What is pyelonephritis? Causes, symptoms, diagnosis, treatment and prevention of pyelonephritis

Fortunately, only a few know firsthand what pyelonephritis is. This disease is associated with damage to the renal pelvis or parenchyma. It is infectious. Pathogenic bacteria cause the disease.

From the course of school anatomy, we all know that the kidneys are a natural filter of blood in our body. These paired organs are also responsible for the formation of urine. In two tubes called ureters, fluid is transported from the kidney to the bladder, and from there it is already excreted through the urethra. In the predominant number of cases, the causes of pyelonephritis lie in the spread of bacterial infection from the bladder. Pathogenic microorganisms get there in an ascending way through the urethra from the skin or mucous membrane.

It often happens that bacteria penetrate the kidneys, bypassing the bladder and urethra, without causing an inflammatory process in them. So what is pyelonephritis? This is a kidney infection that can be acute or chronic.

Short description, ICD-10 code

Pyelonephritis is assigned a separate number in the International Classification of Diseases of the tenth revision. The disease is included in the section "tubulointerstitial kidney disease" with the coding N10-N16. In this case, a separate labeling is assigned to chronic and acute pyelonephritis.

Depending on the form of the course, the pathology of the kidneys may have different clinical signs. Acute pyelonephritis without complications can manifest itself as a sudden development of the inflammatory process. As a rule, its occurrence is associated with an ascending infection, about the mechanism of ingestion that we described above. The most common causative agent of renal pathology is E. coli.

An untreated acute form of the disease leads to the development of recurrent kidney disease. And the main mistake of patients is a refusal of further therapy when stopping symptoms. Treatment of pyelonephritis involves the complete destruction of pathogenic microflora in the kidneys and the restoration of normal outflow of urine, and this may take more than one week.

Unlike acute, a protracted form of the disease is not so common. Pyelonephritis is detected during ultrasound diagnostics or urinalysis, since the chronic inflammatory process in the kidneys is characterized by an asymptomatic course.

This disease can also provoke birth defects in the kidneys. The cause of the disease is considered to be progressive damage and scar formation in the tissues. Without appropriate treatment, the disease often leads to renal failure. Chronic pyelonephritis is often diagnosed at an early age.

Causative agents of the disease

The causative agents of pyelonephritis are no different from the bacteria that cause urinary tract infections. In most cases, as already mentioned, the cause of the disease is E. coli. Quite often, other gram-negative bacteria are detected during the examination of the patient:

• Klebsiella;
• Proteus;
• Staphylococcus aureus;
• Enterobacter;
• Pseudomonas;
• Serratia Citrobacter.

In patients with immunodeficiency and diabetes, Candida fungi can cause the disease.

Predisposing factors

To start the pathological process, only the penetration of pathogenic microorganisms is not enough. In a person with strong immunity, the body repels pathogens. A favorable background for the development of pyelonephritis is a disease or condition that causes stagnation of urine in the urinary tract. It helps to multiply bacteria in the urinary tract and weaken the immune system - this is exactly what is needed for the pathogen. A similar factor is the presence of a catheter, urinal in the urinary tract.

As for diseases that prevent the normal outflow of urine, they are very likely to lead to pyelonephritis. When the transport of body fluid slows down, bacteria easily enter the ureters. Among the reasons that serve as a convenient background for the development of pyelonephritis are worth noting:

• benign prostatic hypertrophy;
• oncology of the prostate gland;
• malignant tumors of the bladder (in both sexes);
• congenital malformation of the urinary tract;
• cancers in the renal tract and metastatic lesions of the kidneys;
• consequences of radiation or chemical therapy or surgery;
• multiple sclerosis and other disorders of the central nervous system;
• polycystic kidney disease;
• AIDS;
• myeloproliferative pathologies;
• diabetes;
• complications after organ transplantation.

In addition, patients over 50 years old are at risk of acute pyelonephritis. At the same time, women get sick with this disease more often than men. The cause of pyelonephritis in the weaker sex lies in the features of the anatomical structure of the urethra - their urethra is much shorter.

Pyelonephritis is especially dangerous for pregnant women (however, like other forms of urinary tract infection). The inflammatory process increases the risk of premature birth.

A genetic predisposition to renal pathology cannot be completely ruled out. So, for example, vesicoureteral reflux is a hereditary disease that occurs in the patient's blood relatives. Autosomal dominant inheritance is also attributed to polycystic kidney disease.

