Pyelonephritis - symptoms and treatment. How to treat pyelonephritis Chronic phase pyelonephritis

Chronic pyelonephritis is a kidney disease that poses a threat to the general condition of the body. What is chronic pyelonephritis and how can it be dangerous? Read our article.

Causes of chronic pyelonephritis

Most often, chronic pyelonephritis is a consequence of improper treatment of diseases of the genitourinary system (cystitis, urethritis, acute pyelonephritis or urolithiasis). However, doctors also identify other causes of chronic pyelonephritis:

• Hormonal imbalances and gynecological diseases in women;
• Decreased immunity;
• Promiscuous sexual intercourse;
• Stress and emotional stress;
• Hypothermia;
• Diabetes.

The disease can be caused by different types of bacteria:

• Escherichia coli;
• Enterococci;
• Proteus;
• Staphylococcus;
• Streptococci.

All of them have varying degrees of resistance to antibiotics, so in order to prescribe adequate treatment it is important to correctly determine the etiology of the disease. Regardless of the cause, the chronic form is always preceded by an acute attack. Chronicity of the disease is caused by untimely outflow of urine. It can be caused by urolithiasis, the peculiar structure of the ureter, nephroptosis and prostate adenoma. Diseases not related to the genitourinary system can also maintain inflammation in the body:

• Cholecystitis;
• Appendicitis;
• Enterocolitis;
• Tonsillitis;
• Otitis;
• Sinusitis, etc.

Decreased immunity, obesity and intoxication of the body contribute to the development of infection.

Incorrectly prescribed therapy threatens the patient with an increase in recovery time and the development of complications. Reliable identification of the etiological factor is the key to successful treatment and recovery of the patient.

Classification of chronic pyelonephritis

According to the WHO classification, there are many forms of this disease. According to the activity of infection, chronic pyelonephritis is divided into three phases:

1. Active inflammation phase;
2. Latent inflammation phase;
3. Remission phase.

Each phase has differences both in symptoms and research results. Adequate treatment contributes to the transition of the acute period to the latent period. The latent period is expressed very weakly, almost imperceptibly. The patient may be bothered by general fatigue, low-grade body temperature and headaches. There may be no symptoms specifically indicating a genitourinary disease. After several months, the disease, which had been latent, gives way to recovery (remission) or a new attack. In the acute stage, it is already possible to clearly distinguish the symptoms inherent in pyelonephritis. Urine culture during this period also indicates pathology. Bacteria and leukocytes are released into the urine (bacteriuria and leukocyturia), as well as protein up to 3 g/l (proteinuria).

Based on their occurrence, there are two forms of chronic pyelonephritis:

1. Primary – not associated with previous urological diseases. When studying the pathology of this form, doctors usually do not find factors that could contribute to the retention of bacteria in the kidney tissues.
2. Secondary – if there were previously lesions of the urinary tract. For example, the calculous form develops against the background of urolithiasis.

Depending on the location of pyelonephritis, the following forms are distinguished:

• Left-handed;
• Right-handed;
• Bilateral.

Symptoms

The symptoms of pyelonephritis will vary depending on the stage of pathogenesis (development of the disease), as well as in different categories of patients (men, women or children). Doctors suspect chronic pyelonephritis even with the following signs:

• Increased body temperature;
• Pain in the lumbar region;
• Dysuria;
• Headaches and general malaise;
• Increased fatigue;
• The presence of swelling and bags under the eyes.

It should be noted that symptoms in the acute phase are more pronounced and require immediate treatment. The feeling of pain becomes unbearable. A symptom of exacerbation such as high temperature can reach a critical point (up to 41 C).

The latent period of pyelonephritis is characterized by sluggish symptoms. Most often, they are indirect and are not attributed either to the patient or to the doctors to a disease of a urological nature. Thus, chronic pyelonephritis can result in high blood pressure (hypertension). Kidney function and the cardiovascular system are closely related. If the condition of the kidneys worsens, a hypertensive crisis occurs. Increased blood pressure is quite common in patients with kidney disease (about 40%).

Symptoms of pyelonephritis in women do not differ from the general clinical picture. However, if in parallel the patient suffers from cystitis or another urological disease, the symptoms become mixed, making it difficult to make an accurate diagnosis and treatment. In men, symptoms of pyelonephritis may be signs of other urological or andrological diseases. Therefore, it is important to contact a specialist in a timely manner. Manifestations of pyelonephritis can even occur in infants and infants. In children, pyelonephritis most often has obvious symptoms. A feature of the course of pyelonephritis in children is very rapid intoxication due to a rise in temperature. At home, you can help your baby with symptomatic treatment methods:

• Bed rest;
• Anesthesia;
• Decreased body temperature.

Diagnostics

It is easiest to diagnose chronic pyelonephritis in a hospital setting. To make a diagnosis, an experienced nephrologist usually only needs to order a standard examination. Diagnosis of chronic pyelonephritis includes:

• Blood and urine tests;
• Ultrasound examination of the kidneys;
• Analysis of smears in women (if gynecological diseases are suspected).

The test results will help the doctor determine the nature of the disease (etiopathogenesis). The main criteria by which the disease is determined through tests are leukocyturia, bacteriuria and proteinuria. An increase in the number of leukocytes is not always associated with a severe course of the disease. Therefore, test data are always compared with the patient’s complaints and the overall clinical picture. An ultrasound will show possible diffuse changes in the kidneys. To more accurately formulate a diagnosis, the doctor may prescribe additional tests. There are often cases when the disease is diagnosed by chance, during examination for another disease.

Treatment

Chronic pyelonephritis is treated comprehensively. Antibiotics and uroseptics are used. The doctor may also prescribe herbal remedies. The successful outcome of treatment largely depends on preliminary urine culture to determine drug sensitivity. In this way, the doctor determines which antibiotics should be used to treat the disease in each individual case. Most often, pyelonephritis in the acute stage can be cured with the following medications:

• Penicillins (amoxicillin, carbenicillin, azlocillin);
• Cephalosporins;
• Fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin).

Nitrofurans (furadonin, furagin, furamag) cope well with pyelonephritis, but have many side effects (nausea, vomiting, bitterness in the mouth). Sulfanilamide (Biseptol) and hydroxyquinoline drugs (Nitroxoline) are well tolerated by humans, but bacteria have also recently become less sensitive to them. Treatment can be prescribed either in tablet form or in injections.

In the treatment of pyelonephritis, the most important thing is to adhere to the specified treatment regimen. The drug must be taken exactly as many days as prescribed by the doctor. Otherwise, the therapy will not cope with the bacteria completely and after some time they will begin to attack the body again. Successful treatment of an exacerbation leads to the disease going into remission.

