The prognosis for life in the presence of calculous pyelonephritis is determined by how strongly the obstruction of the outflow of urine is expressed. Also, the prognosis is determined by the intensity of inflammation. The more severe the pathological change, the more pronounced the clinical manifestation. The ailment in this case is, as a rule, secondary in nature. Calculous pyelonephritis (according to ICD N20.9.) Is a non-specific inflammation in the kidneys that develops against the background of urolithiasis. That is, this is a complication of urolithiasis. Next, we find out what are the causes of the development of this disease, find out how it manifests itself, and get acquainted with the main methods of its treatment.
What are the features of this disease?
Factors that contribute to calculous pyelonephritis include:
- The presence of a large size or number of stones.
- The development of persistent urinary tract obstruction.
- Decreased immune reactivity of the human body.
- The period of old age.
- The presence of past inflammatory pathologies of the genitourinary tract.
Inflammation can occur in an extremely severe form of pyelonephritis (in acute course), or with minor symptoms in the chronic type of the disease. According to the data, urolithiasis is found in forty percent of cases of urological pathologies. Its peculiarity lies in the development of the disease at working age (from twenty to fifty years), which occurs in sixty percent of patients. This contributes to disability in twenty-five percent of cases.
Where are the stones formed?
Stones often form in the kidney cup, but can also be found in the ureters, pelvis, bladder, and so on. As a rule, a unilateral lesion occurs. And in thirty percent of cases, the disease occurs on both sides. Stones are single or multiple, having a diverse shape and size (from one millimeter to ten centimeters or more). Inflammation in the kidneys mainly affects women, although urinary canal calculi are more common among men. In the elderly, the prevalence of the disease increases in both sexes. Next, find out what causes this pathology among the population.
Causes of the disease
The following causes contribute to the development of calculous pyelonephritis:
- The presence of metabolic disorders along with an increase in the content of salts and other chemical compounds in the form of cysteine, oxalates, fructose, galactose.
- Excess freeze-dried and canned food. Too much intake of vitamin D. Deficiency of vitamins A and C.
- High temperature along with climate humidity (the fact is that increased sweating increases the concentration of salt in the urine).
- Prolonged impaired urinary outflow in combination with worsening microcirculation in the kidneys.
- The occurrence of chronic inflammatory diseases in other parts of the genitourinary system.
- The presence of foreign bodies in the urinary canals, and in addition, kidney injury.
- Prolonged bed rest (for example, with diseases of the spine and strokes).
- Some pathologies in the form of hyperparathyroidism, gout, etc.
Microbial reproduction
Not every patient with urolithiasis can develop calculous pyelonephritis (ICD-10 N20.9.). In rare situations, its symptoms are not detected at all. However, the presence of stones favors the emergence and reproduction of microbes.
Often with the onset of the disease, Escherichia coli, coccal flora, enterococci or bacterial flora are detected. Less commonly, Klebsiella can be detected along with Pseudomonas aeruginosa, enterobacteria, cytobacteria, fungi and so on. Now we will understand what symptoms accompany this disease.
Symptomatology
The clinical picture of calculous pyelonephritis directly depends on many different factors, for example, gender, age, and in addition, physical activity. In some patients, pyelonephritis can leak for years and will be detected by accident. In other situations, symptoms occur acutely. Often, calculous pyelonephritis has such manifestations:
- temperature increase;
- the occurrence of chills and sweating;
- the appearance of pulling pain in the lumbar region;
- the occurrence of pain in the muscles and joints;
- the appearance of changes in the frequency of urination;
- the appearance of a discoloration of urine;
- the presence of headache and general weakness.
The chronic form of this pathology
Chronic calculous pyelonephritis is found in a fairly large number of patients. It acts as an inflammatory disease that directly affects the functional system of the kidney. This disease can develop in a person at absolutely any age, and it occurs in both men and women. Chronic calculous pyelonephritis (ICD-10 N20.9.) Is an independent disease or a direct result of another. Symptoms of it are:
- The presence of aching, fairly weak and asymmetric pain. In the event that the kidney is mobile, the pain may be in the abdomen.
- An increase in body temperature to approximately thirty-eight degrees.
- Urination in the patient becomes frequent.
- Significantly increased pressure.
- There is fatigue along with weakness, mood decline, headaches, and so on.
The treatment of this disease involves the elimination of the pathogen. For this, different antibiotics with uroseptics are used. Penicillins are also prescribed along with cephalosporins, fluoroquinolones, nitrofurans and oxyquinolines.