Symptomatology

The characteristic manifestations of the disease may differ in all patients with pyelonephritis (ICD-10 code N10-N16), depending on the age, severity of the pathology and individual characteristics of the body. The main symptoms of this disease are as follows:

• malaise;
• low-grade fever;
• chills (with acute pyelonephritis);
• vomiting and nausea;
• pain with pyelonephritis is usually localized under the ribs, in the lower back, is given to the suprapubic region, the iliac fossa;
• frequent painful urination;
• hematuria;
• pungent smell and cloudy color of urine.

In young children, pathology proceeds secretively. Therefore, there may not be any specific signs of pyelonephritis. The course of acute renal disease in infants practically does not differ from the manifestations of an infectious lesion of the urinary tract. Patients in old age, on the contrary, suffer the disease extremely hard. In old age, confusion, incoherent speech, hallucinations are possible.

For the chronic form, as a rule, a latent course is characteristic , which periodically declares itself to be dull aching pain in the lower back, especially in the winter season.

How to recognize an ailment

Diagnosis of pyelonephritis is usually not difficult. To confirm the disease, the doctor examines the patient, paying particular attention to his general appearance, measures the body temperature, heart rate, blood pressure, palpates the abdomen, lower back. In addition, if pyelonephritis is suspected, the specialist will direct the patient to undergo a number of clinical, laboratory and instrumental studies:

• Bacteriological culture of urine. The analysis is carried out in order to determine the pathogen that caused the development of the disease.
• Bacteriological blood culture. Such diagnosis is resorted to only in the presence of pronounced signs of pyelonephritis with a complicated course.
• Detailed blood test. In the results of the study, special attention is paid to the rate of creatinine, a by-product of the normal breakdown of muscle tissue. The substance undergoes renal filtration and leaves the body with urine. The kidney function associated with its processing is called creatinine clearance. In a laboratory examining a patient’s blood sample, the glomerular filtration rate — the rate of blood flow through the kidneys — is determined. Normally, the level of creatinine in the blood should not exceed 106 μmol per liter of blood in adult men and 90 μmol in women.
• Urinalysis Laboratory testing of urine almost always indirectly indicates signs of pyelonephritis, which is indicated by the presence of white blood cells and protein in the urine.
• Ultrasound Using ultrasound screening, specialists identify abscesses, the presence of calculi in the kidneys and determine the causes of stagnation of urine, assess the risk of congenital defects of the urinary tract.
• CT scan. As a rule, there is no need to undergo a CT scan, but if ultrasound does not allow doctors to see the full picture of the pathological process, this type of study will dot all the “and”.

In addition, a diagnostic complex may also include a gynecological examination. The thing is that in women, pyelonephritis is similar to the symptoms of individual sexually transmitted diseases.

Pyelonephritis treatment

Symptoms can only be treated with antibiotics. In the predominant number of cases, the duration of the course of antibiotic therapy in the uncomplicated course of the disease usually does not exceed two weeks.

Antibiotics are administered orally or parenterally if their release form allows. The doctor comes from a specific situation, choosing one or another drug. The results of laboratory tests for bacteria that provoked the disease, a tendency to allergies, the presence of chronic diseases, age, and pregnancy are taken into account. Most often, the following antibiotics are prescribed for pyelonephritis:

• "Penicillin";
• "Trimethoprim";
• "Sulfamethoxazole";
• "Ciprofloxacin";
• Cefotaxime;
• "Cefaclor";
• "Cefuroxime";
• Levofloxacin.

To overcome the disease in pregnant women, the use of broad-spectrum antibiotics is resorted to in the most severe cases. A safer alternative to antibiotics is nitrofurans. The group of these drugs include "Furagin" and "Furadonin."

For the prevention of chronic pyelonephritis, drugs containing nalidixic acid are used. This substance helps prevent relapse, and with exacerbations of a chronic form, Nitroxoline is recommended.

To have an idea of ​​what antibiotics are needed for pyelonephritis caused by one or another pathogen, take into service the table below:

What pyelonephritis is most often known to people with a weakened immune system.

Common complications

With complications of pyelonephritis that arose against the background of diabetes, urolithiasis, due to injuries, injuries, anatomical intrauterine abnormalities of the kidneys and pregnancy, hospitalization and inpatient treatment are indicated.

If the disease is accompanied by severe pain, fever, chills, severe nausea and vomiting, the patient requires emergency medical attention and the implementation of measures to prevent dehydration. With vomiting, antibiotics are administered intravenously. Persistent fever and chills may also indicate that a kidney infection has spread into the bloodstream.

