Inflammation, which is caused by an infection that affects the pelvis, calyx, and tubule of the kidney, is called chronic pyelonephritis. This is the most common disease that occurs in 65% of cases of kidney disease. Women are more susceptible to it, due to the structure of their urethra, as a result of which it is much easier for bacteria to penetrate the body. Chronic pyelonephritis according to the ICD-10 code has a value of N11.
Causes
There are several common causes of a disease. The first factor in this disease is considered to be the appearance in the body and the prosperity of an infection of the so-called agent. Doctors consider Escherichia coli the most common and frequent causative agent of pyelonephritis, but this does not mean that other infections do not cause it. For example, infections that can cause this disease are various staphylococci, streptococci, protea, and enterococci.
In addition to bacteria, the disease can cause fungal infections. The transmission of these microorganisms occurs in two ways:
- Urinogenous, or ascendant. Infection when it enters the urethra rises. The method of transmission of microorganisms is found in women.
- Hematogenous. The transmission pathway is due to blood flow. Bacteria and fungi are transferred from the affected area to an organ that is capable of being infected by blood vessels.
The disease is not able to attack a healthy body. In this regard, there are certain factors in the presence of which pyelonephritis can occur. The first factor is a decrease in overall immunity. And the second is congenital or acquired weakness of the kidneys or their diseases, which lead to a violation of the outflow of urine.
Signs of illness
Symptoms of chronic pyelonephritis depend on its stage. Primary pyelonephritis has more pronounced symptoms than secondary. With exacerbation of chronic pyelonephritis, the following symptoms are distinguished:
- Increase in body temperature to 39 degrees.
- The appearance of pain in the pelvic organs, including pain is unilateral or bilateral.
- Identification of urination disorders.
- Deterioration of the body, fatigue.
- Lack of appetite.
- The presence of persistent headaches.
- Abdominal pain with vomiting and nausea.
- A visual change in the body, i.e. the presence of edema and swelling.
In the period of remission, diagnosing this disease is much more difficult. Possible signs of chronic pyelonephritis of this course are as follows:
- Minor and intermittent pain in the lumbar region.
- The pain may be pulling or aching.
- Violations in urination are absent, and if they are noticed, then against the general background they are not critical for the patient.
- Body temperature practically does not change, but there may be a slight increase to 37 degrees in the evening.
- Increased fatigue of the body, especially if the disease was started and not treated properly. And also patients begin to notice drowsiness, loss of appetite and causeless headaches.
- As it develops, problems with urination increase, peeling, dryness and discoloration of the skin are observed.
- A plaque appears on the oral cavity and a general dryness of the oral cavity is revealed.
- Arterial hypertension is often associated with this disease, which provokes a pronounced increase in pressure.
- Perhaps the appearance of nosebleeds.
With advanced stages of chronic pyelonephritis, pain in the bones and joints is detected. The disease is manifested by increased urination (up to 3 liters of urine per day) and severe thirst.
Stages
Chronic pyelonephritis has four stages of inflammation in the kidney tissue.
The first stage is characterized by uniform atrophy of the collecting tubules (tubes designed to remove urine). The glomeruli at this stage are completely healthy, pathological processes do not proceed in them. There is also a slight leukocyte infiltration of the connective tissue of the brain substance.
The second stage is characterized by the presence of damage to the connective tissue and atrophy of a small number of glomeruli, after which they resolve. Following the glomeruli, the surrounding renal tubules begin to die. Some vessels are significantly narrowed, constricted and closed.
In the third stage, healthy kidney tissue is replaced by cicatricial, the kidney is reduced in size and acquires a wrinkled appearance with bulges and depressions.
The fourth stage, depending on the activity of inflammation, is divided into the following:
- Active. This stage is able to move on to the next.
- Latent (stage of calm). It is able to go both to the next and return to the previous one.
- Remission is the stage of clinical recovery, that is, the absence of signs of the presence of the disease and the improvement of urine analysis.
Complications and consequences
With improper treatment of chronic pyelonephritis, an exacerbation period may occur. With a long period of exacerbation, complications appear that arise by the mechanism of acute pyelonephritis. Complication, with all forms of chronic pyelonephritis, takes the form of chronic renal failure. A sign of this is an increase in the amount of urine excreted per day, as well as a decrease in its concentration, constant thirst and dry mouth.
Chronic renal failure has the following stages:
- Hidden (latent). At this stage, the symptoms against the background of chronic pyelonephritis practically do not appear.
- Conservative. Fatigue is noticeable with little physical exertion, general weakness, which is especially manifested in the evening, a sharp decrease in weight and appetite.
