How to recognize the chronic course of pyelonephritis? Pyelonephritis: what is it, what is dangerous, symptoms and treatment of pyelonephritis How chronic pyelonephritis manifests itself

Chronic pyelonephritis is a pathology of the renal tissue (code N11 according to ICD-10), which is provoked by disease-causing agents, lasting for years, aggravated when the immune system is weakened.

Exacerbation of chronic pyelonephritis

Morbidity statistics show that the disease occurs frequently, and after death it is recorded in every tenth. Among women, the disease is more common, which is caused by a short urethra in comparison with men.

Chronic pyelonephritis (ICD 10 code - N11) is able not to manifest itself for a long time, to proceed hidden. In this form, the disease sometimes persists until death, which occurs from causes not related to kidney disease.

With stones, narrowing of the urinary canals, urinary retention, decreased immunity, the disease can become more active and progress.

Causes

The reason for the recurrence of chronic pyelonephritis is the weakening of the immune system, a long stay in the cold, infection. E. coli, enterococci, staphylococcus, streptococcus, fungi, viruses, Pseudomonas aeruginosa provoke a relapse.

During pregnancy, 85% of women develop chronic pyelonephritis from E. coli. In pregnant women, Klebsiella, Proteus, and Pseudomonas aeruginosa are also found.

Pathogenic microorganisms are activated:

• hypothermia;
• climate change;
• irrational nutrition;
• diabetes
• hepatitis.

Symptoms

Exacerbations of inflammation of the kidneys are accompanied by:

• pains;
• temperature;
• edema;
• intoxication;
• violation of urination;
• pressure increase;
• anemia.

The temperature may not rise above 37.2 0 C, but sometimes there is a fever of 39 0 C with chills. High temperature is observed infrequently, usually in patients there is an increase in temperature to subfebrile condition in the evening, signs of intoxication with a relapse of chronic pyelonephritis are erased.

Exacerbation of chronic pyelonephritis manifests as dull pain in the lower back, lateral parts of the abdomen, radiating to the groin, the front side of the thigh. Pain in chronic pyelonephritis is sometimes very similar to the sensations in sciatica, gastritis, cystitis, inflammation of the ovaries.

To confirm the renal origin of the pain, you can use the symptom of Tofilo. For the test, the patient is asked to lie on his back, bend his leg at the knee, press it to his chest while inhaling. If the pain in this position increases, then this increases the likelihood of chronic pyelonephritis.

Indirect signs of exacerbation are swelling of the face after sleep, fever, pressing nature of pain in the lower back. An exacerbation of chronic pyelonephritis is accurately diagnosed using ultrasound, laboratory tests of urine and blood.

Hypertension is noted in 75% of those suffering from chronic pyelonephritis. At the beginning of the disease, pressure increases appear only during periods of exacerbations, but over time, hypertension becomes a frequent occurrence for patients, and in 10% of patients it takes a complicated course.

Violation of daily urination is manifested by:

• nocturia.

During periods of exacerbation, there is a decrease in the specific gravity of urine, the presence of protein, leukocytes in the urine. When urinating, pain may be felt.

Exacerbation of chronic pyelonephritis causes a decrease in the production of erythropoietin, which causes anemia. During pregnancy, chronic pyelonephritis often worsens in the 2nd trimester. There is a risk of exacerbation 3 weeks after birth.

First aid

With exacerbation of chronic pyelonephritis, it is necessary to limit the mode of physical activity. With high blood pressure, acute pain, bed rest is recommended, it is only allowed to get up to visit the toilet and the dining room.

With severe pain, you should immediately call a doctor at home. You can not put a heating pad on the patient, give painkillers or offer to drink plenty of fluids. You need to wait for the arrival of the doctor.

Treatment

They treat with exacerbation with antibiotics, sulfonamides, nitrofurans, supplementing drug therapy with phytotherapy. Antibiotics are prescribed according to the results of bacterial culture.

Antibiotics are prescribed for kidney infection:

• coli - ampicillin, cephalosporin, chloramphenicol;
• proteem - ampicillin, carbenicillin, gentamicin;
• Pseudomonas aeruginosa - gentamicin, carbenicillin;
• enterococcus - ampicillin, carbenicillin;
• Staphylococcus aureus - penicillins, ampicillin;
• streptococcus - penicillins, cephalosporins;
• mycoplasmas - erythromycin.

In addition to antibiotics, derivatives are used to treat relapses of chronic pyelonephritis:

• nitrofuran - furazolidone, furadonin, furagin;
• nalixic acid - navigramone, blacks;
• 8-hydroxyquinoline - nitorxoline, 5-NOC.