In isolated cases, pyelonephritis progresses with the formation of a purulent-inflammatory focus - an abscess. If the antibacterial treatment does not bring the desired effect, the abscess is opened. The procedure that is done in this case is called nephrostomy: a special tube is inserted through the skin on the back directly into the focus of inflammation on the kidney and the purulent contents are pumped out.

Folk remedies

In parallel with taking antibacterial drugs for pyelonephritis, doctors often recommend the use of herbs and folk remedies that have anti-inflammatory and diuretic effects. Herbal medicine is also successfully used in the treatment of chronic kidney disease. The following is an example of several well-known folk recipes for the preparation of pyelonephritis:

• Decoction of corn stigmas. Plant fibers are taken in the amount of two tablespoons, pour a glass of boiling water. You need to cook in a water bath. Put the cookware on the stove, cover and simmer over low heat for about 30 minutes. After this, cool and strain, add a little boiled water. Before use, the product is slightly heated and shaken.
• An infusion of birch buds and yarrow helps to relieve manifestations of cystitis and urinary tract infections. To cook it, you will need dry raw materials. Both components are used in equal proportions (2 tbsp) and poured with a liter of boiling water. Then the product is left for a couple of hours to insist. Take a drink twice a day for half a glass, on an empty stomach.
• Birch tar. To relieve inflammation in the kidneys, it is necessary to use a glass of warm milk containing 5-10 drops of tar three times a day. The course of treatment is 2 weeks.
• Dill infusion. Finely chopped greens (approximately 10 g) are poured with hot water and, having covered with a lid, set aside for an hour. The finished infusion is drunk three times a day before meals.

Fresh cranberries, as well as cranberry decoctions and fruit drinks have long been known for their diuretic and antimicrobial properties. 2-3 handfuls of this berry should be eaten by pregnant women in order to prevent pyelonephritis. Regular eating of celery and spinach is also a preventative measure of the disease. These products inhibit the development of inflammatory processes in the kidneys, providing a good outflow of fluid and a decongestant effect.

The nuances of diet

In search of an answer about what pyelonephritis is and how to deal with this disease, it is impossible to ignore the issue of nutrition. With the described disease, it is dieting that plays a huge role, determining, in fact, the patient's chances of recovery. The patient runs the risk of nullifying the effect of the use of drugs, ignoring the simple rules of creating a daily menu for kidney pyelonephritis.

Nutrition is based on the principles of maximum restriction in the consumption of salt and smoked foods. Salt is a mineral that holds fluid in the body tissues and contributes to the development of edema against the background of renal dysfunctions. Its daily intake should not exceed 6 g.

During the period of acute pyelonephritis (or exacerbation of chronic), canned food, fatty, spicy, fried foods, sweets and pastries fall under the ban. Urologists recommend completely abandoning coffee (natural and instant), carbonated and alcoholic drinks. Care must be taken to include mushrooms and legumes in the diet.

The features of the daily menu and nutrition for pyelonephritis are built on the need for mandatory consumption of diuretic and anti-inflammatory products, herbal decoctions. Teas made of chamomile, rosehip, lingonberry and horsetail, green tea, mineral still water will be useful.

In the summer, with kidney disease (pyelonephritis), you need to eat fresh vegetables, fruits, and melons. To stop an exacerbation against the background of the chronic course of the disease, give preference to a vegetable-dairy menu, including dairy and sour-milk non-fat foods, dried fruits in the diet. They are enriched with potassium, and this trace element, as you know, removes salt from the body and maintains muscle tone. In strictly limited quantities, you can use butter, cereals, bread. It is desirable to minimize protein foods of plant origin.

When preparing salads from fresh vegetables, try to chop everything very finely or grind, and season the dishes with olive oil. When boiling meat (chicken, rabbit, turkey), it is advisable to drain the first broth a few minutes after boiling and cook the meat in a new broth - this will remove all extractives from the tissues.

Kidney Disease Prevention

To minimize the likelihood of developing renal pyelonephritis, you must:

• Drink a few glasses of water every day. This contributes to the leaching of pathogenic bacteria from the urinary tract and kidneys, preventing their reproduction.
• Timely treat any inflammatory processes in the body, regardless of their severity.
• Eat well and give up bad habits, lead an active and healthy lifestyle.
• Avoid hypothermia, keep your legs and lower back warm, do not sit on a cold surface.

If there are problems with the urinary system, you can not delay with treatment. Launched pathologies often require surgical intervention to restore satisfactory function of the genitourinary system and prevent relapse in the future.