Treatment in the remission stage comes down to preventive measures:

• Diet;
• Drinking regime;
• Alternation of oxidizing and alkalizing foods in the diet;
• Herbal teas;
• Strengthening immunity;
• Moderate physical activity;
• Spa treatment.

The latter, by the way, is one of the most effective ways to maintain the patient’s quality of life at the proper level. The main factor when choosing a sanatorium for kidney treatment is the availability of mineral waters. Using the healing properties of water, harmful substances are removed from the kidneys and inflammatory processes are eliminated. The medical standard of modern resorts involves a nursing process. This is an integrated approach to treating patients, including the provision of professional medical care and patient care. Modern clinics also provide quality nursing care.

If you follow all the doctor’s clinical recommendations, the prognosis for chronic pyelonephritis can be quite favorable. The disease can be cured completely, forever forgetting about its unpleasant symptoms. In this case, the patient may even be removed from the register if he had previously been seen by a doctor. Ignoring medical instructions can have serious consequences for the patient. Untreated pyelonephritis is dangerous due to numerous complications (carbuncle or kidney abscess, sepsis). They can cause disability or bacteriotoxic shock, which is fatal. Bilateral pyelonephritis leads to liver damage (hepatorenal syndrome).

Therefore, despite the fact that the disease is in remission, take care of your health. Do not self-medicate, get tested on time and visit a specialized doctor. He will tell you how to properly treat pyelonephritis.

The unique remedy ASD-2 helps in the treatment of kidney diseases. The main active ingredient of the drug is folic acid. Under its influence, the process of reabsorption of necessary substances occurs faster in the renal tubules. In addition, ASD-2 helps restore the body’s adaptive capabilities, normalizing Ph-balance and increasing resistance to pathogenic factors (physical, emotional overload and stress). At the remission stage, this is an excellent remedy, thanks to which the disease can completely go away.

Diet

Diet is the basis for the treatment of chronic pyelonephritis. For patients who have suffered acute pyelonephritis, the “Table 7” diet is indicated. The diet of a patient with pyelonephritis should include natural foods, steamed or boiled. It is necessary to reduce salt intake to a minimum. It is better to replace purified tap water with mineral water.

What you can eat:

• Low-fat poultry, meat and fish;
• 1 egg per day;
• Yesterday's bread;
• Pasta from durum wheat;
• Cereals;
• Fruits and vegetables;
• Fruit drinks (especially cranberry).;
• Weak black and green tea;
• Vegetable and butter oils.

What not to eat:

• Strong broths from fatty meats;
• mushrooms;
• Spicy and fatty foods;
• Fried foods;
• Chocolate, confectionery;
• Strong coffee;
• Legumes;
• Fresh bread and rolls.

Eating this therapeutic diet is not so difficult. It is enough to get used to the natural taste of the products. Thematic books with dietary recipes will help to diversify medical nutrition.

Prevention

Prevention of chronic pyelonephritis includes timely treatment of the acute phase of the disease. To prevent acute pyelonephritis, you need to avoid overcooling and eliminate foci of infections in the body in a timely manner. It is very important to strengthen the immune system from the inside with vitamins, proper balanced nutrition and hardening procedures. Be sure to have blood and urine tests done once a year or more often.

During pregnancy

Chronic pyelonephritis and pregnancy are quite common. The reason for this is the growth of the fetus, due to which the kidneys are displaced. There is a violation of the outflow of urine, bacteria are not removed from the body in time - inflammation occurs. Pregnancy itself with chronic pyelonephritis can proceed quite normally. However, the condition of the expectant mother leaves much to be desired. To complicate the situation, antibiotic therapy is contraindicated during pregnancy. After passing all the necessary tests and confirming the diagnosis, the attending physician prescribes the most appropriate medications with minimal risk to the child. Many mothers are concerned about the question of whether it is possible to give birth if this disease was discovered during pregnancy. Doctors say that timely detection of pathology and control over it allows women to give birth independently in 95% of cases.

Do they take into the army with chronic pyelonephritis?

Conscripts with chronic pyelonephritis may not serve in the army. However, there are many nuances here. To make a diagnosis, leukocyturia and bacteriuria must be observed in the urine for 12 months. It is known that in the remission stage these indicators can be reduced. Therefore, to make the most accurate diagnosis, a commission is appointed several times.

Chronic pyelonephritis develops against the background of a long-term untreated acute form of the disease and can cause the development of renal failure and disability of the patient.

Chronic pyelonephritis is an infectious-inflammatory disease characterized by involvement of the kidney tubules in the pathological process and subsequent damage to the glomeruli and blood vessels. According to medical statistics, chronic kidney pyelonephritis is diagnosed in 60% of cases among possible infectious diseases of the genitourinary system and occupies a leading place as one of the causes of patient disability.

What is this disease and who is at risk?

Representatives of the weaker sex are more often susceptible to the development of chronic pyelonephritis, which is due to the structural features of their urethra - it is short and wide in women. Pathogenic microorganisms easily penetrate through the urethra into the bladder and then into the kidneys, causing an inflammatory process in them.

The main difference between acute pyelonephritis and the chronic form is that in the second case the pathological process spreads to both kidneys, while acute inflammation is observed mainly on one side only (usually in the right kidney). The chronic form of the disease is characterized by periods of remission and exacerbation, during which the symptoms are pronounced, as with.

If in acute pyelonephritis recovery does not occur within 3 months, then the disease gradually subsides and becomes chronic. Further, any predisposing factor will cause an exacerbation, and each exacerbation, in turn, will cause parenchymal changes in the structure of the kidneys. Gradually, changes in the structure of the organ completely disrupt its functioning, which is a direct path to kidney failure and disability.

Symptoms of chronic pyelonephritis

Symptoms of chronic pyelonephritis directly depend on the localization of the inflammatory process in the kidneys, on the degree of spread of inflammation to the organ (one or both kidneys at once), on the presence of associated complications in the form of narrowing of the lumen of the ureters or urethra. Signs of chronic pyelonephritis may not be felt at all for many years, but meanwhile the inflammation will slowly spread to all tissues and parts of the kidney.

Symptoms appear clearly during the period of exacerbation of the disease and are characterized by the following:

• high body temperature (up to 38.5-39.0 degrees);
• dull pain in the lumbar region on one side or both sides;
• various dysuric phenomena - impaired urine outflow, a feeling of incomplete emptying of the bladder, pain and pain at the time of urination, decreased daily diuresis;
• severe headaches and increased blood pressure;
• nausea, general weakness;
• swelling of the limbs and face;
• vomiting and symptoms of general intoxication of the body;
• pale skin and rapid pulse.

Important! During the period of subsidence of pronounced clinical symptoms, it is very difficult to diagnose the disease, since pyelonephritis passes into a latent (hidden) form of the course.