An operation is necessary if the exacerbation is caused by apostema,. The purpose of the operation is to drain the kidney, aimed at restoring the outflow of urine.

Treatment during pregnancy

The task of treating exacerbation of pyelonephritis during pregnancy is becoming more complicated, the requirements for the safety of the drug are increasing. How to treat depends on the pathogenic flora, while the treatment must be absolutely safe for the fetus.

Treatment is carried out in a hospital, the course lasts 2 weeks. Treatment begins with intravenous administration of drugs, later switching to oral tablets. Do not use furazolidone, biseptol, chloramphenicol, tetracycline, fluoroquinolone, streptomycin during pregnancy because of the risk to the fetus.

The drug of choice for solving this problem is the inhibitor-protected penicillin ampicillin + sulbactam, amoxicillin + clavunate. Macrolides, cephalosporins are used during pregnancy.

Cefazosporins during pregnancy are used:

• the first 2 trimesters - 2nd generation drugs Cefaclor, Cefuroxime;
• in the 3rd trimester - preparations of 3rd, 4th generations Cedex, Maxipin, Fortum.

If the exacerbation is caused by Pseudomonas aeruginosa, cefaperazone + sulbactam, ceftazidime is used. In case of allergy to penicillins, cephalosporins, aztreon is the reserve drug. The drug is prescribed strictly according to indications, with caution.

With a particularly difficult course of exacerbation, thienams (carbapenems) are used. A feature of the treatment of chronic pyelonephritis is the abolition of sulfonamides and nitrofurans 20 days before delivery due to the possibility of complications in the fetus. Do not prescribe ototoxic antibiotics (gentamicin) that cause hearing damage to the fetus.

With lactation

Aztreonam, gentamicin, furadonin, furagin, cephalosporins cefaclor, ceftributen practically do not penetrate into breast milk. This allows medication to be used without interrupting breastfeeding.

Temporarily stop breastfeeding during treatment with antibiotics from the group of fluoroquinolones - ofloxacin, ciprofloxacin, perfloxacin.

Herbal preparations

You can use for treatment both herbal preparations Fitonefrol, Canephron N, and medicinal herbs, fees for preparing decoctions.

The preparation contains lovage, rosemary, centaury. They take the medicine in a course, it enhances the effect of antibiotics that are used in the main therapy, is an aseptic, diuretic, and has an anti-inflammatory effect.

The use of Kanefron can reduce proteinuria, reduce protein loss in the urine due to a decrease in the permeability of blood capillaries.

Medicinal plants that are used to prepare decoctions at home for chronic pyelonephritis should have the following properties:

• anti-inflammatory - bearberry, lingonberry, chamomile, St. John's wort, marshmallow, nettle;
• - birch leaves, juniper, parsley, kidney tea, cornflower flowers, corn silk, elecampane, bearberry.

Diet Features

In chronic pyelonephritis in the acute stage, diet No. 7 is recommended, in which:

• sharply reduce the amount of salt (or exclude on the recommendation of a doctor);
• protein products are slightly limited;
• increases plant foods containing vitamin C, thiamine, riboflavin, iron, nicotinic acid, potassium, magnesium;
• seasonings, smoked meats are excluded;
• food is prescribed up to 6 times a day;
• drinking regime during exacerbation - up to 1.5 l / day.

Prevention of exacerbations lies in the fact that the diet includes foods high in iron (raspberries, pomegranates, apples), potassium (dried apricots, raisins, figs). It is recommended for the period of illness a dairy-vegetarian diet with a small amount of additions in the form of boiled meat, fish.

On the video about the symptoms and treatment of exacerbation of chronic pyelonephritis:

An inflammatory disease called chronic pyelonephritis is localized in the pyelocaliceal region of the kidneys. Its development is possible at any age in both women and men. Chronic pyelonephritis is formed as a consequence of infectious diseases or as an independent disease.

Main features

Chronic pyelonephritis has the following symptoms:

• Lumbar aching pains, not very strong and asymmetrical. Moreover, it can hurt from the side opposite to the affected kidney;
• There is heaviness in the lower back, especially after prolonged standing;
• Young children, as well as adults with a mobile or low-lying kidney, may experience abdominal pain;
• In the evening, for no reason, the temperature can rise to 38 C;
• At night, urination becomes more frequent;
• Blood pressure rises;
• Painful feeling of tiredness, especially in the morning;
• Headaches and worsening of mood;
• In the morning, swelling of the face and hands may form, and in the evening - feet and shins.

It often happens that in this state the patient feels cold in the lower back and begins to dress warmer.

