Pyelonephritis is a non-specific inflammation that affects not only the pelvis and calyx of the kidneys, but also affects the interstitial tissue. Subsequently, vascular involvement in the course of pathology occurs. Regardless of the etiology of pyelonephritis, such a disease affects mainly women due to the peculiarities of the anatomical structure of their genitourinary system. Often, many begin to suffer from a similar disease during the course of pregnancy.
In old age, the occurrence of kidney inflammation is more common in men. The etiology of pyelonephritis in this case is associated with pathology of the prostate. Often, the disease manifests itself as a complication of diabetes.
Features of the disease
Regardless of the etiology and clinic of pyelonephritis, this disease refers to common urological pathologies characterized by the occurrence of infectious and inflammatory processes in the kidneys. With the penetration of pathogens from the lower parts of the urinary system, inflammation develops.
The causative agent of the disease is mainly E. coli, which is found in urine. Despite the etiology, the symptoms of pyelonephritis in women are much more pronounced than in men, as the painful sensations very quickly become acute and difficult to tolerate. It is worth noting that the disease is divided into acute, chronic or exacerbated chronic form. In addition, the etiology, pathogenesis, clinic and treatment of pyelonephritis depend not only on its form, but also on gender.
Quite often, the disease occurs in childhood, which occurs when various pathogens penetrate the baby's body. The etiology of pyelonephritis in pregnant women is associated with hormonal changes, squeezing of the ureters, as well as a decrease in the tone of the urinary tract. All these factors create favorable conditions for the exacerbation of the chronic type of disease or the occurrence of acute.
Disease classification
Despite the development of medicine, an accurate classification of pyelonephritis does not exist. Such a disease is provoked by many different causes, and is also characterized by various kinds of changes in the structure of renal tissue. However, doctors often classify pyelonephritis by:
- the nature of the course - acute and chronic;
- localization - one-sided and two-sided;
- the cause of development is primary and secondary.
In addition, a complicated and uncomplicated form of the disease is distinguished, depending on the general well-being of the patient.
Acute form
With the onset of the acute form of the disease, the kidney increases in size, and its capsule thickens. The etiology of acute pyelonephritis is associated with the penetration of pathogens into the kidney tissue. The disease occurs at absolutely any age in both sexes. However, most often young and middle-aged children and women suffer from it.
The etiology of acute pyelonephritis is associated with the penetration of staphylococci into the body, and the clinical picture is characterized by a combination of local and general signs of the disease. Common manifestations include a deterioration in overall well-being, fever, severe chills and sweating, as well as signs of general intoxication. You can determine the presence of the disease by the presence of changes in blood and urine.
Local signs are manifested in the form of painful sensations, muscle strain, and sometimes there is rapid and painful urination.
Chronic form
The etiology of chronic pyelonephritis is mainly associated with an untreated acute form of the disease. This happens when it was possible to eliminate inflammation, but the pathogens remained in the kidney, and also failed to normalize the outflow of urine. Chronic pyelonephritis can constantly cause discomfort to the patient and manifest as aching dull pain in the lumbar region. They are especially acute in cold and damp weather. In addition, an exacerbation of the chronic process periodically occurs.
Doctors identify general and local signs of the course of the disease. Local symptoms are more pronounced in patients whose etiology of chronic pyelonephritis is associated with other diseases, in particular, such as:
- benign or malignant proliferation of the prostate;
- omission of the kidney;
- urolithiasis disease;
- uterine fibroids.
Patients note the presence of periodically occurring pains in the lumbar region, which are often unilateral. Their occurrence mainly occurs at rest and is in no way associated with the patient's active movements. In some cases, urination disorders are noted.
Features of the disease in children
Such a urological disease often occurs in childhood, and also has fairly characteristic signs of a course. If the etiology of acute pyelonephritis in children is established in a timely manner, as well as the correct diagnosis and treatment are given, then the occurrence of dangerous pathological abnormalities in the child's body can be avoided in the future.
In newborns and infants, the disease is expressed in general signs of intoxication, in particular, such as:
- lethargic sucking or breastfeeding;
- vomiting and regurgitation after feeding;
- fever, which can cause seizures.
A classic manifestation may be blanching of the skin with signs of cyanosis, manifested in the form of blueness of the skin around the mouth or over the upper lip. The etiology of pyelonephritis in infants is based on a change in the conditionally pathogenic microflora, which provokes signs of dysbiosis, which occurs as a result of the penetration of coccal infections. At an older age, when the child may indicate pain, the course of the disease can be recognized by the presence of characteristic signs.
Depending on the etiology of pyelonephritis in children and the features of its course, treatment can be carried out in a hospital or on an outpatient basis. Hospitalization is carried out in the case of pronounced signs of intoxication. The main goal of the therapy is:
- determination of the etiology of pyelonephritis in children and the elimination of a provoking factor;
- removal of pathogens from the urinary tract of the child;
- antibiotic therapy;
- elimination of clinical symptoms;
- correction of existing urodynamic disorders.