During the period of remission, intermittent symptoms may appear, to which the patient does not pay attention:

• rare pains in the lumbar region of a dull, pulling nature - they intensify after exercise, consumption of salty, spicy, alcohol;
• minor dysuric phenomena - oliguria, frequent urge, discomfort when urinating;
• body temperature rises to subfebrile levels (37.0-37.4), but the general condition of the patient is not impaired;
• frequent headaches and swelling of the face and limbs in the morning, especially after eating pickles, large amounts of liquid, or alcohol.

If the disease is not diagnosed for a long time and is not treated in any way, then the symptoms progress.

The patient develops the following symptoms:

• itching and flaking of the skin (the skin becomes yellowish or earthy);
• secondary arterial hypertension appears;
• frequent nosebleeds occur.

You can learn more about how pyelonephritis manifests itself in chronic form in the video in this article - the information is for informational purposes only and cannot replace consultation with a urologist.

Why does chronic pyelonephritis develop: the main reasons

The causes of chronic pyelonephritis are directly related to kidney damage by pathogenic microorganisms. In order for the infection to enter directly into the kidney structure and inflammation to develop, favorable conditions are required.

Most often, the development of acute and then chronic pyelonephritis is promoted by Escherichia coli, Pseudomonas aeruginosa, Amoeba Proteus, streptococci and staphylococci. The development of a chronic pathological process in the kidneys is facilitated by microorganisms that are resistant to antibiotics and other drugs, and this happens in situations where the patient self-medicates or voluntarily stops the course of therapy prescribed by the doctor, believing that he has already recovered.

Chronic pyelonephritis is always preceded by an acute inflammatory process, and predisposing factors to the transition of the disease to chronicity are:

1. Diseases of the urinary system, which are accompanied by impaired outflow of urine. Such pathologies include kidney prolapse, prostate adenoma in men, urolithiasis, narrowing of the bladder sphincter, and oncological formations in the ureters and bladder.
2. Untreated acute inflammatory process in the kidneys or self-medication. It is strictly forbidden to arbitrarily begin a course of therapy or stop taking antibiotics prescribed by a doctor. Persons who have suffered acute pyelonephritis should be under the supervision of a urologist for 3 months, since this is a critical period when the disease can silently become chronic.
3. Immunodeficiency states - weakened individuals with weak immunity are more susceptible to chronic inflammatory processes than people with a good immune response.
4. Chronic pyelonephritis often develops as a complication of previous tonsillitis, ARVI, influenza, measles pneumonia, scarlet fever.
5. The presence of chronic inflammatory processes in the body - tonsillitis, sinusitis, sinusitis, gastritis and colitis. Carious neglected teeth can also be a source of the spread of bacterial flora, causing inflammatory processes in the kidneys.
6. In women, a predisposing factor to the development of acute and then chronic pyelonephritis is pregnancy. In the later stages, as the fetus grows, all internal organs, including the bladder, are compressed in the uterus. Stagnation of urine and disruption of its outflow contributes to the proliferation of bacteria in the bladder, and with weakened immunity in the expectant mother, the risk of infection spreading to the kidneys increases.
7. Anomalies of the development of the urinary system organs - hydronephrosis of the kidney, bladder diverticula, narrowing of the lumen of the ureters. All these conditions prevent the full outflow of urine and create the preconditions for the active proliferation of microbes.
8. Severe hypothermia of the body, especially the lumbar region.

How does chronic pyelonephritis manifest: stages of the disease

Chronic inflammatory process of the kidneys develops in stages, each of which has its own clinical symptoms:

Possible complications

Is it possible to cure chronic pyelonephritis without complications? In the absence of timely diagnosis and therapy, this is almost impossible. A common consequence of long-term untreated chronic inflammatory process in the kidneys is pyonephrosis.

What is pyonephrosis? This is a purulent kidney lesion, which is more typical for patients over 40 years of age; in children, such a complication practically does not occur.

Other common complications of untreated chronic pyelonephritis are:

• acute renal failure– a reversible condition characterized by a sudden disruption of the kidneys or complete shutdown of the functions of the organ;
• chronic renal failure– a condition caused by the death of kidney cells and the complete cessation of organ function (such patients are tied to renal dialysis and can only live thanks to this procedure or a donor kidney transplant);
• urosepsis– a complication that often ends in death and is characterized by the spread of infection from the affected kidneys through the bloodstream throughout the body;
• purulent inflammation of the perinephric tissue.

Methods for diagnosing the disease

In order to make an accurate diagnosis to the patient and differentiate chronic pyelonephritis from other urinary tract diseases, it is necessary to conduct a comprehensive examination. It includes laboratory and instrumental diagnostic methods.

Laboratory examination of the patient

A patient with suspected chronic inflammatory process of the kidneys is prescribed:

• general blood test - chronic pyelonephritis, which has not yet been treated, is characterized by anemia, increased ESR, a shift in the leukocyte formula to the left, pronounced leukocytosis;
• general urine analysis - if treatment for chronic pyelonephritis has not yet been carried out, then the urine analysis reveals an alkaline environment, low density and turbidity, which is due to the high content of bacteria and leukocytes in the material;
• – pronounced leukocytosis, active leukocytes;
• urine sample according to Zimnitsky - this study reveals a decrease in the density of urine in various daily portions;
• biochemical blood test - reveals an increase in urea, sialic acids and seromucoid.

Instrumental diagnostic methods

The presented diagnostic methods are chosen by the attending physician and allow you to clarify the diagnosis and severity of the pathological process:

• chromocyotoscopy - a study that allows you to determine a unilateral or bilateral inflammatory process;
• Ultrasound of the kidneys - using ultrasound, the doctor assesses the size of the kidneys, the wrinkling of the organ, the presence of gross structural changes;
• retrograde pyelography is a study that allows you to diagnose existing deformations of the renal pelvis and calyces;
• CT and MRI.

If modified areas of the kidney are detected, in some cases the patient is prescribed a biopsy to clarify the diagnosis. A tissue sample is taken from the suspicious area and sent for further detailed examination in a histological laboratory. This method is highly informative for detecting kidney cancer at an early stage.

Important! When examining a patient, one should differentiate chronic pyelonephritis from renal amyloidosis, hypertension, and diabetes mellitus, since the listed pathologies may have similar clinical symptoms.

Treatment of chronic pyelonephritis

Treatment for chronic pyelonephritis is comprehensive and includes:

• regime and strict diet;
• antibacterial therapy;
• implementation of measures aimed at normalizing the outflow of urine.

How to cure chronic pyelonephritis? First of all, you need to be prepared for the fact that the therapy will be long-term, and during periods of exacerbations the patient must be hospitalized in a hospital.

Regime and diet

During the period of exacerbation of the disease, the patient must observe strict bed rest - failure to comply with this condition increases the risk of complications and renal failure. Dietary nutrition and drinking regimen are integral aspects of effective treatment.