When conducting tests of urine and blood of a patient, the following signs of chronic pyelonephritis are revealed:

• reduced hemoglobin;
• an increased number of leukocytes in the urine;
• a large number of pathogenic bacteria in the urine;
• increased number of red blood cells.

Chronic pyelonephritis - treatment

To eliminate pathogens, antibiotics and uroseptic agents are used. The drugs used must be non-toxic to the kidneys and effectively fight the most common infectious pathogens: staphylococcus aureus, Klebsiella, E. coli, Pseudomonas aeruginosa, Proteus, etc. Before starting treatment, the sensitivity of bacteria to antibiotics is determined, for this, the patient's urine is analyzed.

Most often, the doctor prescribes antibiotics of the penicillin series (amoxicillin, azlocillin, carbenicillin). Their spectrum of action is wide, and nephrotoxicity is the most minimal.
In hospital treatment, both 2nd and 3rd generation cephalosporins are used. Their effectiveness does not differ from previous drugs, but for the most part they are used in the form of injections. Suprax or Cedex is prescribed on an outpatient basis.

Fluoroquinolones have a good effect. They qualitatively destroy the infection in the urinary tract, but are not recommended for use in pediatrics, lactating and pregnant women. These drugs also have a side effect - photosensitivity appears after taking them. Therefore, during the treatment period, it is impossible to stay in the sun for a long time.

Nitrofurans also treat pyelonephritis well. These include furadonin and furamag. But some patients do not tolerate them well due to nausea, bitterness in the mouth or vomiting.

Oxyquinolines are well tolerated. From this series, nitroxoline and 5-Noc can be called.

The amount of fluid you drink should be increased to about 3 liters during the day. If the symptoms of intoxication plus a high temperature are strongly pronounced, it is recommended to drink pharmacy rehydron or citroglucosolan.

If it is not possible to determine the origin of the pathogen that caused pyelonephritis, or the antibiogram is not yet ready, then broad-acting antibiotics are prescribed. Such, for example, as carbenicillin, nitroxoline, ampioks, cephalosporins, quinolones.

Perhaps the development of chronic renal failure (CRF for short). In this case, reduce the dose of uroantiseptics and increase the intervals between their intake.
There are 4 groups of antibiotics that are used differently in case of CRF:

• drugs used in usual doses: chloramphenicol, dicloxacillin, erythromycin, oleandomycin;
• antibiotics with a dose reduced by 30% due to their accumulation in the body in chronic renal failure: ampicillin, methicillin and oxacillin;
• means with mandatory dose and interval adjustment: streptomycin, biseptol, gentamicin, kanamycin, carbenicillin;
• drugs that are not recommended for use in chronic renal failure: nitrofurans, nevigramon and tetracyclines (except doxycycline).

Chronic pyelonephritis treatment is long. The first course of treatment takes place within 6-8 weeks. During this time, infection activity is suppressed and inflammation is reduced. If the inflammatory process is difficult and is not removed for a long time, then antibacterial agents are used in combinations. For example, drugs based on nalidixic acid are combined with cephalosporins, aminoglycosides, or carbenicillin. The drug 5-Nock is well combined with antibiotics. With the simultaneous use of bactericidal antibiotics such as penicillins and aminoglycosides or penicillins and cephalosporins, they further enhance their effect.

When the patient enters the stage of remission, treatment is made intermittent. Antibacterial therapy should be repeated 3-5 days before the next exacerbation is expected to begin. The duration of the courses is done for 8-10 days, with the same drugs from which relief came at the beginning of treatment.

Phytotherapy

Herbal remedies as an addition to antibiotic therapy are very effective, but they cannot completely replace it and are not recommended for use during periods of exacerbations. They are used for prophylaxis during remission periods or after a course of antibiotics.

The table below lists all the herbs used in the complex therapy of chronic pyelonephritis.

Medicinal plants used in pyelonephritis (including chronic)

So, for example, bearberry, or as it is also called bear ears, contains a substance that breaks down in the body into the antiseptic hydroquinone and glucose. Apply bearberry in the form of decoctions. Best of all, its action is manifested in an alkaline environment. Therefore, drinking a decoction is recommended with alkaline mineral waters. Raspberries, pears, apples alkalize urine well.

The antimicrobial and diuretic property of lingonberry leaves is used similarly to bearberry. The reception is the same, a decoction together with an alkaline mineral water.

Treatment with physiotherapy procedures

Physiotherapeutic methods are used in combination with the main treatment. This method works as follows:

• increases blood flow to the kidneys, which allows antibacterial agents to enhance their effect;
• the excretion of harmful substances from the renal pelvis improves due to the removal of muscle spasms.

