Pyelonephritis treatment clinical recommendations. Pyelonephritis in pregnant women. Sample diet menus and special meal occasions

High quality and effective treatment Kidney disease is impossible without following the recommendations of specialists. A professional approach and selection of optimal therapy will help not only completely restore the functionality of the urinary system and the filtration abilities of the kidney, but also do without surgical intervention. Regardless of the stage of the disease, therapeutic procedures are carried out in full; you cannot stop taking pills, just as you should not disturb your sleep, eating, and drinking patterns.

• urinary tract infection (UTI) characterized by the growth of bacteria in the urinary tract;
• bacteriuria - an increased number of bacteria in the urine (from 105 colony-forming units in 1 ml of urine);
• asymptomatic bacteriuria– a pathology detected in children during a targeted study, but without pronounced symptoms;
• acute pyelonephritis– inflammatory process in the pelvis, kidney parenchyma due to infection (may be due to stagnation of urine);
• acute cystitis is an inflammatory process of bacterial origin;
• chronic pyelonephritis– organ damage, characterized by fibrosis, destruction of the pelvic cups, occurring against the background of anatomical abnormalities, congenital or acquired obstructions;
• vesicoureteral reflux– a pathology in which urine flows back into the kidneys;
• reflux nephropathy– sclerotic lesion of the parenchyma of focal or diffuse nature, the root cause is vesicoureteral reflux, which provokes intrarenal reflux, leading to attacks of pyelonephritis and sclerosis of the kidney parenchyma;
• Urosepsis is an infectious pathology of a generalized nonspecific type, the appearance of which is associated with the penetration of microorganisms and toxic substances from the urinary system into the bloodstream.

The prevalence of pyelonephritis in children is more than 18%. The frequency of manifestation of the pathology depends on the age and gender of the patient; children in the first year of life are most often affected. For infants, UTI is one of the most severe infectious pathologies, observed in 10-15% of cases.

Important! Until the age of 3 months, UTIs are more common in boys, then the pathology more often develops in girls. After the first illness, the risk of relapse increases with a frequency: in girls from 30% within 12 months after the first episode, in boys 15-20% within 12 months after the first episode.

Consultation with pediatric specialists is necessary at the first signs of leukocyturia or primary dysuritic disorders (inability to urinate with a clear desire, pain during urination, decreased volume of daily urine, change in smell, color of urine, etc.). The cause of the pathology may be local inflammation of the genitals or the presence of phimosis.

Important! In acute forms of the disease, children may not experience damage to the upper respiratory tract even during nephropathic fever. In the first 12 months of a child’s life, an ultrasound examination of the kidneys and bladder is mandatory to eliminate the threat of developing pathology.

Primary prevention of childhood pyelonephritis according to the clinical recommendations of specialists includes the following points:

• regular (do not tolerate) emptying the bladder and bowels;
• compliance with the drinking regime;
• body hygiene.

Rehabilitation activities for children include:

1. regular examinations if episodes of infection recur;
2. in the first 90 days after an exacerbation chronic pyelonephritis or during the course of acute pathology, taking clinical urine samples once every 10 days, for 3 years once a month, then once a quarter;
3. analysis of urine culture for leukocyturia is carried out with unmotivated rises in temperature;
4. Ultrasound of the kidneys once a year;
5. instrumental examination once every 2 years.

The prognosis for complete cure for pyelonephritis in children is positive. Active diagnosis and early treatment reduces the risk of focal organ shrinkage to 10-12% (in the presence of relapses and refluxes), scar changes do not exceed 24% in children and 13% in children under 14 years of age.

The types of infectious diseases in adults are identical to those in children, but preventive measures are aimed at normalizing kidney function and preventing relapses. If acute or chronic pyelonephritis develops, the following recommendations must be followed:

1. hygiene of the external genitalia: proper washing in women (from front to back due to the anatomical proximity of the exit channels and the possibility of infection, infection with ascending pyelonephritis);
2. maintaining optimal body temperature balance: warm feet, warm clothes, but without excessive overheating;
3. no hypothermia;
4. timely emptying of the bladder;
5. maintaining a physical activity regime without overload: normal activity is only beneficial, as it normalizes metabolic processes and restores the body’s water balance;
6. swimming at a water temperature below +21 C is prohibited, overheating in the bathhouse/sauna is prohibited, taking a contrast shower is prohibited;
7. compliance with diet therapy with abstinence from alcohol, spicy and fatty foods (basic detailed nutritional recommendations will be given by a specialist observing the patient);
8. compliance with the drinking regime in sufficient quantities (but only without the presence of cardiovascular and other pathologies);
9. fasting no more than once a week for 1-2 days with the use of immunostimulating agents (consultation with a doctor is required in advance, as active protein breakdown occurs and waste products are removed by the kidneys, which is not always useful for inflammatory processes in the filtration organs);
10. compliance with therapeutic methods of treatment after suffering seasonal colds (drugs indicated for complete cure, drink full course);
11. Avoid working in hot workshops that involve inhaling gasoline fumes, heavy metal salts and heavy physical exertion.

Important! Chronic pyelonephritis allows for treatment at home with normal body temperature, absence of nausea, vomiting, acute local or widespread pain. Therapeutic drugs in the form of antibiotics and uroseptics are used in full, the diet and regimen are followed.

As a rule, the course of therapy lasts no more than 14-21 days. At acute course pathology requires hospitalization of the patient and compliance with bed rest. Not bad to take herbal teas once every six months to prevent exacerbations. The type and volume of the course will be determined by the attending doctor.

Chronic pyelonephritis is a disease that is characterized by the development of inflammation in the kidney tissues. As a result, a person experiences destruction of the pelvis, as well as the vessels of the organ. To protect yourself from this unpleasant pathology, you should carefully study the main causes, symptoms, as well as modern methods of diagnosis and treatment.

The definition of chronic pyelonephritis applies to a disease that long time It proceeds latently and can be activated only under certain conditions. If the disease was diagnosed in childhood or adolescence, then there is a high probability of its return in a more mature period.

Among the main factors that contribute to the development of the disease are:

• hypervitaminosis and hypovitaminosis;
• severe hypothermia, as well as prolonged stay in a stuffy room;
• decreased level of human immunity;
• frequent overwork, stress;
• negative impact of infectious factors;
• the presence of diseases of other abdominal and pelvic organs.

The most common cause of chronic pyelonephritis in men is androgen deficiency. It is caused by changes in hormonal balance, and the presence of tumor-like neoplasms of the prostate is also possible.

There are many more factors that contribute to the development of a disease such as bilateral chronic pyelonephritis in women.

These include:

• short length of the urinary canal;
• the presence of colon microflora in the outer part of the vagina;
• residual urine in the bladder;
• frequent infections of the bladder by infectious agents during close sexual contact.

Often the pathology becomes more active during pregnancy. At this time, the protective function of the immune system is significantly reduced. This is due to the limitation of fetal rejection in the woman’s body.

Pathology has several types. The classification of chronic pyelonephritis implies its division into primary and secondary forms. The first acts as an independent disease, and the second develops against the background of previous lesions genitourinary system. According to localization, chronic pyelonephritis is classified into unilateral and bilateral pathology. In this case, we are talking about the disease affecting one or two kidneys.

Poorly expressed symptoms, a frivolous attitude to therapy, as well as incomplete awareness of the danger of chronic pyelonephritis are the main prerequisites for the transition of this disease to a chronic form. For this reason, it is very important to know the symptoms and treatment of the pathology.

All symptoms of chronic pyelonephritis can be divided into local and general. The first signs are more pronounced in women. They appear in people who have a secondary form of chronic pyelonephritis. This is due to the presence of factors that disrupt the normal flow of urine. In men, symptoms are less pronounced, which significantly complicates the diagnosis of the pathology.

General signs of chronic pyelonephritis have their own classification. They are done for early manifestations and late ones.

The first experts include:

• cachexia;
• episodic asthenia;
• urinary tract obstruction;
• absolute or relative lack of appetite;
• small increases in performance blood pressure;
• poor tolerance to habitual physical work;
• pain syndrome.

Exacerbation of these processes can lead to the development of acute renal failure. Progression of the disease itself usually leads to the appearance of chronic renal failure. This condition is characterized by the presence of irreversible disorders in the urinary system.

This pathology manifests itself through:

• unpleasant pain in the lumbar region;
• dry mouth, as well as some gastric symptoms;
• suppressed psychological activity;
• pale skin;
• polyuria.

Late symptoms of chronic pyelonephritis often indicate that the patient has both organs affected, and there is also a possibility of chronic renal failure. When making a residual diagnosis, they play an important role clinical manifestations, as well as diagnostic data and pathological stages.

Experts distinguish 3 stages of chronic pyelonephritis:

1. The initial stage of the pathology is characterized by the development of inflammatory processes, especially swelling of the connecting ball of the inner layer of the urinary system, which causes compression of the vascular structures. As a result, tubular atrophy develops.
2. The next stage is accompanied by the presence of diffuse narrowing of the arterial bed of the kidneys, as well as atrophy of the walls of the interlobar vessels.
3. The third stage is due to compression and obstruction of all vascular structures of the kidneys. In this case, the tissue of this organ is replaced by connective tissue. This gives the organ the appearance of a prune and kidney failure develops.

The diagnosis of chronic pyelonephritis is made based on comprehensive examination patient. Establishing an accurate result requires various instrumental and laboratory research methods.

The first experts include:

1. Performing radiography. The chronic course of the pathology is characterized by a decrease in the size of the kidneys.
2. Chromocystoscopy. With chronic pyelonephritis in the kidneys, the doctor may notice a violation of the excretory function of the genitourinary system.
3. A radioisotope scanning method that detects asymmetry of the kidneys, as well as their deformation or heterogeneity.
4. Excretory and retrograde pyelography, which allows you to notice any pathological processes in the organ.
5. Ultrasonography.
6. Computed tomography and magnetic resonance imaging.
7. Biopsy of the urinary system, as well as diagnostics of the obtained material.

The formulation of the diagnosis occurs after a comprehensive diagnosis of the pathology.

This will help with special laboratory research methods:

1. General analysis blood. On chronic pathology Anemia may indicate high level leukocytes, as well as increased speed erythrocyte sedimentation.
2. General urine analysis. In this case, the patient's material will have an alkaline environment. The urine will have low density and a cloudy color. There may be cylinders. The number of leukocytes is increased.
3. Nechiporenko's test. With its help, you can detect increased levels of leukocytes, as well as their active component.
4. Prednisolone and pyrogenal test. In this case, the patient is given a special dose of the drug and after some time a certain amount of urine is collected.
5. Zimnitsky's test. In this case, several portions of urine are collected during the day and its density is determined.
6. LHC analysis will help determine the level of sialic acids, urea and fibrin.

When asked whether chronic pyelonephritis can be cured, many experts give a negative answer. Treatment tactics consist of an individual approach to each patient, as well as integrated use different methods of therapy that are aimed at his speedy recovery. It consists of following a diet, following doctor’s instructions regarding taking medications, as well as eliminating factors that interfere with the normal outflow of urine.

If there are symptoms of chronic pyelonephritis, the patient should be treated in a hospital. This will help to stop attacks in a short time, as well as effectively deal with their causes. With the primary form of the disease, patients are assigned to the therapeutic department, and with the secondary form, to the urological department.

The duration of bed rest depends entirely on the course of pyelonephritis. In this case, it is imperative to follow a special diet, which is an important point in the treatment of this pathology.

Treatment of chronic pyelonephritis in women has several nuances. In this case, one of the main tasks is to reduce the amount of edema that is often observed with this disease. Compliance with the drinking regime is accompanied by the consumption of drinks such as water, fruit drinks, juices, as well as homemade compotes and jelly. The volume of liquid should not exceed two liters per knock. Only a doctor can change the amount of its consumption. He can do this based on the presence of primary arterial hypertension in the patient or changes in urine passage.

Treatment of this disease involves the use of antibiotics. They can be prescribed in the early stages of the development of chronic pyelonephritis. The period of their use is long, since bacterial agents tend to develop resistance to some drugs. Only a doctor knows how to treat pathology using these medications, so you should not self-medicate to avoid the development of severe complications.

Therapy for chronic pyelonephritis consists of using the following groups of drugs:

1. Semi-synthetic penicillins. These include Ampicillin, Sultamicillin, Oxacillin and Amoxiclav.
2. Cephalosporins. Among them are Ceftriaxone, Cefixime, Kefzol and Ceporin.
3. Nalixidic acid preparations. Among them, the most effective are Nevigramon and Negram.
4. Aminoglycosides. These include Amikacin, Gentamicin and Kanamycin.
5. Fluoroquinolones, namely Ofloxacin, Moxifloxacin and Levofloxacin.
6. Antioxidants. In this case, treatment comes down to the use of Retinol, Ascorbic acid and Tocopherol.