Important! The main mistake of patients with chronic pyelonephritis is a sharp restriction of water in the diet, and yet it is not water that needs to be limited, but the amount of salt, since it is salt that provokes swelling and disrupts the flow of urine.

Ordinary clean water is suitable for drinking, including slightly alkaline mineral water without gas, jelly, fruit drinks, compotes, juices, rosehip decoction. During an exacerbation of the disease, the patient can drink up to 2 liters of liquid, not counting first courses. Reducing water in the diet is advisable only with a pronounced increase in blood pressure and complications from the cardiovascular system.

To prevent edema and fluid retention in the body, you should reduce the amount of table salt, and sometimes completely eliminate it for a certain period. The patient is prescribed diet No. 7 with the exception of spicy foods, pork, animal fats, herbs, spices, vinegar, smoked meats and preserves.

Proteins are limited, as they increase the load on the kidneys. The diet is dominated by dishes of plant origin, stewed vegetables, fresh fruits, vegetable soups, porridges (buckwheat, oatmeal, rice).

Drug treatment

If symptoms characteristic of chronic pyelonephritis are diagnosed, treatment cannot be done without antibiotics, which, unfortunately, are not always effective, especially if the pathological process is identified at an advanced complicated stage. The urologist decides how to treat each individual patient, depending on the severity of the disease.

To treat chronic inflammatory process in the kidneys, the following groups of antibiotics are used:

1. Penicillins with clavulanic acid– Amoxicillin, Amoxiclav, Flemoxin solutab. A distinctive feature of these drugs from conventional penicillins is their ability to dissolve the protective capsule of penicillin-resistant pathogens. These drugs may be prescribed in the form of injections or tablets, depending on the severity of the disease.
2. Cephalosporins– Ceftriaxone, Loraxone, Cefixime, Ceporin. Drugs in this group can sometimes be combined with aminopenicillin antibiotics in severe cases of the inflammatory process.
3. Aminoglycosides– Gentamicin, Amikacin. Prescribed by injection in combination with cephalosporins or penicillins for complicated pyelonephritis.
4. Drugs of the nitrofuran series– Furadonin, Furazolidone. They are uroseptics and enhance the effect of antibiotics.
5. Sulfonamides- Biseptol. These drugs are combined with antibiotics; they have a bacteriostatic effect, that is, they slow down the growth and reproduction of pathogenic microorganisms.

To maintain the patient’s immune system, injections of Ascorbic acid and vitamins A and E, which are powerful antioxidants and fight free radicals, are prescribed.

Important! For chronic pyelonephritis, a course of antibiotic therapy is prescribed for up to 21 days - in the first 7 days the medications are administered by injection, and if the test results improve, the patient is transferred to tablets.

The success of drug therapy can be judged by the following signs:

• the outflow of urine improves and dysuric phenomena disappear;
• urine and blood tests are normalized;
• body temperature is within normal limits;
• swelling disappears and blood pressure normalizes.

Ancillary drugs

• to prevent allergic reactions to numerous medications, the patient must be prescribed antihistamines - Suprastin, Loratadine, Diazolin;
• for the treatment of anemia, which is a frequent accompaniment of chronic kidney damage, iron supplements and vitamins B12 are prescribed in the form of injections;
• To normalize blood pressure, drugs from the group of antihypertensive drugs are prescribed - Clonidine, Reserpine, Co-prenessa.

During the period of remission, the patient is prescribed sanatorium-resort treatment.

Disease prevention

Below are instructions for actions aimed at preventing the transition of acute pyelonephritis to the chronic form of the course:

• after acute pyelonephritis, you should be registered with a urologist for at least 3 months, and in case of a complicated course - 1 year;
• after an infection, avoid physical overload and hard work for six months;
• do not overcool;
• in the first six months after pyelonephritis, be sure to follow diet No. 7, give up alcohol, coffee and spices;
• Every 4 weeks during the first year after pyelonephritis, urine and blood tests should be taken - if all indicators are within normal limits, then the patient can be removed from the dispensary register.

Important! If within a year after pyelonephritis there has been a relapse of the disease at least once, then the dispensary registration is extended for 3 years with regular monitoring of tests and the patient’s condition.

To strengthen the body’s immune forces, you should sanitize all foci of chronic infection, including carious teeth, eat well, rest more, and engage in moderate physical activity.

Leaking chronic pyelonephritis with alternating phases of active and latent inflammation and remission. Chronic pyelonephritis does not have such pronounced manifestations as acute pyelonephritis, and therefore it is much more dangerous.

Usually the disease occurs as a result of incompletely cured acute pyelonephritis. There may be cases when chronic pyelonephritis is almost asymptomatic. It can drag on for months and even years, gradually destroying the kidneys and rendering them inoperable. The patient has no symptoms of the disease, well, sometimes his lower back ache a little, and he often has a headache for a long time. People attribute all this to the weather or physical activity. Fluctuations in blood pressure do not alarm them either. Many people simply try to knock it down on their own, without consulting a doctor.

There are the following forms of chronic pyelonephritis.

By occurrence:

Primary - not associated with any

urological disease,

Secondary - developing due to damage to the urinary tract.

According to the localization of the inflammatory process:

Unilateral,

Bilateral,

Total - affecting the entire kidney,

Segmental - affecting part of the kidney.

According to the clinical picture:

Latent,

Recurrent,

Hypertensive,

Anemic,

Azotemic,

Hematuric.

In latent form Chronic pyelonephritis is characterized by an unclear clinical picture - general weakness, headache, and fatigue quickly. High temperatures are rare. Impaired urination, pain in the lumbar region and swelling are usually absent, but Pasternatsky's symptom sometimes appears. There is a small amount of protein in the urine, and the number of leukocytes and bacteria changes. In addition, the latent form is usually accompanied by impaired renal function, primarily their ability to concentrate, which manifests itself in increased urine formation and hyposthenuria - the release of urine with low specific gravity.

Patients with a latent form of chronic pyelonephritis can remain able to work for a long time. Permission to work is limited only to high arterial hypertension and is completely excluded in case of its malignant course, as well as in cases of impaired nitrogen excretory function of the kidneys.

In the recurrent form of chronic pyelonephritis, alternating periods of exacerbations and remissions are characteristic. Patients experience constant discomfort in the lumbar region, the process of urination is disrupted, and after a chill, the temperature may suddenly rise, and signs of acute pyelonephritis appear.

As the recurrent form intensifies, the symptoms of certain diseases begin to predominate.

In some cases, hypertensive syndrome may develop with its characteristic symptoms - headaches, dizziness, disorders, pain in the heart, etc.

In other cases, anemic syndrome becomes predominant - general weakness, fatigue, shortness of breath. Subsequently, chronic renal failure develops.