The physical procedures used are listed below:

• erythromycin electrophoresis;
• furadonin electrophoresis;
• electrophoresis of calcium chloride;
• ultrasound (in the absence of kidney stones);
• microwave;
• thermal procedures (paraffin and ozokerite applications, therapeutic mud, diathermy).

All physiotherapy procedures are applied to the kidney area.

Treatment at mineral water resorts

The use of mineral waters in the treatment of chronic pyelonephritis has a positive effect on the patient's condition. Mineral waters with their alkaline composition help relieve inflammation, increase the alkalinity of urine, wash out salts and harmful bacteria.

In chronic pyelonephritis, the following mineral water resorts are useful: Truskavets, Zheleznovodsk, Sairme, Jermuk. As well as mineral springs Slavyanovsky and Smirnovsky.

Spa treatment includes, in addition to taking mineral waters, physiotherapy procedures.

There are contraindications for spa treatment:

• high blood pressure;
• anemia;

Anti-relapse treatment

To prevent periods of exacerbation of chronic pyelonephritis, there are several methods. One of them involves antibiotic treatment several times a year in combination with antiseptics and medicinal plants.

The following technique involves the use of the following drugs for 4 weeks:

• In the first week - biseptol (at night 1 or 2 tablets);
• In the second week - a vegetable uroantiseptic;
• In the third week - 5-NOC (2 tablets at night);
• In the fourth week - chloramphenicol (1 tablet at night).

In the future, they do the same, but with other drugs of similar action. If an exacerbation has not been observed for more than 3 months, you can use plant-based antiseptics. Apply them for 2 weeks a month. The cycle can be repeated, and in the absence of exacerbation, take a break for 1-2 weeks.

Another version of the technique involves drinking rosehip decoctions, vitamins and cranberry juice for one week. The second and third weeks to use medicinal fees. In the fourth week, an antibiotic is applied, which should be changed monthly.

- This is a chronic nonspecific bacterial inflammation, occurring mainly with the involvement of the interstitial tissue of the kidneys and pyelocaliceal complexes. Manifested by malaise, dull pain in the lower back, subfebrile condition, dysuric symptoms. In the process of diagnosing, laboratory tests of urine and blood, ultrasound of the kidneys, retrograde pyelography, and scintigraphy are carried out. Treatment consists in following a diet and a sparing regimen, prescribing antimicrobial therapy, nitrofurans, vitamins, and physiotherapy.

ICD-10

N11 Chronic tubulointerstitial nephritis

General information

Causes

The etiological factor causing chronic pyelonephritis is the microbial flora. Mostly these are colibacillary bacteria (para-Escherichia and Escherichia coli), enterococci, Proteus, staphylococci, Pseudomonas aeruginosa, streptococci and their microbial associations. A special role in the development of the disease is played by L-forms of bacteria, which are formed as a result of ineffective antimicrobial therapy and changes in the pH of the environment. Such microorganisms are resistant to therapy, difficult to identify, able to persist in the interstitial tissue for a long time and become activated under the influence of certain conditions.

In most cases, chronic pyelonephritis is preceded by an acute attack. There are cases of a combination of pyelonephritis with chronic glomerulonephritis. Chronic inflammation is promoted by:

• unresolved urinary outflow disorders caused by kidney stones, ureteral stricture, vesicoureteral reflux, nephroptosis, prostate adenoma;
• other bacterial processes in the body (urethritis, prostatitis, cystitis, cholecystitis, appendicitis, enterocolitis, tonsillitis, otitis, sinusitis, etc.);
• general somatic diseases (diabetes mellitus, obesity), chronic immunodeficiency and intoxication.

In young women, the impetus for the development of chronic pyelonephritis may be the onset of sexual activity, pregnancy or childbirth. In young children, the disease is often associated with congenital anomalies (ureterocele, bladder diverticula) that disrupt urodynamics.

Classification

Chronic pyelonephritis is characterized by three stages of inflammation in the kidney tissue.

1. At stage I, leukocyte infiltration of the interstitial tissue of the medulla and atrophy of the collecting ducts are detected; renal glomeruli are intact.
2. At stage II of the inflammatory process, cicatricial-sclerotic lesions of the interstitium and tubules are noted, which is accompanied by the death of the terminal sections of nephrons and compression of the tubules. At the same time, hyalinization and desolation of the glomeruli, narrowing or obliteration of the vessels develop.
3. In the final, III stage, the renal tissue is replaced by scar tissue, the kidney has a reduced size, looks wrinkled with a bumpy surface.

