Each patient has their own medical history. Pyelonephritis, as can be seen from medical statistics, was present at some point in time in many. The disease is nonspecific. The term denote the presence of infectious renal infection. At the same time, parenchyma tissues, primarily interstitial, as well as calyxes, and pelvis of the organ, suffer. In the history of the disease, the doctor necessarily fixes, the disease struck one side or symmetrically, primary or appeared against other diseases, proceeds in a chronic form or acute, accompanied by serous discharge or suppuration. If there is a tendency to relapse, this fact will also be noted.
Pathology Features
The doctor always mentions the reasons that provoked pyelonephritis in the patient’s medical history, if it is possible to determine exactly what has become such. It is known that in the predominant percentage of cases, the condition is explained by infection with strepto-, staphilo-, enterococcus, proteins or Escherichia. In about a third of patients with acute form, it is possible to identify several pathogens at once. Among chronic sufferers, this is characteristic of two-thirds of all patients.
The treatment process is complicated by the addiction of pathological life forms to the antimicrobials used, which is also necessarily recorded by the doctor in the map and medical history. Pyelonephritis is a disease in which it is necessary to do repeated crops of urine often enough to identify medications that are effective for a particular case. Take into account that seeding does not reveal protoplasts that can cause relapse.
Status Nuances
As a rule, another relapse of pyelonephritis in the medical history is mentioned when a person's immune status decreases for some reason or the state of the body worsens for other reasons. The development of the disease largely depends on the general condition of the person. An infectious agent gets the opportunity to enter the renal pelvis through the blood or lymph flow, through the ureter walls from the lower urine excretion pathways. In the presence of retrograde reflux, pathological microflora can enter the kidneys through the lumen of the ureter.
Urine stasis, violation of the outflow of lymph, blood through the veins from the kidneys - such pathological conditions are often referred to as symptoms in chronic conditions. pyelonephritis in the medical history. Often, before the initial case of detection, the patient has already turned to doctors with interstitial cystitis, which is also mentioned in the patient’s personal card. There is a possibility that cystitis proceeded in a latent form. When choosing adequate therapy, it should be borne in mind that the acute form of the disease without timely qualified help can cause nephritis, renal carbuncle.
How to notice?
All the symptoms with which the patient turns to the doctor are necessarily recorded in the card during the medical history (compilation of the medical history). Acute pyelonephritis in children and adults usually begins with fever - sometimes the fever reaches 40 degrees. The patient is shivering, sweat is plentifully allocated, the lower back hurts. On the side where the infection occurred, the anterior wall of the peritoneum is tense, the rib-vertebral area is given by sharp and severe pain. A person feels weak, worried about general malaise, thirsty. Possible pollakiuria, dysuria.
Over time, the acute form or exacerbation of pyelonephritis as an additional symptom provokes a headache and nausea. Sometimes the patient vomits. These manifestations indicate that poisoning of the body occurs very quickly. Leukocytosis, aneosinophilia, the presence of purulent discharge in urine, blood and protein inclusions are possible. If the condition worsens, leukocytosis can progress to leukopenia. Pasternatsky’s symptom in the predominant percentage of cases is positive. In a bilateral acute infectious process, organ failure is observed. Complications in the form of necrotic processes, paranephritis are frequent.
Status Update
It is very important for the doctor to keep a detailed history of the case of chronic pyelonephritis. The differential diagnosis of this disease and acute form is an important and crucial stage, since the manifestations are similar to some other disorders. As a rule, specifying the patient's condition, the doctor first of all collects a complete medical history. Some chronic pathologies, in the recent past experienced purulent diseases, indicate a high probability of pyelonephritis.
Sometimes a preliminary diagnosis is accurate even on the basis of information obtained from examination and questioning of the patient. As is known from many physicians gathered in practice, specializing in urology, medical records, pyelonephritis is very often accompanied by purulent, protein, and blood inclusions in urine. The liquid contains bacteria, rather dense. The patient is in fever, lower back hurts. Observed oliguria, dysuria.
To clarify the condition, it is necessary to make a number of specific analyzes. A differential diagnosis is carried out, given that bacterial inclusions can be explained by foci of infection not only in the kidneys, but also in other organs through which urine flows. As a rule, the patient is referred for x-ray - with pyelonephritis, the diseased kidney is larger in volume; an urography showing a limitation of organ mobility during breathing. You can suspect a carbuncle by squeezing the pelvis, calyx.
How to help?
When a patient reveals chronic pyelonephritis in the acute stage in the medical history, the doctor not only records all the patient's complaints and test results, but also specifies which treatment program is chosen for a particular case. In particular, it is a specialized food. The acute stage of the disease calls for food on the seventh table (subtype A). A day you need to drink at least two liters of liquid, you can drink more. The doctor monitors the patient’s condition, as the improvement improves the diet, increasing protein saturation and fat content of the diet. If acidosis associated with metabolism is observed, sodium bicarbonate must be used. It is taken orally up to 5 g or injected into a vein up to 60 ml of solution (not more saturated than 5%).