In case of chronic pyelonephritis of the kidneys, it is necessary to first study the acidity of the patient’s urine. This factor has an adverse effect on the effectiveness of drug therapy.

Chronic obstructive pyelonephritis can be called successfully treated if several criteria are met.

Among them it is worth highlighting:

1. Normalization of urine and blood parameters.
2. Stabilization of the patient's temperature.
3. Absence of leukocyturia, proteinuria and bacteriuria.

A positive treatment result does not protect against the possibility of relapse of the pathology. The probability of this phenomenon is 70-80%. For this reason, doctors recommend carrying out therapy that will eliminate risk factors for the recurrence of the disease for many months after successful treatment of the pathology.

If an allergy to medications occurs during the treatment of acute chronic pyelonephritis, the patient is prescribed antihistamines.

These include:

• Tavegil;
• Diazolin;
• Corticosterone.

With primary chronic pyelonephritis, anemia often develops. To eliminate it, iron supplements, vitamin B12, and folic acid are used.

Bilateral pyelonephritis in men is in most cases accompanied by secondary arterial hypertension. In this case, antihypertensive drugs are used, among which Hypothiazide, Triampur and Reserpine are considered the most effective.

If there is chronic pyelonephritis in the kidneys, treatment should be started as early as possible. This will reduce the number and nature of destructive changes, which will have a beneficial effect on the patient’s health.

The outcome of chronic pyelonephritis directly depends on compliance special diet. It consists of limiting spicy, fried, smoked foods, as well as various seasonings from the patient’s diet.

It is not recommended to underestimate your daily calorie requirement. The diet should be balanced in terms of the amount of proteins, fats and carbohydrates. Equally important is the presence of a large amount of vitamins and minerals in food.

An optimal diet should contain a large number of a variety of vegetables: cabbage, beets, potatoes, and greens. Fruits rich in vitamins and fiber are also recommended.

Iron deficiency in chronic pyelonephritis is treated with strawberries, pomegranates, and apples. At any stage of the disease, watermelons, melons, cucumbers, and pumpkin will be useful. These products have a diuretic effect, which allows you to quickly cope with pathology.

Meat and fish should be served exclusively boiled and without salt. It retains water in the patient's body. It is advisable to exclude pork due to its high fat content in the presence of pyelonephritis in men.

Preventive measures applied to a disease such as chronic pyelonephritis are aimed at reducing general level morbidity of the population.

Among them it is worth highlighting:

1. Timely treatment of patients, as well as dispensary registration of patients with an acute form of pathology.
2. Special recommendations for employing people with this disease. Such patients are not recommended to perform heavy physical work and remain in constant nervous tension. It is also worth choosing a job where there are no temperature changes and being in a static position for a long time.
3. Maintain proper nutrition with a limited amount of salt, fried, fatty and spicy foods.
4. Complete elimination of the cause of the development of a secondary form of pathology. Another important point is the complete elimination of obstacles to the normal outflow of urine.
5. Rapid identification of foci of infection.
6. Dispensary observation of patients who have recovered for a year. If during this period the patient does not have leukocyturia, proteinuria and bacteriuria, then the patient is removed from the register. If these signs persist, observation is extended for up to three years.
7. Placing patients with the primary form of the disease in a hospital, where they are treated under the supervision of medical personnel.
8. Correction of the immune system. To do this, you should adhere to a healthy lifestyle, proper nutrition, spending free time on fresh air, as well as dosed physical activity.
9. Visiting sanatorium-resort establishments with a specialized profile. In this case, remission of the pathology is often achieved.
10. Preventive actions are aimed at people with weakened immune systems. These include pregnant women, children and the elderly.

With a latent course of the disease, patients do not lose their ability to work for a long time. Other forms of the disease have a significant impact on the patient’s performance, since there is a possibility of rapid development of severe complications.

It is worth remembering that early diagnosis of the disease significantly increases the chances of favorable treatment and reduces the likelihood of relapses. Therefore, when the first symptoms appear, you should immediately consult with specialized specialists, because only they know how to cure pyelonephritis forever, and will be able to preserve the main value of a person - his health!

Antibiotics for pyelonephritis: which drug to choose

Referring to statistics, we can say that currently the disease pyelonephritis, an inflammation of the kidneys caused by bacteria, has become widespread.

This disease most often affects children in the school age group, aged 7-8 years. This is due to the unique anatomical structure of their urinary system, as well as the need to adapt to school.

Girls and women of sexually active age are also predisposed to it. Men of the older age group also suffer from the disease, especially those with prostate adenoma.

The clinical picture unfolds with an emerging headache, muscle aches, a rise in body temperature to 38 - 39 degrees for a short period of time, accompanied by chills.

If you have these symptoms, you should immediately contact the nearest clinic for examination, where the doctor will select and prescribe an appropriate treatment program, or call a specialist at home, so as not to lead to complications of pyelonephritis.

Treatment of kidney pyelonephritis is carried out in a hospital, in which bed rest is recommended, drinking plenty of fluids, diet and antibiotics (antibacterial drugs) are necessarily prescribed. How to treat pyelonephritis with antibiotics?

Why are antibiotics effective in the fight against pyelonephritis?

Antibiotics are medications(natural or semi-synthetic origin) capable of blunting or influencing the growth or death of certain microorganisms. For pyelonephritis, antibiotic tablets are most often prescribed. Moreover, the main requirements for antibacterial drugs in the treatment of pyelonephritis should be the presence of:

• their concentration in urine is high,
• they should not have a toxic effect on the patient's kidneys.

Which antibiotic is best to take for pyelonephritis? To answer this question, it is necessary to conduct a survey in which

• identify the causative agent of pyelonephritis,
• determine the condition and function of the kidneys,
• determine the state of urine outflow.

In the occurrence and development of pyelonephritis, the main role is played by bacteria (microorganisms), which primarily affect the tissues of the kidney, its pelvis and calyx, therefore, in the forefront, in the complex treatment of the disease, it is worth using

• antibiotics (Ampicillin, Amoxicillin, Cefaclor, Gentamicin).
• sulfonamides (Co-Trimoxazole, Urosulfan, Etazol, Sulfadimezin).

Although they are prescribed for mild forms of the disease, sulfonamides are rarely used at present.

If one of the two conditions is absent, the use of drugs is not used.

• nitrofurans (Furadonin, Furagin, Furazolin)

Antibacterial drugs with wide range actions, and their concentration in the patient’s urine is observed (based on clinical studies of drugs) within 10-15 hours.

• production of nalidixic acid (Negram, Nalidix).

They are well tolerated by the body, but have little effect.

Advantages of antibiotics compared to herbal remedies and other drugs

• Treatment with herbal remedies and achievement of results takes a long period of time (during which pain and cramps are tormented). A course of antibiotics usually does not exceed a week and gives a quick effect.
• Excessive use of herbal remedies can cause a diuretic effect, the consequence of which will be the “movement” of stones (the result of a secondary form of pyelonephritis).
• the action of antibiotics is directed at the source of the disease and does not affect other areas (elimination of bacteria, normalization of body temperature, elimination of sediment in urine).

Antibacterial agents for the treatment of pyelonephritis

For mild forms of pyelonephritis, treatment is carried out with the following drugs:

• Urosulfan,
• Etazol,
• Sulfadimezin

They stop the growth of bacterial cells, are well absorbed from the stomach, and are not deposited in the urinary tract.

If there is no improvement within 2-3 days from the start of taking the drugs listed above, experts recommend adding the following antibiotics (taking into account microbial infection). These include:

• Penicillin

• Erythromycin

It is not prescribed for breastfeeding women; it may affect the baby through breast milk. Can be used by children.

• Oleandomycin

It is an outdated tool. It is practically not used in modern medicine and has been replaced by newer drugs.

• Levomycetin

Contraindicated during pregnancy. Prescribed for children over 3 years of age.

• Colimycin
• Mycerin.

For purulent forms of pyelonephritis, drugs are prescribed intravenously (antibiotics)

• Gentamicin
• Sizomycin.

All drugs are aimed at blocking the development and inhibition of microorganisms that affect the development of pyelonephritis.

The most commonly used in practice are:

• Aminopenicillins (Amoxicillin, Ampicillin). Blocks the development of enterococci and E. coli. Prescribed to pregnant women for the treatment of inflammatory processes in the kidneys.
• Flemoklav Solutab (polysynthetic antibiotic). The difference and usefulness of this drug from others is that it is prescribed to children over 3 months and pregnant women (most drugs are contraindicated).
• Cephalosporin antibiotics (semi-synthetic and natural drug). It is prescribed when there is a predisposition to the transition of pyelonephritis from an acute form to a purulent one. Most patients experience improvement on the 2nd day of taking the drug. This type includes:

1. Cephalexin
2. Cephalothin
3. Zinnat
4. Claforan
5. Tamycin.

• Aminoglycosides (Gentamicin, Amikacin, Tobramycin). Prescribed for severe pyelonephritis. They have a nephrotoxic effect and can affect hearing impairment. Not assigned to older people age category and their repeated use is allowed after a year from the start of the first use.
• Fluoroquinolones. These include:

1. Ciprofloxacin.

They have a wide spectrum of action and are well tolerated by patients. Have minimal toxic effect on the body. Treatment with these antibiotics is prescribed for chronic pyelonephritis. Not prescribed for pregnant women.

Thus, for the treatment of pyelonephritis, today there is a huge range of different drugs intended for both the initial and subsequent forms of the disease.

The expediency and rationality of use depends on the complex treatment that a specialist will select.

It should be borne in mind that the selection of the dose depends on the individual characteristics of the patient (kidney anatomy, urine composition).

At the same time, it is certainly much easier to fight the disease in the early stages. That is why you should not let a painful condition develop and self-medicate. At the first symptoms of the disease, consult a doctor immediately.

Symptoms and treatment of kidney pyelonephritis

Kidney pyelonephritis is a bacterial infection of its internal structure, mainly the pyelocaliceal system.

With untimely or ineffective therapy, the disease may become chronic, the formation of a purulent abscess and disruption of the basic functions of the kidney up to its complete atrophy.

Mostly women are susceptible to pyelonephritis childbearing age. Very often it develops simultaneously with the onset of sexual activity, during pregnancy or after childbirth.

In men, this disease most often occurs in adulthood. In most cases, this is due to impaired urodynamics due to prostate hyperplasia and muscular dysfunction of the urinary tract.

Among diseases of children under three years of age, pyelonephritis ranks second after diseases of the upper respiratory tract.

Etiology of the disease

The main causative agents of pyelonephritis are Escherichia coli and Staphylococcus aureus. In addition, the causes of this disease can be Klebsiella, Proteus, and Candida fungi.

Infection can enter the kidney in several ways:

• ascending with the return of urine into the pyelocaliceal system;
• hematogenous with blood flow from foci of infection of any location;
• lymphogenous with lymph flow.

Accordingly, this disease is caused by the following reasons:

• diseases that lead to disruption of the outflow of urine from the kidneys, for example, prostate adenoma in men, tumor diseases of nearby organs, scars on the ureters after surgical interventions;
• chronic cystitis;
• sluggish inflammatory processes caused by staphylococcus, Proteus or Klebsiella;
• genital infections;
• vesicoureteral reflux in children;
• stagnation of urine in neurogenic dysfunctions of the bladder.

According to research results, one infection of the lower urinary system or genital organs is not enough for the development of pyelonephritis.

The main role is played by impaired urine passage, as well as a significant weakening of a person’s immunity against the background of constant stress, overwork, and vitamin deficiency. An exception is pyelonephritis in children.

Due to the peculiarities of the anatomical structure in early age the infection easily “rises” up the urinary tract to the kidneys. This disease is especially common in girls.

This is mainly due to insufficient perineal hygiene. In boys, a common cause of pyelonephritis is phimosis (narrowing of the foreskin).

Separately, it is worth mentioning the role of hormones in the development of pyelonephritis.

Medical experiments have shown that long-term use hormonal drugs for treatment or contraception, as well as violation hormonal levels in women, as a result of illness or pregnancy, it leads to changes in the structure of the kidney tissue.

This is also a factor contributing to the occurrence of pyelonephritis against the background of another infection, for example cystitis.

This disease also occurs in almost half of people with diabetes. This is caused by a whole complex general violations in organism.

As for chronic pyelonephritis, the development of bacterial resistance to antibiotics plays a significant role.

Most often this occurs due to excessive self-medication, taking antibacterial drugs without good reason, or an incomplete course of treatment with antimicrobial agents.

What happens during bacterial inflammation?

The mechanism of inflammation depends on how the infection entered the kidney. If the causative agents of pyelonephritis were brought in by the blood or lymph flow, then, first of all, the kidney tissue and the nephrons located in it are affected.

