Pyelonephritis is an inflammatory process in a chronic or acute form of the course. It involves not only the pelvis and calyx of the kidney, but also the renal parenchyma with a primary lesion of its interstitial tissue. This is precisely the main difference between the pyelonephritis clinic and other inflammatory processes in the tissues of the urinary system. This disease lends itself to therapy rather severely and most often takes on the form of a chronic course for the rest of its life. From this article, the reader will be able to learn about the etiology, pathogenesis, clinic, diagnosis and treatment of chronic pyelonephritis.
Disease classification
Uronephrology distinguishes between two types of the course of the disease:
The clinic of acute and chronic pyelonephritis differ from each other, primarily, the intensity of the inflammatory process. These two forms of the disease can be distinguished even by an ignorant person in medicine, they are so different. Drug therapy in both cases will also vary significantly.
The clinic of acute pyelonephritis distinguishes between the primary and secondary type of disease. Primary - if kidney and urinary tract diseases are not preceded, and secondary - if inflammation develops and persists against a background of a urological disease, leading to impaired urine outflow or to impaired lymph and blood flow in the pelvis and calyx of the kidney, as well as in the renal parenchyma. Acute pyelonephritis occurs at any age (10-15% of all diseases of the urinary system). Statistical data confirm that the most common clinical manifestations of acute pyelonephritis in children and women under twenty years of age. Men suffer from a similar pathology at times less, because their urinary system is arranged a little differently.
Clinic of pyelonephritis of chronic etiology is more difficult to treat, since the process proceeds unnoticed. In rare cases, the disease makes itself felt by a feeling of weakness, lack of vitality, dysphoria, jumps in blood pressure, swelling of the face and hands. Such a pathological process is extremely dangerous in that the cells of the renal parenchyma can be deformed and degenerate, which will lead to the development of chronic renal failure within a few years.
Main symptoms
Signs and symptoms of acute pyelonephritis clinic:
- a sharp increase in temperature in an hour or two from 36 degrees to 40: the process is accompanied by chills, fever, tremor;
- the patient may lose consciousness, faint, it may darken in his eyes (this condition is caused by jumps in blood pressure, which is not uncommon in the clinic of acute pyelonephritis);
- sometimes acute or aching pains develop in the lumbar region, but most often the disease is painless;
- tachycardia and shortness of breath;
- urine may darken and a sediment appears in it - but this does not always happen, it all depends on the degree of inflammation of the pelvis.
Acute pyelonephritis can be unilateral (an inflammatory process in one kidney) or bilateral (respectively, in both kidneys). When the first signs appear (chills and fever up to forty degrees), an ambulance should be called. Do not hesitate and try to self-medicate. At home, it is neither possible to conduct a competent diagnosis, nor to determine the optimal antibiotic for a particular patient. Procrastination in some cases can lead to the loss of one or both kidneys of their functionality and the development of chronic renal failure (chronic renal failure).
Signs and symptoms of a chronic pyelonephritis clinic:
- the development of the inflammatory process is very slow - therefore, the temperature either does not increase at all, or rises to 37.3 degrees and remains at this level for weeks;
- weakness, the appearance of fatigue even after slight physical exertion;
- decreased immunity;
- headaches, dizziness, problems with blood pressure (it is possible to increase or decrease it).
Possible consequences if untreated
If pyelonephritis is not treated, then the patient faces the following complications:
- Chronic renal failure is the loss of one or two kidneys of their functions. This condition is incurable and means complete disability until the end of life. The patient requires either a kidney transplant from the donor, or, in the absence of such an opportunity, a regular visit to the hemodialysis procedure. This is a special medical practice in which the patient receives a transfusion of his own purified blood, while the function of the damaged kidney is performed by a special hemodialysis apparatus.
- Bacteriotoxic shock - occurs with a purulent form of the course of pyelonephritis. With bilateral renal damage, this complication is very dangerous dangerous - in half the cases ends with the death of the patient. With unilateral pyelonephritis with bacteriotoxic shock, the probability of death is about 35%. During pregnancy, regardless of the trimester and general health of the woman, bacteriotoxic shock leads to fetal death.
- Secondary paranephritis develops with advanced pyelonephritis, both in acute and chronic course. The condition is characterized by damage to the perinephric tissues, in which the inflammatory process develops under the influence of pathological microorganisms. For paranephritis, the development of pain in the lower back is acute, paroxysmal in nature. In some cases, the pain may not be pronounced and aching.
Features of the treatment of pyelonephritis
The study and treatment of the clinic of pyelonephritis in adults is carried out by neurophrology.
First of all, the doctor determines which pathogen caused the development of inflammation (based on this information, further antibacterial therapy will be prescribed):
- E. coli;
- staphylococcus;
- enterococcus.
Approximately 20% of patients have microbial combinations. The most common combination in the clinic of pyelonephritis is E. coli and enterococcus. The patient may experience a change in the pathogen of the infectious process. Because of this, complex multiresistant forms of microorganisms develop. Such a situation can threaten a person’s life with the illiterate use of antibiotics.
Diagnostic Methods
Modern uronephrology uses the following diagnostic methods (the treatment and clinic of chronic pyelonephritis directly depend on a competent determination of the type of pathogen and antibiotic therapy prescribed after this):
- Urine culture is considered an ideal way to identify the pathogen and the selection of an adequate antibacterial drug. Alas, in reality this is not entirely true: a single analysis result provides 20% of false-positive results. Because of this, the practice of nephrology is generally accepted three times sowing. It takes from a few days to a week to get the results of such an analysis. In the treatment of an acute condition, when the countdown goes to the clock, and procrastination threatens the life of the patient, such a long period is unacceptable.
