Pyelonephritis - symptoms, causes, types and treatment of pyelonephritis. Basic methods of treatment. According to the patency of the urinary tract

The main goal of physical therapy is to help the patient using a variety of physical factors, such as magnetic waves, electric current, thermal and infrared radiation, laser exposure and ultrasound. Thanks to high security and low risk occurrence of side effects, these techniques are often used to treat chronic pathologies. Physiotherapy for pyelonephritis not only relieves symptoms of exacerbation, but can also be used for long-term treatment.

In such conditions, it allows you to reduce the risk and severity of subsequent exacerbations and increase the duration of remission. In addition, with long-term use of combined treatment regimens, including physiotherapeutic techniques and drug therapy, it is possible to stabilize the patient’s condition and slow down the progression of the pathology. This allows doctors to reduce the likelihood of complications.

How does pyelonephritis occur?

Pyelonephritis is a nonspecific inflammation that primarily affects the renal tubular system. Most often, it is caused by the entry of various bacteria into the renal pelvis. Moreover, the most common pathogens are Escherichia coli, Enterococcus, Staphylococcus, Pseudomonas aeruginosa and Proteus. They penetrate the kidney tissue from the blood (hematogenous route). In this case, pathological foci will be located mainly around intralobular vessels in the cortex.

Also in adults, a common cause of infection is urinary stasis due to urolithiasis or ureteral strictures. Often this form of pyelonephritis occurs in pregnant women, due to the fact that the enlarged uterus compresses the urinary tract. In this case, a fan-shaped and wedge-shaped arrangement of inflammatory infiltrates is observed, directed from the pelvis to the outer surface of the kidneys.

Therapeutic tactics for inflammatory processes in the kidneys

There are acute and chronic variants of the disease. The key difference is the duration and severity of the pathological process. If the disease appears for the first time, and there is no history of similar cases within the next three months, then we're talking about about an acute process. In this case, much attention is paid to antibiotic therapy and elimination of the pathogen. Also when acute processes Patients are advised to drink more fluids to avoid urinary stagnation.

In case of exacerbation or newly diagnosed acute pyelonephritis, antimicrobial and detoxification therapy is first prescribed, while physiotherapeutic techniques are used only after stabilization of the patient’s condition.

If necessary, surgical treatment is recommended to restore the flow of urine. During rehabilitation or outpatient treatment, such combined treatment methods are practiced, however, it is necessary to first consult with a physiotherapist.

Use of electric current for pyelonephritis

Under the influence of an electric current, the mobility of dispersed solution particles increases, which makes it possible to use electrophoresis for the oral administration of certain drugs. This allows doctors to achieve a number of effects:

• The current promotes the ionization of drug molecules, which significantly increases their chemical activity.
• Due to their high mobility, the molecules penetrate deeper, creating a kind of depot in the tissues, which prolongs the effect of the medication.
• There is no saturation of the lymph or blood with the active substance, due to which the work of other organs and systems is not affected and is reduced Negative influence drug on the body.
• The substance can be injected directly into the inflammatory focus, which can be blocked for drugs in the blood due to local microcirculatory disorders.
• Due to the fact that medications act bypassing the hepatic bloodstream, they are not destroyed, so smaller doses of drugs can be used.

Electric current also has its own healing effects. Under its influence, vascular tone is normalized, which improves blood supply to the pathological focus. This promotes better oxygen delivery and nutrients in the tissue, the rapid removal of accumulated metabolic products and remnants of dead cells.

In addition to electrophoresis, the galvanization method and stimulation with sinusoidal modulated currents are also used. They improve the function of the muscles of the ureter and pyelocaliceal structures. This normalizes the outflow of urine from the kidney and eliminates stasis, which is one of the risk factors for the introduction of bacteria through the ascending route.

Magnetic therapy has a similar effect - under the influence of a specially selected low-frequency magnetic field, the medicinal substance better penetrates through the skin into the deep tissues, where it exerts its effect. The magnetic waves themselves affect chemical reactions in the affected area, promoting the activation of immune mechanisms and enzymatic reactions, which contributes to the speedy completion of inflammatory processes.

In addition, both electric and magnetic forces influence nerve endings, helping to improve neuromuscular transmission in the affected area, and also cause reflex reactions aimed at normalizing innervation. Therefore, these physical procedures can effectively combat pain, relieve inflammation and normalize tissue metabolic processes.

Proper nutrition and lifestyle modifications

An important role in the treatment of any form of disease is played by the patient’s responsible approach to own health. For chronic pyelonephritis, patients are advised to switch to special mode nutrition, allowing to reduce the load on the kidneys, and at the same time rich in all the necessary elements to maintain immunity.

Patients should avoid eating fried, baked and spicy food. It is advisable to reduce the amount of bread and other flour products consumed, especially fresh ones. It is also necessary to exclude from food allergenic products, reduce the amount of protein consumed per day.

Regular salt consumption should be reduced to 0.5 grams per day, because it significantly increases the load on the kidneys. It is advisable to limit sweet foods and avoid carbonated sweet water. Sometimes it can be quite difficult for a child to accept such a need, however, doctors and parents need to explain to him the importance of such a step, because the patient’s health depends on it.

Conclusion

Physiotherapy plays an important role in helping patients with pyelonephritis, especially if it is a chronic process. Most physiotherapy procedures rarely cause side effects, and therefore they are often combined with medication and surgical treatment. They make it possible to stabilize the patient’s condition and slow down further progression of the disease, which lengthens periods of remission and reduces the likelihood and severity of exacerbations.

Medicinal electrophoresis is the effect on the body of a direct electric current in combination with the introduction of various medicinal substances through the skin or mucous membranes. In physiotherapy, electrophoresis is the most popular method, as it has many positive effects on the patient’s body:

The principle of the method is that drugs enter the body through the intercellular spaces, sebaceous and sweat glands in the form of positive or negative particles (ions). Medicinal dose with electrophoresis it is low: only 2-10% of the total volume of the drug contained on the pad.

Most of the drug is retained in the skin and subcutaneous fat, that is, it does not immediately enter the bloodstream, but a day or more after the procedure. This property determines the delayed (prolonged) effect of the physiotherapy procedure: improvement of metabolism and innervation, removal pain syndrome, swelling, etc.

During electrophoresis, active medicinal substances accumulate as much as possible in the pathological focus, since the pad with the medication is applied directly to the “sore spot”, and is several times higher than the dose administered by injection or orally. Therefore, the efficiency of drug electrophoresis is quite high. Bypassing the gastrointestinal tract, the drug practically does not cause side effects on the body.

Indications for electrophoresis in adults

Medicinal electrophoresis is widely used in the complex treatment of neurological, therapeutic, surgical, gynecological diseases, as well as in traumatology, pediatrics and dentistry. The physiotherapy procedure can be prescribed repeatedly, and electrophoresis does not have any specific time limits.

Diseases of ENT organs (ear, throat, nose)

Diseases genitourinary system women and men

Eye diseases

Postoperative rehabilitation

• postoperative wounds;
• postoperative scars.

Contraindications

Drug electrophoresis is quite universal and affordable way physiotherapy, but it has a number of contraindications. These include:

• tumors of any location and etiology;
• heart failure;
• presence of an artificial pacemaker (pacemaker);
• inflammatory process in the acute phase;
• increased body temperature;
• bronchial asthma (severe form);
• bleeding disorders (increased bleeding, tendency to bleed);
• skin pathologies (eczema, dermatitis);
• impaired sensitivity of the skin;
• mechanical damage in the area where medicinal pads are applied (wounds, cuts, abrasions);
• intolerance to electric current;
• allergy to a drug that needs to be administered using electrophoresis.

On a note: menstrual bleeding is not an absolute contraindication to electrophoresis, since it is a natural process not caused by any pathological (inflammatory or infectious) factor. It is not advisable to perform the procedure during menstruation if it is known that the electrodes will be applied to the area of ​​the uterus and ovaries.

Methodology

The essence of the procedure lies in the location medicine(solution or gel) perpendicular to the movement of electric current, i.e. between the electrode and the surface of human skin. Depending on the method of applying electrodes and the method of drug administration, several methods of drug electrophoresis are distinguished.

