Pyelonephritis - symptoms of acute and chronic forms, treatment and drugs. Signs and treatment of pyelonephritis in women

Good day, dear readers!

In today's article, we will consider with you such as pyelonephritis, as well as everything connected with it. So…

What is pyelonephritis?

Pyelonephritis – inflammatory disease kidneys, which affects mainly their pyelocaliceal system (calyces, pelvis, tubules and parenchyma of the kidneys, more often its interstitial tissues).

main cause of pyelonephritis- infection of the kidneys with E. coli (Escherichia coli), staphylococci, enterococci and other pathogens, but to a greater extent, still bacteria. It is not uncommon for the disease to develop due to the simultaneous damage to the organ by several types of infection, especially a pair of E. coli + enterococci.

Synonyms of pyelonephritis - pyelitis (inflammatory-infectious process is limited only to the pelvis of the kidney).

Pyelonephritis is characterized severe course and symptoms such as - severe pain in the area of ​​the affected kidney and increased, often up to high values Body temperature.

If we talk about the distribution by gender, then pyelonephritis in women occurs almost 6 times more often than in men, and this inequality is observed even among children.

The appearance and development of pyelonephritis, as we said, is due. Pathogenic microflora reaches the pyelocaliceal system in an ascending way - from the reproductive system to the bladder and above, to the kidneys. Such a phenomenon usually produces poor urine patency, for example, with (prostatic hyperplasia), prostatitis, decreased tissue elasticity due to aging of the body. It is also allowed to get the infection downstream when a person becomes seriously ill, and the infection, getting into the bloodstream or lymphatic system spreads throughout the body.

The onset of the disease is predominantly severe - acute pyelonephritis. The kidney at the same time increases in size, its capsule becomes thickened. After, the surface of the kidney may bleed, signs of perinephritis may appear. In the kidney itself, during acute pyelonephritis, to the interstitial tissue there is a large number of perivascular infiltrates, as well as a tendency to abscess formation (formation).

Purulent formations in combination with bacterial microflora move further and capture the lumen of the tubules and begin to form pustules in the medulla of the kidney, which in turn form serous-yellowish purulent stripes reaching the papillae. If the process is not stopped, the blood circulation in the kidney is disturbed and the parts of the organ cut off from the blood supply, and, accordingly, the nutrition, begin to die (necrosis).

If you leave everything as it is, do not consult a doctor, or take any antibiotic without consultation that did not completely stop the spread of the infection, the disease often becomes chronic.

Acute pyelonephritis is accompanied by high body temperature, chills, acute pain, bacteriuria, leukocyturia.

Chronic pyelonephritis is characterized by less pronounced symptoms, however, exacerbations of the disease may occur periodically, especially when exposed to various pathological factors (hypothermia and others).

Pyelonephritis can be primary and secondary.

Primary pyelonephritis develops as an independent disease - with direct infection of the kidneys.

Secondary develops against the background various diseases, for example, when urolithiasis.

Distribution of pyelonephritis

The disease pyelonephritis is annually diagnosed in 1% of the world's population (about 65,000,000 people).

Most of the pyelonephritis is in women, in a ratio of 6 to 1 compared to men.

The preponderance was also noticed between children, towards the female body. However, in old age, pyelonephritis in men is more common, which is associated with some characterized by urodynamic disorders.

Pyelonephritis accounts for 14% of all kidney diseases.

Pyelonephritis in pregnant women, on average, occurs in 8% of women, and the trend is increasing - over the past 20 years, the number of cases has increased 5 times.

This kidney disease is considered difficult to diagnose. So, autopsies show that every 10-12 deceased had pyelonephritis.

With adequate therapy, symptoms are minimized in almost 95% of patients already in the first days from the start of treatment.

Pyelonephritis - ICD

ICD-10: N10-N12, N20.9;
ICD-9: 590, 592.9.

Among the main signs of the disease can be identified ...

Symptoms of acute pyelonephritis

• Severe pain in pyelonephritis is one of the main signs of the disease, the localization of which depends on the affected kidney. Pain can also carry a girdle character, radiating to the lower back. Increased pain is observed on palpation or deep breathing;
• Symptoms of intoxication of the body, which are accompanied by a lack of appetite, and malaise;
• , which during the day can either drop to 37 ° C, then rise again, ;
• , muscle pain;
• increased frequency of urination;
• Moderate swelling of the patient;
• The presence of bacteria and leukocytes in the urine and blood of the patient;
• Approximately 10% of patients may develop bacterimic shock;
• Among not specific symptoms can be observed - , .

Symptoms of chronic pyelonephritis

• Frequent urge to urinate;
• Pain during urination, with a feeling of cutting;
• Urine is dark in color, often cloudy, sometimes bloody, and may smell like fish.