After all, this is where the main capillary and lymphatic network of vessels passes.

If bacteria are introduced into the kidney via the ascending route through the ureter, then the primary inflammation covers the pyelocaliceal system, and the renal tissue is affected if the disease lasts for a long time or if there is no treatment.

If the patient does not receive adequate therapy, then over time the process of formation begins in the kidney purulent abscesses, which covers all its internal departments.

This condition can even lead to permanent dysfunction of organs and even to their atrophy.

Classification

Currently, there is no exact and generally accepted classification of pyelonephritis. This disease is caused by a fairly large number of causes and is characterized by various changes in the renal structure.

But most often in medical practice, various forms of pyelonephritis are classified as follows:

• according to the nature of the course into acute and chronic, which in most cases develops against the background ineffective treatment acute pyelonephritis;
• by localization - unilateral and bilateral, although often this disease affects only one kidney;
• depending on the general condition patient - complicated by concomitant pathologies and uncomplicated;
• due to development - into primary, which develops against the background of normal urine passage, and secondary, which occurs when urodynamics are disturbed.

The clinical symptoms of pyelonephritis depend on the form in which it occurs - acute or chronic.

Thus, acute pyelonephritis is characterized by a sharp increase in temperature to 38.5 - 39º. At the same time, cloudiness of the urine and a change in its odor are observed. The patient complains about aching pain in the lower back.

Moreover, if you tap on the back under the shoulder blade with the edge of your palm, the pain syndrome will intensify on the side of the affected kidney.

In contrast of pain syndrome with urolithiasis is that the intensity of pain does not change depending on movement or change in posture.

The listed symptoms are accompanied increased fatigue, drowsiness, sometimes nausea or vomiting, loss of appetite.

Almost from the very beginning of the disease, urinary disorders are noted, the urge to urinate becomes more frequent, and the process itself is accompanied by pain.

If the formation of purulent abscesses has begun, then a wave-like increase in temperature is characteristic: usually, after a sharp increase to 38 - 39º, there is a decrease to subfebrile values.

It is necessary to note that in children the symptoms of pyelonephritis may differ; in addition, it is clear that a small child cannot tell what is hurting him.

Therefore, most often the only symptoms of a bacterial kidney infection are fever and lethargy.

As for the chronic form of pyelonephritis, symptoms may not appear at all for a long time. Unless there is a long subfebrile temperature after suffering from colds.

The disease in this form occurs with alternating periods of exacerbation and remission.

In the acute phase, symptoms characteristic of acute pyelonephritis are noted: fever in the evenings, general deterioration of the condition, which is associated with prolonged intoxication, lower back pain, pain when urinating, increased urge to urinate.

The color and clarity of urine also changes. In the remission phase, there may be no symptoms, and the disease is detected only during clinical examination.

At the late stage of chronic pyelonephritis, symptoms of renal failure are noted: swelling in the face, increased blood pressure, changes in heart rate.

Diagnostics

Naturally, if such symptoms are observed, this is a reason to immediately visit a doctor. Before treating any nephrological pathology, it is necessary to determine the exact location of the infection.

This disease is diagnosed by characteristic changes in blood and urine tests, as well as in x-rays or ultrasound of the kidneys.

Clinical urine analysis shows a significant increase in the number of leukocytes, usually they occupy the entire field of view. Severe bacteriuria is also detected.

When renal tissue or the epithelial wall of the collecting system is involved in the inflammatory process, red blood cells may also appear in the urine. In addition, the protein level is also higher than normal.

An increase in the level of leukocytes and ESR is observed in the blood, and these are direct symptoms of the development of a bacterial infection.

If the excretory function of the kidneys is impaired (this is typical for bilateral pyelonephritis), the concentration of creatinine, urea and other metabolic products increases.

An ultrasound or x-ray shows an expansion of the pyelocaliceal system and a change in the structure of the renal tissue.

In case of pyelonephritis, urine culture with determination of sensitivity to antibiotics is required. But this analysis takes about 3 to 5 days, so in the acute course of this disease, treatment begins immediately.

And when the results of the study are received, the treatment regimen is adjusted.

Treatment

Treatment of pyelonephritis is only medicinal. For constant monitoring of the patient’s condition and kidney function, it must be carried out in a hospital setting.

It is especially important to treat children only in a hospital, since many medications for the treatment of this disease are administered by injection and can cause a severe allergic reaction.

The main treatment of pyelonephritis is carried out with antibacterial agents that act on pathogenic microflora.

Combinations of two to three drugs are usually prescribed. In severe cases, these medications are administered intramuscularly, but if the patient’s condition allows, then, in principle, one can limit oneself to tablets or suspensions.

As mentioned above, pyelonephritis should be treated with regular bacterial culture. Depending on the results of the analysis, treatment is adjusted: the medications themselves may be changed or the course of treatment may be extended.

The selection of antibiotics takes into account their toxic effects on the kidneys. Naturally, treatment is carried out with drugs with minimal nephrotoxicity.

Treatment with non-steroidal anti-inflammatory drugs helps reduce the intensity of the inflammatory process. Drugs that improve blood flow in the kidneys are also prescribed.

Treatment with so-called functional passive kidney exercises is very effective. This method involves periodically taking diuretics.

Such therapy is carried out only under the strict supervision of a doctor, since an overdose of diuretics may cause leaching of microelements in the microorganism. This can lead to a significant deterioration in the patient's condition.

To improve the functioning of the immune system, treatment is carried out with immunomodulators and immunostimulants.

Diet

It takes much longer to treat pyelonephritis if the patient does not adhere to a certain diet.

Thus, for acute pyelonephritis, treatment is supplemented with natural juices, weak tea, compotes, cranberry juice, and rosehip decoction.

Depending on the time of year, the diet must contain pumpkin, watermelons, zucchini or other vegetables and fruits that have a diuretic effect.

You should reduce your salt intake, especially if the disease is accompanied by high blood pressure.

For chronic pyelonephritis, the diet is approximately the same as for acute pyelonephritis. The diet must be designed in such a way as to prevent the development of vitamin deficiency.

The menu must include lean meat and fish, low-fat dairy products, vegetables and fruits. It is worth using honey instead of sugar.

Considered ideal fractional meals(5 – 6 meals during the day).

Timely treatment of pyelonephritis guarantees a favorable outcome of the disease with complete restoration of kidney function. Wide choose modern drugs allows you to treat this disease in infants and pregnant women.

Clinical guidelines include advice regarding diagnosis and therapeutic measures with inflammation of the kidneys. Focusing on the recommendations, the doctor examines, diagnoses and treats the patient in accordance with the form of the disease and its causes.

Description and forms

Pyelonephritis is an inflammatory disease that affects the renal tissue and pyelocaliceal system (PCS). The cause of the disease is the development of an infection that sequentially affects the parenchyma, then the calyx and pelvis of the organ. Infection can also develop simultaneously in the parenchyma and the CLS.

In the vast majority of cases, the causative agents are Escherichia coli, streptococcus, staphylococcus, less often Klebsiella, Enterobacter, Enterococcus and others.

Depending on the effect on the process of urination, inflammation can be primary and secondary. In the primary form, urodynamic disturbances are not observed. In the Tuesday form, the process of formation and excretion of urine is disrupted. The causes of the latter type can be pathologies of the formation of the organs of the urinary system, urolithiasis, inflammatory diseases of the genitourinary organs, benign and malignant tumor formations.

Depending on the location of the inflammatory process in the kidneys, the disease can be unilateral (left- or right-sided) or bilateral.

Depending on the form of manifestation, pyelonephritis occurs acutely and chronically. The first develops rapidly as a result of the proliferation of bacterial flora in the organ. The chronic form is manifested by a long course of symptoms of acute pyelonephritis or its multiple relapses during the year.

Diagnostics

Pyelonephritis is accompanied by a feeling of pain in the lower back, fever and changes in the physicochemical properties of urine. In some cases, with inflammation of the kidneys, feelings of fatigue and weakness, headaches, disorders of the digestive tract, and thirst may be present. Pyelonephritis in children is accompanied by increased excitability, tearfulness and irritability.

During diagnostic measures The doctor must determine what led to the development of the inflammatory process in the kidneys. For this purpose, a survey is conducted to determine the presence of chronic diseases, inflammatory diseases of the urinary system in the past, anomalies in the structure of the organs of the urinary system and disorders in the functioning of the endocrine system, and immunodeficiency.

During examination for pyelonephritis, a patient may be diagnosed with elevated temperature body, which is accompanied by chills. During palpation, pain occurs in the kidney area.

To identify the inflammatory process in the kidney, tests are performed to detect leukocyturia and bacteremia. An increase in leukocytes in the urine is determined using test strips, general analysis and Nechiporenko analysis. The most accurate results are laboratory tests (sensitivity about 91%). Test strips have lower sensitivity - no more than 85%.

The presence of bacterial flora will be shown by a bacteriological analysis of urine. During the study, the number of bacteria in urine is counted, the number of which determines the form of the disease. Bacteriological analysis also makes it possible to determine the type of bacteria. It is important to study the microflora of urine to determine the resistance of the pathogen to antibiotics.

General clinical, biochemical and bacteriological blood tests help determine the clinical picture of the disease. In primary pyelonephritis, blood testing is rarely used, since the test results will not show significant deviations. With secondary pyelonephritis, changes in leukocyte counts occur, as well as in the erythrocyte sedimentation rate. A biochemical blood test is carried out according to indications, in the presence of other chronic diseases or when complications are suspected. A bacteriological blood test helps confirm the type of infectious pathogen.

Instrumental diagnostic methods will help clarify the diagnosis, determine the condition of the kidneys and organs of the urinary system, and establish the cause of the development of inflammation. Using ultrasound, you can see the presence of stones, tumors, and purulent foci in organs. The development of pyelonephritis will be indicated by an increased size of the pyelocaliceal system.

If within 3 days after the start of treatment the symptoms intensify, computed tomography, x-ray diagnostics with the introduction of contrast agent. If you suspect malignant neoplasms, which were identified during ultrasound, require cystoscopy.

Treatment should be aimed at eliminating the source of the disease, preventing complications and relapses.

In acute primary pyelonephritis, treatment is carried out on an outpatient basis using antibacterial agents. Treatment in a hospital setting is carried out according to indications or in the absence of effect from the drugs used.

Hospitalization is necessary for patients with secondary inflammation, which can lead to serious complications as a result of poisoning the body with toxic compounds.

Urgent hospitalization is also necessary for patients with one kidney, exacerbation of a chronic inflammatory process, which occurs with symptoms of renal failure. In a hospital setting, treatment is necessary in the presence of other chronic diseases (diabetes mellitus, immunodeficiency) and in case of accumulation of pus in the kidney cavity.

Treatment

Non-drug treatment involves drinking adequate fluids to help maintain adequate urination. For this purpose, diuretics are used. The diet excludes the consumption of fried, fatty, spicy foods, baked goods and salt.

Drug treatment involves a course of antibacterial drugs, which are prescribed taking into account their compatibility, the patient’s allergies, concomitant diseases, and the patient’s special condition (pregnancy or lactation).

Antibiotics are prescribed immediately after pyelonephritis is detected. General antibiotics are used. After the results of the bacteriological analysis, specific antibiotics are prescribed.

After 48-72 hours, the effectiveness of therapy is monitored. After the results of the analysis, if there is no effectiveness, a decision is made regarding the prescription of other drugs or increasing the dose prescribed.

To treat the primary form, fluoroquinolones, cephalosporins, and protected aminopenicillins are prescribed. In case of secondary inflammatory process, aminoglycosides are added to the specified list of drugs.

During pregnancy, pyelonephritis is treated outside the hospital with antibiotics if there is no threat of miscarriage. In other cases, hospitalization is required. Protected aminopenicillins, cephalosporins, and aminoglycosides are used for treatment. Fluoroquinols, tetracyclines, and sulfonamides are strictly contraindicated.

In case of complicated pyelonephritis, preference is given to ureteral catheterization or percutaneous nephrostomy (PPNS). These methods involve the installation of a drainage system and are aimed at normalizing the passage of urine.

Operations open method are carried out when pus forms, the disease prolongs, or it is impossible to use minimally invasive methods of surgical intervention.

Timely diagnosis and correctly prescribed therapy provide a great chance for a favorable outcome of pyelonephritis. Antibiotics, diet, and water regimen are used for treatment. According to indications, surgical intervention is prescribed.

The kidneys in the human body act as a filter, purifying the blood from harmful substances. About 200 liters of blood pass through the kidneys every day. Poor quality water junk food, medications are filtered by the kidneys, removing harmful substances. Do not forget that all infections that enter the body also pass through the kidneys. Malfunction is vital important body entails unpleasant consequences.