Galvanic (percutaneous) - gauze or filtered paper pads are impregnated with a medicinal solution, which are placed on the patient’s body on opposite sides of the pathological focus to create a field within which the medicinal substance will move. Electrodes are placed inside the gaskets and covered with a protective film on top;

Bath - the required volume is poured into a special container (bath), which is already equipped with electrodes medicinal solution. The patient immerses the painful part of the body (arm or leg) in the liquid;

Cavity - a solution of a drug is injected into hollow organs (stomach, bladder, rectum, vagina, uterus), one of the electrodes is placed there, and the second is located on the surface of the body;

Interstitial - the drug is administered orally (through the mouth) or by injection, after which electrodes are placed in the area of ​​the pathological focus. Interstitial electrophoresis is most effective in the treatment of respiratory diseases (bronchitis, laryngitis, tracheobronchitis, etc.)

Treatment with electrophoresis

Bath electrophoresis

Effective in the treatment of arthritis, polyarthritis, plexitis, polyneuritis and other diseases of the joints and nervous system.

Electrophoresis with Karipazim

Karipazim is a drug for the treatment of hernias intervertebral discs(active ingredient papain). The standard course of treatment with caripazin is 15-20 sessions (to obtain stable clinical effect you need to take 2-3 courses with breaks of 1-2 months).

Electrophoresis with lidase

Lidase (hyaluronidase) increases tissue and vascular permeability, improves the movement of fluids in the interstitial spaces, and helps soften scars. Therefore, electrophoresis with lidase is very often prescribed in gynecology, traumatology and surgery to resolve adhesions.

Electrophoresis with aminophylline

Eufillin has an analgesic, bronchodilator effect, improves blood circulation and blood supply to internal organs. Therefore, electrophoresis with aminophylline is widely used for the treatment of pulmonary, vascular, neurological and other diseases.

Electrophoresis with calcium

Prescribed for bronchitis, neuralgia, neuritis, myositis. Calcium electrophoresis is most often used in orthopedics to replenish relative and absolute calcium losses. The effect that calcium has on the body:

• detoxification;
• antiallergic;
• hemostatic;
• anti-inflammatory;
• strengthens blood vessels and reduces their permeability.

Electrophoresis with potassium

It is used in the treatment of inflammatory diseases of the respiratory tract, bronchial asthma, and eye pathologies.

In most cases, electrophoresis is carried out using the galvanic method, i.e. Electrodes with a drug-impregnated pad are simply placed on the skin. But what technique is used (collar, belt, according to Shcherbak or Ratner), depends on the diagnosis and localization of the pathological focus. Typically, the choice of method is determined by the attending physician (or a physical nurse in the absence of a doctor).

The most effective and widely used medicinal electrophoresis techniques:

Ionic reflexes according to Shcherbak

• prescribed for hypertension, neuroses, peptic ulcer stomach and duodenum.

Ionic collar

• effective in the treatment of traumatic brain injuries, neuroses, hypertension, sleep disorders, etc.

Ionic belt

• used in the treatment of inflammatory diseases of the female genital organs and various sexual dysfunctions.

General electrophoresis (Vermeule method)

• The method is most effective in the treatment of hypertension, atherosclerosis, cardiosclerosis, neurosis, migraine, etc.

Electrophoresis according to Bourguignon (orbital-occipital)

• the procedure is prescribed for the treatment of neuritis of the facial or trigeminal nerve, as well as vascular, traumatic and inflammatory processes in the brain.

Nasal electrophoresis

• used in the treatment of vascular, inflammatory and traumatic pathologies of the brain, stomach and duodenal ulcers, and metabolic disorders.

Electrophoresis according to Ratner

• used to treat circulatory disorders in cervical spine spine, in the treatment of cerebral palsy and to restore normal functioning of organs after birth injuries in children.

Side effects and complications

When performing medicinal electrophoresis, side effects or more serious complications are observed very rarely. Usually this allergic reactions to the administered medicinal substance, which are manifested by redness of the skin, an itchy rash, and slight swelling at the site of application of the electrodes. When canceling the procedure and using antihistamines negative manifestations disappear quickly.

Also, during the 2-3 electrophoresis procedure, a slight increase in pain and an increase in local or general temperature in inflammatory diseases (functional exacerbation) is allowed. By the end of the course of physiotherapy discomfort pass on their own.

Electrophoresis for children and infants

Infants under one year of age are prescribed electrophoresis for the treatment of the following pathologies:

• increased or decreased muscle tone;
• minor neurological disorders;
• diseases of the musculoskeletal system;
• diseases accompanied by severe pain;
• diathesis;
• pathologies of ENT organs;
• burns.

On a note: Increased muscle tone is a serious obstacle to normal physical development child. Treatment with electrophoresis allows you to replace the injection or oral administration of necessary medications.

Each child tolerates the electrophoresis procedure differently: some calmly and quietly, others nervously and irritably. If the baby’s reaction is sharply negative (cries throughout the entire procedure and after it, sleeps and eats poorly, etc.), then the decision to continue treatment is made only taking into account possible benefits and existing risks.

Children over 1 year of age have no restrictions for treatment with electrophoresis, except for individual intolerance to the drug.

Electrophoresis during pregnancy and gynecology

For pregnant women, in the absence of contraindications, doctors often prescribe physiotherapeutic procedures as a supportive measure.

Usually this is electrophoresis - a method that is considered not only gentle, but also the most optimal during pregnancy and lactation for improving blood circulation and reducing muscle tone, including the tone of the uterus.

Electrophoresis should not be used during pregnancy in the following cases:

• vomit;
• kidney diseases;
• low blood clotting with risk of bleeding;
• poor fetal condition;
• eclampsia (severe toxicosis in the second half of pregnancy).

In gynecology, electrophoresis is prescribed for the treatment of chronic inflammatory diseases (cervicitis, endometritis, endometriosis, etc.).

The most effective method in these cases will be interstitial electrophoresis with antibiotics. For cervical erosion and endometriosis, the procedure is used as one of the methods of delivering medications (iodine, zinc, lidase, amidopyrine) to the affected tissues.

Electrophoresis for uterine fibroids is included in the conservative treatment program and helps to completely eliminate or reduce the clinical manifestations of the disease, restore the function of the ovaries and uterine myometrium.

Electrophoresis at home

Medicinal electrophoresis, as one of the main physiotherapy procedures, is provided by any government agency free of charge. If it is not possible to visit the hospital every day to undergo the procedure, then you can do electrophoresis at home.

To do this you need:

• purchase the device and the necessary medications;
• get detailed recommendations for home treatment from a physiotherapist;
• invite a physical nurse to your home for the first (training) session.

Alternative Methods

Another popular method of introducing medicinal substances into the human body, but not with the help of electric current, but through ultrasonic waves, is phonophoresis. In terms of effectiveness, phonophoresis is not inferior to electrophoresis and has much fewer contraindications for its implementation.

The question of which method to use in a particular case is decided by the attending physician. But as practice shows, electrophoresis is most often prescribed, and only if it is impossible to carry out it, phonophoresis is chosen, since not all medicinal substances that are used in electrophoresis are used for phonophoresis.

This is due to the fact that under the influence of ultrasound these substances are destroyed, lose their activity or change their pharmacological properties. For example, novocaine, platyphylline, atropine, some vitamins (ascorbic acid, B vitamins).

Physiotherapy for pyelonephritis

Pyelonephritis is a nonspecific inflammatory process of the pyelocaliceal system, tubules, and interstitium of the kidneys with subsequent damage to the glomeruli and renal vessels.

According to Shulutko B. (1996), chronic pyelonephritis is: “genetically caused by infection-induced immune damage to the renal tissue with an initial predominant lesion of the renal interstitium, followed by involvement of all structures of the kidney in the pathological process, characterized by a recurrent course resulting in nephrosclerosis.”

According to generalized data, chronic pyelonephritis is more common than glomerulonephritis and other kidney diseases. Among hospitalized patients with kidney pathology, it accounts for 32-58%.

