical features and hormonal background.
According to ICD 10, the disease has a code N10.
The obstructive form of the disease is accompanied by a violation of the outflow of urine due to the appearance of an obstruction in the ureters or urinary tract.
Obstructive pyelonephritis occurs with a predominance of local symptoms, non-obstructive - general.
Stages of pyelonephritis
The acute stage has the most pronounced symptoms. Common symptoms include prolonged fever up to 37.5-38 * C, accompanied by chills.
Patients complain of weakness, muscle and joint pain. Local manifestations are back pain and urinary disorders.
Acute pyelonephritis is treated by various methods, including. In the acute form of the disease, hospitalization in the department is indicated.
Traditional ways
The main treatment for acute pyelonephritis is medication. From the first day must be appointed. The drugs are chosen depending on the causative agent of the disease. The standard course of treatment is 10 days.
Table. Antibacterial drugs.
The following are used as symptomatic treatment:
- non-steroidal anti-inflammatory;
- antimicrobial;
- vitamins;
- immune correctors;
- detoxification therapy.
A person is assigned to bed rest until the temperature returns to normal. An abundant drink is shown - up to 2 liters of acidified liquid per day.
The diet is prescribed dairy-plant, with a sufficient protein content. Fatty and fried foods, preservatives, spices are excluded. You can not use strong tea, coffee, alcohol. The salt content is limited.
In the presence of obstruction of the urinary tract, their decompression is required - this is a type of surgical treatment. The method consists in passing a thin catheter through the urinary tract. If this method is not feasible, a percutaneous nephrostomy is applied.
Surgical treatment is also carried out with the formation of abscesses in the kidney. The surgeon performs an autopsy, removes pus, etc. If the kidney is completely affected, and there is no possibility of its recovery, it is removed.
ethnoscience
Alternative treatment can only be auxiliary and should not be used as an alternative to antibiotic therapy.
Medicinal plants are used that act on the inflammation process and improve:
- bearberry;
- St. John's wort;
- birch buds;
Decoctions and infusions are prepared from these plants. Take the funds in a warm form in a glass during the day. The treatment is long lasting at least a month.
Exacerbations of the disease
Exacerbations of acute pyelonephritis include:
- the transition of inflammation to the perineal tissue;
- development of retroperitoneal peritonitis;
- formation and abscess of the kidney;
- sepsis;
- infectious toxic shock;
- renal failure.
Complications develop due to late seeking medical help.
Disease prevention
Preventive measures include:
- careful adherence to personal hygiene;
- elimination of foci of chronic infection;
- avoiding hypothermia;
- maintaining strong immunity;
- adherence to the principles of asepsis when carrying out medical actions.
People who have had acute inflammation of the kidneys need dispensary supervision of a therapist, etc.
Forecast
With insufficient treatment, acute pyelonephritis turns into and periodically worsens.
Timely started allows you to completely eliminate the infectious and inflammatory process in the kidneys. The treatment period is 2-3 weeks.
Acute pyelonephritis is a disease with a high risk of complications. In the absence of adequate treatment, there is a gradual destruction of the kidney tissue. Pyelonephritis is especially dangerous for children and pregnant women.
Pyelonephritis is a kidney disease caused by pathogens that invade the kidneys and cause inflammation in the renal pelvis. In Russia, the International Classification of Diseases of the 10th revision is in force, which allows keeping records of morbidity, causes of complaints of patients and appeals to medical institutions, as well as conducting statistical studies. ICD 10 identifies pyelonephritis in chronic and acute forms. From this material you will learn the ICD 10 code for pyelonephritis, the classification of the forms of the disease in this system, as well as the symptoms, causes and methods of treatment of pathology.
Acute pyelonephritis ICD 10
Acute tubulointerstitial nephritis is the full name of this pathology in the 10th revision of the International Classification of Diseases. Acute pyelonephritis ICD 10 code is defined by number 10. This code also denotes acute infectious interstitial nephritis and acute pyelitis. When it is important to identify the pathogen in the diagnosis of a disease, doctors use codes B95-B98. This classification is used for similar agents that have caused the disease: streptococci, staphylococci, bacteria, viruses and infections. The use of these codes is optional in the primary coding of the disease.