Pyelonephritis – serious illness. The inflammatory process in its acute form is accompanied by a sharp rise in temperature, pain in the lumbar region, and swelling. The situation is fraught with intoxication and increased blood pressure. The stage of remission alternates with exacerbation.

In case of exacerbation of the disease, the help of a specialist is necessary. The doctor prescribes medication. However, diet plays an important role in the treatment of pyelonephritis in adults.

The common phrase “a man is what he eats” is true. Correct selection products in the treatment of pyelonephritis contributes to a speedy recovery of the patient.

Diet for pyelonephritis in adults plays an important role in the treatment process. Deviations in nutritional rules can result in an exacerbation of the disease.

Nutrition for pyelonephritis is aimed at stimulating metabolic processes in the body, evacuation of toxins, and the maximum possible utilization of salts and nitrogenous compounds. As a result of proper nutrition, there is a decrease in swelling and normalization of pressure. Proper nutrition creates gentle conditions for the functioning of the kidneys.

According to the gradation of specific therapeutic nutrition, according to the system of the Soviet scientist Pevzner, the diet for pyelonephritis corresponds to table No. 7. The basic principles of dietary nutrition in this case are exclusion from the daily menu or reduction to a minimum of salt intake, reduction of protein foods in the daily diet, and increased intake of vitamins.

Methods of cooking and eating while dieting

A diet for kidney inflammation allows you to eat at any time. heat treatment, even moderately fried. It is reasonable to divide the daily intake of products into 4-5 doses. Thus, the body is provided with all the necessary nutrients evenly throughout the day, thereby facilitating the functioning of the kidneys.

The diet for pyelonephritis involves reducing salt intake, which has a beneficial effect on kidney function. Salt prevents the removal of toxins from the body and provokes destabilization of blood pressure. If you consume salt in moderation, there is a risk of kidney stones due to excess accumulation of sodium ions.

The diet for chronic pyelonephritis in adults involves an unconditional abstinence from alcohol. Alcohol-containing products have a negative effect on kidney function. As a result of alcohol intake, the rate of elimination of nitrogenous compounds formed as a result of metabolic processes in the body decreases. Alcohol-containing products negatively affect kidney function: they retain fluid, which causes edema and aggravates health problems.

What can you eat?

Eating vegetables and fruits in unlimited quantities, milk and dairy products has a beneficial effect on work. This kind of food can shift the acid-buccal balance of urine to the alkaline side. The point is that in acidic environment Pathogenic microorganisms actively multiply, so alkalization of urine will only benefit the kidneys.

The diet for acute pyelonephritis is designed for a week and involves the use of herbal and fruit infusions, as well as tea, in the first 2-3 days. The use of sugar in food during an exacerbation period is excluded. For food, vegetable, non-salty soups are recommended. After three days, you are allowed to expand the range of foods you eat, giving preference to foods of plant origin. 4 days after the start of a strict diet, it is allowed to include milk, cottage cheese, and sour cream in the diet.

Products strictly contraindicated for pyelonephritis

Table No. 7 has a beneficial effect on kidney function, while at the same time not having a negative effect on other internal organs. Any diet implies some restrictions. For pyelonephritis, the following list of products should be excluded from the menu:

• Concentrated broths - fish and meat, as well as mushroom and bean soups.
• Cheeses – both sharp and salty.

Among products of plant origin, it is recommended to avoid spicy and sour vegetables, such as onions, sorrel, capsicums, radishes, spinach, radishes, as well as canned, pickled and salted vegetables (cucumbers, tomatoes, squash, etc.).

Acute pyelonephritis requires a salt-free diet. It is necessary to completely exclude puff pastry and smoked fish from the menu, as well as fatty varieties fish

Condiments and spices.

Coffee and strong tea.

Sweets: chocolate, candies and other confectionery products.

High fat sour cream.

A strict diet, even with exacerbation of pyelonephritis, is provided only for the first few days. Then comes a relaxation. The menu is quite varied. A small number of products are banned. What is recommended to include in the diet:

• Chicken, lean fish and boiled and stewed meat.
• Soup: from vegetables or cereals, milk soups.
• Porridge, mainly buckwheat and oatmeal.
• Vegetables: carrots, potatoes, pumpkin, zucchini.
• Dairy products: low-fat, low- and medium-fat.
• All types of fruits, as well as melon and watermelon.
• From flour products - pancakes and pancakes.
• Dried bread.
• For drinks, it is recommended to give preference to green tea, rosehip infusion, and compote.

Chronic pyelonephritis does not worsen if you follow a diet.

A few nuances

Herbal infusions will help alleviate the patient’s condition, relieve inflammation, and improve kidney function. They can be consumed instead of tea, compote or between meals. Grass is not a medicine, but you cannot drink it mindlessly in unlimited quantities. Healing herbs have a beneficial effect on kidney function and do not wash away beneficial substances from the body. They drink herbal infusions for 2-3 weeks, then take a break for 1-2 weeks and switch to another herb. A positive effect on the functioning of the kidneys is exerted by: chamomile, yarrow, bearberry, birch buds. It is recommended to brew these herbs in a water bath. But if you buy phyto-packages, then it is enough to brew them with boiling water and let it brew for 15 minutes. Rosehip infusion has a good effect on the kidneys. Rosehip is brewed in a thermos or boiled crushed berries for 15 minutes over low heat.

An infusion of carrot seeds or dill seeds is good for the kidneys. A tablespoon of seeds is poured into 750 ml of cooled boiled water and leave for 12 hours.

Infusions of berries, herbs and seeds for teaching the state of the kidneys are taken throughout the day in a volume of 0.5 - 0.75 ml per day.

Herbal infusions are not a cure for pyelonephritis and in the acute period cannot replace drug treatment. Rather, it is a component of the diet that gives good results with long-term use.

47. De la Prada FJ, Prados A, Ramos R et al. Silent ischemic heart disease in patient with Wegener's necrotizing glomerulonephritis. Nephrologia. 2003; 23 (6): 545-549.

48. Arenillas JF, Candrell-Riera J, Romero-Farina G et al. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis. Stroke. 2005; 36: 12011206.

49. Sejil S, Janand-Delenne B, Avierinos JF et al. Six-year follow-up of a cohort of 203 patients with diabetes after screening for silent myocardial ischaemia. Diabet Med. 2006; 23 (11): 1186-1191.

50. Bounhoure JP, Galinier M, Didier A et al. Sleep apnea syndromes and cardiovascular disease. Bull Acad Natl Med. 2005; 189(3):445-459.

51. Devereaux PJ, Goldman L, Yusuf S et al. Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review. CMAJ. 2005; 173(7):779-788.

© E.V. Arkhipov, O.N. Sigitova, A.R. Bogdanova, 2015 UDC 616.61-002.3:001.8(048.8)

ARKHIPOV EVGENY VIKTOROVICH, Ph.D. honey. Sciences, assistant at the Department of General Medical Practice, Kazan State Medical University, Ministry of Health of Russia, Russia,

420012, Kazan, st. Butlerova, 49, tel. 843-231-21-39, e-mail: [email protected]

SIGITOVA OLGA NIKOLAEVNA, Dr. honey. Sciences, Professor, Head. Department of General Medicine

practices of the State Budgetary Educational Institution of Higher Professional Education "Kazan State Medical University" of the Ministry of Health of Russia,

Russia, 420012, Kazan, st. Butlerova, 49, tel. 843-231-21-39, e-mail: [email protected] BOGDANOVA ALINA RASYKHOVNA, Ph.D. honey. Sciences, assistant at the Department of General Medical Practice, Kazan State Medical University, Ministry of Health of Russia, Russia,

420012, Kazan, st. Butlerova, 49, tel. 843-231-21-39, e-mail: [email protected]

Abstract. Pyelonephritis is one of the most common and potentially treatable diseases in outpatient practice; it often takes a relapsing course and progresses to chronic kidney disease. The goal is to analyze modern data on the problem of diagnosis, classification and treatment of pyelonephritis. Material and methods. A review of publications by domestic and foreign authors was carried out, data from randomized clinical and epidemiological studies were studied. Results and its discussion. Presented modern classification, approaches to diagnosis and tactics of antimicrobial therapy for pyelonephritis from the perspective of evidence-based medicine, which should be a guide for practitioners caring for and treating such patients. Conclusion. The use of modern methods of diagnosis and treatment of pyelonephritis in clinical practice makes it possible to reduce the risk of relapses and complications of the disease, and to achieve not only clinical, but also microbiological recovery.

Key words: pyelonephritis, urinary tract infection, diagnosis, antibacterial therapy.

For reference: Arkhipov, E.V. Modern recommendations for the diagnosis and treatment of pyelonephritis from the perspective of evidence-based medicine / E.V. Arkhipov, O.N. Sigitova, A.R. Bogdanova // Bulletin of modern clinical medicine. - 2015. - T. 8, issue. 6. - P.115-120.

52. Ozhan N, Akdemir R, Duran S et al. Transient silent ischemia after percutaneous transluminal coronary angioplasty manifested with a bizarre electrocardiogram. J Electrocardiology. 2005; 38(3):206209.

53. Caglar M, Mahmoudian B, Aytemir K et al. Value of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) gated SPECT for the detection of silent myocardial ischemia in hemodialysis patients: clinical variables associated with abnormal test results. NucI Med Commun. 2006; 27 (1): 61-69.

54. Witek P. Silent myocardial ischemia. Przegl Lek. 2001; 58 (3): 127-130.

55. Xanthos R, Ekmektzoglou KA, Papadimitriou L. Reviewing myocardial silent ischemia: Specific patient subgroups. Int J Cardiol. 2007; 1-8.

56. Zellweger MJ. Prognostic significance of silent coronary artery disease in Type 2 Diabetes. Herz. 2006; 31 (3): 240-246.

current RECOMMENDATioNs

for the diagnosis and treatment

of pyelonephritis and evidence-based medicine

ARKHIPOV EVGENIY V., p. Med. Sci., assistant of professor of the Department of general practice of Kazan State Medical university, Russia, Kazan, tel. 843-231-21-39, e-mail: [email protected]

SIGITOVA OLGA N.. D. Med. Sci., professor, Head of the Department of general practice of Kazan State Medical university, Russia, Kazan, tel. 49, 843-231-21-39, e-mail: [email protected]

BOGDANOVA ALINA R., C. Med. Sci., assistant of professor of the Department of general practice of Kazan State Medical university, Russia, Kazan, tel. 843-231-21-39, e-mail: [email protected]

abstract. Pyelonephritis is one of the most common and potentially treatable diseases in outpatient practice, often it takes a relapsing course and progresses to chronic kidney disease. The aim of the article is to analyze of current data on the issue of diagnosis, classification and treatment of pyelonephritis. Materials and methods. A review of publications

domestic and foreign authors, studied data from randomized clinical and epidemiological studies. Results. Modern classification, approaches to diagnosis and tactics of antimicrobial therapy of pyelonephritis are Present in the article from the position of evidence based medicine, that should be the guide for practitioners engaged in management and treatment of these patients. Conclusion. Use in practice of modern methods of diagnosis and rational therapy of pyelonephritis can significantly reduce the risk of recurrence and complications of the disease, with a real ability to fully achieve both clinical and microbiological cure.

Key words: pyelonephritis, urinary tract infection, diagnosis, antibacterial therapy.

For reference: Arkhipov EV, Sigitova ON, Bogdanova AR. Current recommendations for the diagnosis and treatment of pyelonephritis and evidence-based medicine. The Bulletin of Contemporary Clinical Medicine. 2015; 8 (6): 115-120.

Urinary tract infections (UTIs) are among the 20 most common reasons patient referrals to general practitioners and therapists. Management of patients with community-acquired uncomplicated pyelonephritis is usually carried out at the prehospital stage. Inpatient treatment Patients with complicated, obstructive pyelonephritis and when it is impossible to take medications orally (for example, with vomiting) are subject to treatment. Diagnosis and treatment of urinary tract infection usually does not cause difficulties. However, the problem of microbiological recovery with eradication of the uropathogen remains one of the most pressing.

Pyelonephritis is a nonspecific inflammatory process in the kidney tissue and pyelocaliceal system with predominant defeat tubulointerstitium - one of the most common infectious diseases in all age groups. Up to 1.3 million cases of acute pyelonephritis are registered annually in Russia. Pyelonephritis, together with cystitis, asymptomatic bacteriuria and infections of the male genital organs, is combined into a syndrome

The classification of pyelonephritis was developed by the International and European Associations of Urology (EAU, 2004), using the UTI criteria of the Infectious Diseases Society of America (IDSA, 1992) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID, 1993).

1. Based on the place of origin, it is divided into:

Out-of-hospital (outpatient);

Nosocomial (in-hospital).