With an exacerbation of the disease, pronounced changes in the composition of urine occur - proteinuria, leukocyturia, cylindruria, bacteriuria and hematuria are possible. As a rule, the patient's blood ESR increases and the number of neutrophils increases (neutrophilic leukocytosis).

Hypertensive form of chronic pyelonephritis characterized primarily by the presence of hypertension. Patients suffer from dizziness, headaches, pain in the heart, and shortness of breath. They develop insomnia and hypertensive crises. Often hypertension is malignant. There are usually no disturbances in urination.

Anemic form of chronic pyelonephritis is characterized by the fact that among the signs of the disease, symptoms of anemia predominate - a decrease in the number of full-fledged red blood cells. This form of the disease in patients with chronic pyelonephritis is more common, more pronounced than in other kidney diseases, and is usually hypochromic in nature. Disturbances in urination are mild.

To the azotemic form of chronic pyelonephritis These include those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of an already existing, but not timely identified latent course of the disease. It is the azotemic form that is characteristic of chronic renal failure.

Hematuric form of chronic pyelonephritis known for repeated attacks of macrohematuria and persistent microhematuria, which is associated with venous hypertension, which contributes to the disruption of the integrity of the vessels of the fornical zone of the kidney and the development of fornical bleeding.

Chronic pyelonephritis usually develops over 10–15 years or more and ends with shrinkage of the kidneys. Wrinkling occurs unevenly with the formation of rough scars on the surface. If only one of the kidneys shrinks, then, as a rule, compensatory hypertrophy and hyperfunction of the second kidney is observed. That is, within a few weeks the mass of the remaining kidney increases, and it takes over the functions of the diseased kidney. At the final stage of chronic pyelonephritis, when both organs are affected, chronic renal failure develops.

DIAGNOSIS OF CHRONIC PYELONEPHRITIS

Chronic pyelonephritis is recognized based on:

Anamnesis data (medical history),

Available symptoms

Results of leukocyturia - examination of urinary sediment using the Kakovsky-Addis method,

Quantitative detection of active leukocytes in urine, called Stenheimer-Malbin cells,

Bacteriological urine analysis,

Kidney biopsies.

It is often not possible to identify chronic pyelonephritis and accurately determine the form of its course in a timely manner, especially in a clinic setting due to the variety of clinical manifestations of the disease and the relatively frequent latent course.

Also, if chronic pyelonephritis is suspected, a general blood test is performed to determine residual nitrogen, urea and creatinine in it, the electrolyte composition of blood and urine is determined, and the functional state of the kidneys is examined.

Using the X-ray method, changes in the size of the kidneys, deformation of their pelvis and calyces, and disturbances in the tone of the upper urinary tract are determined, and radioisotope renography allows one to obtain a graphic image and evaluate the functional state of each organ separately.

An additional research method for diagnosing chronic pyelonephritis is intravenous and retrograde pyelography and scenography, echographic examination of the kidneys, and chromocystoscopy.

It is necessary to distinguish chronic pyelonephritis from chronic glomerulonephritis, amyloidosis, hypertension, diabetic glomerulosclerosis.

Unlike chronic pyelonephritis, chronic glomerulonephritis is characterized by an increased concentration of red blood cells in the urinary sediment, the absence of active leukocytes and the presence of microbes in the urine. Amyloidosis can be recognized by the presence of foci of chronic infection, paucity of urinary sediment (there are only single leukocytes, red blood cells and casts, no sugar at all), as well as by the absence of bacteriuria and radiological signs of pyelonephritis.

Hypertonic disease It is more often observed in older people, occurs with hypertensive crises and more pronounced sclerotic changes in the coronary, cerebral vessels and aorta. In patients with hypertension, there is no leukocyturia, bacteriuria, or pronounced decrease in the relative density of urine characteristic of chronic pyelonephritis, and X-ray and radioindication studies do not reveal changes inherent in chronic pyelonephritis. With diabetic glomerulosclerosis, the patient has signs and other symptoms of diabetic angiopathy - generalized damage to blood vessels.

TREATMENT OF CHRONIC PYELONEPHRITIS

Treatment of chronic pyelonephritis is at least four months. If the disease proceeds without complications, therapy can be reduced on the recommendation of a doctor.

Every month the patient undergoes a urine test and an antibiogram. If the white blood cell count is still higher than normal, the drug should be replaced. Sometimes it happens that a month after the start of treatment, the tests are normal. But this does not mean that the disease has passed and the kidneys are out of danger. Under no circumstances should you give up treatment.

Antibacterial therapy is currently the main method of treating chronic pyelonephritis. Taking antibiotics begins only after the causative agent of the infection has been identified and its sensitivity to drugs has been determined. Antibiotics that suppress gram-negative flora are usually indicated. The doctor should prescribe only those drugs that do not have a toxic effect on the kidneys. Treatment is carried out with regular laboratory monitoring of the sensitivity of microflora to the antibiotic.

Modern fluoroquinolone antibiotics have a good therapeutic effect with a low probability of relapses and adverse reactions: ciprofloxacin, norfloxacin, levofloxacinpefloxacin; cephalosnorins: cephalexin, cefuroxime, cefenim, semisynthetic penicillins with beta-lacgamase inhibitors Augmentin, Unasin.

Taking nonsteroidal anti-inflammatory drugs that prevent the formation of blood clots in blood vessels is also suggested in the complex treatment of chronic pyelonephritis. This could be aspirin, movalis, voltaren, ibuprofen and others. To improve microcirculation in the kidneys, patients take chimes, tren-tal or venoruton, and to activate renal circulation - urolisan, cystenal, olimetsn, uroflux.

The doctor may prescribe immunocorrective drugs for severe disease and complications, especially in older people. If a chronic urinary tract infection is detected, peptide bioregulators are prescribed.

To prevent taking antibiotics, especially powerful ones (the so-called fourth line), from leading to intestinal dysbiosis, you must follow a fermented milk diet throughout the entire course of treatment. But if dysbiosis does appear, then to restore the intestinal microflora, about a week before the end of the main therapy, it is necessary to start taking bifidumbacterin. In difficult cases, the doctor may prescribe antifungal drugs.

Prevention of the development of chronic pyelonephritis and its complications is possible only with constant monitoring of the patient by a urologist. Control tests and studies should be done at least three times a year. During this period, the patient should not have heavy physical exertion, hypothermia, or high humidity at work; such people should not work the night shift. Patients are removed from the register if they do not show signs of exacerbation of chronic pyelonephritis within two years.

Chronic pyelonephritis is considered one of the most common diseases among girls and women. Symptoms and treatment depend on the degree of neglect of the pathology. This article discusses its main causes, signs and stages of development.