- Ultrasound examination allows you to diagnose the expansion of the renal pelvis (characteristic of both acute and chronic course of pyelonephritis). Ultrasound also allows you to consider the degree of coarsening of the contour of the cups, the state of the parenchyma, the presence of scarring (usually determined after several years of chronic pyelonephritis).
- Computed tomography is used in modern nephrology mainly for the differentiation of pyelonephritis with tumor processes. In other cases, if there is no suspicion of the development of neoplasms, this diagnostic method has practically no advantages over ultrasound.
Treatment of pyelonephritis in adults and children
Therapy in adults is faster, and the recovery period after hospitalization is shorter. The clinic of pyelonephritis in children most often has far-reaching consequences: in 90% of cases, the disease acquires a constant course. As a result, the child, even having matured, suffers from periodic exacerbations. In some cases, chronic pyelonephritis can lead to the development of chronic renal failure after several decades (and sometimes faster).
Therefore, in the treatment and diagnosis of pyelonephritis clinic in children, medical personnel should be especially careful, and parents must meticulously fulfill all the instructions of a urologist and nephrologist.
The use of antibiotic therapy
Successful treatment of pyelonephritis depends on three components:
- well-chosen antibiotics;
- compliance with bed rest;
- diet on a diet number 7.
The treatment of pyelonephritis clinic can be carried out with the following antibiotic drugs:
- Cefixim (Suprax, Cefspan);
- Ceftibuten (Zedex);
- Cefuroxime (Zinnat).
Medicines with antibiotic action are selected based on the results of urine culture. Both intramuscular administration and oral administration are effective. In a hospital, it is better to choose injections. Intravenous or intramuscular administration reduces the toxicity of the drug to the organs of the gastrointestinal tract.
Surgical treatments
Surgery is mainly necessary after the diagnosis of acute pyelonephritis clinic with a complication in the form of suppuration.
Apostems and carbuncles of the kidney must be removed. The question of the nature of the operation is finally decided at the time of the surgery itself. It is determined by the extent of kidney damage and the pathogenesis of the disease.
The purpose of the operation in pyelonephritis with a purulent process, apostems and carbuncles is to suppress the progression of the purulent-inflammatory process in the affected kidney. It is very important to prevent its occurrence in a healthy kidney. Also, the task of the operating surgeon is to restore the outflow of urine along the upper urinary tract in case of its pathology.
Surgical intervention, if necessary, can expose the kidney (lumbotomy, decapsulation) for drainage. Such manipulation is necessary if the patient, for one reason or another, cannot urinate on his own (blockage of the ureter or an overly advanced inflammatory process).
The use of homeopathy and traditional therapy: harm or benefit?
In modern nephrology, homeopathic medicines are widely used. This is "Kanefron", "Renel." Impressive citizens who like to avoid visiting a doctor and find antibiotics too harmful are very fond of being treated with these medicines.
In no case should you replace competent treatment with antibiotic drugs that kill the source of kidney inflammation with dubious homeopathic remedies and alternative methods. Treatment with herbs and mushrooms, of course, can contribute to the diuretic effect or the passage of sand, but the source of inflammation is not able to stop. The longer the patient hesitates and does not go to the nephrologist, the greater the likelihood that the cells will begin to die and the process will develop into chronic renal failure.
It is especially dangerous to let it drift and try to treat pyelonephritis in children with herbs. This condition does not go away on its own, the child’s condition will worsen, and in the end he will either be hospitalized or die.
The clinic of pyelonephritis in pregnant women allows therapy with homeopathic preparations only under the supervision of a doctor. When propagating pathogenic microorganisms, antibiotics will have to be used in one way or another. Modern medicines will not harm the growing fetus.
Medical diet for the treatment of chronic pyelonephritis
The clinic of the disease implies its constant chronic course, even if the patient feels well. In rare cases, the disease makes itself felt by a feeling of weakness, lack of vitality, dysphoria, jumps in blood pressure, swelling of the face and hands. Such a pathological process is extremely dangerous in that the cells of the renal parenchyma can be deformed and degenerate, which will lead to the development of chronic renal failure within a few years.
The principles of diet No. 7 (therapeutic nutrition for infectious and inflammatory diseases of the kidneys):
- limit the amount of protein in the diet to the minimum value (refuse meat and dairy products, eggs, protein mixtures);
- Limit or completely abandon the use of salt (until the test results come back to normal);
- increase the proportion of fruits and vegetables in the diet up to 70%;
- it is important to remember that fruits with a high potassium content are prohibited;
- the use of alcoholic beverages of any strength is strictly prohibited;
- refuse to eat bakery products ;
- in the acute course of the disease, it is sometimes worth limiting the amount of fluid consumed (after a doctor’s recommendation).
You can eat oatmeal and rice porridge without salt every day. As a dessert, you can eat bee products. Allowed vegetable salads with the addition of vegetable oils (but without salt), vegetable soups, puree stew. It is optimal to eat turkey and chicken fillet - not more than 100 grams per day. This restriction is necessary in order not to exceed the proportion of protein in the diet.
How to prevent a relapse of pyelonephritis: advice from nephrologists and urologists
If you follow simple recommendations, you can achieve long-term remission and not recall the manifestations of pyelonephritis:
- adhere to the rules of nutrition for people with sick kidneys;
- from time to time to drink the course "Kanefron" in order to facilitate the work of the tissues of the kidneys and bladder;
- avoid overcooling of both the whole body and its individual sections;
- do not get in the rain, do not bathe in ponds with cold water;
- refuse to be in situations that plunge the patient into a state of stress;
- fully relax, sleep at least ten hours a day.
Any nephrologist will confirm that the patient’s psycho-emotional state is very important. Kidney diseases often have psychosomatic causes and develop after severe shocks and prolonged exposure to overwork and stress.