All selected measures, drugs, their dosages must be recorded in the medical history. Therapy of pyelonephritis requires measures to stimulate blood flow in the kidneys and relieve soreness. Thermal procedures are shown. The doctor will explain how to make compresses, heating pads. A popular procedure is diathermy. If the pain is still severe, its thermal effect does not weaken, it is necessary to take medications. Antispasmodics - “Papaverine” and “Platifillin” will help. They are intended for short-term use, they make it possible to alleviate the condition, but you can’t take such drugs constantly - they have side effects.
Medicines: what will help?
All drugs selected by the doctor must be fixed - this will allow us to evaluate their effectiveness, and if resistance to pathological microflora is identified, replace it with more effective ones. The drugs and dosages used, the doctor fixes all the features of the course in the medical history. Therapy of chronic pyelonephritis at the acute stage, acute involves the use of antibiotics. They usually start with nalidixic acid. In pharmacies, it is presented under the trade names Negram and Nevigramon. The duration of the program is a week or two, the dosage is 0.5-1 g, the frequency is four times daily.
An alternative is nitrofuran pharmaceutical products. Their effectiveness in a particular case will also have to be recorded in the medical history. Therapy of chronic pyelonephritis at the stage of relapse, acute involves the use of Furadonin four times a day for 0.15 g or Nitroxoline, the dosage of which does not exceed 0.2 g, and the duration of the course reaches three weeks. Nitroxoline is taken four times daily.
The nuances of treatment
With exacerbation of pyelonephritis, the listed drugs are used in turn. At the same time, derivatives of nitrofuran and nalidixic acid are strictly forbidden to be used, since these two agents mutually weaken the effect. In addition, the probability of developing resistance in pathological microflora increases.
Often when managing an exacerbation of chronic pyelonephritis in the medical history, the doctor indicates that hexamethylenetetramine was prescribed to the patient. On sale this compound is presented under the name "Urotropin". The tool is used in the first six days of an acute case, if the pathological microflora shows increased resistance to antimicrobial agents. "Urotropin" is taken daily four times. Dosage - up to a gram orally or intravenously up to 10 ml of solution for injection.
Combinations for increased efficiency
Particular attention is paid to acute pyelonephritis in pediatrics. There are a lot of history of the disease - pathology is quite widespread among children, and there are many reasons for this - lifestyle, low immunity, and a number of other individual factors. It is known from the experience of doctors that in relapses, the optimal approach is often the combination drug therapy, in which the patient is simultaneously prescribed antibacterial compounds and sulfonamides. Antibiotics are selected based on an analysis of the resistance of microorganisms to various substances.
Most often, treatment is practiced by penicillin compounds - they are quite common with acute pyelonephritis in pediatrics. The medical histories of many children contain a reference to such a disease and the use of Benzylpenicillin in it at a dosage of 1-2 million units per day, or Oxacillin, 2-3 g daily. Ampicillin can be used in amounts up to 10 g per day, ampicillin salt and Streptomycin twice a day, half a gram or less.
Options and alternatives
Allergic reactions to penicillin antibiotics are frequent, especially in the medical history of children. In this case, chronic pyelonephritis can be tried using tetracycline. The drug "Tetracycline" is used orally up to six times a day, the dosage reaches 0.3 g. Derivatives of the specified substance can be used - "Metacyclin" or "Morphocycline".
Macrolides are distinguished by a rather mild effect and weak negative consequences, therefore, they are also often resorted to if children need treatment. Widespread "Tetraolean", "Oletetrin" in pediatrics. In the case history of chronic pyelonephritis in many patients, it is indicated that the drugs were prescribed a quarter gram up to six times a day, and such therapy showed a pronounced result.
A possible approach to the treatment of pyelonephritis is the use of aminoglycosides. Of the pharmacy names, it is worth mentioning "Kanamycin", injected into muscle tissue twice or thrice daily, half a gram, as well as "Gentamicin", used in a similar way, but the dosage is less - 0.4 mg.
What else to try?
With pyelonephritis, cephalosporins are effective. Apply "Zeporin" and "Cephaloridin". Dosage - up to two grams per day.
Antimicrobial drugs are changed every ten days, used in moderate dosage. Doctors who prescribe a course for patients with kidney failure should be especially careful.
You can use sulfa drugs. From the pharmacy names, this is Etazol, Urosulfan. The dosage reaches a gram, the frequency of use is up to six times a day. Well-established sulfonamides of prolonged effectiveness. This is “Sulfapyridazine”, used on the first day in a two-gram dose, and then in half the last two weeks, and “Sulfadimethoxin”, “Sulfamonomethoxin”.