The incidence of chronic pyelonephritis varies significantly depending on age, gender and concomitant diseases. Thus, women under the age of 40 develop chronic pyelonephritis 2-5 times more often than men, which accounts for 75% of the overall incidence. The greater susceptibility of women to the disease at this age is explained by upcoming pregnancies, which disrupt urodynamics both mechanically (pressure of the enlarged uterus on the ureters, bladder) and due to dyshormonosis (changes in the concentration of progesterone, estrogens, glucocorticoids in the blood serum), which causes dilation and atony of the urinary tract and creates conditions for vesicoureteral reflux. Besides, anatomical structure urethra in women increases the likelihood of infection and development of the disease. Men, on the contrary, are more likely to develop chronic pyelonephritis over the age of 50 years. As a rule, this is associated with prostate adenoma, urostasis or impaired lymphourokinetics. Often chronic pyelonephritis complicates the course of diabetes mellitus.

Etiology.

Chronic pyelonephritis is caused predominantly by gram-negative flora: E. coli, Proteus, klebsiella and other gram-negative coccobacilli (Corynebacterium hactjbacillus). Also, the pathogen can be represented by a microbial association or gram-positive microorganisms (Staph. epiolermiolis, staph. saprophiticus, etc.). The causative agent is also fungi and viruses. However, not in all cases of pyelonephritis it is possible to isolate the causative agent of the disease. In approximately 15% of cases, it cannot be detected by the usual method, either in urine cultures or in cultures from renal tissue taken during surgery. In some cases, this is due to the possibility of transformation of pyelonephritis pathogens into unique forms, devoid of cell walls, which retain pathogenic properties and are resistant to conventional types of antibacterial therapy. The so-called L-forms and mycoplasmas (in particular, ureaplasma) have been studied in most detail. It has been shown that unstable L-forms, under favorable conditions, can reverse to their original form and support the inflammatory process, and the association of mycoplasmas with bacterial forms can increase the severity of pyelonephritis. In particular, some antibiotics, serums and other factors have an L-transforming effect on microorganisms. More frequent occurrence L-form bacteria is another manifestation of the so-called antibacterial era. Everything described above shows that achieving remission of pyelonephritis with the absence of bacteriuria and other signs does not always indicate complete suppression of the infection. The cause of the development of chronic pyelonephritis can also be foci of infection ( chronic tonsillitis, cholecystitis, osteomyelitis, furunculosis) both independently and in combination with inflammatory processes in organs genitourinary area(urethritis, cystitis, prostatitis, adnexitis, etc.), in the pelvic tissue (paraproctitis)

Routes of infection in chronic pyelonephritis:

1 urogenic (ascending)

2 hematogenous (descending)

3 mixed (when the source of infection is localized in the lower urinary tract)

Often the route of infection cannot be determined. The pathogen can be introduced during instrumental and surgical interventions, or sexual intercourse.

Predisposing factors play an important role in the development of the disease. The latter include:

1. Urodynamic disorders:

1. 1. due to developmental anomalies of the genitourinary area

a) ureteral stricture;

b) severe atony of the ureter;

c) duplication of the ureters, renal pelvis;

1. 2. presence of stones

1. 3. prostate adenoma

1. 4. pathological refluxes:

1. 5. prevention of pregnancy using intrauterine contraceptives, pregnancy, many gynecological diseases, and radiation methods treatment of female genital cancer.

a) vesicourethral, ​​which can be primary or secondary due to obstruction Bladder, hormonal disorders during pregnancy;

b) pyelorenal: pyelovenous or pyelolymphatic

2. Infection during instrumental studies;

3. The tropism of individual microorganisms to the kidney tissue and the low resistance of the mucous membrane of the genitourinary tract to the pathogen;

4. Long-term use of oral contraceptives;

5. The presence of a number of common diseases (diabetes mellitus, tuberculosis, liver pathology, autoimmune processes);

Currently, the main route of infection into the kidney is considered to be ascending (urinogenic) through the urethra, bladder and ureter, along the lumen or wall of the latter. Recent studies convince us of the possibility of this route of infection even without previous vesiureteral reflux or mechanical obstruction urinary tract.

As it turned out, most gram-negative bacteria - potential causative agents of pyelonephritis - have peculiar cilia of a protein nature, or fimbriae, the receptors for which are some structures of the membranes of urinary tract cells. For the so-called P-fimbriae, the receptors are glycosphingolipids of the uroepithelium. The presence of fimbriae allows bacteria to successfully attach to cells of the urinary tract, which has been called the phenomenon of bacterial adhesion.

The adhesion phenomenon facilitates the manifestation of bacterial virulence, which is associated with the presence of capsular and endoplasmic antigens, the so-called K- and O-antigens. K-antigens prevent opsonization and phagocytosis of bacteria, and O-antigens, which are bacterial lipopolysaccharides, determine their endotoxic effect. The latter, along with other manifestations, has a pronounced effect through the prostaglandin system on the smooth muscles of the urinary tract, reducing their peristaltic activity until it is completely blocked. As a result, so-called “physiological” obstruction of the urinary tract occurs with an increase in urine pressure in them. This increase, as it turned out, is sufficient for the implementation of pelvic-renal reflux, which occurs especially easily in complex calyces.

Thus, adhesion to the uroepithelium allows them to resist mechanical leaching from the urinary tract, and the endotoxic effect, leading to disruption of urodynamics with the occurrence of turbulent urine flow in the marginal zones of the ureter, facilitates the movement of bacteria along the wall of the ureter to the kidney.

Hematogenous infection of the kidneys appears to occur less frequently than previously thought.

The progression of pyelonephritis to a certain extent may be associated with the ability of urine to penetrate into direct channels (tubular reflux). Tubular refluxes occur as a result of extravasation of urine into the papilla along straight tubules, which can already occur during the pyelonephritic process, when the fornix is ​​sclerotically changed, and the openings of the tubules lose their rigidity and gape. The appearance of extravasation at the renal gate (sinus reflux) leads not only to the further development of pyelonephritis, but also to a peri-process that spreads to the tissue at the liver gate. When the latter is inflamed (called pedunculitis), 1-2 lymph nodes located on the posterior surface of the pelvis, collecting lymph from lymphatic vessels passing through the fibrous capsule from the kidney. This leads to lymphostasis in the kidney and to lymphatic reflux, and then to venous stasis and venous reflux.

Thus, tubular, lymphatic and venous refluxes are not only pathogenetic factors contributing to the occurrence of pyelonephritis, but also a consequence of it. Pathogenetically, it can be represented as follows: pyelonephritis – pedunculitis – lymphostasis – venous stasis – rupture of thin-walled (fornical) veins – fornical bleeding – fornical reflux. In this case, fornical reflux can occur in the patient in the presence of an obstructive factor and without an increase in intrapelvic pressure.

In addition to the above, it should be noted that immune mechanisms are undoubtedly involved in the development of pyelonephritis. This is confirmed by the fact that the development of the disease is associated with the presence of HLA antigens - A1 and B17, a number of antigenic combinations, the detection of bacteria coated with antibodies in most patients with morphologically confirmed pyelonephritis and in 100% of cases in active phase diseases, the presence in the urine of immune complexes containing antibodies to the pathogen.

Also noteworthy is the correlation between the level of circulating immune complexes and serum immunoglobulin A, and the high density of receptors in the mucous membrane of the urinary tract that are tropic to the pathogen. A number of studies have shown a genetic cause of pyelonephritis.

Thus, the disease occurs due to a combination of genetic and immune predisposition and a nonspecific mechanism (impaired urodynamics, decreased resistance of the body as a whole).

It should be noted that due to reflux in kidney tissue What gets in is not so much infected urine, but urine containing immune complexes. An inflammatory process of an immune nature develops. Consequently, chronic pyelonephritis is a disease of impaired urodynamics in combination with infection, which acts as a triggering factor of the immune response.