In urine and blood tests, the inflammatory process may not make itself felt - only a certain amount of leukocytes can be observed in the urine, and the period of remission, the indicators are mostly normal.

Complications of pyelonephritis

Among the complications of the disease can be identified:

• kidney failure;
• kidney abscess;
• septic shock;
• Kidney carbuncle;
• kidney necrosis;
• paranephritis;
• Uronephritis;
• Necrotic papillitis;
• Lethal outcome (mainly due to sepsis).

The main cause of pyelonephritis is infection in the kidneys, mainly - coli(Escherichia coli), and others (Proteus, Clecibella, Pseudomonas, Enterobacter, mycotic microorganisms).

A secondary cause is a decrease in reactivity immune system, because of which the body is not able to repel the attack of pathogens, stopping the infection, preventing it from settling and further spreading.

A decrease in the protective properties of immunity is facilitated by -, an inactive lifestyle, uncontrolled intake of medications.

How does infection get to the kidneys?

The source of E. coli, which is responsible for the development of pyelonephritis in 90% of all cases, is the intestine. Other types of infection can get through contact with dirty hands, personal hygiene items.

During emptying, from the anus, the infection often enters the urinary system - the urethra, due to their close location. It is because of this feature that pyelonephritis in women develops most often.

Pyelonephritis in children often develops due to a pathology such as vesiculourethral reflux (vesicoureteral reflux)

Vesiculourethral reflux is characterized by the reverse flow of urine from the bladder to the ureters and partly to the renal pelvis. If this pathology not detected in time, frequent reflux of urine and its stagnation lead to the multiplication of pathological microorganisms throughout the urinary system, resulting in the development inflammatory process in the kidneys.

Other negative consequence vesiculourethral reflux is a violation of the structure of the kidneys - the more often there is stagnation of urine with an acute inflammatory process, the faster the normal renal tissue is replaced by scars. As a result, the work of the kidneys is disrupted, it is becoming more and more difficult for them to perform their function.

Doctors note the presence of vesicoureteral reflux in most children with diagnosed pyelonephritis, under the age of 6 years. In addition, kidney disease childhood often causes serious harm to health for the rest of a person's life - about 12% of all patients on hemodialysis in childhood had pyelonephritis.

Another cause of pyelonephritis, but quite rare, is the infection of the kidneys through the blood and lymphatic system from other organs and systems. This is facilitated by the presence of common infectious diseases especially with complications.

Other Causes of Pyelonephritis (Risk Factors)

• Urolithiasis, in which the normal outflow of urine is disturbed, and, accordingly, it stagnates;
• kidney stone disease;
• Transferred operational methods treatment of the pelvic organs;
• Damage spinal cord;
• , AIDS;
• Obstruction of the bladder due to the introduction of a catheter into it;
• Increased sexual activity in a woman;
• Other diseases and various pathologies of the urinary system - urethritis, neurogenic bladder dysfunction, uterine displacement, etc.

Pyelonephritis in pregnant women can develop due to bearing a child. This is due to the fact that sometimes during pregnancy the tone decreases, and the peristalsis of the ureters also decreases. The risk is especially high when narrow pelvis, large fruit or polyhydramnios.

Types of pyelonephritis

The classification of pyelonephritis is as follows:

By occurrence:

• Primary;
• Secondary.

Along the way of infection:

• Ascending - from the urethra to the kidneys, through the urinary canal;
• Descending - through the blood and lymph.

According to the patency of the urinary tract:

• obstructive;
• Not obstructive.

By localization:

• Unilateral;
• Bilateral.

With the flow:

Acute pyelonephritis- can flow next type(forms):

• Serous;
• Purulent;
  - focal infiltrative;
  - diffuse infiltrative;
  - diffuse with abscesses;
• with mesenchymal reaction.

Chronic pyelonephritis- can be divided into the following forms:

• Asymptomatic;
• Latent;
• Anemic;
• Azometic;
• Hypertensive;
• Remission.

Outcome:

• Recovery;
• Transition to a chronic form;
• Secondary wrinkling of the kidney;
• Pyonephrosis.

Classification of chronic pyelonephritis, taking into account the developments of V.V. Serov and T.N. Hansen:

- with minimal changes;
- interstitial-cellular, which can have the following forms:

• infiltrative;
• sclerosing.

- interstitial-vascular;
- interstitial-tubular;
- mixed form;
- sclerosing pyelonephritis with wrinkling of the kidney.

Diagnosis of pyelonephritis

Diagnosis of pyelonephritis includes the following examination methods:

• Anamnesis;
• Gynecological examination;
• kidneys;
• Cystography;
• excretory urography;
• Nephroscintigraphy;
• renography;
• Retrograde pyeloureterography;
• Angiography of the arteries of the kidneys.