2. According to the presence of complications:

Uncomplicated;

Complicated (abscess, carbuncle, paranephritis, acute kidney injury, urosepsis, shock).

3. Downstream:

Acute [first episode; new infection (de novo) later than 3 months after the acute episode];

Recurrent (relapse is an episode of infection that developed within 3 months after acute pyelonephritis).

The term “chronic” in relation to pyelonephritis in foreign practice is used only in the presence of anatomical abnormalities, renal hypoplasia, obstruction, salt crystals or vesicourethral reflux. In this case, pyelonephritis according to ICD-10 is coded N11.0 (non-obstructive chronic pyelonephritis,

associated with reflux) and is considered as reflux nephropathy.

In domestic medicine, the term “chronic” still means recurrent infection of the tubulointerstitium with nonspecific uropathogenic flora. In this case, exacerbation of pyelonephritis is a clinically manifest disease with fever, lower back pain, dysuria, inflammatory changes in the blood and urine; remission - clinical and laboratory normalization of disease symptoms with or without eradication of the pathogen. The term “latent” (pyelonephritis), sometimes used to designate subclinical microbial inflammation in the tubulointerstitium, should not have the right to exist from the position of evidence-based medicine, since it allows treatment to strive not for convalescence, but for “improvement” of the condition while maintaining the “latent” inflammation. And this is unacceptable, since “latent” bacterial invasion of the calyces, pelvis and tubulointerstitium of the kidney leads to scarring of the renal tissue, wrinkling of the kidney and deformation of the pyelocaliceal system.

Pyelonephritis that occurs on an outpatient basis or during the first 48 hours of the Patient’s hospital stay is community-acquired. Nosocomial pyelonephritis develops after 48 hours of the Patient's stay in the hospital and within 48 hours after discharge from the hospital, and has a more severe course than pyelonephritis that developed on an outpatient basis.

The importance of distinguishing uncomplicated and complicated courses is dictated by the need for a differentiated approach to therapy. Uncomplicated pyelonephritis develops on an outpatient basis in individuals who, as a rule, do not have structural changes in the kidneys or urodynamic disorders. Complicated pyelonephritis has a high risk of developing severe purulent-septic complications, sepsis; usually occur during invasive urological procedures; in persons receiving immunosuppressive therapy, in those suffering from urolithiasis, prostate adenoma, diabetes mellitus, and in immunodeficiency states.

The etiology of pyelonephritis is quite well studied. Most often, the pathogens are representatives of the Enterobacteriaceae family, of which the main pathogen (65-90%) is Escherichia coli. Much less commonly, uncomplicated pyelonephritis is caused by Klebsiella, Enterobacter and Proteus spp., as well as Enterococci. Structure of pathogens of nosocomial pyelonephritis

much more complicated - spectrum bacterial pathogens much wider, while the proportion of gram-negative microbes, including E. coli, decreases, gram-positive cocci are more often isolated - Staphylococcus aureus, Enterococcus spp., Pseudomonas aeruginosa, etc.

The “gold standard” for diagnosing pyelonephritis is the identification of bacteriuria and leukocyturia in combination with complaints (classic triad: low back pain, fever, dysuria), anamnesis and physical examination.

Laboratory diagnostics. Methods of research and treatment of pyelonephritis based on evidence-based medicine are presented with the levels of evidence and degree of recommendations in Table. 12.

Table 1

Levels of Evidence

Level Data Type

1a Evidence obtained from meta-analysis of randomized trials

1b Evidence from at least one randomized trial

2a Evidence from one well-designed, controlled, non-randomized trial

2b Evidence from at least one other type of well-designed quasi-experimental study

3 Evidence obtained from non-experimental research (comparative research, correlation analysis, study of individual clinical cases)

4 Evidence obtained from expert panel reports, opinions or clinical experience of reputable specialists

A The results were obtained from well-designed clinical studies, at least one of which was randomized

B The results are based on well-designed, non-randomized clinical trials.

C Clinical researches were not carried out to the required quality

To detect leukocyturia and bacteriuria, the following express methods can be used:

1. Test strips for leukocyturia as an alternative to a general urine test in the diagnosis of uncomplicated AP (level of evidence 4, grade of recommendation C):

Esterase test for leukocyturia (sensitivity - 74-96%; specificity - 94-98%);

Nitrite test for bacteriuria (sensitivity - 35-85%; specificity - 92-100%): a positive result confirms bacteriuria, a negative result does not exclude it, since with coc-

nitrite test is always negative;

The combined esterase and nitrite test is more accurate (sensitivity - 88-92%; specificity - 66-76%).

2. General urine test (or urine test according to Ne-chiporenko):

Quantitative assessment of the number of leukocytes (sensitivity - 91%; specificity - 50%): more than 3-4 leukocytes in the field of view or more than 4 thousand leukocytes in 1 ml of average urine;

Detection of bacteriuria (+ sign) corresponds to 105 CFU in 1 ml of urine;

Proteinuria is minimal or moderate;

Hyposthenuria as a consequence of a violation of the concentration function of the tubules; with oliguria, hypersthenuria is possible;

Microhematuria (rarely macrohematuria with necrosis of the renal papillae).

3. Bacteriological examination (urine culture):

Counting the number of microorganisms in urine:

The threshold value for detecting bacteriuria is 102 CFU/ml urine;

The level of bacteriuria for diagnosing symptomatic UTI is 103 CFU/ml urine;

Uncomplicated pyelonephritis in non-pregnant women >104 CFU/ml urine - clinically significant bacteriuria (level of evidence 2b, grade of recommendation C);

Complicated pyelonephritis in non-pregnant women >105 CFU/ml urine;

Complicated pyelonephritis in men >104 CFU/ml urine;

Pyelonephritis in pregnant women >103 CFU/ml urine (level of evidence 4, grade of recommendation B).

Determination of pathogen sensitivity to antimicrobial drugs, indications for bacteriological examination:

Lack of effect from empirical antimicrobial therapy after 5-7 days from the start of treatment (level of evidence 4, grade of recommendation B);

Pyelonephritis in pregnant women, including control 1-2 weeks after treatment (level of evidence 4, grade of recommendation A);

Relapse of pyelonephritis (level of evidence 4, grade of recommendation C);

Nosocomial pyelonephritis;

Complicated pyelonephritis;

Pyelonephritis in hospitalized patients.

For uncomplicated pyelonephritis, satisfactory condition patient and a good response to a course of antimicrobial therapy, urine culture is not required.

4. A general blood test for uncomplicated pyelonephritis is not mandatory; for complicated pyelonephritis, the erythrocyte sedimentation rate in the blood increases, neutrophil

BULLETIN OF MODERN CLINICAL MEDICINE 2015 Volume 8, no. 6

leukocytosis with a shift of the leukocyte formula to the left, sometimes leukopenia, anemia.

5. Biochemical analysis blood and additional research carried out only according to indications (if complications are suspected, relapse of pyelonephritis or an alternative diagnosis): electrolytes, serum creatinine (for recurrent and/or complicated course, nosocomial pyelonephritis and urinary tract obstruction, as well as in hospitalized patients); blood plasma glucose (in patients with diabetes or suspected diabetes).

6. Bacteriological blood testing (allows identification of the pathogen in a third of patients) is carried out in the presence of fever with leukopenia, distant foci of infection, immunodeficiency states, intravascular interventions; in combination with urine culture increases the percentage of pathogen identification to 97.6% (level of evidence 4, grade of recommendation B).

7. Pregnancy test: if the test is positive, treatment of pyelonephritis in a pregnant woman is carried out with antimicrobial drugs, taking into account their teratogenic safety according to FDA criteria.

Instrumental diagnostics allows you to clarify the diagnosis of pyelonephritis (level of evidence 4, grade of recommendation B): Ultrasound of the kidneys, bladder and prostate gland - to exclude urinary tract obstruction or urolithiasis (level of evidence 4, grade of recommendation C), as well as to exclude other kidney diseases (tumor , tuberculosis, hematoma).

If the patient's fever persists for more than 72 hours from the start of therapy, multislice computed tomography, excretory urography or radioisotope renoscintigraphy is performed to exclude stones, structural changes, abscesses of the kidney or paranephric space if ultrasound is not informative (level of evidence 4, grade of recommendation C). Routine excretory urography and cystoscopy to determine the cause of obstruction in women with recurrent UTI is not recommended (level of evidence: 1b, grade of recommendation: B). If complicated pyelonephritis is suspected during pregnancy, ultrasound and magnetic resonance imaging are preferred to avoid radiation risk to the fetus (evidence level 4, grade of recommendation B).

Treatment is aimed at clinical, laboratory and microbiological recovery (achieving abacteriuria). Clinical and laboratory recovery without abacteriuria is acceptable in patients with diabetes mellitus and urinary tract obstruction. Non-drug methods, particularly increased fluid intake, are not effective in treating pyelonephritis (grade of recommendation: C). For the purpose of prevention, it is possible to use cranberry juice (level of evidence 1b, grade of recommendation C).

Empirical antimicrobial therapy plays a decisive role in achieving recovery, which

paradise begins immediately after diagnosis (an “incubation period” between diagnosis and the start of treatment is not allowed), until the pathogen is identified.

The choice of initial empirical therapy is determined on the basis of data from microbiological studies (regional and/or national) of the spectrum of UTI pathogens and the level of their sensitivity and resistance to antimicrobial drugs. If the resistance of the uropathogen to an antimicrobial drug is more than 10-20%, the antibiotic is not used as a drug of empirical choice.

When choosing an empirical antimicrobial agent, the following factors should also be considered (grade of recommendation B):

Pregnancy and breastfeeding;

Other medications taken (compatibility);

Allergy history;

Previous treatment with antibiotics (for rational choice of empirical antibacterial drug);

Recent infections (taking antibiotics);

Recent travel (possibility of infection with a resistant microbe);

Contact with a person taking antibiotics (possibility of infection with a resistant microbe).

The effectiveness of therapy is assessed 2-3 days after the start of therapy; in the absence of positive clinical and laboratory dynamics, either the dose of the antimicrobial drug is increased, or the drug is replaced, or a second antimicrobial drug with a synergistic effect is added. After obtaining the result of bacterial culture and identification of the pathogen with determination of its sensitivity/resistance to antimicrobial drugs, treatment is adjusted if there is no clinical and laboratory improvement or resistance of the microbe to the empirically prescribed drug is detected.

Treatment of community-acquired uncomplicated pyelonephritis is carried out on an outpatient basis with antibacterial drugs for oral administration until recovery; treatment for 10-14 days is sufficient (IDSA, 1999), (level of evidence 1b, grade of recommendation B). If it is impossible to take oral medications(nausea, vomiting), “stepped” therapy is prescribed: initial parenteral administration of the drug, followed by transfer to oral administration after improvement of the condition (level of evidence 1b, grade of recommendation B). The duration of therapy for complicated pyelonephritis is usually 10-14 days (level of evidence 1b, grade of recommendation A), but can be extended to 21 days (level of evidence 1b, grade of recommendation A).

Drugs of choice for community-acquired uncomplicated pyelonephritis: fluoroquinolones (uro-

BULLETIN OF MODERN CLINICAL MEDICINE 2015 Volume 8, no. 6

2 times a day.

Alternative drugs:

2nd-3rd generation cephalosporins (level of evidence 1b, grade of recommendation B): cefuroxime axetil 250 mg 2 times a day; cef-podoxime 100 mg 2 times a day; ceftibuten or cefixime 400 mg per day;

Protected aminopenicillins (level of evidence 4, grade of recommendation B): amoxicillin/clavulanic acid 500 mg/125 mg

3 times a day.

For complicated pyelonephritis, therapy should begin only after elimination of urinary tract obstruction (risk of bacteriotoxic shock). The selection of the drug is also carried out empirically, with a transition to etiotropic therapy after receiving the results of a bacteriological examination of urine.

Initial empirical therapy for community-acquired complicated pyelonephritis or hospital-acquired pyelonephritis:

Fluoroquinolones: ciprofloxacin IV 250-500 mg 2 times a day; levofloxacin IV 500 mg once a day; ofloxacin IV 200 mg 2 times a day; pefloxacin IV 400 mg once a day;

Protected aminopenicillins: amoxicillin/clavulanic acid IV 1.5-3 g per day; Ticarcillin/clavulanic acid IV 3.2 g 3 times a day;

2nd-3rd generation cephalosporins: cefurok-sim IV 750 mg 3 times a day; cefotaxime IV or IM 1-2 g 2-3 times a day; ceftriaxone IV 2 g per day; ceftazidime IV 1-2 g 3 times a day; Cefo-perazone/sulbactam IV 2-3 g 3 times a day;

Aminoglycosides: gentamicin IV or IM at a dose of 1.5-5 mg/kg 1 time per day; amikacin IM, IV 10-15 mg/kg/day 2-3 times a day;

A combination of fluoroquinolones with aminoglycosides or cephalosporins with aminoglycosides is possible.