Thus, exactly complex connections between the virulence of bacteria, the routes of their penetration into the kidneys and the factors contributing to this, the nature of the body’s immune response and the circumstances influencing it, as well as the presence or absence of pre-existing functional or organic diseases urinary tract and kidneys and form the characteristics of the course of pyelonephritis in specific cases. Paid Advertising:

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Scheme 1. DEVELOPMENT OF PYELONEPHRITIS

In what cases is electrophoresis prescribed for arthrosis?

Arthrosis is a serious disease that can make a person disabled for life. If you neglect this disease, you can permanently lose a joint in your leg or arm. In such cases, there is only one solution left - prosthetics. With early arthrosis, there is still cartilage tissue in the joint, so effective treatment Maybe. One of the most clear symptoms This disease is a crunch in the joints. During physical work, infections or colds appear aching pain in the limbs. If you experience pain in your knees, this is a clear sign of arthrosis of the hip joint.

Today, arthrosis “makes itself known” not only in the elderly, but also in young people. The main thing is to recognize a terrible illness in time in order to consult a specialist doctor. He will prescribe medications, electrophoresis and other methods of therapy. After all, many people know that electrophoresis for arthrosis is one of the most effective methods treatment. There is plasma lifting, which helps for short term get rid of joint diseases and spinal osteochondrosis.

Basic treatment methods

All kinds of painkillers have a lot of side effects and contraindications. What cannot be said about plasma lifting, which is used to treat arthrosis. Therefore, to save general condition health and treatment of illness in early and late stages The doctor prescribes a course of physiotherapy. Dosed exposure to electric current on the body is electrophoresis. Charged particles move in a magnetic field, heading directly to the infected joint. Thus, the medicine reaches that area of ​​the zone that is affected by arthrosis. The modern treatment method includes not only electrophoresis, but also consists of a number of other procedures:

1. Plasmolifting
2. Hirudotherapy
3. Water aerobics
4. Aerobics

Plasmolifting and electrophoresis are carried out in an equipped office or in a hospital under the supervision of a physiotherapist. Some methods of treating arthrosis with electrophoresis are worth considering in more detail.

Plasmolifting truly gives joints a new and healthy life. With the help of plasma lifting it is possible full recovery cartilage tissue and mobility of limb joints. In addition, ligaments, tendons and muscle tissue begin to actively “work”. Plasmolifting has no contraindications, so it is prescribed not only for treatment, but also for the prevention of arthrosis. Even those who suffer from spinal osteochondrosis can safely use plasma lifting - absolutely painless method. After just a few sessions of using plasma lifting, improvements occur: the joint fluid returns to normal, joint pain disappears, and the cartilage begins to be better nourished. Plasmolifting has recently been used in the treatment of arthrosis, but has already established itself as one of the most effective methods.

Medicinal leeches

Nowadays, a common method of treating arthrosis is hirudotherapy. Even in ancient times in Rus', small slippery leeches were “called upon” for help if a person had aches in his legs and arms. What, exactly, is the meaning of hirudotherapy? Leeches stick to the sore spot and thin the blood with the help of a unique substance “hirudin”. In this way, the blood is cleared of decay products, and the patient with arthrosis feels much lighter. Hirudotherapy for arthrosis is prescribed both in the early and secondary stages of the disease. The main thing is not to self-medicate, but to consult a doctor about hirudotherapy for arthrosis in a physiotherapy room.

Everyone knows that not only hirudotherapy, but also simple physical exercises allow a person to get rid of arthrosis. Movement is not only life, but also the maximum of positive emotions. To treat arthrosis, doctors prescribe aqua aerobics, which is performed in a pool accompanied by music. The duration of the lesson is 45 minutes, and you can do them up to 3 times a week. During exercise, weight decreases, muscle tone increases, blood pressure normalizes and the cardiovascular system is trained. Specially designed aerobics has a beneficial effect on the entire body and fights arthrosis. After all, water is a dense liquid that makes our body move stronger.

Prevention of joint disease

It is better to prevent any disease than to treat it. Everyone knows about this, but, alas, they remember the famous saying only at the most critical moments. Arthrosis can appear suddenly and in an inflammatory form. By the way, electrophoresis and plasma lifting sessions cannot be used at this time. In order not to “reward” yourself unpleasant illness, you need to correctly observe the following preventive measures:

Arthrosis can appear from a lack of vitamins in the body. Specifically, there is a lack of vitamin D, which is the “builder” of cartilage tissue in joints. It is recommended to eat more jelly-like jellied meat, which is excellent for joint arthrosis.

Who is contraindicated for physiotherapy?

Regarding contraindications to physiotherapy, a patient with arthrosis should consult with their doctor. But there is general instructions conditions for which electrophoresis is not recommended:

By the way, the causes of arthrosis have not yet been fully elucidated. But most often these are frequent injuries, constant walking in high heels, all kinds of bruises and sprains. If arthrosis has already declared itself, then procedures such as plasma lifting and electrophoresis are the most effective methods of treating arthrosis and other joint diseases. It is impossible to completely get rid of arthrosis, but the condition can be alleviated. The main thing is not to run insidious disease and use complex therapy for treatment. You can go to a sanatorium that specializes in the treatment of arthrosis. It is necessary to regulate nutrition and increase immunity.

IN otherwise The patient will undergo knee replacement and rehabilitation after surgery. Which, by the way, most often happens to those people who did not pay due attention to their condition throughout their lives. There are no miracles; how a person takes care of himself is how he feels in old age.

Be sure to consult your doctor before treating any illness. This will help take into account individual tolerance, confirm the diagnosis, ensure the correctness of treatment and exclude negative interactions drugs. If you use prescriptions without consulting your doctor, it is entirely at your own risk. All information on the site is presented for informational purposes and is not a medical aid. All responsibility for use lies with you.

Treatment of chronic pyelonephritis (very detailed and understandable article, many good recommendations)

Okorokov A. N.

Treatment of diseases of internal organs:

Practical guide. Volume 2.

Minsk - 1997.

Treatment of chronic pyelonephritis

Chronic pyelonephritis- a chronic nonspecific infectious-inflammatory process with predominant and initial damage to the interstitial tissue, pyelocaliceal system and renal tubules with subsequent involvement of the glomeruli and renal vessels.

The patient's regimen is determined by the severity of the condition, the phase of the disease (exacerbation or remission), clinical features, the presence or absence of intoxication, complications of chronic pyelonephritis, and the degree of chronic renal failure.

Indications for hospitalization of the patient are:

In any phase of the disease, patients should not be subjected to cooling; significant physical activity is also excluded.

In case of latent course of chronic pyelonephritis with normal level Blood pressure or mild arterial hypertension, as well as with preserved renal function, do not require regimen restrictions.

During exacerbations of the disease, the regime is limited, and patients with a high degree of activity and fever are prescribed bed rest. Visits to the dining room and toilet are allowed. In patients with high arterial hypertension and renal failure, it is advisable to limit physical activity.

As the exacerbation is eliminated, symptoms of intoxication disappear, blood pressure normalizes, decreases or disappears symptoms of chronic renal failure the patient's regimen is expanding.

The entire period of treatment for exacerbation of chronic pyelonephritis until the regime is completely expanded takes about 4-6 weeks (S.I. Ryabov, 1982).

The diet of patients with chronic pyelonephritis without arterial hypertension, edema and chronic renal failure differs little from the usual diet, i.e. A diet with a complete content of proteins, fats, carbohydrates, and vitamins is recommended. A dairy-vegetable diet meets these requirements; meat, boiled fish. The daily diet should include dishes from vegetables (potatoes, carrots, cabbage, beets) and fruits rich in potassium and vitamins C, P, group B (apples, plums, apricots, raisins, figs, etc.), milk, dairy products ( cottage cheese, cheese, kefir, sour cream, yogurt, cream), eggs (soft-boiled, omelet). Daily allowance energy value diet is 2000-2500 kcal. Throughout the entire period of the disease, the intake of spicy foods and seasonings is limited.

In the absence of contraindications, the patient is recommended to consume up to 2-3 liters of liquid per day in the form of mineral waters, fortified drinks, juices, fruit drinks, compotes, and jelly. Cranberry juice or fruit drink is especially useful, as it has an antiseptic effect on the kidneys and urinary tract.