According to the activity of inflammatory processes in the renal tissue in the development of chronic pyelonephritis, the phases of active inflammation, latent inflammation, remission (clinical recovery) are distinguished. Under the influence of treatment or in its absence, the active phase is replaced by a latent phase, which, in turn, can go into remission or again into active inflammation. The remission phase is characterized by the absence of clinical signs of the disease and changes in urine tests. According to clinical development, erased (latent), recurrent, hypertensive, anemic, and azotemichesky forms of pathology are distinguished.

Symptoms of chronic pyelonephritis

The latent form of the disease is characterized by poor clinical manifestations. Patients are usually worried about general malaise, fatigue, subfebrile condition, headache. Urinary syndrome (dysuria, back pain, edema), as a rule, is absent. Pasternatsky's symptom may be weakly positive. There is a slight proteinuria, intermittent leukocyturia, bacteriuria. Violation of the concentration function of the kidneys is manifested by hypostenuria and polyuria. Some patients may present with mild anemia and moderate hypertension.

The recurrent variant of chronic pyelonephritis proceeds in waves with periodic activation and subsidence of inflammation. The manifestations of this clinical form are heaviness and aching pain in the lower back, dysuric disorders, periodic feverish conditions. In the acute phase, a clinic of typical acute pyelonephritis develops. With progression, hypertensive or anemic syndrome may develop. Laboratory, especially during exacerbation, is determined by severe proteinuria, constant leukocyturia, cylindruria and bacteriuria, sometimes hematuria.

In the hypertensive form, the hypertensive syndrome becomes predominant. Arterial hypertension is accompanied by dizziness, headaches, hypertensive crises, sleep disturbances, shortness of breath, pain in the heart. Hypertension is often malignant. Urinary syndrome, as a rule, is not expressed or has an intermittent course. The anemic variant of the disease is characterized by the development of hypochromic anemia. Hypertension is not expressed, urinary - fickle and meager. Azotemic form combines cases when the disease is detected only at the stage of CRF. Clinical and laboratory findings of the azotemic form are similar to those of uremia.

Diagnostics

The difficulty of diagnosing chronic pyelonephritis is due to the variety of clinical variants of the disease and its possible latent course. Diagnostic tactics include:

• Urinalysis. In the general analysis of urine, leukocyturia, proteinuria, cylindruria are detected. The study of urine according to the method of Addis-Kakovsky is characterized by the predominance of leukocytes over other elements of the urinary sediment. Bacteriological culture of urine contributes to the detection of bacteriuria, identification of pathogens of chronic pyelonephritis and their sensitivity to antimicrobial drugs. To assess the functional state of the kidneys, Zimnitsky and Reberg tests, a biochemical study of blood and urine are used.
• General blood analysis. Hypochromic anemia, accelerated ESR, neutrophilic leukocytosis are found in the blood.
• Instrumental research. The degree of impaired renal function is specified using chromocystoscopy, excretory and retrograde urography, nephroscintigraphy. A decrease in the size of the kidneys and structural changes in the renal tissue are detected by ultrasound, MRI and CT of the kidneys. Instrumental methods objectively indicate a decrease in the size of the kidneys, deformation of the pelvicalyceal structures, and a decrease in the secretory function of the kidneys.
• Kidney biopsy. In clinically unclear cases of chronic pyelonephritis, a kidney biopsy is indicated. Meanwhile, sampling during a biopsy of unaffected renal tissue can give a false negative result in the morphological study of the biopsy.

In the process of differential diagnosis, kidney amyloidosis, chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis are excluded.

Treatment of chronic pyelonephritis

Patients are shown compliance with a sparing regimen with the exclusion of factors provoking exacerbation (hypothermia, colds). Adequate therapy of all intercurrent diseases, periodic monitoring of urine tests, dynamic monitoring by a nephrologist are necessary.

Diet

Recommendations for the diet include the rejection of spicy foods, spices, coffee, alcoholic beverages, fish and meat broths. The diet should be fortified, containing dairy products, vegetable dishes, fruits, boiled fish and meat. It is necessary to consume at least 1.5-2 liters of fluid per day to prevent excessive concentration of urine and to ensure the washing of the urinary tract. With exacerbations of chronic pyelonephritis and with its hypertonic form, restrictions are imposed on the intake of table salt. Cranberry juice, watermelons, pumpkin, melons are useful.

Conservative therapy

Exacerbation requires the appointment of antibiotic therapy, taking into account the microbial flora (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) in combination with nitrofurans (furazolidone, nitrofurantoin) or nalidixic acid preparations. Systemic chemotherapy is continued until bacteriuria ceases as determined by laboratory results.