For pyelonephritis in pregnant women, treatment in the absence of complications and/or threat of miscarriage is carried out on an outpatient basis with antibacterial drugs for oral administration until recovery (level of evidence 1b, grade of recommendation A). The duration of treatment for uncomplicated pyelonephritis in pregnant women is the same as in non-pregnant women - from 7 to 14 days (level of evidence 1b, grade of recommendation B). Pregnant women with complicated pyelonephritis or who are unable to receive oral medications require hospitalization and step-down therapy (level of evidence 4, grade of recommendation B).

Drugs as initial empirical therapy in pregnant women:

Protected aminopenicillins: amoxicillin/clavulanic acid IV 1.5-3 g per day or orally 500 mg/125 mg 3 times a day;

2nd-3rd generation cephalosporins: cefurok-sim orally 250 mg 2 times a day or intravenously 750 mg 3 times a day; ceftibuten orally 400 mg per day; cefixime 400 mg per day; cefotaxime IV or IM 1 g 2 times a day; ceftriaxone IV or IM 1 g per day;

Aminoglycosides (used only for health reasons): gentamicin IV at a dose of 120-160 mg per day;

Fluoroquinolones, tetracyclines, sulfonamides are contraindicated throughout pregnancy, co-trimoxazole - in the first and third trimester.

Pyelonephritis in the elderly often occurs against the background concomitant pathology(diabetes mellitus), hemodynamic disorders (atherosclerosis of the renal arteries, arterial hypertension) and urodynamics (prostate adenoma). It is possible to change the pathogen and develop multidrug-resistant forms during the course of the disease. A recurrent, more severe course is characteristic. It is acceptable to achieve clinical cure without microbiological cure. Doses of antibacterial drugs are selected taking into account renal function; nephrotoxic drugs (aminoglycosides, polymyxins, nitrofurans) are contraindicated.

Research transparency. The study had no sponsorship. The authors are solely responsible for submitting the final version of the manuscript for publication.

Declaration of financial and other relationships. All authors participated in writing the manuscript. The final version of the manuscript was approved by all authors.

LITERATURE

1. Resistance of pathogens of outpatient urinary tract infections according to multicenter microbiological studies UTIAP-I and UTIAP-II / V.V. Rafalsky, L.S. Strachunsky, O.I. Krechikova [and others] // Urology. - 2004. - No. 2. - P.1-5.

2. Lohr, J.W. Pyelonephritis chronic / J.W. Lohr, A. Gowda, Ch.M. Nzerue. - 2005. - URL: http: // WWW: emedicine. medscape.com/article/245464-overview (accessed 11/04/2015).

3. Schaeffer, A.J. Infection of urinary tract / A.J. Schaeffer // Campbell's Urology. - 1998. - Vol. 1. - P.533-614.

4. Tisher, C.C. Renal pathology with clinical and functional correlations / C.C. Tisher, B.M. Brenner. - Lippicott Company, Philadelphia, 1994. - 1694 p.

5. Current state of antibiotic resistance of pathogens of community-acquired urinary tract infections in Russia: results of the DAR-MIS study (2010-2011) / I.S. Palagin, M.V. Sukhorukova, A.V. Dekhnich [et al.] // Clinical microbiology and antimicrobial chemotherapy. - 2012. - T 14, No. 4. - P.280-303.

6. Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genital organs. Russian national recommendations/ T.S. Pere-panova, PC. Kozlov, V.A. Rudnov, L.A. Sinyakova. - M.: Prima-print LLC, 2013. - 64 p.

7. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA) / G.G. Zhanel, T.L. Hisanaga, N.M. Laing // International Journal of Antimicrobial Agents. - 2005. - Vol. 26. - P380- 388.

BULLETIN OF MODERN CLINICAL MEDICINE 2015 Volume 8, no. 6

8. Rafalsky, V.V. Antibacterial therapy for acute purulent kidney infection / V.V. Rafalsky // Consilium Medicum. - 2006. - T. 8, No. 4. - P.5-8.

9. Stamm, W.E. Management of urinary tract infections in adults / W.E. Stamm, T.M. Hooton // N. Engl. J. Med. - 1993. - Vol. 329(18). - P1328-1334.

10. Evaluation of new anti-infective drugs for the treatment of UTI / U.S. Rubin, V.T. Andriole, R.J. Davis//Clin. Infect. Disease. - 1992. - No. 15. - P.216-227.

11. General guidelines for the evaluation of new anti-infective drugs for the treatment of UTI / U.S. Rubin, V.T. Andriole, R.J. Davis. - Taufkirchen, Germany: The European Society of Clinical Microbiology and Infectious Diseases. - 1993. - P.240-310.

12. Stothers, L. A randomized trial to evaluate the effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women / L. Stothers // Can. J. Urol. - 2002. - T. 9, No. 3. - P1558-1562.

13. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA) /

J.W. Warren, E. Abrutyn, J.R. Hebel // Clin. Infect. Dis. - 1999. - Vol. 29(4). - P745-58.

14. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial / L.K. Millar, D.A. Wing, R.H. Paul // Obstet. Gynecol. - 1995. - No. 86 (4, pt. 1). - P.560-564.

15. Schaeffer, A.J. Infections of the urinary tract / A.J. Schaeffer, E.M. Schaeffer // Cambell-Walsh urology / Editor A.J. Wein. - 10th edition. - Philadelphia: Saunders, an imprint of Elsevier Inc., 2012. - P.257-326.

1. Rafal"skiJ VV, StrachunskiJ LS, Krechikova 01 et al. Rezistentnost" vozbuditeleJ ambulatoryh infekciJ mochevyvodJashhih putej po dannym mnogocentrovyh mikrobiologicheskih issledovaniJ UTIAP-I i UTIAP-II. UrologiJa. 2004; 2:1-5.

2. Lohr JW, Gowda A, Nzerue ChM. Pyelonephritis chronic. 2005. Access mode: WWW. URL: http://emedicine. medscape.com/article/245464-overview. - 04.11.2015.

3. Schaeffer AJ. Infection of urinary tract. Campbell's Urology, 7th Edition. 1998; 1: 533-614.

4. Tisher CC, Brenner BM. Renal pathology with clinical and functional correlations. Lippicott Company, Philadelphia. 1994; 1694 p.

5. Palagin IS, Suhorukova MV, Dehnich AV et al. Sovremennoe sostoJanie antibiotikorezistentnosti

vozbuditeleJ vnebol"nichnyh infekciJ mochevyh puteJ v Rossii: rezul"taty issledovaniJa "DARMIS" (2010-2011). KlinicheskaJa mikrobiologi i antimikrobnaJa himioterapiJa. 2012; 14 (4): 280-303.

6. Perepanova TS, KozIov RS, Rudnov VA, SinJakova LA. AntimikrobnaJa terapiJa i profilaktika infekciJ pochek, mochevyvodJashhih puteJ i muzhskih polovyh organov: rossiJskie nacional"nye rekomendacii. M: 000 "Prima-print". 2013; 64 p.

7. Zhanel GG, Hisanaga TL, Laing NM et al. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). International Journal of Antimicrobial Agents. 2005; 26: 380-388.

8. Rafal"skiJ VV. Antibakterial"naJa terapiJa ostroJ gnoJnoJ infekcii pochek. Consilium Medicum. 2006; 8 (4): 5-8.

9. Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993; 329(18):1328-1334.

10. Rubin US, Andriole VT, Davis RJ et al. Evaluation of new anti-infective drugs for the treatment of UTI. Clinical Infectious Disease. 1992; 15: 216-227.

11. Rubin US, Andriole VT, Davis RJ et al. General guidelines for the evaluation of new anti-infective drugs for the treatment of UTI. Taufkirchen, Germany: The European Society of Clinical Microbiology and Infectious Diseases. 1993; 240-310.

12. Stothers L. A randomized trial to evaluate the effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002; 9 (3): 1558-1562.

13. Warren JW, Abrutyn E, Hebel JR et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999; 29 (4): 745-758.

14. Millar LK, Wing DA, Paul RH et al. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial. Obstet Gynecol. 1995; 86 (4): 560-564.

15. Schaeffer AJ, Schaeffer EM. Infections of the urinary tract. Cambell-Walsh urology; 10th edition: editor AJ Wein, Philadelphia: Saunders, an imprint of Elsevier Inc. 2012; 257-326.

© A.R Bogdanova, RR Sharipova, 2015 UDC 616.61-005.4-085.21.3(048.8)

MODERN PRINCIPLES OF DRUG TREATMENT OF ISCHEMIC NEPHROPATHY

BOGDANOVA ALINA RASYKHOVNA, Ph.D. honey. Sciences, assistant at the Department of General Medical Practice, Kazan State Medical University, Ministry of Health of Russia, Russia,

420012, Kazan, st. Butlerova, 49, e-mail: [email protected]

SHARIPOVA ROSALIA RADIKOVNA, therapist of the therapeutic department of the clinical hospital of the Ministry of Internal Affairs of the Republic of Tatarstan, Russia, 420059, Kazan, st. Orenburg tract, 132, e-mail: [email protected]

Abstract. The goal is to analyze current data on the problem of conservative treatment of ischemic nephropathy. Material and methods. A review of publications by domestic and foreign authors devoted to the issue of drug correction of arterial hypertension as the leading syndrome of ischemic nephropathy and lipid metabolism disorders was carried out. Results and its discussion. Modern principles presented

BULLETIN OF MODERN CLINICAL MEDICINE 2015 Volume 8, no. 6

1) Daily routine.

In the acute period of pyelonephritis, bed or semi-bed rest. Maintaining a daily routine sufficient sleep. Stay in the fresh air for at least 4-5 hours. Ventilation of premises.

2) Drink plenty of fluids.

Sweet drinks (compotes, jelly, weak tea), fruit and vegetable juices. Children of the first year of life - 200-400 ml/day From 1 year to 3 years - 1 liter. From 4 to 7 years old - 1.5 liters. Adults and children over 7 years old - 1.5-2 liters.

3) Mode of urination.

Maintain a regular urination regime every 2-3 hours.

4) Self-care.

Avoid hypothermia, overwork, and heavy physical activity. After 2 weeks from the onset of exacerbation of pyelonephritis, physical therapy is recommended.

5) Nutrition and diet.

Meals: 4-5 times a day at the same hours. Cooking: boiled and steamed. Patients who have had pyelonephritis are prescribed a dairy-vegetable and gentle cabbage-potato diet.

allowed:

stale bread, vegetarian soups, low-fat boiled meat and fish dishes, vegetables (potatoes, cabbage, beets, carrots, tomatoes, pumpkin, zucchini), a variety of cereals, soft-boiled eggs.

prohibited:

any spicy and fried foods, smoked foods (ham, sausages), spices, rich soups, canned food, salted and pickled vegetables, mayonnaise, ketchup, mustard, garlic, onions, legumes, carbonated drinks and alcohol. Constant monitoring by a nephrologist.

6) Regular medical observation by a doctor with monitoring of urine analysis and kidney function.

Treatment of chronic foci of infection: sinusitis, chronic tonsillitis, caries, etc.

7) Vitamin therapy.

Mainly vitamins A, E and B vitamins.

Treatment and prevention of kidney and urinary tract infections (as prescribed by a doctor).

8) As part of complex therapy with antibiotics and/or uroseptics, the herbal medicinal product Canephron® N (Germany) is used for the treatment and prevention of inflammatory diseases of the kidneys and urinary tract (cystitis, pyelonephritis), as well as for urolithiasis.

2.5 Recommendations for organizing patient care at home

Care for chronic pyelonephritis

The leading problem in care for chronic pyelonephritis is the patient’s lack of knowledge about his disease, the risk factors for exacerbations, the possible adverse outcome of the disease and measures to prevent it.

Pyelonephritis (including chronic) most often affects young and middle-aged people who lead a mainly active lifestyle. It is especially important for this category of patients, who try not to think about their illness, to learn to take it into account and not provoke the development of complications.

What is pyelonephritis? This is an infectious inflammation of the kidney tissue (the tissue that forms the frame of the kidney), calyces, and pelvis (these kidney structures collect and drain urine into the ureter). It can be acute, or it can become chronic. This inflammation is caused by various types of bacteria.

The source of infection can be:

* carious teeth;

*chronic tonsillitis;

*furunculosis;

*cholecystitis;

*inflammation of the urethra, bladder;

*inflammation of the prostate gland, ovaries.

What factors contribute to the emergence of a disease or the exacerbation of an existing one?