During the course of the exacerbation, the child is recommended strict adherence to bed rest, as well as diet therapy, subject to the limited intake of salt, as well as protein. In addition, high fluid intake is recommended.
Causes of occurrence
To date, it is still impossible to fully determine the etiology of pyelonephritis. That is why it is believed that the cause of the development of the disease can be the patient's own microorganisms or penetrated from the outside. Often these are possible cocci or Escherichia coli. Mostly pyelonephritis occurs if there is a mixed infection in the body. Doctors distinguish such pathways of pathogens:
- through infected urine;
- through lymph coming from nearby organs;
- along with blood flow.
There are certain factors that trigger the development of pyelonephritis, which include:
- chronic stress;
- lack of vitamins;
- weakness;
- chronic overwork;
- decrease in immunity.
In addition, one can distinguish the presence of pathological conditions, during the course of which there is a certain obstacle to the normal outflow of urine. The etiology and pathogenesis of chronic pyelonephritis can be briefly described as follows: the patient experiences periodic relapses of the acute form of the disease. As a result of its course, a gradual replacement of normal renal tissue with connective tissue occurs. In some cases, chronic pyelonephritis is complicated by the addition of arterial hypertension or renal failure.
Development pathogenesis
The etiology and pathogenesis of acute pyelonephritis are associated with the penetration of pathogens along with blood flow into the vascular system of the renal glomeruli. As a result of this, inflammatory degenerative changes develop. A leukocyte infiltrate is formed near the affected blood clots, the subsequent course of which largely depends on the characteristics of the treatment and the general well-being of the patient.
In the case of a favorable course of the disease, the resulting infiltrates are replaced by connective tissue, followed by scarring. With the progression of the pathological process, many ulcers are formed. The etiology and pathogenesis of pyelonephritis can also be associated with a pathology such as the formation of a reverse flow of urine, as a result of which pathogens penetrate the renal pelvis, from where they enter the general bloodstream.
Subsequently, pathogenic microflora along the wall of the urinary tract penetrates into the interstitial tissue of the kidney, where inflammation develops under favorable conditions. The etiology of pyelonephritis can be associated with general and local provoking factors. Common ones include:
- the immunological state of the body;
- the presence of diseases that reduce immunity;
- overwork;
- general hypothermia.
Local factors include impaired urine outflow and the presence of ureteral reflux. Considering the pathogenesis and etiology of pyelonephritis, an instrumental examination of the urinary tract and many other factors are often identified as a provoking factor and the cause of the onset of the disease. Depending on this, the disease is divided into primary and secondary.
Primary pyelonephritis refers to inflammation in which urodynamics or other kidney diseases are not detected. The secondary form of the lesion occurs against the background of the presence of various diseases of the kidneys and urinary tract.
Main symptoms
If an infection in the bladder was detected, and appropriate treatment was not carried out, then after a while characteristic signs of inflammation of the parenchyma in the kidneys may occur. Among the most common signs of pyelonephritis, the following should be highlighted:
- tingling pains in the back or groin;
- temperature rise;
- severe abdominal pain;
- impurities of blood or pus in the urine;
- frequent and severe urination;
- pain and burning during urination.
All these signs must be considered more carefully, because if you do not conduct a timely examination and treatment, then various kinds of complications may arise.
Diagnostics
If the first signs of the disease occur, you should immediately seek help from an experienced specialist. Be sure to consider the etiology, pathogenesis and clinic when diagnosing pyelonephritis. Treatment is prescribed on the basis of the data obtained, it must be comprehensive to prevent the likelihood of relapse.
To make a diagnosis, you will need to conduct a urine test. In the presence of pyelonephritis, protein and blood impurities can be detected in the analyzes. This is due to the fact that inflammation disrupts the normal reabsorption process, as a result of which blood cells and protein compounds penetrate the urine. Based on the results, you can determine the causative agent of the disease, as well as select the most effective drugs.
In addition, instrumental diagnostics using x-ray, ultrasound and radionuclide techniques is required. In some cases, cystoscopy may be required.
When conducting ultrasound in patients with pyelonephritis, there is an expansion of the renal pelvis, scarring area. Later manifestations include a change in the contour of the kidney, a decrease in its size, which can also be observed with other diseases. Another diagnostic method is radiopaque techniques that allow you to visualize the urinary tract and detect the presence of irregularities.
Therapy Features
The etiology and clinic are very important in the diagnosis. Treatment of pyelonephritis is prescribed only on the basis of the diagnosis. An integrated approach to therapy is recommended. For this, medications are prescribed, in particular, such as:
- antibiotics
- antimicrobial;
- diuretics
- medicines that improve blood circulation in the kidneys;
- vitamin and fortifying drugs;
- herbal medicines.
In addition, the use of folk remedies and methods as additional therapeutic measures gives a good effect. Throughout the entire period of therapy, strict dietary compliance is required. It is worth remembering that when using antibacterial drugs, you need to strictly observe their dosage and maintain the prescribed course of therapy, even in the case of a significant improvement in well-being.
All medicines, as well as alternative methods, can be used only after consultation with the treating doctor. The secondary form of pyelonephritis implies the elimination of a disease that triggered the onset of inflammation.
