Pyelonephritis is a rather unpleasant and complex process of inflammation of the kidney tissue, which has a non-specific bacterial etiology and mainly affects the interstitial tissue of the renal parenchyma.
It is noteworthy that this disease is quite common in people of different ages, and according to doctors, pyelonephritis occupies the highest positions in terms of its prevalence after acute respiratory viral infections. So, over the past year in Russia, about a million cases of pyelonephritis have been identified.
It is known that this disease is characterized by the presence of some age peaks, and also depends on gender. The first cases of pyelonephritis occur in childhood and adolescence, and, in the female, its manifestations occur much more often than in men.
The last peak in the development of pyelonephritis occurs in old age. By the way, in this group, pyelonephritis in most cases affects men due to the appearance of problems with the prostate gland.
What are the consequences of pyelonephritis in children and adults in the future? We will talk about this later.
Predisposing factors
The possibility of this disease to a large extent depends on the state of the body and what indicators of functioning of the human immunity. Several pathways are known for the penetration of pathogenic microorganisms into the kidneys: the lymphogenous, hematogenous or ascending pathway, in which the infection rises up the urogenital system, especially in the presence of reflux in the urine.
The following risk factors are noted:
- Stasis of urine due to urodynamic disorders.
- Outflow problems in the veins of the kidney.
- Anatomical defects of the urinary tract, which can be congenital or acquired.
- Omission of the kidneys.
- The presence of an epicystostomy for urine diversion.
- Problems with innervation of the walls of the bladder.
- The presence of bacteriuria, even if it is asymptomatic.
- Other conditions that reduce the overall reactivity of the body.
Another risk factor for the development of pyelonephritis is called adherence to this disease of the female, because they have a special anatomy, which has the facilitated entry of harmful microorganisms into the kidney tissue.
Symptoms of the disease
The specificity and severity of the existing symptoms of this disease depends on its developing form. Pyelonephritis in acute form has a visible manifestation, and in order to better understand the clinical picture, the syndromes are conditionally divided into the following groups:
- The pain syndrome can have various intensities and increase in the region of the lower back and navel.
- Intoxication - the patient is concerned about fatigue, excessive weakness, fever to febrile or subfebrile, decreased appetite, pale skin, worried about chills and excessive sweating.
- The main consequence of acute pyelonephritis in women is that the temperature can change to febrile, the patient is concerned about vomiting and nausea.
- Urinary syndrome - an increase in microproteinuria, bacteriuria and leukocyturia. If a person has urolithiasis, the development of hematuria and crystalluria is possible.
- Dysuric disorders are characterized by impaired urination, the development of pollakiuria and nocturia.
- Extrarenal symptoms - the patient develops edema and arterial hypertension, there is a change in acid-base balance, itching and dry skin.
Chronic pyelonephritis
Chronic inflammation of the kidney parenchyma can develop without any symptoms, as a result of which this type of pyelonephritis can be detected late. Improper therapy, as well as violations in the outflow of urine, contribute to chronic inflammation. In the early stages, the effects of pyelonephritis during pregnancy for a child are not so severe, but the disease will leave a definite imprint on the baby’s health.
Chronic inflammation is caused by:
- recurring relapses of acute pyelonephritis;
- disorders of the urogenital system and other urological pathologies;
- chronic urine reflux;
- improper selection of antibiotics;
- development of extrarenal localization.
Usually this type of inflammation of the kidney tissue is a one-way process, which is characterized by the appearance of dull pain in the affected kidney. In addition, the patient has pain during urination.
During the exacerbation period, only a quarter of patients have such a consequence of pyelonephritis during pregnancy as an increase in temperature, leukocytes predominate in the urine, and the amount of protein increases. After some time, the severity of the syndromes may subside, which is explained by wrinkling of the organ and a decrease in its filtration.
Despite this, over time, the inflammatory process can spread quite quickly into the surrounding kidney tissue, affecting the tubules as well, causing tubular atrophy - wrinkling of the organ.
Due to impaired functioning of kidney tissue, a consequence of chronic pyelonephritis during pregnancy for a child and mother may develop, namely arterial hypertension.
Laboratory diagnostics
Before the patient will be diagnosed with pyelonephritis, the doctor prescribes some informative laboratory tests. They are carried out in all people who have a suspicion of the disease, including pregnant women. After all, the consequences of pyelonephritis during pregnancy for a child can be different:
- Bacteriological culture of urine.
- A general urine test, and it may not have negative results, so the diagnosis is considered doubtful.
With pyelonephritis, the number of leukocytes increases - leukocyturia develops. The protein content in the urine does not exceed the permissible norm, so proteinuria may not be detected due to microalbuminuria. Assessing the density of urine, hypostenuria or hyperstenuria is usually detected - malfunctions in the filtration of the kidneys, as well as a decrease in the amount of urine excreted. When kidney glomerular necrosis occurs, macrohematuria is usually determined.
In case of poor urinalysis results, it is supposed to conduct an analysis according to Nechiporenko, which makes it possible to assess the level of sediment. Zimnitsky analysis is also effective, which evaluates the concentration function of the kidneys.
There is a risk of pyelonephritis in a person, the performance of bacosowing is shown, which helps:
- Determine how the pathogen responds to the prescribed empirical antimicrobial therapy.
- Count the number of harmful microorganisms.
- Assess the effect of the therapy performed.
If necessary, the following diagnostic methods can be additionally prescribed:
- Clinical blood test to control the level of white blood cells and neurophiles.