Forced diuresis helps relieve the inflammatory process. Fluid restriction is necessary only when an exacerbation of the disease is accompanied by a violation of the outflow of urine or arterial hypertension.

During the period of exacerbation of chronic pyelonephritis, the use of table salt up to 5-8 g per day, and in case of impaired urine outflow and arterial hypertension - up to 4 g per day. Outside of exacerbation, with normal blood pressure, the almost optimal amount of table salt is allowed - 12-15 g per day.

For all forms and at any stage of chronic pyelonephritis, it is recommended to include watermelons, melons, and pumpkin in the diet, which have a diuretic effect and help cleanse the urinary tract of microbes, mucus, and small stones.

With the development of chronic renal failure, the amount of protein in the diet is reduced; in case of hyperazotemia, a low-protein diet is prescribed; in case of hyperkalemia, potassium-containing products are limited (for details, see “Treatment of chronic renal failure»).

In case of chronic pyelonephritis, it is advisable to prescribe predominantly acidifying foods (bread, flour products, meat, eggs), then an alkalizing diet (vegetables, fruits, milk) for 2-3 days. This changes the pH of the urine, the interstitium of the kidneys and creates unfavourable conditions for microorganisms.

3. Etiological treatment

Etiological treatment includes eliminating the causes that caused the disruption of urine passage or renal circulation, especially venous circulation, as well as anti-infective therapy.

Restoration of urine outflow is achieved by using surgical interventions(removal of prostate adenoma, stones from the kidneys and urinary tract, nephropexy for nephroptosis, plastic surgery of the urethra or ureteropelvic segment, etc.), i.e. restoration of urine passage is necessary for so-called secondary pyelonephritis. Without sufficiently restored urine passage, the use of anti-infective therapy does not provide stable and long-term remission of the disease.

Anti-infective therapy for chronic pyelonephritis is the most important measure for both the secondary and primary variants of the disease (not associated with impaired urine outflow through the urinary tract). The choice of drugs is made taking into account the type of pathogen and its sensitivity to antibiotics, the effectiveness of previous courses of treatment, nephrotoxicity of drugs, the state of kidney function, the severity of chronic renal failure, the influence of urine reaction on the activity of drugs.

Chronic pyelonephritis is caused by a wide variety of flora. The most common pathogen is Escherichia coli; in addition, the disease can be caused by enterococcus, Proteus vulgaris, staphylococcus, streptococcus, Pseudomonas aeruginosa, mycoplasma, and less commonly by fungi and viruses.

Often chronic pyelonephritis is caused by microbial associations. In some cases, the disease is caused by L-forms of bacteria, i.e. transformed microorganisms with loss cell wall. The L-form is an adaptive form of microorganisms in response to chemotherapeutic agents. Shell-free L-forms are not available for the most commonly used antibacterial agents, but retain all the toxic-allergic properties and are able to support the inflammatory process (in this case, bacteria are not detected by conventional methods).

For the treatment of chronic pyelonephritis, various anti-infective drugs - uroantiseptics - are used.

The main causative agents of pyelonephritis are sensitive to the following uroantiseptics.

Escherichia coli: highly effective are chloramphenicol, ampicillin, cephalosporins, carbenicillin, gentamicin, tetracyclines, nalidixic acid, nitrofuran compounds, sulfonamides, phosphacin, nolicin, palin.

Enterobacter: highly effective chloramphenicol, gentamicin, palin; Tetracyclines, cephalosporins, nitrofurans, and nalidixic acid are moderately effective.

Proteus: ampicillin, gentamicin, carbenicillin, nolicin, palin are highly effective; Levomycetin, cephalosporins, nalidixic acid, nitrofurans, and sulfonamides are moderately effective.

Pseudomonas aeruginosa: gentamicin and carbenicillin are highly effective.

Enterococcus: ampicillin is highly effective; Carbenicillin, gentamicin, tetracyclines, and nitrofurans are moderately effective.

Staphylococcus aureus (does not form penicillinase): penicillin, ampicillin, cephalosporins, gentamicin are highly effective; Carbenicillin, nitrofurans, and sulfonamides are moderately effective.

Staphylococcus aureus (forming penicillinase): oxacillin, methicillin, cephalosporins, gentamicin are highly effective; Tetracyclines and nitrofurans are moderately effective.

Streptococcus: penicillin, carbenicillin, cephalosporins are highly effective; Ampicillin, tetracyclines, gentamicin, sulfonamides, nitrofurans are moderately effective.

Mycoplasma infection: tetracyclines and erythromycin are highly effective.

Active treatment with uroantiseptics must begin from the first days of exacerbation and continue until all signs of the inflammatory process are eliminated. After this, an anti-relapse course of treatment must be prescribed.

Basic rules for prescribing antibacterial therapy:

1. Correspondence of the antibacterial agent and the sensitivity of the urine microflora to it.

2. The dosage of the drug should be made taking into account the state of kidney function and the degree of chronic renal failure.

3. The nephrotoxicity of antibiotics and other uroantiseptics should be taken into account and the least nephrotoxic ones should be prescribed.

4. In the absence therapeutic effect The drug should be changed within 2-3 days from the start of treatment.

5. In case of a high degree of activity of the inflammatory process, severe intoxication, severe course of the disease, or ineffectiveness of monotherapy, it is necessary to combine uroantiseptic agents.

6. It is necessary to strive to achieve a urine reaction that is most favorable for the action of the antibacterial agent.

The following antibacterial agents are used in the treatment of chronic pyelonephritis: antibiotics ( table 1), sulfa drugs, nitrofuran compounds, fluoroquinolones, nitroxoline, nevigramon, gramurin, palin.

3.1. Antibiotics

Table 1. Antibiotics for the treatment of chronic pyelonephritis

Diet for pyelonephritis

In patients with chronic pyelonephritis, the prescription of a special diet depends on the complications of the underlying disease. At chronic renal failure (chronic renal failure) with polyuria accompanied by hypokalemia, a “potassium diet” is indicated, including raisins, fruit juices, fresh cabbage, baked potato. Antibacterial therapy with the introduction of certain drugs requires correction of the acid-base state by prescribing not only drugs, but also “sour”, mainly meat, or “alkaline”, dairy and plant foods.

To do this, you need to know the optimal environment in which a particular antibacterial drug acts. For ampicillin sodium salt, the optimal pH is 5.5-6.0; for erythromycin - 8.0-8.5; for tetracycline - 6.1-6.6; for streptomycin - 7.8-8.0; for kanamycin - 7.0-8.0; for gentamicin - 7.5-8.5; for 5-NOK and nitroxoline - 5.5-6.0; for furadonin - 5.0-6.0.

Indications for the diet are also available for some patients with calculous pyelonephritis, who have certain urolithiasis proven by examination: uric acid, oxaluric or phosphaturic.

With uric acid urolithiasis and diathesis, patients are advised to have an “alkaline”, dairy-vegetable diet and limit foods high in purines, which go into the formation of xanthine bases from which uric acid is synthesized (legumes, herring, liver, kidneys, pork, sprats, turkey, chicken and etc.). The work of M.I. Pevzner (1958) describes products that are richest in purine bases.

Patients with oxalic acid urolithiasis and diathesis are limited to foods containing purines, and also sorrel and spinach. There is no need to limit tomatoes, cabbage and other vegetables. According to Z.S. Weinberg (1971), when eating apples and pears, the excretion of oxalic acid increases.

In case of phosphorus-calcium urolithiasis with phosphaturia and alkaline urine reaction, predominantly “sour”, meat foods are indicated, naturally, within reasonable limits, since the patient cannot be deprived of foods containing vitamins. Patients with hypercalciuria should limit their intake of milk and dairy products in order to slightly reduce the amount of absorbed dietary calcium. If, with bilateral urolithiasis, complicated by bilateral pyelonephritis and chronic renal failure, there is polyuria, which leads to hypokalemia, then foods containing potassium (raisins, fruit juices, baked potatoes) should be recommended.