Drug treatment
Depending on the etiology and symptoms of pyelonephritis, the principles of treatment and patient care are selected strictly individually. First of all, doctors recommend the use of antibacterial drugs for therapy. They help eliminate pathogens that cause kidney infection.
Basically, a few days after the start of antibiotic therapy, the general well-being of the patient is normalized. In some cases, the course lasts for a week or more. It is very important not to stop therapy after the relief of acute symptoms, as this can trigger relapses. With a severe course of the disease, intravenous administration of antibacterial drugs is required. Basically, antibiotics are prescribed, such as:
- aminoglycosides - "Tobramycin", "Amikacin", "Gentamicin";
- quinolones - Ofloxacin, Ciprofloxacin;
- beta-lactams - Zinaz, Amoxicillin;
- macrolides;
- polymyxins.
To eliminate existing problems with the kidneys, it is absolutely necessary to use other medicines. In particular, these include chemotherapeutic drugs. The most popular means of this group is the drug "Biseptolum". It is often used in the acute form of the disease. This drug is also prescribed when single-component therapy is ineffective. In addition, this drug is also used after antibiotic therapy, since the urinary tract may still be vulnerable to infection.
Chemotherapeutic agents include the Nitrox drug. It is used to treat kidney diseases, including pyelonephritis, provoked by fungal or viral infections. In addition, it is prescribed to prevent relapse.
In diseases of the urinary system, homeopathic remedies can also be prescribed, especially in the presence of a kidney infection. To eliminate pain and discomfort during urination, Apis is prescribed. The effect of conducting is to urinate more quickly. In addition, Berberis is used to treat pyelonephritis. It is important that the prescribed drugs do not provoke the occurrence of side effects and are effective against bacteria that provoked the disease.
Folk techniques
Good diuretic, antiseptic and anti-inflammatory qualities are possessed by medicinal plants, in particular, such as:
- elder;
- highlander bird;
- Birch tree;
- knapweed;
- bearberry;
- juniper;
- parsley;
- wheat grass.
Apply medicinal fees prepared from medicinal plants before meals. The course of therapy is carried out until the symptoms disappear completely.
Dieting
All patients, regardless of the stage and characteristics of the course of the disease, are recommended to use a large amount of liquid. You can drink fruit and herbal decoctions, fruit drinks, juices, weak tea. Cowberry or cranberry juice and mineral water will be especially beneficial for patients. The total amount of fluid consumed per day should be approximately 2 liters.
If you follow a diet, you must include gourds in your usual diet, as they have good diuretic qualities. The food consumed should contain a large amount of protein, however, during the exacerbation period, only milk-vegetable and unloading fruit days are recommended. In the absence of renal failure and hypertension, a significant limitation of salt intake is not required. Be sure to completely eliminate alcohol, coffee, spicy dishes, canned food, spices, strong broths.
In the chronic form of the disease, the diet is about the same as in acute pyelonephritis.The diet should be made in such a way as to prevent the occurrence of vitamin deficiency. In the usual menu must be present low-fat fish and meat, dairy products, fruits and vegetables. Instead of sugar, it is recommended to consume honey. An ideal option is fractional nutrition.
Surgical intervention
Depending on the etiology and symptoms of pyelonephritis, treatment can be done with surgery. If conservative methods of conducting therapy with the use of antibacterial drugs did not bring the desired result and the patient's well-being continues to deteriorate, surgery is indicated.
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Possible complications
Pyelonephritis alone is not as dangerous as its complications. First of all, an acute, untreated form of the disease can go into the chronic stage with periodic relapses. Chronic pyelonephritis can cause significant discomfort.
In addition, it is worth noting that suppuration can join the infectious process, and this can lead to kidney loss, which is why treatment should be approached with all responsibility. The insidiousness of pyelonephritis lies in the fact that it often proceeds without obvious signs, or the symptoms are quite blurred. Among the main complications, the following should be highlighted:
- abscess formation;
- acute infection of the renal pelvis;
- scar tissue formation;
- renal failure;
- hypertension;
- shock, sepsis.
In some cases, pyelonephritis can lead to papillary necrosis.
Prevention and prognosis
Preventive measures consist in timely rehabilitation of foci of infection, especially in the presence of chronic diseases of the genitourinary system. Timely treatment for diabetes is also required.
Prevention means carrying out activities aimed at increasing immunity. The main condition for normalizing the outflow of urine is compliance with hygiene rules and maintaining a healthy lifestyle. During the period of remission, a spa treatment will be a very good prevention of relapse. Mud baths, mineral water, and other physiotherapy techniques have a beneficial effect on the kidneys.
Of particular importance is dietary nutrition. It is worth limiting the consumption of fatty and spicy foods. The food should be fractional and you need to eat in small portions. To prevent the occurrence of relapse, it is necessary to undergo the prescribed examination in a timely manner.
With uncomplicated pyelonephritis, the prognosis is quite good and rarely leads to kidney damage. Repeated course of the disease can lead to its transition to a chronic form, as well as provoke the development of various complications.