*impaired urine outflow (stones, kinks of the ureters, their narrowing, prolapse of the kidney, pregnancy, etc.);

*weakening of the body: decreased resistance to infection as a result of overwork, low vitamin content in food, excessive cooling;

*a number of existing diseases (diabetes mellitus, tuberculosis, liver disease).

Chronic pyelonephritis is usually a consequence of untreated acute pyelophritis, but often from the very beginning the disease occurs without acute manifestations, in a latent form. Patients note weakness, fatigue, and sometimes an increase in body temperature to 37.0 - 37.5°C. Leukocytes and bacteria are found in increased numbers in the urine.

The disease can occur with an increase in blood pressure, the so-called hypertensive form of the disease. Young patients suffer from headaches and take various types of painkillers for this reason, and the presence of arterial hypertension is often discovered by chance; further examination leads to the detection of chronic pyelonephritis.

There is also an anemic form of the disease, when the leading signs are a decrease in the number of red blood cells and hemoglobin in the blood. Patients feel weakness, fatigue, and possible shortness of breath.

The main symptoms of exacerbation of pyelonephritis are: fever, pain in the lumbar region, often unilateral, frequent, painful urination, discomfort when urinating. Sometimes an exacerbation can manifest itself only by a rise in temperature to 37.0-37.2°C after colds, this temperature tends to last for a long time.

Outside of exacerbations, chronic pyelonephritis occurs with very few symptoms, but at this time an increase in renal failure occurs.

There are cases when chronic pyelonephritis first manifests itself as an outcome - symptoms of chronic renal failure, in which the kidneys are not able to cleanse the blood of toxins. The accumulation of toxins in the blood leads to poisoning of the body.

When starting care for a patient with pyelonephritis, you need to explain to him the essence of the disease and talk about the factors that contribute to its exacerbation. The patient must change his lifestyle and attitude towards his health.

Caring for patients during exacerbation of the disease

The patient needs bed rest for 2-3 weeks. When a person experiences pain, suffers from fever or weakness, bed rest seems natural to him, but when the symptoms subside or are absent, it is quite difficult to keep a young patient in bed, so it is necessary to have conversations during which it is necessary to explain that it is easier and better for the kidneys to work when horizontal. body position, that the kidneys “love” warmth and that a warm bed is one of the best means treatment.

The patient may experience frequent urge to urinate both day and night, so it is advisable that the ward or room where the patient lies is located near the toilet. The patient should be encouraged to use a bedpan at night to avoid hypothermia.

It is necessary to ventilate the room either in the absence of the patient, or by covering him warmly (in the cold season, you need to cover your head). The room should be warm, and the patient should be dressed warmly enough, always wearing socks. When cooling, especially the legs, the patient urinates more frequently.

Caring for a patient in remission (not exacerbation)

Although the patient does not need constant bed rest, it is still necessary to streamline the work and rest schedule. The patient's sleep should be at least 8 hours. Daytime rest is also important (even if not every day), at least 30 - 40 minutes in a horizontal position. Work in cold rooms, on the street (especially in the cold season), on night shifts, in hot shops, stuffy rooms, heavy physical activity is contraindicated for patients with chronic pyelonephritis. A change of job is sometimes difficult for the patient, but loved ones must tactfully but persistently convince the patient of the need for the right choice, since continued work associated with hypothermia or heavy loads will provoke an exacerbation of the disease. When planning your vacation on vacation, holidays or weekends, the patient should remember the risk of hypothermia and heavy physical exertion. Therefore, of course, it is better to avoid kayaking or camping in cold weather! The patient needs to remember (or be reminded) about the need to choose the right clothes: according to the season, especially for young girls and boys who are embarrassed to wear warm underwear and warm shoes. An important preventive measure is good and timely urine flow. Often (especially in sick schoolchildren and students) artificial retention of urination occurs, usually associated with false shame more frequent visits toilet or some purely situational problems. A confidential conversation with a loved one can eliminate this problem. Stagnation of urine is a serious risk factor for exacerbations. Once every 6 months, the patient must visit the dentist, must visit an ENT doctor and follow his recommendations for the prevention and treatment of nasopharyngeal diseases. The patient's diet outside of an exacerbation is not so severe, but spicy foods and spices should not be on the patient's table. Fluid intake (except for cases of hypertonic form, as mentioned above) should be quite large (at least 1.5 - 2 liters per day). The kidneys should be “washed” well. During the period of remission (weakening or temporary disappearance of symptoms of the disease), the patient is usually given intermittent maintenance therapy for 3-6 months (as prescribed by a doctor). It is also called anti-relapse. What does it mean? For 10 days of each month, the patient must take one of the prescribed antibacterial drugs, according to the list given by the doctor. A new medicine is taken every month. In the intervals between taking antibacterial drugs, the patient takes herbal decoctions (lingonberry leaf, birch buds, horsetail, bearberry, also known as bear's ears, kidney tea) - for 10 days each decoction. For example, from July 1 to 10 the patient takes nitroxoline (an antibacterial drug), from July 11 to 21 - a decoction of birch buds, from July 22 to 31 - lingonberry leaf, and from August 1 to 10 - nevigramon (an antibacterial drug), etc. . Naturally, even in a state of remission, the patient must periodically undergo control urine tests. To ensure proper implementation of prescribed therapy, it is good to keep a self-monitoring diary. Currently, with appropriate therapy and correct behavior in relation to one’s health, the prognosis of the disease becomes favorable - it is possible to prevent the development of renal failure and create conditions for the patient to live a full life.

Diet and drinking regime

During exacerbation of chronic pyelonephritis, food should be high-calorie; alcoholic beverages, spicy foods, seasonings, spices, meat and fish soups, coffee, and canned food are excluded. All vegetables and fruits are allowed; in all cases, watermelons, melons, pumpkins, and grapes are recommended. In the anemic form of chronic pyelonephritis, the diet includes fruits rich in iron and cobalt: strawberries, strawberries, apples, pomegranates. The patient can eat boiled meat and fish, eggs, dairy and fermented milk products. If the patient does not have high blood pressure or obstruction to the normal outflow of urine, an enhanced drinking regime is prescribed to prevent excessive concentration of urine and to flush the urinary tract. Fluid intake should be at least 2 liters per day. The patient should take fruit drinks; cranberry fruit drinks are especially good, because... it contains a substance that is converted in the body (in the liver) into hippuric acid, which suppresses the activity of bacteria in the urinary tract - rosehip decoction, compotes, tea, juices, mineral waters (Essentuki No. 20, Berezovskaya).

In the hypertensive form of chronic pyelonephritis, salt intake is limited to 6-8 g per day (salt has the ability to retain fluid in the body). It is recommended not to salt food when preparing it, but to give the prescribed amount of salt to the patient’s hands so that he can salt the food himself. Forced restrictions are often difficult for patients to tolerate, so it is necessary to explain with great patience that these measures are part of the treatment, that by “irritating” the kidneys with poor nutrition or consuming more than the right amount of salt, we will not be able to achieve the subsidence of the process, normalization of pressure, and therefore We will steadily bring the development of renal failure closer. At the same time, you need to try to diversify the menu, make the food high-calorie and tasty.

Exercise therapy for pyelonephritis

Exercise therapy classes begin to be carried out after acute phenomena have subsided as the patient’s general condition improves, severe pain stops and temperature normalizes.

Therapeutic exercise for pyelonephritis is a means of pathogenetic therapy that can reduce inflammatory changes in the renal tissue, improve and normalize the state of renal function.

The main tasks of exercise therapy for pyelonephritis:

ensure proper blood circulation in the kidneys;

improve urine flow and reduce congestion in the urinary system;

increase the body's nonspecific resistance;

improve the regulation of metabolic processes;

normalize blood pressure;

Exercises for the abdominal muscles are included with caution, avoiding increasing intra-abdominal pressure and, especially, straining. The pace of most exercises is slow and medium, the movements are smooth, without jerking.

A sauna (bath) followed by a warm shower is recommended (swimming in the pool or swimming in ponds is excluded!); performing a massage with heated oil or massage with brushes in a warm bath (temperature not lower than 38°C), or manual massage in the bath. Massage course 15–20 procedures.

Massage for pyelonephritis: massage the back, lumbar region, buttocks, abdomen and lower limbs using hyperemic ointments. Impact techniques are excluded. The duration of the massage is 8-10 minutes, the course is 10-15 procedures. For chronic pyelonephritis, manual massage and massage with brushes in the bath (water temperature not lower than 38°C) are indicated, 2-3 procedures per week.

Contraindications to the use of physical therapy are:

1. General serious condition of the patient.

2. Danger of internal bleeding.

3. Unbearable pain when performing physical exercises.

* avoid hypothermia and drafts, generally avoid all colds;

* after completing the course of treatment, regularly donate urine;

* avoid excessive stress on the back;

* treat your sex life with some restrictions.

Suggested Exercises

Since in in this case indications for moderate loads, choose:

Walking like remedy is widely used to restore motor functions, train the cardiovascular and motor systems, etc. Walking with crutches, in special “walkers,” walking on stairs, in water, etc. is also used. Dosage is carried out according to tempo, length of steps, time, terrain (flat, rough, etc.). Walking is used to restore the gait mechanism (in case of injuries, amputations, paralysis, etc.), improve joint mobility, as well as to train the cardiovascular system in patients with coronary artery disease, hypertension, vegetative-vascular dystonia, pulmonary pathology (pneumonia, bronchial asthma and etc.), with metabolic disorders. Measured walking and walks in areas with different terrain (trail paths) are practiced.

And a course of exercises:

1. Starting position - lying on your back, legs bent, feet apart slightly wider than shoulders. After take a deep breath As you exhale, alternately tilt your shins inward, taking out the mattress (15-20 times).

2. Starting position - the same, feet together. After a deep breath, bend your knees to one side or the other (15-20 times).

3. Starting position - the same, legs bent, slightly apart, arms bent at the elbow joints. Leaning on your feet, shoulders and elbows, after inhaling and exhaling, raise and lower your pelvis.

4. Starting position - the same. A bag of sand on the stomach (either in the upper or lower abdomen). As you exhale, raise it as high as possible, and while inhaling, lower it.

5. Starting position - the same. After a deep inhalation and exhalation, alternately raise the straight leg with circular rotations in the hip joint in one direction or the other.

6. Starting position - lying on the left, then on the right side, legs bent at the knee and hip joints. As you exhale, move your leg back, gradually increasing the amplitude of leg abduction and decreasing the angle of flexion.

7. Starting position - lying on your back, arms along the body, cross movement of straight legs (right over left, left over right).

8. Starting position - lying on your back, legs extended and spread to the sides as much as possible, feet placed in loops made of elastic bandages attached to the headboard. Bringing your legs together with resistance. The same in the opposite direction with the legs together, move them apart with resistance.

9. Starting position - sitting, leaning back in a chair, with your hands grasping the seat of the chair. After a deep inhalation, as you exhale, leaning on your arms and legs, raise your pelvis, return to the Starting position - inhale.

10. Starting position - sitting on a chair. After a deep inhalation, as you exhale, pull the leg bent at the knee and hip joint towards the abdominal and chest wall.

11. Starting position is the same. Full extension of the torso back followed by a return to the starting position (fix the legs).

12. Starting position - sitting, arms along the body, legs together. After a deep breath, alternately tilt the torso to the right and left with your arm raised up (opposite to the tilt of the torso).

13. Starting position - sitting, legs apart slightly wider than shoulders. After a deep breath, bend your torso forward, alternately reaching out to the toes of your right and left feet. Bend forward, reaching the floor with your hands.

14. Starting position - standing, holding the back of a chair. After a deep inhalation, as you exhale, alternately move your legs to the side and back.

15. Starting position is the same. After a deep inhalation, as you exhale, alternately rotate the legs at the hip joint (knee slightly bent) to the right and left.

16. Starting position - standing, feet shoulder-width apart, hands on the belt. Turn the body to the right and left.

17. Starting position - standing. Walking, 2-3 steps - inhale, 4-5 steps - exhale, walking with turns of the torso, after inhaling as you exhale, throwing out your left leg, make a moderately sharp turn of the torso to the left while simultaneously swinging both runes to the left, and the same to the right.

18. Starting position - standing, legs wide apart, hands behind your head “locked”. Spreading your shoulders to the sides, move your head back, inhale as much as possible, squeeze your shoulder blades together, slowly exhale, lower your head and tilt your torso forward and relax.

Treatment control

Treatment is monitored continuously; every 7-10 days the patient undergoes the necessary urine tests prescribed by the attending physician. It is very important to properly prepare for the test. First of all, it is necessary to toilet the external genitalia.

As part of complex therapy with antibiotics and/or uroseptics, the herbal drug Canephron® N is used.

Sanitation rules for men.