When eating foods plant origin the patient must take into account the chemical composition of vegetables and fruits. This is especially important for urolithiasis. So, to plant products, which shift the urine reaction in the direction of alkalosis, include apples, bananas, beets, carrots, potatoes, melon, lemons, peaches, oranges, etc.

For gout and uric acid diathesis, so-called green days are indicated, when patients take raw vegetables and salads and exclude from the diet foods rich in purine bases (sorrel, spinach, coffee, legumes, as well as meat products, especially pork, lamb, duck, liver, kidneys).

For oxaluria, vegetables low in oxalic acid are recommended (apricots, eggplants, bananas, peas, any cabbage, cucumbers, lettuce, asparagus, turnips, pumpkin, lentils) and limited to vegetables rich in oxalates (quinces, oranges, beans, pears, strawberries, figs, potatoes, dogwood, gooseberries, lemon, onions, carrots, parsley, tomatoes, rhubarb, beets, celery, plums, green beans, tea, spinach, sorrel, apples). A number of vegetables, berries and fruits have pronounced diuretic properties. These include those listed below.

Watermelon

Eggplant

Banana cultivated

Common pear

Melon

Wild strawberry

White cabbage

Cranberry

Gooseberry

Carrots

Lettuce

Black currant

Red currants

Pumpkin

Dill

Blueberry

Fruit drinks and juices from medicinal berries can be prescribed to replace collections of healing plants, which simplifies the continuation of the course for the patient who is somewhat tired of preparing infusions, decoctions and tinctures. The most effective and familiar to the population are cranberry juices and syrups. Swamp cranberries, or four-petalled cranberries, as well as small-fruited ones growing in peat bogs, are poured with water and boiled and cooled somewhat. sugar syrup.

The berries are preserved both in syrup and in water for many months or even several years due to the organic acids they contain, quinic, benzoic, ursolic, which has a hormone-like effect and promotes the dilation of coronary vessels. The cranberry “sour drink” can be topped up with water as it is consumed. Its properties, including antivitaminosis due to great content vitamin C, are stored for a long time. Cranberry fruit drinks and syrups are recommended for patients suffering from chronic pyelonephritis, including those with kidney stones.

Lingonberry fruit drinks and syrups are prepared in a similar way, which also last for a long time. Lingonberries contain benzoic acid and other organic acids, vitamin C, carotene, essential oils, some of which (thymol, cineol, etc.) give an antiseptic and antispasmodic effect. The intake of fruit drinks and syrups from lingonberries is optional.

The marsh cloudberry and its cuttings (petals around the berry) have a pronounced antispasmodic effect in urolithiasis. We observed patients in whom small stones passed from the ureters and kidneys after taking cloudberries.

To treat urolithiasis, eat pine nuts or prepare an alcohol tincture (1:5), infusing them for 8-9 days. Take 25-30 drops 3 times a day before or after meals. Some plants are taken with honey. For chronic pyelonephritis, crushed black radish is kept with honey (4: 1 or 4: 2). Admission is optional.

For disorders of sexual function, the diet in men with pyelonephritis is normal, preferably vitamin-rich, from fresh foods, for some patients - with the complete exclusion or limitation of alcoholic beverages. For male infertility, in addition to fresh fish, honey, egg yolk, walnuts, sunflower, olive, corn or peanut oil are recommended, fresh vegetables and fruits, etc. Exclusion or limitation of spicy foods, seasonings and smoked foods, alcoholic beverages.

Children suffering from chronic pyelonephritis need a special diet if they have persistent oxaluria, which predisposes them to this disease. They are advised to limit food products containing purine bases and oxalic acid. They recommend “potato days” for 1 week per month or for a decade every 1-1 1/2 months or somewhat more often. If uric acid diathesis served as the background for the development of pyelonephritis, then a dairy-vegetable diet is indicated for such children.

However, it can be prescribed only if there is confidence in the presence of uric acid diathesis, confirmed by the presence of hyperuricemia, hyperuricuria, low urine pH (up to 4.0-6.0), constantly determined by the presence of urates in the urine. There are still no indications for following a strict diet for pyelonephritis.

Spa treatment

There are observations of improvement in the condition of patients with primary chronic pyelonephritis after a stay (no more than 1-1 1/2 months at the Bayram-Ali resort in Turkmenistan). This is explained by a significant decrease in diuresis, a kind of “rest” for sick kidneys. A reverse development of inflammation occurs in some areas of the kidney (with pyelonephritis, the lesions are focal). Improvement in the condition of patients during their stay in the southern regions of the country (less active phases of inflammation and frequent remissions, as well as in the summer in middle lane and in the northern regions) is also explained by a decrease in the number of colds, acute respiratory viral infections, influenza epidemics, sore throats, inflammatory processes in the genital organs in women, etc.

However positive effect Such climatic treatment is most often unstable. This is explained as follows. Pyelonephritis - inflammatory disease not only the interstitial substance of the medulla of the kidney, but also all the renal cavities - urinary tubules, cups, pelvis. As urine output decreases in hot, dry climates due to dehydration, crystal concentrations increase urinary salts and cellular elements in the urine, the lumens of the renal tubules are clogged with mucus, leukocytes, bacteria, desquamated epithelial cells, urinary salt crystals, and sometimes pus. In this case, the basic surgical principle of treating inflammatory-purulent diseases - creating an outflow, drainage - is violated. Improvement after such climatic treatment may not be permanent.

When asked by chronic patients with primary or calculous pyelonephritis whether they can go to the southern regions of the country and swim in southern reservoirs and seas, the doctor can answer in the affirmative. This is possible if the patient, during his stay in the south, undergoes anti-relapse treatment with the prescription of herbal diuretics and antiseptics, as well as periodic intake of uregitis or furosemide. Such patients are recommended fruits and vegetables that increase diuresis (watermelons, grapes, etc.), as well as a slightly increased drinking regimen.

For chronic primary and calculous pyelonephritis, sanatorium-resort treatment can only be balneological. Among the resorts for the treatment of these patients should be named Zheleznovodsk, Truskavets (Ukraine), Jermuk (Armenia), Sairme (Georgia), Shklo, Berezovsky (Ukraine), etc. Some of them are indicated only for calculous pyelonephritis - Istisu, Kala-Ata (Azerbaijan ) etc. There are resorts that are little known, but have proven themselves in the republics and different regions of the country (Tashkent, Khmelnik, Yangan-Tau and a number of others).

Mineral drinking waters have versatile properties. They have a pronounced anti-inflammatory effect, have diuretic effect, improving renal plasma flow and urine filtration. Drinking water from some springs, especially Naftusya (Truskavets), reduces spasm of the smooth muscles of the renal pelvis and ureter, which promotes the voluntary passage of urinary stones. Mineral waters may also have an effect on urine pH, but, unfortunately, only in the direction of increasing it, which is important for the treatment of patients with uric acid diathesis or urolithiasis (Jermuk, Istisu, Borzhom, etc.).

Medicinal mineral water have a versatile effect on diseases of other organs, such as chronic cholecystitis, cholangitis (Truskavets, Zheleznovodsk), chronic laryngitis, sinusitis (Zheleznovodsk), adnexitis and prostatitis (mud therapy in almost all resorts). Treatment of these diseases is carried out in combination with by physical methods and even with the use of antibacterial agents. This combined treatment leads to the sanitation of foci of infection, which are the source of infection in pyelonephritis.

By chemical composition mineral waters of various sources are heterogeneous. The healing waters of the Slavyansky, Smirnovsky and Lermontovsky springs are hydrocarbonate-sulfate-sodium-calcium, which determines their anti-inflammatory effect. Naftusya (Truskavets) - hydrocarbonate-calcium-magnesium mineral water with high content naphthalan substances that have an anti-inflammatory effect on the kidneys.

Diuretic action depends mainly on the hypotonicity of mineral waters, such as Naftusya, Slavyanovskaya, Smirnovskaya, Berezovskaya, etc. Sairme mineral water, on the contrary, is highly mineralized, but its ability to increase diuresis is due to the presence of silicic acids in it, and to a lesser extent, free carbon dioxide.

