The human body is the highest stage of evolution. A person breathes, lives and moves thanks to the coordinated work of the main organ systems. Each of them fulfills its specific role, but does not interfere with the functioning of the others.
The kidneys are a unique component of the body. This is a paired organ, which is tasked with purifying the blood of harmful substances. When the debugged mechanism fails, various diseases occur. Among the variety, secondary pyelonephritis (obstructive) is considered the most common . About his methods of diagnosis and treatment will be described in detail in today's article.
Medical certificate
Pyelonephritis is an inflammation in the kidneys caused by an infection. At the same time, the renal calyces, pelvis and parenchyma are involved in the pathological process. It may be due to the activity of pathogenic flora. The causative agent of the disease, as a rule, enters the kidneys through the blood from the infected area. Significantly “facilitates” this process a violation of the mechanism of excretion of urine.
Pyelonephritis is a fairly common ailment that occurs in people of all ages. In children, he is one of the three diseases along with respiratory infections. The inflammatory process in the kidneys is also diagnosed in pregnant women. Of adults, almost one in three suffers. It is noteworthy that the fair sex is more likely to see a doctor. This is due to the anatomical features of the urethra: it is short and is located next to the vagina.
Despite the infectious nature, often a single pathogen-bacteria is not enough for the development of pathology. Several provoking factors are necessary to create a favorable environment for the propagation of pathogenic flora. Therefore, in medical practice it is customary to distinguish primary (inflammation develops in an absolutely healthy kidney) and secondary pyelonephritis, when the disease occurs against a background of concomitant diseases (prostate adenoma, urolithiasis, etc.).
The latter variant of the pathology is more common and requires more attention from doctors. His therapy is fraught with many difficulties, since it is necessary to treat both pyelonephritis and the concomitant disease.
Main reasons
In the primary form of pyelonephritis, a defeat of a healthy organ occurs. In this case, the cause of the disease are microbes. They can live in the human body or enter the body from the outside. As a rule, in studies in the urine, Escherichia coli, staphylococcus, Klebsiella or enterococcus are found.
A slightly different etiology in secondary pyelonephritis. Against the background of existing pathologies and abnormalities in the work of the body, this form of the disease develops. It is, first of all, about the following disorders:
- Urolithiasis disease. A calculus with a diameter of more than 5 mm can aggravate the outflow of urine in any part of the urinary system.
- Cystitis. In 50% of cases, inflammation of the bladder causes pyelonephritis. Infection from the bladder freely penetrates the ureters into the pelvis and kidney tissue.
- BPH. An enlarged prostate gland compresses the urethra, causing urine retention.
- Pregnancy. In women in the situation, chronic secondary pyelonephritis is most often found . The medical history is often left unattended, so patients later learn about the existing pathology.
- Narrowing (stenosis) of the ureter. This violation can be either congenital or acquired.
- Anomalies in the structure of organs (horseshoe-shaped kidney, organ prolapse, etc.). In almost 100% of cases, congenital malformations provoke the development of pyelonephritis.
Clinical picture
The disease, by definition, is secondary. Therefore, its appearance is often preceded by signs of primary pathology. This is the so-called triad of symptoms:
- temperature;
- discomfort in the lumbar region;
- changes in urine.
In some cases, secondary pyelonephritis has a latent course. The chronic form of the disease has a slightly different clinical picture, which will be discussed below. First, you need to deal with the triad of symptoms characteristic of the acute course of the disease.
The temperature in the case of pyelonephritis always occurs unexpectedly and remains at high levels for several days. In this case, the patient's condition worsens. He may complain of headache, fatigue, chills and excessive sweating.
Pain in the lumbar region is always present from the affected organ. Sometimes another symptom characteristic of the disease is observed - renal colic. It is accompanied by paroxysmal severe pain, which literally blocks a person. He loses the opportunity to change the position of the body. In some patients, the pain is so severe that they even lose consciousness. An attack can be removed only with the help of potent antispasmodics.
With the "standard" course of the disease, you can observe changes in the urine. It becomes dark and cloudy, sometimes it starts to foam. In the case of a subsequent microscopic examination, bacteria and white blood cells will be detected in the fluid. However, with acute secondary pyelonephritis of this kind, changes rarely occur. This is due to the fact that obstruction of the ureter does not allow urine from the diseased kidney to enter the bladder. Urine from a healthy organ will flow into it. As a result, a standard urine test will be "clean." That is why ultrasound is always additionally recommended to confirm the diagnosis.
The course of the disease in young patients
Secondary pyelonephritis in children is usually manifested by symptoms resembling a fever. The attack begins with the appearance of chills. At the same time, the baby is greatly shaken, it is possible to increase the temperature to high levels. Sometimes it reaches 41 degrees. General malaise is accompanied by nausea and vomiting. Profuse sweating leads to a decrease in temperature, severe weakness.
In children, secondary chronic pyelonephritis develops much more often than in adults. This is due to the anatomical and physiological characteristics of the kidneys of a child who have underdeveloped fatty capsules. Therefore, hypothermia of the organ occurs very quickly, especially in the winter season. On the other hand, the circulatory system is not yet very long. For this reason, infections are much easier to get to the kidneys, because the immune system does not have time to destroy it.
The manifestation of a chronic form of the disease
Developing after a primary acute pyelonephritis, the secondary form is often chronic. This situation is possible if the treatment was not effective enough. Secondary chronic pyelonephritis is characterized by the following clinical picture:
- headache;
- chills;
- weakness;
- mild back pain, and it can be on the side of a healthy kidney;
- low temperature (no more than 38 degrees).