Description of the disease

It is an inflammatory infectious process that forms in the kidney tissues. This disease develops due to the active activity of various types of bacteria. It is predominantly common among the fair sex. This is explained by the morpho-functional characteristics of the urethra. Thanks to its special structure, the penetration of microorganisms into internal organs is greatly facilitated. Pathology can develop during certain periods of the female cycle (defloration, pregnancy, menopause).

What is the difference between chronic pyelonephritis? The stage of remission and subsequent exacerbation - these two stages usually alternate with each other. Therefore, various polymorphic changes (foci of inflammation, scar zones, areas of unchanged parenchyma) can be simultaneously detected in the kidneys. The involvement of more and more areas of healthy organ tissue in this pathological process causes its gradual death and the formation of renal failure.

The disease itself does not cause serious discomfort to a person, but it can cause the development of very serious complications. First of all, the inflammatory process does not allow the kidneys to fully perform their main function. As a result, the patient’s usual water-salt metabolism is disrupted and edema appears. In addition, against the background of inflammation, other urological pathologies may occur. The most dangerous consequence is the addition of a purulent infection, which is very difficult to fight.

Main reasons

The etiological factor causing this disease is microbial flora. As a rule, these are the so-called colibacillary bacteria (Escherichia coli), enterococci, staphylococci. A special role in the development of the inflammatory process belongs to L-forms of bacteria, which are formed as a result of ineffective antimicrobial therapy or changes in the pH of the environment. Such microorganisms are difficult to identify, activate under certain conditions, and are resistant to treatment.

Very often, chronic pyelonephritis is preceded by a stage of exacerbation of the pathology. Chronic inflammation is promoted by failure to promptly correct urine outflow disturbances due to stones in prostate adenomas. Such a pathological process in the body can be supported by other diseases of a bacterial nature (otitis media, prostatitis, urethritis, cholecystitis, appendicitis, etc.), general somatic ailments (diabetes mellitus, obesity), as well as immunodeficiency.

In young women, the impetus for the development of this disease can be the onset of sexual activity, childbirth and pregnancy. Quite often, doctors diagnose and among young patients chronic can be caused by disturbances in the functioning of the body at the congenital level, which change the usual urodynamics (ureterocele, bladder diverticula).

Clinical signs

Symptoms of the disease are nonspecific, and lately asymptomatic disease has become increasingly common. A patient who has previously dealt with acute pyelonephritis or other urological pathologies must be responsible for their own health and listen to the body. Often the occurrence of the disease is a consequence of a violation of the body’s immune response, which accompanies diabetes mellitus and tuberculosis. A weakening of the defenses is also observed due to insufficient intake of vitamins and minerals. Despite the specificity of clinical manifestations, a number of signs of this disease can be identified that require special attention:

• Increase in temperature in the evening for no apparent reason.
• Headache.
• Increased fatigue, weakness.
• Frequent urge to urinate.
• Painful discomfort in the lumbar region, which manifests itself when walking.
• Changes in the color and smell of urine, cloudiness.

All of the above signs indicate chronic pyelonephritis. The symptoms and treatment of the disease are general in nature, this has already been discussed in the article. Patients often perceive such clinical manifestations as a common cold and begin treatment with appropriate medications. Such therapy can really relieve symptoms and improve the patient’s condition at first. And the inflammatory process will continue to develop. That is why in this case it is recommended to seek advice from a specialist rather than try to overcome the disease on your own.

It is easy to confuse the symptoms of exacerbation of pyelonephritis with ARVI, because they are inherent in many inflammatory processes in the body. As a rule, if a person has already been diagnosed with a chronic form, he understands the signs associated with the disease. In this case, the patient may experience the following conditions:

• Dysuria.
• Head and
• Febrile temperature.
• Cloudiness of urine (proteinuria) and the appearance of an uncharacteristic odor.
• Hematuria.

Classification

How is chronic pyelonephritis classified? The stages of the disease are distinguished depending on the manifestation of the inflammatory process. At the first stage, active inflammation with pronounced symptoms is observed. The second stage is characterized by a pathological process. It can only be detected after a series of laboratory tests. The patient's condition is accompanied by the following symptoms: fatigue, chills, and a slight increase in temperature. The third stage of development is chronic pyelonephritis in remission. What does it mean? If over the next five years there is no exacerbation of the disease, the doctor confirms a complete cure.

In addition, pyelonephritis can be unilateral or bilateral, depending on the number of affected organs.

Based on the severity of the disease, the following forms are distinguished:

1. Pyelonephritis without complications.
2. Pyelonephritis complicated by tumors, congenital anomalies, urolithiasis, diabetes mellitus, HIV infection.
3. Anemia.
4. Secondary reno-parenchymal arterial hypertension.

Pyelonephritis and pregnancy

Many pregnant women who have had to deal with this disease worry about how it can affect the baby’s health. All those who let this pathology take its course and do not seek qualified help may face very serious problems. Why is chronic pyelonephritis dangerous during pregnancy?

The consequences of the disease primarily affect the fetus. The child may suffer seriously from an intrauterine infection that develops. As a rule, such kidney pathology causes spontaneous abortion or premature birth. The consequences of infection for children manifest themselves in different ways. Some are diagnosed with the most common conjunctivitis, which does not pose a threat to life, while others are diagnosed with severe infectious lesions of the internal organ systems.

During pregnancy with this disease there is also a risk of intrauterine hypoxia. This means that the fetus receives less oxygen than it actually needs. As a result, a child is born with low weight and insufficient development. Based on all of the above, we can come to the conclusion that chronic pyelonephritis should not be left to chance.

Symptoms and treatment of the disease should be determined exclusively by a specialist. If an inflammatory process is detected, the doctor prescribes antibiotics to the expectant mother. Of course, it is undesirable to take such medications while carrying a baby. However, a specialist can select remedies that will not cause serious harm to the fetus and will help the mother cope with the disease. Also in this kind of situation, painkillers, antispasmodics, vitamins, sedatives are prescribed, and physiotherapeutic procedures are performed.

Establishing diagnosis

Quite often it is difficult to confirm chronic pyelonephritis. Symptoms in women can vary; moreover, cases of latent disease are not uncommon. The diagnosis is usually made taking into account the medical history, laboratory results, and the presence of a characteristic clinical picture. Additionally, the following diagnostic methods may be required:

• General urine/blood test.
• Quantitative determination of cells (Stenheimer-Malbin method).
• Examination of urinary sediment.
• Determination of electrolyte content in urine and blood.
• X-ray of the kidneys.
• Radioisotope renography.
• Kidney biopsy.