- Pronounced symptoms begin to appear only at the terminal or final stage. In this case, the smell of ammonia from the mouth and the presence of persistent headaches are detected. The skin becomes pale, dry, sagging. The work of all body systems is deteriorating. It is difficult to remove toxins from the body, which in normal condition should be excreted in the urine.
A prolonged course of chronic pyelonephritis can lead to the development of diseases such as pedunculitis, that is, inflammation in the area of the kidney gate, and nephrosclerosis, which leads to kidney deformation.
Diagnostics
As a rule, it is much more difficult to diagnose chronic forms of pyelonephritis. Diagnosis is complicated by the latent course of the disease. Information about other diseases can clarify the causes of the development of this pathology. Most often, when diagnosing doctors, the presence or absence of the following anomalies is of interest:
- Pathology of the kidneys and urinary organs.
- Inflammatory diseases of the female reproductive system.
Chronic biased pyelonephritis most often passes with mild symptoms, which complicates its detection. Diagnosis in such cases is based on the results of laboratory and instrumental methods of research. Physical examination may not reveal pathological processes in the kidneys. It consists in an objective examination for the presence of pallor of the skin, swelling of the face and eyelids, discomfort when striking the lumbar region, and also helps to identify visual intoxication.
Laboratory studies of chronic pyelonephritis (ICD-10: N 11) in patients consist in the following analyzes:
- General urine analysis. With it, a quantitative indicator of leukocytes in the blood is revealed.
- Urinalysis by the Zimnitsky method. The results assess the functional state of the kidneys, determine the amount and density of urine at different times of the day.
- A general blood test is aimed at determining the amount of hemoglobin, the erythrocyte sedimentation rate and the cellular composition of the blood.
- A biochemical blood test, in which the presence of changes in the electrolyte composition of the blood is detected.
Instrumental examination in patients is as follows:
- Ultrasound of the kidneys allows you to conduct a study of both the inner side of the kidney and its membrane.
- Ultrasound of the vessels of the surrounding kidneys allows to assess the violation of the blood flow of the renal membrane.
- X-ray examination (including computed tomography) allows you to determine large-scale anomalies of the kidneys and urinary tract, for example, a change in the size or shape of organs.
- MRI is performed in patients who are contraindicated in the administration of contrast agents to the body.
Chronic pyelonephritis (ICD-10: N 11) is similar in symptoms to chronic glomerulonephritis, which complicates the diagnosis when using the above methods. Therefore, differential diagnosis is based on a combination of history data, which are repeatedly refined by the above methods. With this diagnosis, much attention is paid to studies of urine sediment, namely the determination of its bacteriological composition.
Drug therapy
It should be noted that without the use of antibiotics, chronic pyelonephritis in women and men cannot be cured. Therefore, when identifying this stage, they try to start taking antibiotics immediately. The type of drug will depend on the sensitivity of the bacteria that caused kidney inflammation to the antibiotic. The high effectiveness of treatment with such medicines can be lost if antibiotics are taken too late or an incomplete course is taken. This is due to the fact that over time the number of bacteria will increase, as will the affected area.
The main requirement in the treatment of chronic pyelonephritis to antibiotics: minimal toxicity with maximum effectiveness. Also, the antibiotic should cope with most pathogenic bacteria.
The following medications are used to treat exacerbations of chronic pyelonephritis:
- penicillins (Ampicillin, Oxacillin, Sultamycillin, Amoxiclav);
- cephalosporins ("Zeporin", "Kefzol", "Cepepim", "Ceftriaxone", "Cefotaxime", "Cefixime");
- nalidixic acid (Nevigramon, Negram);
- aminoglycosides ("Colimycin", "Kanamycin", "Gentamicin", "Amikacin", "Tobramycin");
- fluoroquinolones (Moxifloxacin, Levofloxacin, Ciprinol, Ofloxacin);
- nitrofurans (Furadonin, Furazolidone);
- sulfonamides (Etazol, Urosulfan);
- antioxidants (tocopherol acetate, ascorbic acid, retinol, selenium).
Despite their high effectiveness, antibiotics have a number of side effects. If a negative reaction is detected, it is necessary to adjust the dosage or replace the drug. To choose one antibiotic or another, the doctor must analyze the acidity of the patient by analyzing the urine, since the effectiveness of treatment with a particular drug depends on this indicator.