Therapy of pyelonephritis at all resorts they carry out comprehensively. In Zheleznovodsk, the intake of mineral waters is combined with external use in the form of mineral baths, with mud therapy, diathermo mud, the administration of sinusoidal modulated currents, with dietary nutrition, and physical therapy. They provide rehabilitation for patients and even those suffering from pyelonephritis of a transplanted kidney. For patients with chronic pyelonephritis, staying at the resort is considered a stage in ongoing treatment, which is generally regarded as a milestone. Treatment of urolithiasis is primarily the treatment of calculous pyelonephritis.

Taking mineral water at the Truskavets resort is often combined with ozokerite applications and other methods of physical treatment, which in case of calculous pyelonephritis is aimed at the underlying disease. The pronounced antispasmodic and diuretic effect of naftusya leads to the discharge of small stones, salt crystals, and mucus, which significantly improves the course of calculous pyelonephritis and, therefore, many patients have obtained good results after staying at the Truskavets resort. V.A. Khokhlov (1975) treated patients with primary chronic pyelonephritis in Truskavets and found a significant improvement in the course of the disease and kidney function.

At the Jermuk resort, complex therapy includes rectal irrigation with mineral water and antibacterial therapy. Positive results treatments at the Sairme resort were obtained by S.A. Arshba (1977) and others.

Indications for spa treatment

Contraindications may be general (cardiovascular and cardiopulmonary insufficiency, severe forms arterial hypertension, tumors and a number of other diseases). With calculous pyelonephritis, patients who need to be operated on, with impaired urine outflow, and with chronic renal failure in the active phase should not be sent to the resort. Patients with chronic renal failure in the latent phase, but without azotemia and obstructive factors, can be treated at the resort, and experience in this regard already exists in Truskavets.

Physiotherapy and employment

Employment and regime

With primary chronic pyelonephritis, promptly treated with anti-relapse methods, complete recovery may not occur, but remissions and latent phases of the disease will be long and favorable. The ability to work in such patients is preserved. It can be lost in patients with a secondary wrinkled kidney and frequent attacks of inflammation in the only functioning kidney, and even more so if the nitrogen excretory function is impaired. Persistent disability occurs with a significant decrease in renal function, especially with azotemia, and is more moderate in patients with a single kidney.

In secondary pyelonephritis, the assessment of disability and expert conclusions depend on clinical form and the severity of the underlying disease. This mainly concerns nephrolithiasis, as well as some forms of kidney and urinary tract abnormalities. In case of urolithiasis, expert decisions should be influenced by the bilateral process of stone formation, its relapses, especially with coral nephrolithiasis, long-term stone excretion with severe pyelonephritis and complete loss of function of one kidney.

Repeated operations and the low effectiveness of surgical and conservative treatment are important. Chronic pyelonephritis with congenital anomalies bladder (cervical obstruction, neurogenic bladder, etc.) leads to early disability of patients. Rehabilitation of disabled people when changing professions is also possible. Often patients who are on constant hemodialysis also work.

Some patients with pyelonephritis need employment, improved working and rest conditions. Long stay on the legs, even with unilateral pyelonephritis, due to increased venous stagnation, worsens the functional state of the kidneys and well-being. It is difficult for such a patient to withstand an 8-hour working day “on his feet”. At the same time, sometimes it is undesirable to change profession or place of work.

In such cases, the shop doctor or urologist at the clinic needs to create some conditions at the first-aid post for a patient with chronic pyelonephritis so that he can lie down for 15-20 minutes during his lunch break. This changes the redistribution of venous blood and reduces venous stasis in the kidneys. Employment opportunities for patients are numerous, often individual and extend the limits of rehabilitation.

Clinical examination patients with chronic pyelonephritis is an indispensable condition for their treatment. Patients with this disease require long-term observation and periodic examination, which includes monthly urine tests (general or quantitative), bacteriological urine cultures with determination of the microbial number and sensitivity of the isolated microflora to antibacterial drugs every 3-6 months, studies of total renal function.

In case of primary pyelonephritis, x-ray urological examination should be carried out every 2-3 years, and more often if necessary, since pyelonephritis can cause stone formation or lead to pedunculitis, periureteritis with fixed kinks of the ureter. In this case, previously undetected nephroptosis can be diagnosed, which, like other diseases, requires surgical correction and even surgical treatment. Periodic cystoscopies are indicated for patients with primary pyelonephritis, since there is a pathogenetic connection between this disease and cystitis.

When the active phase of pyelonephritis has begun, it is necessary to exclude obstructive factors that may appear over time with primary pyelonephritis, the primacy of which in a chronic course can be relative. Therefore, patients with chronic pyelonephritis should be registered with a surgically oriented doctor, i.e., a urologist.

In case of secondary pyelonephritis, this is all the more necessary, since for many patients with urolithiasis, clinical observation is only part of a combined treatment, including surgical interventions, therapy for pyelonephritis in a clinic, and stay at a resort. Patients with certain kidney abnormalities also require surgical correction, which can have a positive effect on the course of the inflammatory process.

Medical examination also includes treatment of pyelonephritis, which should be anti-relapse, which is currently the method of choice. The criterion for cure, in addition to clinical improvement, is the disappearance of not only leukocyturia, but also bacteriuria. The improvement is associated with the normalization of urine analysis, the number of leukocytes in the Kakovsky-Addis, Nechiporenko samples and other indicators.

After recovery, the patient must be registered for a year. Most of them remain under dispensary observation for a long time, if this does not contradict the wishes of the patient, since there are psychological aspects long-term accounting. A urologist is involved in the employment of his patients. Dispensary management of the patient together with a nephrologist is not excluded. Observation of sick children, due to the circumstances and characteristics of the child’s body, is carried out by a pediatrician with periodic consultations with a urologist, if possible a pediatric one.

O.L. Tiktinsky, S.N. Kalinina

Treatment for pyelonephritis still remains actual problem. Physical factors in combination therapeutic measures plays a leading role, since the lytic moment in any method of lithotripsy is traumatic in nature. Physical factors provide beneficial influence, both on the pathogenesis of injury and the morphosubstrates of inflammation that subsequently develops or is the background for the formation of pyelonephritis. Physiotherapeutic treatment is used in the complex therapy of pyelonephritis.

Physiotherapeutic techniques have the following effects:

• - increase blood supply to the kidney, increase renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
• - relieve spasm of the smooth muscles of the renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

The following physiotherapy procedures are used:

• 1 Electrophoresis of furadonin on the kidney area. The solution for electrophoresis contains: furadonin - 1 g, distilled water - 100 ml. The drug moves from the cathode to the anode.
• 2 Electrophoresis of erythromycin on the kidney area. The solution for electrophoresis contains: erythromycin - 100,000 units, ethyl alcohol 70% - 100 g. The movement of the drug occurs from the anode to the cathode.
• 3 Calcium chloride electrophoresis on the kidney area.
• 4 Centimeter waves (“Luch-58”) to the kidney area.
• 5 Amplipulse therapy. Local action- analgesic and muscle relaxant effect. Pronounced vasodilator and trophic effect. Resorption of infiltrates, reduction of edema, enhancement of reparative processes. The general effect is to increase the tone of the intestines, biliary tract, ureter and bladder. Elimination of bronchospasm, improvement of lung ventilation, stimulation of the endocrine and exocrine glands.
• 6 UHF therapy. Local effect - heating tissues, accelerating cellular metabolism, improving microcirculation, relaxing vascular muscles, reducing swelling. The general effect is a decrease in the tone of the sympathetic and increase in the tone of the parasympathetic nervous system, a decrease blood pressure. Activation of nonspecific immunity, increase in the number of red blood cells. Strengthening motility and secretion of the stomach, intestines and digestive glands. Increased glucocorticoid levels. Every day or every other day. At low radiation intensity it has an anti-inflammatory effect. With moderate intensity radiation, metabolic processes are predominantly stimulated.
• 7 Sodium chloride baths. The general effect is a decrease in the sensitivity of pain receptors, expansion of superficial blood vessels, improvement of microcirculation, anti-inflammatory effect on the skin and joints. Normalization of blood pressure, improvement cardiac automatism. Reduced blood clotting and platelet aggregation ability. Direct immunostimulating effect due to the release of biologically active substances. Decreased excitability of the central nervous system. Anti-stress effect.
• 8 Thermal procedures on the area of ​​the diseased kidney: diathermy, therapeutic mud, diathermo mud, ozokerite and paraffin applications.
• 9 Mineral waters. General effect - replenishment of electrolyte imbalance, reduction of acidity gastric juice. Choleretic effect, changes in urine acidity, dissolution of kidney stones. Mucolytic and expectorant action. Water is consumed daily in a volume of 1-2 liters per day.