Chronic and treatment

Drug therapy for the disease should be aimed at eliminating its main causative agent. For this purpose, antibiotics and uroseptics are prescribed. It is considered optimal to conduct a urine culture to determine sensitivity to antibiotics before starting therapy. In this case, the choice of drugs will be more accurate. As a rule, the following drugs are used for treatment:

• Penicillins with a broad spectrum of action (Amoxicillin, Azlocillin).
• Second and third generation cephalosporins.
• Fluoroquinolones (“Levofloxacin”, “Ofloxacin”, “Ciprofloxacin”). Drugs in this group are prohibited for use by pregnant and lactating women.
• Nitrofurans (“Furadonin”, “Furamag”). Sometimes patients experience side effects such as nausea, a bitter taste in the mouth, and vomiting.
• Sulfonamide drugs (“Biseptol”).

The duration of therapy is at least 14 days. If symptoms of the disease persist, the course of treatment may increase to one month. It is advisable to periodically repeat urine cultures and change medications.

Chronic pyelonephritis: diet

Regardless of the stage of the disease, patients are advised to follow a special diet. It implies the exclusion from the diet of spicy foods and spices, alcoholic beverages, coffee, meat and fish broths. On the other hand, nutrition should be as fortified and balanced as possible. It is allowed to consume almost all fruits and vegetables (preferably raw), eggs, boiled meat/fish (low-fat varieties), and dairy products.

It is very important to pay attention to your drinking regime. It is recommended to drink at least two liters of still water per day to prevent excessive concentration of urine. It is useful to drink the most common cranberry juice, because these berries contain natural antibacterial substances that help fight pathologies such as chronic pyelonephritis.

The diet during the period of exacerbation of the disease is somewhat different. At this time, it is recommended to reduce fluid intake, as the outflow of urine slows down significantly. It is equally important to limit the consumption of table salt (up to 4 g per day).

Help from traditional medicine

Herbal medicine can be used as an additional treatment to the main one. You should not try to overcome chronic pyelonephritis on your own with the help of traditional medicine. Treatment with antibiotics is usually more effective and safer for human health.

Medicinal plants used for this disease most often have a diuretic effect. The course of treatment can range from several months to one and a half years. This duration helps prevent the development of complications and re-entry of infections.

Treatment with herbs involves taking them orally and using baths. For example, taking a bath with parsley has not only an anti-inflammatory, but also a cleansing effect. It increases blood flow and helps eliminate existing toxins. Chamomile has an antibacterial and at the same time calming effect on all internal organ systems. St. John's wort is an excellent assistant in the fight against various types of infections.

Sometimes in patients the disease is accompanied by the formation of polyps (small growths). In this case, it is recommended to take celandine, but do not abuse it. For a glass of boiling water you only need one teaspoon of herb. It is recommended to drink this infusion in small sips throughout the day. Celandine has an anti-inflammatory effect and is an excellent remedy in the fight against many cancer diseases.

Some experts advise drinking tea with blueberry and lingonberry leaves before bed. Blueberries are rich in vitamins and minerals, and lingonberries are an excellent natural antiseptic. This tea helps strengthen the immune system, increase the level of hemoglobin in the blood and reduce pain discomfort in the lumbar area.

Once again, it should be noted that you should not try to overcome chronic pyelonephritis on your own. Symptoms and herbal treatment are two mutually dependent factors that the doctor must pay attention to. Each patient has clinical manifestations of the disease, the degree of their severity may vary. Moreover, not in every case does herbal medicine have a positive effect; sometimes it significantly aggravates the health condition.

Prevention

How can chronic pyelonephritis be prevented? How long do people with this diagnosis live?

Prevention of the disease primarily implies timely treatment of all diseases of a urological nature. Here we are talking, first of all, about competent drug therapy. Many patients resort to traditional medicine or prefer to be treated on the advice of friends and relatives. This approach is highly undesirable. The whole point is that in this way you can harm your own health, and the disease itself will progress.

It is equally important to maintain the correct amount (about two liters of fluid per day). If possible, hypothermia and taking non-steroidal analgesics should be avoided. It is not recommended to endure a small need; it is necessary to empty the bladder every time before going to bed and after the next sexual intercourse.

This article provides information about the dangers of chronic pyelonephritis during pregnancy. Symptoms in women of this disease during the period of carrying a fetus inside the womb should alert and become a reason to consult a doctor. Only a specialist can recommend truly effective and safe treatment. In order not to encounter this pathology during pregnancy, it is recommended to check your body before planning it. If you have any ailments, you must undergo a course of treatment. A very important role in the prevention of pyelonephritis at this time belongs to compliance. Of course, you should lead an active and healthy lifestyle.

As for the question of life expectancy with this disease, there is no clear answer. If the patient strictly follows all the doctor’s recommendations, eats right and monitors his condition, he can live a long and happy life. If the disease is aggravated by constant alcohol intoxication and lack of proper therapy, then the likelihood of death increases several times.

Conclusion

It is important to remember that only a qualified specialist can recommend how to cure chronic pyelonephritis. Symptoms, diagnosis, causes of the disease - all these factors are an important component of timely therapy. Be healthy!

Chronic pyelonephritis is an infectious and inflammatory disease that affects the calyces, pelvis and tubules of the kidneys. It is a consequence of the acute form of the disease. Treatment of chronic pyelonephritis is aimed at eliminating the cause of the disease and symptomatic relief of the patient's condition.

The therapy provides several directions of treatment, which will ultimately lead to remission and the absence of an immediate relapse. This is the destruction of infectious agents, normalization of urinary excretion, increasing the patient’s immunity, and eliminating chronic foci of infections.

During treatment, natural defense mechanisms are also important, which make themselves felt from the first stages of the disease.

• Increased diuresis. This is a mechanical rinsing of the urinary tract, which helps remove pathogenic bacteria. In this regard, drinking plenty of fluids is recommended.
• Urine acidity levels increase. This is a natural protection against the spread and development of bacteria, since in an acidic environment their growth and reproduction is inhibited.

If these mechanisms fail, the infection intensifies. Treatment is aimed at maintaining such processes, and not at disrupting them.

Today, it is quite difficult to cure chronic pyelonephritis completely, because it is impossible to completely suppress the infection in the kidney.

Approach to therapy

In order for the treatment of chronic pyelonephritis to be successful, experts advise that the patient’s regimen be correctly drawn up. It depends on the degree of the disease, the phase that is currently taking place, symptoms, and the degree of intoxication. In some cases, hospitalization is necessary:

• Uncorrectable hypertension.
• Diuresis disturbance.
• The need for functional diagnostics of the urinary organs.
• Obvious acute form of the disease.

At any stage of the development of the disease, strong physical activity and hypothermia are excluded. If the patient’s condition is assessed as stable and there are no sharp jumps in blood pressure, the kidneys are functioning normally, then no restrictions are imposed.

In severe phases of exacerbation, bed rest is recommended. With an uncontrolled increase in blood pressure, the patient’s physical activity is limited. By the time the exacerbation subsides, the symptoms of intoxication disappear, the pressure normalizes, and the regimen is relaxed.