What is the duration of therapy?
The duration of active treatment of chronic calculous pyelonephritis, as a rule, is at least two weeks, and in the case of remaining complaints, it can last up to one month. It is recommended to replace the indicated preparations once every ten days, repeating urine culture, and also taking into account the effectiveness of each of the medicines.
What is the diagnosis of this disease?
In diagnostics, methods can be simultaneously used that reveal signs of urolithiasis and calculous pyelonephritis (code according to ICD-10 N20.9.). The following examinations are prescribed to patients:
- General urine and blood tests.
- Conducting a biochemical blood test. The indicators of this study make it possible to suspect a disease. In order to clarify the diagnosis, a more thorough study is required.
- Ultrasound examination of the kidneys.
- Performing cystoscopy and excretory urography.
- Scintigraphy with radioactive drugs. In this case, the functional state of the kidneys can be evaluated.
- Performing computer and magnetic resonance imaging.
How is this pathology treated?
Treatment of calculous pyelonephritis is carried out according to the general principles of therapy of the secondary form of pathology. Of particular importance is the treatment of urolithiasis, which is the root cause of pyelonephritis. The most effective is the removal of stones. In this case, the main cause of pyelonephritis is eliminated. Surgical techniques are dangerous for the occurrence of complications and do not exclude the reappearance of stones. Depending on the indications (as determined by the doctor), the following methods of treatment are used:
- Appeal to conservative techniques for stone discharge. For example, the use of citric acid drugs ("Uralit" and "Blemaren") for the withdrawal of urate stones. The use of dry madder extract, Cystenal and other drugs may also be prescribed. Water loads are often used, for example, drinking up to two liters of warm tea (which should be drunk in thirty minutes), and the subsequent administration of antispasmodics and diuretics.
- Stopping a patient with renal colic. Antispasmodics in the form of "Baralgin" are usually used, they are combined with a thermal procedure (heating pad or hot bath).
- The operation to remove stones. There are various techniques, for example, the use of endoscopic techniques in combination with transdermal methods. In complicated and severe course, an open surgery is performed.
- Performing drug or instrumental destruction of stones. The most widely used is remote wave lithotripsy (when ultrasonic waves are used).
- Alternative methods of treatment also take place. Basically, such methods are used during remission. Herbal preparations can have a positive effect. Mineral waters also have a therapeutic effect. They are used for a small size of stones (up to fifty millimeters in diameter), as well as in the absence of severe urinary tract obstruction. Indications for the appointment of therapy are determined by the doctor. With the improper use of mineral waters, the opposite effect is possible (that is, an increase in stones).
- In the treatment of chronic calculous pyelonephritis, diet is important. In the event of the appearance of urate stones in the diet, the use of smoked and fried meat, meat broths, dried fish and offal is limited or excluded. In the case of the formation of phosphate stones, meat foods are recommended with the exception of dairy products, peas and beans. In the presence of oxalate stones, it is undesirable to eat tomatoes, sorrel, tomato paste and herbs.
Are complications of the disease possible?
Calculous pyelonephritis is fraught with the following complications:
- The development of hydronephrosis and secondary wrinkling of the kidney (in the case of prolonged conservation of pyelonephritis).
- Acute renal failure. The occurrence of such manifestations as anuria along with thirst, nausea, vomiting and other symptoms. In the case of sluggish pyelonephritis, the patient may develop chronic insufficiency of this organ.
- The development of paranephritis (inflammation of the perinephric tissues) along with the spread of purulent inflammation to other organs of the abdominal region.
- Infectious and toxic shock.
- The occurrence of renal bleeding. This happens due to stone damage to the mucous membrane, renal tissue necrosis, and coagulation disorders.
- The development of anemia. This occurs in acute form as a result of toxic effects or during a prolonged course of the disease.
- The development of symptomatic nephrogenic arterial hypertension (due to nephrosclerosis or due to fluid retention).
Urologist's advice for this pathology
Urologists as part of the prevention of this disease are advised to follow a diet that limits meat broths, coffee, fried and spicy dishes with dairy products. In addition, at least one and a half liters of fluid per day should be consumed.
Doctors also insist on the timely detection of the initial forms of urolithiasis and pyelonephritis. No less important, according to experts, the rehabilitation of foci of acute or chronic infection. In addition, careful monitoring of the compensation of diabetes, gout, and other diseases is recommended.