Causes of pyelonephritis
Most often, pyelonephritis occurs during the off-season, when the body succumbs to various external factors that become a trigger for the development of the disease. The disease itself is caused by pathogenic microorganisms, among them:
- staphylococci;
- pseudomonas;
- enterococci;
- enterobacter;
- xibella and others.
The penetration of these bacteria into the cavity of the bladder, where they multiply and carry out their vital activity, occurs through the urethra. Often the causative agent of pyelonephritis is Escherichia coli, which enters the body after defecation due to the close location of the anus and urethra. A provoking factor in pathology may be a decrease in immunity due to:
- transferring colds and viral diseases;
- observed infectious processes;
- hypothermia of the body;
- neglect of the rules of intimate hygiene;
- diabetes;
- problems with urine outflow: incomplete bowel movement, backflow of urine;
- urolithiasis with complications.
At risk of developing pyelonephritis are people susceptible to diseases of the genitourinary system. Also, people with congenital diseases of the kidneys, bladder and genitals can face this pathology. The likelihood of getting sick increases in the presence of previous operations, age-related changes, injuries, as well as active sex life.
Symptoms of the acute form
In the acute course of pyelonephritis, symptoms appear almost immediately after damage to the renal pelvis with pathogens. The disease can be recognized by the appearance of the following clinical picture:
- Painful sensations in the kidney area while walking, physical activity and even at rest. Pain can be localized in one area, or it can spread throughout the lower back, bearing a girdle character. When tapping in the kidney area, as well as palpation of the abdomen, there may be an increase in pain.
- There is a deterioration in well-being, increased fatigue, general weakness and malaise.
- Lack of appetite, nausea and vomiting.
- Fever with chills that may last for a week.
- Increased urination and cloudy urine.
- Swelling of the eyelids and limbs.
- Pallor of the skin.
These symptoms appear in almost every case of pyelonephritis. There is also a list of symptoms that are not typical for this disease, but indicate it:
- Toxic poisoning resulting from the vital activity of bacteria. It is manifested by fever and a strong increase in temperature (up to 41 ° C).
- Increased heart rate, accompanied by pain.
- Dehydration of the body.
Ignoring such symptoms can lead to a complicated course of pyelonephritis and the transition of an acute form to a chronic one.
Chronic pyelonephritis ICD 10
The full name of this disease according to the International Classification of Diseases is designated as chronic tubulointerstitial nephritis. Chronic pyelonephritis code according to ICD 10 is identified by number 11. Code number 11 also includes chronic forms of diseases such as infectious interstitial nephritis and pyelitis. In a narrower classification, chronic pyelonephritis ICD 10 is subdivided into several more items. The number 11.0 denotes non-obstructive chronic pyelonephritis, that is, one in which urine flows normally. Number 11.1 designates obstructive chronic pyelonephritis, in which the function of the urinary system is impaired. If necessary, the documentation indicates not only the ICD 10 code for pyelonephritis, but also the causative agent of the disease using codes B95-B98.
Symptoms of the chronic form
The chronic form of the disease in a quarter of cases is a continuation of the acute form of pyelonephritis. Due to the peculiarities of the structure of the female genitourinary system, women are more susceptible to the development of this disease. Chronic pyelonephritis most often occurs in a latent form, so the symptomatic manifestations are very weak:
- Soreness in the lower back usually does not occur. There is a weakly positive Pasternatsky's symptom (the occurrence of painful sensations when tapping the lower back).
- Violation of the outflow of urine is not observed, however, the amount of urine produced increases, its composition changes.
- Headaches, weakness, and increased fatigue are present.
- There is an increase in blood pressure.
- Decreases hemoglobin.
Chronic pyelonephritis can be exacerbated several times a year during the off-season or as a result of other diseases. With an exacerbation, the chronic form is similar in symptoms to the acute one.
Diagnostics
When the first symptoms of the disease occur, it is necessary to consult a urologist who will listen to the patient's complaints and prescribe a series of tests to confirm the diagnosis. The following instrumental and laboratory research methods will help to identify pyelonephritis:
- Ultrasound of the kidneys. The disease is characterized by the occurrence of calculi, changes in the density and size of the organ.