Before collecting urine, the patient should treat the head of the penis and the entrance to the urethra with a 0.05% chlorhexidine solution. This drug is available for sale in special plastic packaging with a nozzle.

Sanitation rules for women.

The patient performs a morning wash with soap, dries the labia majora and minora with a clean diaper, after which she treats the area of ​​the labia majora and minora with a 0.05% chlorhexidine solution using sterile napkins moistened with the solution, and then the urethral area using the nozzle supplied with the pharmacy package. If patients cannot make a toilet themselves, a nurse or person caring for the patient comes to help. When washing a woman, a bedpan is placed under her, the patient spreads her legs wide enough and the helper performs the washing (from front to back), and then treatment with a disinfectant solution (chlorhexidine). When collecting urine, the container must be clean and dry. The patient should secrete the first few drops into the toilet or bedpan. When collecting the so-called average portion, a larger amount of urine is released into the toilet, about a third, then collection is carried out, the last third also needs to be allocated into the toilet (or vessel).

Patients with the hypertensive form of chronic pyelonephritis need to measure diuresis (the amount of urine excreted per day) and determine hydrobalance (the ratio between the liquid drunk and urine excreted per day). The patient is given a container that is comfortable for urination. It is necessary to prepare a measuring cup or other measuring utensils. Measurements begin in the morning. At 6 o'clock in the morning the patient empties his bladder. This urination is not taken into account in the measurement. Then, every time the patient wants to urinate, he does so in an appropriate container and then the urine is poured into a measuring cup to determine its volume. All urine excreted by the patient during the day is taken into account in the same way. The last measurement will be taken on the morning of the new day, at approximately 6 am. In parallel with this, the liquid taken is counted and recorded. It is not only the liquid that needs to be taken into account pure form(tea, fruit drink, compote), but also soup, fruit. Normally, 65-75% of the ingested fluid is released. A decrease in these numbers indicates fluid retention in the body and the development of edema, and, conversely, if they increase, it indicates excessive fluid loss, for example, when a patient takes diuretics. Depending on the course of the disease and diuresis data, an appropriate drinking regimen is prescribed. Most often, the calculation of the volume of required fluid (for edema, high blood pressure) is made as follows: the amount of urine excreted per day + 400 - 500 ml. In patients with this form of chronic pyelonephritis, blood pressure should be measured in the morning and evening.

In the practical part, important issues were developed to identify pathologies of the urinary system, preparation and conduct of laboratory tests, development of a memo for the patient, features of patient care at home, as well as the prevention of relapses and complications of pyelonephritis.

Conclusion

The leading problem in care for chronic pyelonephritis is the patient’s lack of knowledge about his disease, the risk factors for exacerbations, the possible adverse outcome of the disease and measures to prevent it. This course work covered all the theoretical and practical issues related to this disease, which is no less important for both the patient and the medical worker.

The following were outlined: the causes of occurrence, classification, stages and features of pathogenesis, pathomorphology, as well as clinical manifestations, prevention and treatment of the disease pyelonephritis, as well as research methods and diagnostics for making a diagnosis were described in detail.

The goals of the course work were achieved, namely the development of stages of diagnostic activity (algorithms) for making a diagnosis with pathology of the urinary system and caring for a patient with pyelonephritis in the particulars of a hospital and clinic.

Applications

Appendix A

Table 1

Appendix B

Table 2. Microorganisms causing urinary tract infections and pyelonephritis (in%)

Annex B

Table 3. Diagnosis of pyelonephritis

Appendix D

Fig.1 Kidney damage due to pyelonephritis

Appendix D

Excretory urography

The fundamental research method in urology involves intravenous administration of a substance and allows one to obtain images of the renal parenchyma, calyces, pelvis, ureters, bladder and in some cases the urethra.

Assess the anatomical structure of the kidneys, ureters and bladder, the excretory function of the kidneys and the evacuation capabilities of the urinary tract.

To facilitate the differential diagnosis of renovascular arterial hypertension.

Preparation:

It should be explained to the patient that the study allows one to evaluate the anatomical structure and functional state of the organs of the urinary system.

If the volume of blood volume is insufficient, the fluid deficit should be replenished. The patient must refrain from eating for 8 hours before the test. He should be informed who and where will perform the EC.

The patient should be warned that during the administration of a contrast agent, a short-term burning sensation along the vein or a metallic taste in the mouth may occur and that if any other sensations occur, the patient should inform the doctor.

The patient is warned that during the examination (while taking pictures) he will hear loud clicking sounds.

It is necessary to ensure that the patient or his relatives give written consent to the study.

It is necessary to find out whether the patient is allergic to iodine, radiopaque agents and products with high content Yoda. All cases of an allergic reaction should be reflected in the medical history and brought to the attention of the doctor performing the study.

If necessary, the evening before the examination, the patient is prescribed a laxative, which improves the quality of X-ray images.

Equipment

Contrast agent (sodium diatrizoate or iothalamate, meglumine diatrizoate or iothalamate), 50 mL syringe (or infusion set), 19-21 gauge needle, venous catheter or butterfly needle, venipuncture kit (tourniquet, antiseptic solution, adhesive bandage), x-ray table, x-ray machine and tomograph, resuscitation kit.

Procedure and aftercare

The patient is placed supine on the X-ray table. Execute overview shot organs of the urinary system, develop and analyze it to exclude macroscopic changes. If they are absent, a contrast agent is administered intravenously (the dose depends on the patient’s age). Monitor the patient for timely detection of signs of an allergic reaction (facial redness, nausea, vomiting, urticaria or shortness of breath).

The first shot, which allows one to obtain an image of the renal parenchyma, is taken 1 minute after the administration of the contrast agent. If a small space-occupying lesion (cyst or tumor) is suspected, the image is supplemented with tomographic sections.

Then the images are repeated after 5, 10, 15 and 20 minutes.

After taking the picture, at the 5th minute, compression of the ureters is performed by inflating two small rubber balls (chambers) located on the anterior abdominal wall on the sides of the midline of the abdomen and fixed to the body using a special belt.

After 10 minutes, compression of the ureters is eliminated

At the end of the study, an image is taken after urination to determine the amount of residual urine, as well as changes in the mucous membrane of the bladder and urethra.

If a hematoma forms at the injection site, warm compresses are prescribed.

Precautionary measures

Patients with severe bronchial asthma or an allergy to radiopaque agents, premedication with corticosteroid drugs is carried out.

Deviation from the norm

EU allows you to diagnose many diseases of the urinary system, including stones of the kidneys and ureters, changes in the size, shape or structure of the kidneys, ureters and bladder, the presence of an accessory kidney or the absence of a kidney, polycystic kidneys, accompanied by an increase in their size, duplication of the pyelocaliceal system and ureter ; pyelonephritis, kidney tuberculosis; hydronephrosis, renovascular hypertension.

Annex E

Dynamic scintigraphy

Allows you to determine kidney function in patients with various diseases kidney;

How is the examination carried out?

For examination, radioactive substances are introduced into the patient’s body, which, in combination with special pharmacological drugs and the bloodstream, enter the organ or organ system being examined. The data is processed using a computer, as a result the doctor receives information about the topography, size, shape and function of the examined organ

During dynamic scintigraphy, the patient lies down. The examination begins with the administration of a radiopharmaceutical; information about the migration of the drug throughout the body and its accumulation in the examined organ is automatically recorded.

Duration of the examination: kidneys - 20 - 30 minutes;

Contraindications

The only contraindication is pregnancy, although this is also not absolute - for example, if there is a danger to the life of the mother, the examination can be carried out in the last stages of pregnancy.

Job 3

Practical part from the thesis

I did my internship at the G.E. Sibirtsev Children's Infectious Diseases Hospital. I worked in the infectious diseases department on the second floor at post No. 2. For the questionnaire and the introduction of a dynamic observation sheet, I interviewed five patients with viral meningitis from 3 to 5 years old (see Appendix No. 1). The purpose of my thesis is to identify the patient’s disrupted needs and draw up a nursing care plan according to the Henderson model (see Appendix No. 2). The sheets of the dynamic status of patients display changes that appeared as a result of nursing and medical interventions (see Appendixes No. 3-6).

The main complaints upon admission to the hospital among the interviewed patients were hyperthermia (in 5 patients), headache (in 5 patients), decreased appetite (in 5 patients), vomiting (in 5 patients), abdominal pain (in 1 patient), pain in the legs (in 1 patient), weakness (in 5 patients), lower back pain (in 1 patient).

Fig.1. Patient complaints upon admission to hospital.

The patients' main problems are decreased appetite, the patient cannot go to the dining room independently due to bed rest, the patient cannot eat and drink independently due to bed rest, vomiting due to the underlying disease, the patient cannot go to the toilet independently due to bed rest regime, sleep disturbance due to fever, the patient cannot change clothes independently due to bed rest, feeling hot due to high temperature, dry mouth due to high temperature, the patient cannot independently treat the oral cavity when vomiting due to bed rest, the patient needs communication due to isolation, the risk of complications due to the underlying disease.

Fig. 2. Patient's problems while in hospital.

During the year, all 5 children suffer from acute respiratory viral infections. Most often, a 3-year-old child is susceptible to colds (up to 5 times a year). Children 4 years old - one gets sick 4 times a year, the other 3 times a year. Patients aged 5 years get sick up to 2 times a year.

Fig. 3. Incidence during the year.

Serous meningitis is registered for the first time in 100% of respondents (5 patients).

Fig. 4. Incidence of viral meningitis for the first time.

The main reasons, according to parents, that contribute to the child’s illness are frequent incidence of acute respiratory viral infections (4 people decided this), non-compliance with personal hygiene rules (1 out of 5 people), untreated acute respiratory disease (5 out of 5 people), self-treatment (1 people out of 5), late visit to the doctor (1 person out of 5).

Fig. 5. Reasons that contributed to the child’s illness

100% of respondents know about the medications that were prescribed to the child.

Fig. 6. Number of mothers who know about drugs (in percentage).

The main drugs that were voiced by patients are acipol (5 patients know about its purpose), suprastin (5 patients know about its purpose), miramistin (5 patients know about its purpose), licopid (2 patients know about its purpose), cephabol ( 1 patient knows about its purpose), vinpocetine (1 patient knows about its purpose), viferon (5 patients know about its purpose), glycine (5 patients know about its purpose), cycloferon (1 patient knows about its purpose), sumamed ( 2 patients know about its purpose), prednisolone (1 patient knows about its purpose), asparkam (4 patients know about its purpose), Actovegin (3 patients know about its purpose), chloramphenicol (1 patient knows about its purpose), amiksin ( 1 patient knows about its purpose).

Fig. 7. Mothers' awareness of specific drugs.

Only 2 people used folk remedies, the remaining 3 patients did not use self-treatment non-traditional methods of treatment.

Fig. 8. Use of folk remedies in treatment.

The duration of the disease was different for everyone. In one patient, the course of treatment was 28 days, in the second it was 13 days, the third was treated in hospital for 14 days, the fourth patient was also treated for 14 days, and the fifth patient was treated for 16 days.

Fig. 9. Duration of the disease.

As a result of viral meningitis, the patients developed complications: 1 patient had mental retardation, and 2 patients had attention problems. The remaining patients had no complications.

Fig. 10. The occurrence of complications after viral meningitis.

The treatment was effective in a medical facility for 100% of respondents.

Fig. 11. Treatment effectiveness as a percentage.

Patients received enough information on child care (5 patients), but sanitary and educational work on infectious diseases was not carried out with any of the patients. (0 patients).

Fig. 12. Conducting consultative conversations with patients.

All 100% of respondents used other sources for additional information on the disease.

Fig. 13.Use of additional sources of information.

According to respondents, more effective treatment for a child is facilitated by the qualifications of the doctor and nursing staff (4 patients think so), the quality of medications and correctly prescribed doses (2 patients think so), timely diagnosis (3 patients think so), and calling (5 patients think so). ).

Fig. 14. Factors contributing to more effective treatment in a child.

The success of treatment, according to the respondents, depends on the doctor (5 patients think so), the nursing staff (3 patients think so), the hospital (4 patients think so), self-confidence (3 patients think so), and the support of others (2 patients think so), material wealth (4 patients think so), from God (1 patient thinks so), from government support (5 patients think so).

Fig. 15. Factors influencing the success of treatment.

Nursing process map

FULL NAME. patient

Age 3 years

Patient Dynamic Assessment Sheet

FULL NAME. patient Starovidenko Vladislav Maksimovich

receipt date 22.04.14 .ward № 3 diet №16

CONCLUSION

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Offers

§ Conduct sanitary and educational work with parents of children on this disease;

§ Involve nursing staff in using the Henderson model in nursing care;

§ Involve patients to participate in all stages of the Henderson model;

§ Organize a care plan according to the patient's impaired needs