It is very difficult to identify this form of the disease in a timely manner. Weakness throughout the body, apathy, and back lumbar pain - such symptoms may indicate not only secondary chronic pyelonephritis. They are characteristic of many disorders, including the inflammatory process in the body, recent stress, and even the common cold. That is why you should not try to diagnose yourself, start treatment. It is better to seek help from a specialist in the field.
Medical examination
Diagnosis of the disease is carried out exclusively in a clinical setting. A timely visit to a doctor allows you not only to correctly diagnose and start therapy, but also to avoid the development of serious complications.
To confirm secondary (obstructive) pyelonephritis, a comprehensive examination is carried out, consisting of the following measures:
- Analysis of urine. With an active inflammatory process, he will show leukocyturia and bacteriuria. Protein may also be present in urine.
- Blood analysis. An increase in white blood cells and lymphocytes, an acceleration of ESR up to 45 mm / h indicates pyelonephritis.
- Indicators of comparative leukocytosis are necessary to determine which of the kidneys is involved in the pathological process. To this end, blood sampling is carried out from the fingers of both hands.
- Survey radiography. Helps determine the presence of stones or tumor formations in the organs, which are most often the cause of the disease.
- A study of blood serum for urea.
- Ultrasound of the pelvic organs.
- A program using a contrast agent. It is carried out to assess the state of the excretory system. The study is recommended to be repeated three times with an interval of 30 minutes.
A physical examination of the patient with palpation of the affected area is mandatory. During such an examination, the doctor specifies the time of onset of the initial symptoms of the disorder, possible causes. The history of past kidney disease is studied in detail.
Conservative therapy
Treatment of secondary pyelonephritis, especially with attacks of renal colic, is carried out in a hospital. It is possible to achieve recovery at home only in exceptional cases and with a mild form of the disease.
First of all, with pyelonephritis, the patient is prescribed a therapeutic diet. It implies the exclusion of spicy and fried foods, spices, saturated fish and meat broths. Alcohol and coffee are prohibited. The diet should mainly consist of vegetables and fruits. Lean fish species are allowed. Particular attention is recommended to be given to the drinking regimen. For example, you should drink at least 3 liters of fluid per day. Compotes, milk and liquid dishes cannot be included in this volume.
Antibiotics are considered the “gold standard” for treating secondary pyelonephritis. Initially prescribed drugs with a wide spectrum of action intravenously or intramuscularly. During the diagnosis, all patients, without exception, are prescribed urine culture on microflora with further determination of the pathogen sensitivity to antibiotics. The results of this analysis come no earlier than 7 days later. After this, the previously prescribed antibiotics are canceled, and only those to which the causative agent of the disease is sensitive are left.
Symptomatic therapy implies the use of antispasmodics (No-Shpa, Drotaverin), anti-inflammatory (Ketorol, Diclofenac) and antipyretic drugs.
Surgical intervention
Surgery for secondary pyelonephritis is prescribed in case of ureteral occlusion with calculi. The amount of intervention is determined by the severity of the pathology, the size of foreign objects in the genitourinary system.
If the stone is small, a catheter is inserted into the ureter. Another condition for the procedure is the prescription of the disease. Catheterization is possible only in the first 3 days of the exacerbation phase of chronic pyelonephritis.
When the course of the pathology is complicated by large calculi, a series of consecutive operations is prescribed to the patient. First, puncture nephrostomy is performed - drainage of the kidney under the control of an ultrasound machine. This procedure allows you to get rid of internal pressure, and the patient gets the opportunity to eat and drink normally.
Then the kidney itself is examined for its functionality. If the organ is healthy and has a positive prognosis for recovery, an operation to remove the stone is prescribed. Most often resort to laparoscopic intervention. A more progressive method is the crushing of stone using ultrasound. The remaining sand and debris are excreted from the body naturally.
Sometimes the patient seeks help too late. In such cases, the course of secondary pyelonephritis can be complicated by pyonephrosis, purulent fusion of the parenchyma. Such unpleasant consequences are an indication for a nephroectomy - an organ resection. The operation avoids subsequent necrosis and blood poisoning. It is carried out under general anesthesia, and in the future the patient is given a disability group.
Help traditional medicine
For the treatment of acute inflammatory process, recipes of folk doctors show low efficiency. Their help is usually resorted to in the chronic course of pathology and only as an addition to the main course of therapy.
For example, phytotea helps well to relieve pain and reduce swelling. It is prepared using chamomile, celandine, burdock and elderberry. All ingredients must be mixed in equal proportions, pour a glass of 2 liters of boiling water and take the infusion several times a day.
Before using this or that prescription, you must always consult your doctor. Some advice from folk healers can do more harm than potential benefits to the body.
Prevention Methods
Prevention of secondary pyelonephritis is reduced to the treatment of the underlying ailment. For example, with urolithiasis, you need to follow a strict diet to avoid re-formation of calculi. In case of cystitis - monitor the hygiene of the genitals, do not supercool the body. With abnormalities in the structure of the genitourinary system, timely surgical intervention is recommended.
Also, to prevent the disease, a comprehensive medical examination should be performed twice a year with a mandatory urinalysis. Men are advised to timely treat "profile" diseases. We are talking about prostatitis, adenoma and prostate cancer.
In the fair sex, inflammatory processes in the kidneys occur mainly in the second half of pregnancy. At this time, the fetus begins to put especially strong pressure on the pelvic organs. To prevent secondary pyelonephritis, doctors advise several times a day to take a body position that excludes increased pressure on the ureters. In addition, you should regularly visit a gynecologist and undergo the examination recommended by a specialist in time.