Thus, in the second chapter, methods of rehabilitation of patients with pyelonephritis were considered. Therapeutic physical education, massage and physiotherapy play an important role in the rehabilitation of patients with pyelonephritis.

Pyelonephritis- a nonspecific inflammatory process with damage to the pyelocaliceal system and interstitial tissue of the kidneys. There are acute and chronic pyelonephritis; diagnosis and treatment of the latter is the prerogative of therapists.

Clinically, polyuria in combination with hyposthenuria, proteinuria, and a predominance of leukocytes over erythrocytes in the urine are typical for a detailed picture of chronic pyelonephritis.

Indications for hospitalization: pronounced exacerbation of the process, development of hypertension, progression of renal failure, impaired urodynamics, intercurrent infections, as well as the need for examination to clarify the diagnosis and make an expert decision.

In case of exacerbation of the disease, the regimen should be limited. With a high degree of activity, bed rest is indicated, especially with febrile syndrome. Limitations in physical activity are also caused by hypertension and renal failure.

Diet - with a complete content of proteins, fats and carbohydrates, sufficiently fortified. The amount of fluid you drink should exceed daily diuresis by 350–500 ml. The content of table salt in the daily diet is within 7–8 g, for hypertension – 4–5 g/day. With hyperazotemia, the amount of protein in the diet is limited.

Drug therapy requires the use of antibiotics. In the acute phase, identification of a urinary infection is necessary. The most preferred are gentamicin (garamycin), amikacin, ampicillin, ampiox, as well as uroseptics (nitroxoline - 5-NOK, negram, nevigramon, bactrim, furadonin). Herbal medicine has not lost its importance. It even has some advantages, because... can be used for a long time without special control studies, is harmless, potentiates the effect of antibiotics and uroseptics. Herbal medicines include decoctions and infusions of bearberry leaves, lingonberry leaves, parsley fruits, and birch leaves and buds.

In case of disturbances in urodynamics and urine passage, measures are necessary to restore urination, including, if indicated, surgical ones (lithotripsy, adenomectomy, etc.).

There is a wide range of indications for physiotherapeutic methods and means. For chronic pyelonephritis, e.p. are indicated. UHF at a power of 40 W with a gap of 2 cm, in an oligothermic dose. Regardless of the phase of the inflammatory process, ultrasound is applied to the kidney area at a power of 0.2–0.4 W/cm2. Amplipulse therapy of the kidney area with a transverse arrangement of electrodes (on the back and on the stomach) in alternating mode, III and IV types of work for 4–6 minutes each at a modulation frequency of 30–100 Hz and a depth of 50–75% is also indicated. Galvanization of the kidneys also has an anti-inflammatory effect. A contraindication to physiotherapy for kidney disease should be considered acute pyelonephritis, impaired urine passage, decompensated hydronephrosis, coral stones of the kidneys and pelvis, severe renal failure.

Dispensary and polyclinic stage has as its objectives the provision of anti-relapse treatment, referral for hospitalization and sanatorium-resort selection according to indications, recommendations for employment, implementation of measures nonspecific treatment(physical therapy, physiotherapy).

Clinical examination of patients with pyelonephritis, who are enrolled in the third group of dispensary registration, continues continuously, with control examinations quarterly with the participation of a urologist, therapist, otorhinolaryngologist, dentist and ophthalmologist. Examination during follow-up examinations includes measurement of blood pressure, blood and urine tests, urine testing according to Nechiporenko, Zimnitsky test, biochemical blood test (for residual nitrogen, urea, protein fractions, glucose).

The plan of health measures includes a diet (diet in relation to diet No. 5 or No. 10, according to indications - No. 7), drug therapy(antibiotics, nitrofuran derivatives) with preventive anti-relapse courses in the spring-summer periods and after intercurrent illnesses, taking multivitamin preparations.

During anti-relapse courses, it is advisable to prescribe, along with medications, physiotherapeutic procedures - DMV therapy on the area of ​​projection of the kidneys, and to influence immune system- to the area of ​​the thymus gland. You can use ultrasound, amplipulse therapy, galvanization in the same way as at the hospital stage. According to the usual general health principles, UGG, walks, and general tonic exercises are prescribed.

Physiotherapy for pyelonephritis aims to prevent inflammation of the urinary tract, has an antispasmodic effect and helps improve blood supply and urine passage.

Chronic pyelonephritis without exacerbation without impairment of nitrogen excretory function of the kidneys and with hypertension up to 160/100 mm Hg. Art. is an indication for referral to balneological resorts - Truskavets, Zheleznovodsk, Pyatigorsk. The effect of sanatorium treatment is greater if patients have eliminated urinary passage disorders.

Climatotherapy― one of the oldest methods of treating patients with chronic pyelonephritis. It is aimed at improving the neurohumoral regulation of the body in general and the urinary system in particular. Air baths are indicated for patients with mild to moderate disease at an air temperature of 22–25°C. With these forms, heliotherapy is also possible, with the exception of hematuric forms, high hypertension and impaired urine outflow. Swimming in the sea is not recommended.

Effective balneotherapy. They use baths from various mineral waters, which have a tonic effect on the central nervous system and improve cerebral circulation and renal blood flow. Baths are used as an additional treatment method that does not have special purpose, at a sodium chloride concentration of 20 g/l, at a temperature of 36–37°C, for 10–15 minutes.

The main type of spa treatment for patients with urological pathology is drinking mineral waters, therefore, patients with chronic pyelonephritis are referred to balneological resorts with sources of drinking mineral waters, low-mineralized. Good effect Moscow, Krainskaya, Slavyanskaya, Smirnovskaya and other drinking mineral waters of similar or similar composition are provided. Low-mineralized water of the “naftusya” type (Truskavets) with a high content of organic substances is used most successfully.

For the treatment of chronic pyelonephritis at resorts they use silt and peat therapeutic mud. Mud applications irritate receptors, improve renal blood flow, increase diuresis, and most importantly, have an anti-inflammatory and desensitizing effect. Mud applications to the lumbar region are prescribed to patients with a mild course of the disease and body temperature up to 40°C, for 15 minutes, for patients with moderate severity of the condition at the same temperature - up to 10 minutes. In the presence of hypertensive syndrome, galvanic mud therapy is indicated. Instead of healing mud You can use other coolants: paraffin, ozokerite.

Physiotherapy methods are widely used in sanatoriums, which are practically no different from the methods used at the hospital and outpatient stages and described above.

Medical nutrition should provide sufficient protein and vitamins. The restriction of table salt should be moderate.

Physiotherapy carried out according to the complexes indicated for patients with CVD.

Medical and social examination

Approximate (optimal-minimum) terms of VL for pyelonephritis:

1. Acute tubulointerstitial nephritis (pyelonephritis):

· light form:

· moderate form:

· severe form: inpatient treatment – ​​18–21 days, outpatient treatment – ​​12–24 days, general duration of VN – 30–45 days.

2. Chronic tubulointerstitial nephritis (pyelonephritis):

Exacerbation:

· lung: outpatient treatment – ​​12–16 days, general duration of VN – 12–16 days;

· moderate severity: inpatient treatment – ​​12–14 days, outpatient treatment – ​​8–11 days, total duration of VN – 20–25 days;

· heavy: inpatient treatment – ​​18–21 days, outpatient treatment – ​​12–24 days, total duration of VN – 30–45 days.