- Computed tomography of the kidneys. It will help to determine the condition of the organ and the renal pelvis, as well as exclude the likelihood of urolithiasis and abnormalities in the structure of the kidneys.
- Excretory urography indicates a limitation of the mobility of diseased kidneys, the presence of deformation of the renal pelvis or a change in the contour.
- Plain urography will help determine the increase in organ size.
- Radioisotope renography will assess the functional ability of the kidneys.
- General blood analysis. The results of the analysis will show an increase in the level of leukocytes with a simultaneous decrease in the level of red blood cells.
- Blood chemistry. Indicates a decrease in albumin, an increase in the content of urea in the blood plasma.
- Analysis of urine. The presence of protein, an increase in the number of leukocytes and the level of salts are observed.
- Bacteriological urine culture. Identifies E. coli, staphylococcus or other microorganisms that provoke the onset of pyelonephritis.
- Zimnitsky's test allows you to analyze the ability of an organ to concentrate urine. Using the sample, doctors determine the amount and density of the material taken, and also compare the obtained sample with the daily rate of urine excreted in a healthy person.
- The test according to Nechiporenko indicates an increase in the level of leukocytes and a decrease in the level of erythrocytes, the presence of bacteria, as well as simple and epithelial casts in the urine.
In chronic pyelonephritis, the indications may differ slightly from the indications of analyzes in the acute form of the disease: pathogenic microorganisms are not detected, and inflammatory processes are not detected. However, an experienced doctor, based on the test results and manifestations of the disease, can always make the correct diagnosis and prescribe timely treatment.
Treatment
Preparations for the treatment of pyelonephritis can only be prescribed by a specialist. Self-medication can cause complications and difficulties with the treatment of pyelonephritis in the future. Most often, doctors prescribe the following therapeutic methods:
- Taking antibacterial drugs. Antibiotics are effective in eliminating microorganisms, which are the main causative agent of pathology. Doctors prescribe both intravenous and oral antibiotics if there are no contraindications. These can be drugs such as Ampicillin, Cefotaxime, Ceftriaxone, or Ciprofloxacin.
- Taking herbal preparations. Means based on herbal ingredients can restore the functional ability of the kidneys, reduce inflammation and stimulate urination.
- Symptomatic treatment. At a high temperature and severe pain syndrome, it is recommended to take antipyretic and analgesic drugs.
Pyelonephritis treatment can take from a week to several months in particularly difficult cases.
The nature and severity of the clinical manifestations of SPE depends on the severity of the general intoxication of the body and on the degree of activity of the pathological process in the kidneys. The first subjective symptoms of the disease usually appear 2-3 days after the start of antibiotic treatment (most often with penicillin or its semisynthetic analogues) along the geo-guide of exacerbation of chronic tonsillitis, tonsillitis, otitis media, sinusitis, ARVI and other diseases preceding the development of SPE. In other cases, they occur a few days after the appointment of non-steroidal anti-inflammatory drugs, diuretics, cytostatics, the introduction of X-ray contrast agents, serums, vaccines. Most patients complain of general weakness, sweating, headache, aching pain in the lumbar region, drowsiness, decreased or loss of appetite, nausea. Often, these symptoms are accompanied by chills with fever, muscle aches, sometimes polyarthralgia, and allergic skin rashes. In some cases, the development of moderate and short-term arterial hypertension is possible. Edema for SPE is not typical and, as a rule, absent. Dysuric phenomena are not usually observed. In the overwhelming majority of cases, polyuria with a low relative density of urine (hypostenuria) is noted from the first days. Only with a very severe course of SPI at the onset of the disease is there a significant decrease (oliguria) of urine up to the development of anuria (combined, however, with hypostenuria) and other signs of acute renal failure. At the same time, urinary syndrome is also detected: insignificant (0.033-0.33 g / l) or (less often) moderately pronounced (from 1.0 to 3.0 g / l) proteinuria, microhematuria, small or moderate leukocyturia, cylindruria with a predominance of hyaline, and in severe cases - and the appearance of granular and waxy cylinders. Oxalaturia and calciumuria are often found.