Attention analysis!
In a predominant percentage of cases, soon after the start of the therapeutic course of urine in patients, it becomes normal, does not contain inclusions indicating the pathology. This is not a reason for cancellation - antibiotics must be taken on, usually a month. If conservative treatment does not show the desired result, urgent surgery is required. Usually it is necessary for carbuncle, jade.
If acute pyelonephritis was left without attention or was not treated, the disease becomes chronic. Primary chronic is also possible, but this is less common - this is diagnosed if, from the very beginning, the pathology does not manifest itself as severe symptoms.
More often, chronic pyelonephritis appears in children, higher risks for girls. When examining a lock of a third of all patients, it is not possible to immediately identify signs that accurately diagnose the disease. But a febrile condition without cause for it is a manifestation that indicates a relapse and helps the doctor to accurately diagnose. As can be seen from the statistics, in recent years, cases of a combined disease have become more frequent - pyelonephritis and glomerulonephritis bother the patient at the same time, both proceed in the form of a chronicle.
Unilateral pyelonephritis: features
For such a disease, dull pain in the lumbar region is characteristic on one side (where the focus of infection is localized). The pain is constant. Dysuria is usually not. With exacerbation, fever is observed in every fifth patient. In the sediment of urine, there are more leukocytes than other structures. With wrinkling of a diseased kidney, urinary syndrome becomes less pronounced. The density of urine does not change.
When making a diagnosis, it is important to determine the concentration of active white blood cells. With the latent form of the disease, it is necessary to put a test with prednisone. 30 mg of the substance is dissolved in 10 ml of liquid and injected into the vein for five minutes, after which several portions of urine are taken for examination - one hour after the procedure, two and three hours later. Such a test is considered positive if in an hour in urine there are 400 thousand leukocytes or more, of which the main percentage is active. If Sternheimer-Malbin structures are detected, one can confidently diagnose the focus of inflammation, although this is not an indisputable indication of pyelonephritis.
Symptoms
Often, doctors record in the case history of gestational pyelonephritis (as, incidentally, any other) that a high concentration of bacteria was detected in the patient's urine. If the amount of microorganisms per 1 ml of liquid is 100 thousand or more, fluid samples should be taken to determine resistance to antimicrobial agents and chemotherapeutic agents.
Often indirectly, pyelonephritis is indicated by increased pressure in the arteries. To a greater extent, this is characteristic of a bilateral process, a chronic form.
To identify the features of the condition, it is necessary to do chromocystoscopy, urography, evaluate creatinine clearance for each of the kidneys. An x-ray is taken using hippuran and the kidneys are scanned. In chronicles, the organ's concentration ability is rather quickly disturbed, but nitrogen release is possible for a long time.
Since with pyelonephritis, the tubules of the organ cannot work normally, acidosis is gradually observed. In some patients, pyelonephritis is indicated by parathyroidism, kidney osteodystrophy, due to leaching of phosphate compounds and calcium from organic tissues.
Disease progression
With the development of pyelonephritis becomes the cause of dry skin, pallor. The patient vomits and feels sick. Possible nosebleeds. As a rule, patients lose weight, anemia is observed, the concentration of iron decreases, while urine does not contain pathological inclusions.
Pyelonephritis can cause necrotic processes, suppuration, nephrolithiasis.
Clinical Practice Nuances: Chronicle
Particular difficulties are associated with clarifying the condition: chronic pyelonephritis is in many ways similar to glomerulonephritis, which proceeds in a chronic form. To clarify the condition, it is important to carefully analyze the urinary syndrome, evaluate the content of various components in urine, and also identify all the features of the functioning of the organ through urography. Nephrotic cider indicates glomerulonephritis.
With increased pressure, it is necessary to consider the possibility of hypertension, vasorenal hypertension and the kidney disease in question. In order for differential diagnosis to give the most correct result, you need to analyze the urinary syndrome, x-ray, the results of a radionuclide study. Pyelonephritis will indicate asymmetric excretion of the coloring component during chromocystoscopy.
You can distinguish a pathological condition from vasorenal hypertension through urography, renography, aortoarteriography.
The nuances of chronic disease therapy
In the chronic form of the disease, the treatment lasts for many years. As a rule, the course begins with the use of nitrofurans, they are combined with nalidixic acid and sulfonamides. Specific names are listed above. All these groups of funds alternate with each other. To increase the efficiency, the patient is prescribed cranberry extract for continuous use.
If these funds do not show the desired result, antimicrobials come to the rescue with a wide spectrum of effectiveness. Before you start taking urine samples to determine the resistance of life forms. The courses of treatment are usually ten-day, although in some cases after such a program, signs of infection can still be detected in urine. Patients with this course of the disease are shown to continuously take antibiotics, switching between forms every week.