In complex drug therapy, vitamins B, A, C are used; antihistamines (mebhydrolin, promethazine, chloropyramine). In the hypertensive form, antihypertensive and antispasmodic drugs are prescribed; with anemic - iron preparations, vitamin B12, folic acid.

Of the physiotherapeutic methods, SMT therapy, galvanization, electrophoresis, ultrasound, sodium chloride baths, etc. have proven themselves especially well. In the case of the development of uremia, hemodialysis is required.

Surgery

Far advanced chronic pyelonephritis, not amenable to conservative treatment and accompanied by unilateral wrinkling of the kidney, arterial hypertension, is the basis for nephrectomy.

Forecast and prevention

With a latent chronic variant of inflammation, patients remain able to work for a long time. In other forms, the ability to work is sharply reduced or lost. The timing of the development of chronic renal failure is variable and depends on the clinical variant of chronic pyelonephritis, the frequency of exacerbations, and the degree of impaired renal function. The death of a patient can occur from uremia, acute disorders of cerebral circulation (hemorrhagic and ischemic stroke), heart failure.

Prevention consists in timely and active treatment of acute urinary infections (urethritis, cystitis, acute pyelonephritis), sanitation of foci of infection (chronic tonsillitis, sinusitis, cholecystitis, etc.); elimination of local disorders of urodynamics (removal of stones, dissection of strictures, etc.); immune correction.

One of the most common kidney diseases is chronic pyelonephritis, which is a bacterial process that occurs in the renal pelvis, calyces and tissues. Pyelonephritis has no age limit. The presence of pyelonephritis is determined by passing a urine test, and symptoms can be pain in the lumbar region, as well as other signs. Often the disease proceeds without extraneous sensations, especially at the initial stage, it can only be determined with the help of analysis.

Reasons for education

Like any disease, chronic pyelonephritis has its onset and is due to:

• metabolic disorders in the body, hypovitaminosis;
• low immunity protection;
• overwork, fatigue, systematic lack of sleep;
• hypothermia of the body;
• infections;
• anatomical structure of the body;
• prostate adenoma or hormonal disruptions (changes occur during pregnancy, childbirth, deprivation of virginity, androgen deficiency);
• congenital anomalies (typical for a child).

The causes of pyelonephritis can be a large set of factors that cannot be foreseen in advance. It is recommended to periodically undergo an examination, take a urine test, especially at a time when there is a risk of pyelonephritis.

Disease classification

Depending on a number of factors, chronic pyelonephritis can be classified in different ways. Given the causes of the formation of the disease, pyelonephritis is primary, secondary, obstructive, non-obstructive. Based on the location of the infection, pyelonephritis can be unilateral or bilateral. According to the stage of the inflammatory process, it is divided into active, latent, in remission. According to the severity, it is categorized into uncomplicated and complicated pyelonephritis. All these factors, their presence or absence, allows us to determine the degree of the disease, as well as to choose the optimal treatment for adults and children.

Symptoms of pyelonephritis

The severity of the disease depends on the form of its course. Therefore, the symptoms of pyelonephritis are characterized in different ways. Pyelonephritis makes itself felt suddenly accompanied by:

• pulling, aching pain in the back;
• an increase in body temperature;
• sleep disturbance;
• change in the color of urine, its smell, transparency;
• the appearance of edema, renal pressure;
• urinary syndrome.

When diagnosing pyelonephritis, the symptoms are divided into local (latent, recurrent) and general (early, late). Each of the forms has its indicators, features, types, manifestations.

Latent

This form has mild symptoms. Accompanied by low (37°) body temperature, headache. Belt pain, swelling may be absent. The condition can lead to anemia, hypertension. The malaise is accompanied by excessive urination, indicates a violation of the kidneys.

anemic

In this case, the number of red cells in the blood decreases sharply, which provokes anemia. With a lack of a special substance that the kidneys produce, a violation of hemoglobin synthesis begins to occur. In this case, general symptoms may be mild, which will make self-diagnosis difficult, and a laboratory examination will be required. The anemic form of the disease is common in people suffering from pyelonephritis.

Hypertensive

The work of the kidneys directly depends on the level of pressure necessary for life. When the blood flow of the kidneys is disturbed, a hormone called renin begins to be released into the body in increased doses, mixed with other components and hormones. Subsequently, a narrowing of the vessels of the kidneys occurs, blood circulation is disturbed, and, as a result, pressure is destabilized. In chronic pyelonephritis, the tissues of the kidneys are destroyed, they are depleted, and there is a serious violation in the structure of the organs. Because of this, depressive substances cease to be produced, arterial hypertension begins. Symptoms in the hypertensive form are expressed in headaches, shortness of breath, dizziness, pain in the region of the heart.