The origin of proteinuria is primarily associated with a decrease in protein reabsorption by the epithelium of the proximal tubules, however, the possibility of secretion of a special (specific) tissue protein Tamm-Horsfall into the lumen of the tubules is not excluded (BI Shulutko, 1983).
The mechanism of occurrence of microhematuria is not entirely clear.
Pathological changes in urine persist throughout the disease (within 2-4-8 weeks). Polyuria and hypostenuria persist especially for a long time (up to 2-3 months or more). The oliguria observed sometimes in the first days of the disease is associated with an increase in intratubular and intracapsular pressure, which leads to a drop in the effective filtration pressure and a transient decrease in the glomerular filtration rate. Along with a decrease in the concentration ability early (also in the first days), a violation of the nitrogen-excreting function of the kidneys develops (especially in severe cases), which is manifested by hyperazotemia, i.e., an increase in the level of urea and creatinine in the blood. It is characteristic that hyperazotemia develops against the background of polyuria and hypostenuria. It is also possible a disorder of electrolyte balance (hypokalemia, hyponatremia, hypochloremia) and acid-base balance with symptoms of acidosis. The severity of the above kidney disorders in the regulation of nitrogen balance, acid-base balance and water-electrolyte homeostasis depends on the severity of the pathological process in the kidneys and reaches the greatest extent in the case of acute renal failure.
As a consequence of the inflammatory process in the kidneys and general intoxication, characteristic changes in the peripheral blood are observed: small or moderate leukocytosis with a slight shift to the left, often - eosinophilia, increased ESR. In severe cases, anemia may develop. A biochemical blood test reveals C-reactive protein, increased levels of the DPA test, sialic acids, fibrinogen (or fibrin), dysproteinemia with hyper-a1- and a2-globulinemia.
When assessing the clinical picture of SPE and its diagnosis, it is important to keep in mind that in almost all cases and already in the first days from the onset of the disease, signs of renal failure of varying severity develop: from a slight increase in the blood urea and creatinine levels (in mild cases) to a typical picture of an arrester (with severe course). It is characteristic that the development of anuria (pronounced oliguria) is possible, but not at all necessary. More often, renal failure develops against the background of polyuria and hypostenuria.
In the overwhelming majority of cases, the phenomena of renal failure are reversible and disappear after 2-3 weeks, however, the impairment of the concentration function of the kidneys persists, as already noted, for 2-3 months or more (sometimes up to a year).
Taking into account the peculiarities of the clinical picture of the disease and its course, the following variants (forms) of SPE are distinguished (B.I.Shulutko, 1981).
1. Expanded form, which is characterized by all of the above clinical symptoms and laboratory signs of this disease.
2. Variant SPE, proceeding according to the type of "banal" (usual) ARF with prolonged anuria and increasing hyperazotemia, with the phase development of the pathological process characteristic of ARF and its very severe course, requiring the use of acute hemodialysis when assisting the patient.
3. "Abortive" form with its characteristic absence of anuria phase, early development of polyuria, minor and short-term hyperazotemia, favorable course and rapid recovery of nitrogen-excreting and concentration (within 1-1.5 months) kidney functions.
4. "Focal" form, in which the clinical symptoms of SPE are poorly expressed, erased, changes in urine are minimal and unstable, hyperazotemia is either absent or insignificant and quickly transient. For this form, acutely occurring polyuria with hypostenuria, rapid (within a month) restoration of the concentration function of the kidneys and the disappearance of pathological changes in the urine are more characteristic. This is the lightest downstream and the most favorable outcome for SPE. In outpatient settings, it usually passes as an "infectious-toxic kidney".
With SPE, the prognosis is most often favorable. Usually, the disappearance of the main clinical and laboratory symptoms of the disease occurs in the first 2-4 weeks from its onset. During this period, the indices of urine and peripheral blood are normalized, the normal level of urea and creatinine in the blood is restored, polyuria with hypostenuria persists much longer (sometimes up to 2-3 months or more). Only in rare cases, with a very severe course of SPI with severe symptoms of acute renal failure, an unfavorable outcome is possible. Sometimes SPE can acquire a chronic course, mainly with its late diagnosis and improper treatment, non-compliance by patients with medical recommendations.
Loading ...