- A biochemical blood test, in which, in the case of an uncomplicated form of this disease, the indicators are acceptable, but there may be a fluctuation in the electrolyte ratios. If renal failure joins pyelonephritis, blood levels of urea and creatinine usually increase from the vein in the blood.
Confirm the presence of pyelonephritis in a person is also helped by instrumental diagnostic methods: specialists perform excretory urography, radiography and ultrasound. Ultrasound of the kidneys reveals the expansion of the pelvis and calyx, the renal capsule swells and thickens, and their parenchyma changes.
Radiography shows an increase in the affected kidney, with urography there is a slight decrease in the mobility of the affected kidney during inspiration.
If the patient has a fever for 3 days, with the right antibiotics, doctors usually prescribe multispiral tomography, which helps to exclude the renal abscess, tumors and hematomas.
Diagnosis of a chronic form
Since pyelonephritis does not have a vivid clinical picture, the diagnosis of chronic kidney disease is somewhat difficult. It is necessary to carefully analyze the history of the disease and determine the presence of Sternheimer - Malbin cells and "living" white blood cells.
To detect them, a small amount of dye is added to the urine, as a result of which viable leukocytes may have different shades, or may not be stained at all. Dead white blood cells are painted in a light pink color, which can turn into a brighter shade.
White blood cells may be different in size and structure. With an excessive increase in leukocytes, the formation of a lobed nucleus, this phenomenon is called Sternheimer - Malbin cells, the presence of which indicates inflammation of the urogenital system in a chronic form.
If there is a suspicion of chronic pyelonephritis, but active leukocytes are not detected, it is recommended to conduct a stress test by performing intravenous administration of the drug Prednisolone. Evaluation of the result is carried out after 1, 2 and 3 hours, as well as a day after the procedure.
The test can be considered positive if at least 400,000 leukocytes are excreted in the hour with urine after the injection, and the preferred part must be “live”, active.
A sign of inflammation of the genitourinary system is resistant bacteriuria. If bacteria in the amount of more than 100 00 per 1 mm are detected in the urine, it is necessary to determine their susceptibility to antibiotics and find out the need for uroseptic measures.
Symptomatic preparations
Therapy of symptoms is intended to eliminate a lack of fluid, relieve pain and correct intoxication. It is not recommended to bring down the elevated temperature with anti-inflammatory and antipyretic drugs because of their nephrotoxic effect.
To remove the pain syndrome, doctors prescribe antispasmodics to patients:
- "Platifillin";
- "Papaverine";
- Drotaverinum.
For inpatient treatment, it is preferable to use parenteral forms of these drugs. The use of Sparex and No-Shpa tablets and capsules is also effective.
Pyelonephritis treatment
For effective treatment of the acute form, it is first necessary to reduce the amount of fluid, especially if the patient has heart disease, arterial hypertension.
Decoctions on herbs and sour fruit drinks that have a diuretic and antiseptic effect will be useful:
- renal fees;
- rosehip decoctions;
- lingonberries;
- cranberry fruit drinks, etc.
Nowadays, the pharmacology market offers a fairly large selection of medications for the effective treatment of pyelonephritis:
- "Kanefron";
- Brusniver
- "Cyston."
Antibiotics
The patient is prescribed etiotropic antibiotic therapy for 5-14 days. With uncomplicated pyelonephritis, which, however, has an acute form, antibiotics with fluoroquinolones are prescribed:
- "Ciprofloxacin";
- Ofloxacin;
- Levofloxacin.
Cephalosporins
As an alternative, cephalosporins are used:
- Ceftibuten;
- Ceftriaxone;
- Cefotaxime.
Inhibitor-resistant penicillins, especially Amoxiclav, are also effective in pyelonephritis.
With inpatient treatment, the therapy is carried out with parenteral fluoroquinolones, and over time they switch to tablets. But with gram-positive microbes in the urine, treatment is carried out through the use of inhibitor-protected cephalosporins.
In the acute form of the disease, therapy should be aimed at eliminating obstruction that occurs in the genitourinary system. A combination of aminoglycosides with fluoroquinolones is possible, which will have low toxicity.
Therapy of chronic pyelonephritis
Before starting antibiotic therapy of this disease in a chronic form, it is necessary to eliminate the foci of infection as quickly as possible: for example, dental caries and tonsillitis, since there is also the possibility of reinfection with good treatment.
Antibiotics should be chosen correctly and carefully, taking into account the results of bacteriosis, as well as determining the sensitivity to the medicines used. Empirical treatment without exacerbation and conditions that can be life-threatening is not recommended.
During treatment, it is necessary to constantly monitor the development of pathogenic microflora, regularly passing urine to bacteriosis, since antibiotic-resistant strains can form that require a change in the treatment regimen.
Treatment of the chronic form of pyelonephritis requires the use of nitroxoline, nalidixic acid and nitrofurans, replacing them from time to time. This is a fairly lengthy process that can take several months. The symptoms of pyelonephritis usually subside after a 10-day course of antibiotic therapy.
But there are cases when, even with effective treatment, the pathogenic flora can continue to be sown. With this course of the disease, continuous and rather long-term antibiotic therapy is indicated, changing drugs every week.
In order to effectively cure pyelonephritis in a patient, it is necessary to eliminate the focus of infection, apply tablet forms of antibiotics and herbal preparations. In chronic pyelonephritis, which occurs in the latent phase, the patient is recommended sanatorium or resort treatment.