Antibiotics are often recommended for a period of at least 2 months. Sometimes alternating the first antibiotic with the second when the course for each of 10 days becomes an effective measure. The duration of antibiotic treatment for a particular patient will depend on the outcome of the studies. They come down to sowing a colony taken from the affected organ, and studying it for sensitivity to the antibiotic. If the disease is started and the patient’s condition is serious, then combinations of antibiotics are prescribed. They are taken both in the form of tablets inside, and in the form of injections.
Alternative methods of treatment
Parsley is the main assistant in the fight against chronic pyelonephritis. It will have a detoxifying and antispasmodic effect, serve as an antiseptic, and most importantly, it will strengthen the function of the urinary system, helping to remove toxins accumulated in the body. Together with parsley, it is also recommended to use dill, celery, onions, lovage and lettuce, which will help strengthen the effect of the main component on the kidney tissue. You need to use a bunch once a week without bread and salt.
In the treatment of chronic pyelonephritis in women, water intake should be abandoned, replacing it with berries, such as:
- raspberries;
- Strawberry;
- cranberry;
- lingonberry;
- blackberry.
They will help replenish the body’s moisture, without creating a burden on the kidneys.
An important effect will have tinctures. The necessary herbs should be taken in the same amount, mixed and poured with boiling water with the calculation of 200 milliliters of water per 1 tablespoon of raw materials. Insist for two hours and strain. Drink half a glass four times a day thirty minutes before a meal. Take this medicine should be warm.
Required Herbal Fees:
- Anise fruits, birch leaves, St. John's wort, three-colored violet.
- Lingonberry leaves, Ivan tea, parsley root, goose cinquefoil, parsley root.
Diet
Patients are prescribed a diet with a high amount of fluid in chronic pyelonephritis. Clinical recommendations should be strictly observed, otherwise deterioration is possible.
At normal pressure, the daily norm should be as follows: proteins - 95-105 g, fats - 75-85 g, carbohydrates - 400 g, salt - 7-9 g, liquid - about 2 liters, while the total calorific value should be 2900-3100 calories. The number of receptions - 5 times.
At high pressure, the daily norm of the elements is as follows: proteins - 70-80 g, fats - 55-75 g, carbohydrates - 400 g, salt - 3-5 g, liquid - in the region of 2 liters, total calorie content - 2400-2900 calories. The number of receptions - 5 times.
It is recommended sometimes to spend fasting days. For example, eat more fruits today, and vegetables tomorrow.
When dieting, you should eat these products:
- dietary varieties of meat, poultry, fish; boiling and stewing is allowed;
- soups based on meat broth;
- milk products;
- white or gray bread;
- pasta, cereals and flour;
- raw vegetables;
- eggs
- fruits and berries;
- honey, jam, pastille, marshmallows;
- any teas and juices.
In chronic pyelonephritis, the clinical guidelines for prohibited foods are as follows:
- smoked and salty foods;
- any mushrooms;
- fatty broths;
- legumes;
- refractory fats;
- fatty cream cake;
- fast food and snacks with plenty of salt;
- coffee and chocolate;
- alcohol.
Prevention
You should know that chronic pyelonephritis of the kidneys will bring a huge amount of inconvenience. Therefore, it is important to take preventive measures against this disease in order to prevent its development. To avoid the appearance of chronic pyelonephritis, it is necessary to completely cure the acute stage of this pathology and subsequently regularly be observed by a doctor. For prevention, it is important to protect the kidneys from bacteria.
To do this, it is necessary to completely cure the following diseases, in most cases exacerbating the course of inflammation in the kidneys: coprostasis, chronic colitis, cholecystitis. It is important to carry out the prevention of pyelonephritis in pregnant women. According to statistics, if you can defeat pyelonephritis during pregnancy, then the chronic form of the disease never occurs.
Also, do not forget about the prevention of exacerbations of chronic pyelonephritis on the observance of general hygiene measures, high-quality and balanced nutrition, the presence in the diet of foods rich in large amounts of vitamins. It is important to prevent the development of other diseases in a timely manner and regularly conduct antibacterial courses aimed at reducing pathogenic microbes in the body.
Spa treatment
The spa form of therapy brings a positive result in the treatment of chronic pyelonephritis (ICD-10 code - N11). In this case, the latest methods are used to help remove inflammation, cleanse the kidneys and bring the patient's condition back to normal. Thanks to the complex of actions that the sanatorium provides, the patient will return to a normal rhythm of life much faster.
How to treat chronic pyelonephritis in a sanatorium? This includes such events:
- Diet.
- Mud baths.
- Therapy with mineral waters.
- Hydrotherapy.
- Heat therapy.
Each of the procedures is carried out only after the appointment of a doctor.