Azotemic

The latent course of the disease is poorly expressed, it does not always allow you to quickly determine the causes and, as a result, diagnose the disease. If the course of the disease is ignored when the first symptoms appear, then the risk of complications is high. Azotemic form of the disease implies a stage when the process of renal failure occurs. The reason is the inability of the kidneys to remove toxic substances from the body, the metabolism is disturbed. The presence of kidney failure is characterized by an increase in creatine, which will be seen from the results of the analysis.

Recurrent form

This is a repetition, when, after the inflammation process subsides, the symptoms subside, an exacerbation occurs again. It can be expressed brighter, stronger, accompanied by a feverish state. A condition such as secondary pyelonephritis qualifies.

Diagnosis of kidney disease

It is quite difficult to identify the presence of the disease, and even without obvious signs and suspicions. To determine pyelonephritis, the following is carried out:

• general urine analysis;
• biochemical blood and urine tests;
• Ultrasound of the kidneys, magnetic resonance imaging, x-ray studies.

Change in blood test results

In the presence of a disease, shaped changes in blood elements occur. Such deviations allow diagnosing the disease, identifying the degree of complication or development. When analyzing blood, the level of hemoglobin, the number of red blood cells, their sedimentation rate, hematocrit (the ratio of red cells to plasma volume) is examined. If a person has pyelonephritis, the results will show a decrease in the number of blood cells, hemoglobin, and hematocrit. Inversely, the ESR indicator begins to increase.

A general analysis shows the number and characteristics of specific cells, therefore, a biochemical blood test is prescribed to study the biologically significant components of plasma.

Changing the properties of urine

Accurate data on the presence of the disease can be given by the study of urinalysis. The indicators of urine in men and women are different, ranging from 0 to 6. The deviation indicates the course of the inflammatory process. Color is an important indicator. In chronic pyelonephritis, it reaches a yellow, orange or red hue. The absence of protein in the urine is a good indicator, and its increase indicates a disease. Also, with pyelonephritis, the number of leukocytes increases, the epithelium is minimized, salt is formed in the urine, the level of cylinders rises, they become granular.

Special laboratory studies

These tests include a complete blood count and urine test. Urine is examined according to the method of Nicheporenko and Zimnitsky. The test results show the predominance of leukocytes over erythrocytes, and also allow you to determine the density of urine.

Bacteriological studies

This group of examinations includes bacteriological culture and enzyme immunoassays. The study of sowing allows you to identify microorganisms in the urine that caused inflammation. The examination reveals the main causative agent of the disease, which makes it possible to prescribe the correct treatment. The results of enzyme immunoassays supplement the information of bacteriological culture, help to more accurately identify the cause of the infection.

Instrumental Research

For an accurate diagnosis, stage of the disease, determination of the condition of the kidneys, other dependent organs, studies are carried out using special medical equipment.

Ultrasonography

With the help of the apparatus and sound waves, you can see the work of the kidneys on the screen. During ultrasound, the state of the organs, the presence of damage, wrinkling, compaction of the pelvis, cups, and deformation of the kidneys are visible. During the procedure, the diagnostician makes some measurements, notes time indicators during work, and, if necessary, takes pictures with the help of the device. In the future, the attending physician, thanks to the pictures, data, determines the degree of chronic pyelonephritis and prescribes the appropriate treatment.

Radiography

Provides three methods of examination: plain radiography, excretory urography, computed tomography. Each of the procedures has its own goals for studying the condition of the kidneys. Depending on the initial indicators, a specific type of radiography is assigned.

Magnetic resonance imaging

Effective and one of the most expensive procedures for examining the body. With the help of an electromagnetic pulse, the atoms in the tissues of the organs react, and the sensor reads the information, which is converted into a finished image. In chronic pyelonephritis, MRI can allow examining a cyst, the formation of new kidney diseases, and examining blood vessels and tissues.

Renal angiography

Allows you to study blood vessels in the kidneys. Depending on the stage of the disease, changes occur in the vascular system. Initially, the number of small vessels decreases, leading to their complete disappearance. At the second stage, wrinkling of the kidney begins, a decrease in its size. At the last stage, the organ is maximally wrinkled, the vessels are deformed, and their number is reduced significantly. Thus, angiography allows you to explore, determine the state of the kidneys in pyelonephritis.