The patient's diet plays an important role. Its volume and content depend on the presence or absence of blood pressure surges. For patients without swelling and severe hypertension, choose a diet that differs little from everyday life. It includes products containing fiber, vitamin complexes, such as combinations of B vitamins, potassium, vitamin C. The presence of dairy and meat products, fruits is mandatory. The restriction only applies to seasonings and spicy foods.

The anti-inflammatory effect is ensured by increased diuresis. It is recommended to drink up to 3 liters of liquid per day, which includes juices, fruit drinks, decoctions, and mineral water. Preference is given to juices that have an antiseptic effect. Restrictions are imposed only when urinary functions are impaired or sharp increases in blood pressure are observed. The consumption of juices in the acute phase of chronic pyelonephritis is severely limited. Natural diuretics are also recommended.

Treatment

Before treating chronic pyelonephritis, it is important to understand what the therapy for this disease is.

Therapy for chronic pyelonephritis is a set of measures aimed at normalizing the speed of urine passage through the urethra, antibacterial treatment and normalizing blood circulation in the kidney.

If diuresis is difficult, surgical intervention may be indicated to normalize urine passage. This could be removal, surgery on the prostate gland, etc. If the causes of such a disorder are not eliminated, then it will not be possible to cure the exacerbation and achieve stable and long-term remission.

Antibacterial drugs for chronic pyelonephritis are the most important stage at all stages and variants of the disease. When choosing a medicine, all previous therapies, the type of bacterium and its sensitivity to antibiotics are taken into account. The effectiveness of drugs in acidic urine also plays an important role.

Antimicrobial drugs to which pathogens of chronic pyelonephritis are sensitive are called uroantiseptics.

Therapy is carried out from the initial acute stage and is guided by the following rules:

1. Bacterial microflora is sensitive to the drug of choice.
2. Dosing is carried out taking into account the functional state of the kidneys.
3. Nephrotoxicity is taken into account.
4. If there is no effect within several days, then the medication is replaced.
5. If the infection process and symptoms of intoxication are severe, combination therapy with uroantiseptic agents is prescribed.

Antibiotics for chronic pyelonephritis

For pyelonephritis, the following groups of drugs are used:

Penicillins

• Benzylpenicillin.
• Oxacillin.
• Ampicillin.
• Amoxicillin.
• Amoxicillin + clavulanic acid.

Broad-spectrum antibiotics, excellent for unknown etiology of the disease. These drugs are effective against gram-negative bacteria and most gram-positive pathogens. But staphylococcus, which produces penicillinase (an enzyme), neutralizes their effect. To eliminate such counteraction, combinations of penicillins with beta-lactamase inhibitors are used. For example, Augmentin.

Cephalosporins

• Cefuroxime.
• Cefotaxime.
• Ceftazidime.
• Ceftriaxone.
• Cefazolin.

Broad-spectrum antibiotics that are very effective. Unfortunately, when affected by enterococci, such drugs have almost no therapeutic effect.

Aminoglycosides

• Gentamicin.
• Amikacin.

Strong bactericidal drugs with a wide spectrum of action. When prescribing, their nephrotoxicity is taken into account.

Lincosamines

• Lincomycin.
• Clindamycin.

Strong bacteriostatic antibiotics that are effective against streptococci, staphylococci, but do not treat gram-negative bacteria and enterococci.

Gram-negative strains, Pseudomonas aeruginosa, and chlamydia are not sensitive to them, therefore, they are prescribed less frequently than antibiotics

Quinolone derivatives

There are 2 generations.

1st generation:

• Nalidixic acid.
• Oxolinic acid.
• Pipemidic acid.

2nd generation:

• Ciprofloxacin.
• Norfloxacin.
• Ofloxacin.
• Pefloxacin.

Nalidixic acid is ineffective against gram-positive microorganisms, Pseudomonas aeruginosa. Pipemidic acid is suitable for the treatment of Staphylococcus aureus. Renal failure and impaired renal function are complete contraindications to the use of this group.

Fluoroquinolone antibiotics are effective against various types of bacteria, but have little effect against enterococci and chlamydia. Ciprofloxacin often becomes the drug of choice, as it is superior to many other antibacterial drugs in the strength of its antimicrobial action.

Nitrofurans

This is a group of broad-spectrum agents. These drugs fight gram-positive and gram-negative infections, but are not effective against anaerobic strains.

Furadonin is concentrated in the urine in high quantities; in the blood the levels are much lower. It copes well with the chronic form of the disease, but in acute cases it is ineffective.

Furagin is concentrated in urine in smaller quantities than furadonin.

This group of drugs can be perfectly combined with antibiotics.

Selected drugs:

• Levomycetin

Bacteriostatic antimicrobial drug of choice for lesions of gram-positive, gram-negative, aerobes, anaerobes, chlamydia and mycoplasmas. Pseudomonas aeruginosa shows resistance to its action.

• Fosfomycin

A broad-spectrum medication that is excreted unchanged in the urine. This indicates its high effectiveness in treating this disease.

Nitroxoline has high concentrations in urine, which ensures strong therapeutic efficacy.

Urine pH influences the choice of drug for treatment. The acid reaction enhances the effectiveness of penicillins and tetracycline. The alkaline reaction enhances the properties of erythromycin, lincomycin, and aminoglycosides. There are also antibiotics independent of the reaction of the environment. For example, chloramphenicol.

Medicines are dosed taking into account the phase of pyelonephritis and are used in long courses, which eliminates the effect of the pathogen in the kidney and urinary tract. The course of therapy may be extended depending on the tests and the general condition of the patient.

Folk remedies

How to cure chronic pyelonephritis with folk remedies? Herbal medicine is effective for preventing relapses and maintaining a normal state during remission, as well as in combination with the main treatment during the exacerbation phase.

• To achieve an anti-inflammatory effect, they choose infusions that contain birch leaves, willow bark, and elderberry.
• Analgesic, decongestant, antiseptic effects are achieved by infusions containing raspberries, birch, fireweed, burdock, chamomile, elderberry, lingonberry and bearberry.
• To enhance diuresis, horsetail, nettle, ammonium dentifrice, and goldenrod are suitable.

Method of preparation: 2 tablespoons of raw material are boiled in a liter of water for 20 minutes. Drink a quarter glass up to 4 times.

Conclusion

The answer to the question whether chronic pyelonephritis can be cured is ambiguous. Unfortunately, at this stage of medical development, it seems very difficult to completely remove the infection from the body due to the presence of chronic foci. Chronic pyelonephritis is difficult to treat and choosing the right set of measures to stop the acute phase until complete remission is not so easy. It all depends on the attending physician, who analyzes each case with its characteristics individually.

With a properly formed course of treatment and subsequent procedures during the period of remission, the patient has every chance to forget about exacerbations and their painful symptoms forever.