Differential Diagnosis

When making a diagnosis, pyelonephritis is differentiated from other diseases, such as hypertension, diabetic and chronic glomerulonephritis, kidney amyloidosis. In some indicators, these diseases resemble pyelonephritis, so the doctor needs the patient's medical history, the results of all tests to determine an unmistakable diagnosis.

Treatment of chronic pyelonephritis

The doctor always prescribes complex treatment, because chronic pyelonephritis is unpredictable in the process of its development and course. A diet must be observed, it is necessary to adhere to recommendations, food prohibitions. Mandatory compliance with the treatment regimen, timely medication, injections. Weakening of immunity can cause inhibition of treatment or its inefficiency, so you need to protect yourself from colds, to prevent hypothermia.

Medical therapy

For the treatment of pyelonephritis, antibiotics, uroseptics, antimicrobials are prescribed. When prescribing, the doctor is guided by the results of tests, examinations, takes into account the source of the inflammatory process. Depending on this, he selects a complex of medicines, the category of which may include penicillin, cephalosporin, oxyquinoline, quinol, sulfanilamide drugs, nitrofunars. Female and male chronic pyelonephritis is treated in the same way, there are no gender differences, and for children, antibiotics with similar properties should be used, but with recommendations for the child. Self-selection is prohibited, the appointment is carried out only by specialists.
The duration of treatment is from two weeks to a month, and then the course of therapy is determined to exclude relapse. Therefore, it is recommended to always have medications on hand that, if necessary, will help prevent exacerbation and start therapy on time.

Surgical intervention

Sometimes it is not possible to cure with medicines, but on the contrary, the formation of purulent foci begins. Then an operation is performed, which aims to eliminate purulent formations. In severe cases, doctors may remove the affected kidney. There are several types of surgical procedures:

• decapsulation;
• pyelostomy;
• opening and excision of purulent-necrotic foci;
• nephrectomy.

Regardless of the type of operation, surgical intervention is a complex procedure that can be accompanied by complications, both during the operation and in the postoperative period. There are also contraindications to surgery, such as cardiovascular disease. Surgical methods are an extreme measure, it will be prescribed only after a thorough, complete examination and study of the medical history.

Other effective treatments

It is advisable to include the use of folk remedies for the treatment of pyelonephritis and rest in sanatoriums to such methods. Traditional medicine is not able to lead to a complete recovery and cure of the kidneys, but is very effective between medications and courses of therapy.

Treatment at home

The use of diuretics, renal herbal preparations based on bearberry, black currant, horsetail, wild rose, juniper, flax seeds will be effective. They have excellent antiseptic, diuretic properties. Cranberries, from which fruit drinks are made, have a powerful bactericidal effect, 0.5-1 liter of drink per day is taken. In addition to the fruit drink, you need to take methionine, which plays the role of an amino acid, affecting the synthesis of the biological components of the body. In addition, such a tandem is able to neutralize toxic compounds. And all this is necessarily accompanied by a diet, spicy dishes, canned foods are excluded from the diet. It is recommended to drink more water.

Prevention

Preventive measures include a whole range of measures:

• timely treatment;
• periodic examination, testing, visiting the attending physician;
• elimination of infectious foci in the body;
• therapy of cystitis, prostatitis, epididymitis until complete recovery;
• during pregnancy, control over the appearance of pathogenic bacteria in the urine;
• removal of stones (if necessary through surgery);
• maintaining personal hygiene;
• the use of vitamins, trace elements, a sufficient amount of water;
• antibacterial protection.

Proper nutrition is the key to health, regardless of the presence or absence of diseases. A diet for chronic pyelonephritis is necessary because the kidneys are directly involved in metabolism. In addition, the diet menu will speed up the process of eliminating pathologies. Therefore, it is worth excluding spicy, fatty, spicy, salty foods. Dairy products, fruits, berries are recommended, as well as drinking at least 2 liters of pure water per day.

Drugs that improve renal blood flow

According to the doctor's prescription, it is necessary to take drugs that improve renal blood flow, such as trental, chimes, aescusan, troxveasin.

Forecast

Only timeliness, the correct diagnosis, the appointment of effective treatment will lead to recovery. Complications occur when metamorphosis occurs in the kidney. Depending on the stage of pyelonephritis, its complexity of treatment, the duration of diagnosis, the onset of remission or the absence of it depends. The prognosis also depends on the rate of progression of pyelonephritis, the presence of urological pathologies, pregnancy, as well as the patient's lifestyle, his desire to be treated. Thus, there are many factors that are responsible for the development of a disease or recovery and depend on medical professionals, as well as the patient himself.

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