• General urine analysis;
• Bacteriological examination of urine;
• Urinalysis according to Nechiporenko;
• Zimnitsky's test;
• Gram stain of urine;
• prednisone test.

Pyelonephritis - treatment

How to treat pyelonephritis? Treatment of pyelonephritis includes the following items:

2. Drug treatment:
2.1. Antibacterial therapy;
2.2. antifungal therapy;
2.3. Anti-inflammatory therapy;
2.4. Infusion-detoxification therapy;
2.5. Strengthening the immune system;
2.6. Normalization of beneficial intestinal microflora;
2.7. Other medicines.
3. Physiotherapy.
4. Diet.
5. Surgical treatment.

1. Bed rest, hospitalization.

In the early days of acute pyelonephritis, it is necessary to observe bed rest, and it is especially important to focus on the frequent stay in a horizontal position, i.e. lie.

Damp cold is very dangerous during this period, so try to stay warm so that complications and exacerbation of pyelonephritis do not form.

If the patient's condition does not allow outpatient treatment and taking medications at home, the patient is subject to hospitalization.

2. Drug treatment (drugs for pyelonephritis)

Important! Before using medications, be sure to consult your doctor!

2.1. Antibiotics for pyelonephritis

Antibacterial therapy for pyelonephritis is an integral part of the overall course of treatment, but only if the root cause of this disease is a bacterial infection.

Before obtaining data from a bacteriological study of urine, antibiotics are prescribed empirically, i.e. a wide range actions. After receiving these analyzes, therapy is adjusted - antibiotics are prescribed more purposefully, depending on the type of pathogen. This point is important enough so that in the future, not to develop resistance (resistance) to antibacterial drugs in the body.

Thus, at the beginning of antibacterial therapy against pyelonephritis, antibiotics fluoroquinolones ("Ciprofloxacin", "Ofloxacin") or cephalosporins ("Cefepin", "Cefixime", "Cefotaxime", "") are usually prescribed.

Further, combinations of more narrowly targeted antibiotics are prescribed - fluoroquinolones + cephalosporins or penicillin + aminoglycosides. The second combination is used less frequently, since many people of our time have developed resistance (resistance) of pathogenic microflora to penicillins.

To increase the effectiveness, it is best to use antibacterial drugs intravenously. Also intravenous infusion These drugs are advisable if the patient has nausea and vomiting attacks.

The course of antibiotic therapy lasts from 1 to 2 weeks, which largely depends on the severity of the disease and the effectiveness of treatment. After the first course, the doctor may prescribe a second course of treatment, but with other antibacterial drugs.

The diagnosis of "Healthy" is made if, within a year after treatment, a bacteriological examination of urine does not show the presence of an infection in the body.

2.2. Antifungal therapy

Antifungal therapy is prescribed if the cause of pyelonephritis is a fungal infection.

Among the antifungal drugs (antimycotics) for pyelonephritis, the most popular are Amphotericin, Fluconazole.

2.3. Anti-inflammatory therapy

Elevated temperature in pyelonephritis is considered normal, since this is an infectious disease, which is why immunity and raises the temperature to stop and destroy the infection.

If the temperature fluctuates around 37.5 ° C, you should not take any action, but to alleviate the course of the disease, you can apply a compress to the frontal part of the head (water at room temperature + vinegar).

In the case of a rapid increase in body temperature to high levels - up to 38.5 ° C and above (in children up to 38 ° C), then the administration of antipyretic drugs of the NSAID group (non-steroidal anti-inflammatory drugs) is prescribed - Diclofenac, Metamizol, "" , "". Children can accept "".

It is also worth noting that taking drugs from the NSAID group also relieves pain in pyelonephritis.

2.4. Infusion-detoxification therapy

Symptoms of intoxication, accompanied by nausea, vomiting, high body temperature, headache, lack of appetite, general weakness and malaise, are the most common companions of infectious diseases. This is primarily due to the poisoning of the body not only by infectious agents, but also by the waste products of pathological microorganisms, which are actually toxins (poison). In addition, the use of antibacterial or antifungal drugs destroy the infection, but do not remove it from the body.

To cleanse the body of toxins, infusion-detoxification therapy is used, which includes:

• Plentiful drink, preferably with the addition of vitamin C, the use of mineral waters is especially useful;
• Intravenous infusion of glucose solutions, polysaccharides ("dextran") and water-salt solutions;
• The use of detoxification drugs - "Atoxil", "Albumin".

2.5. Strengthening the immune system

The development of pyelonephritis, as we said, is due not only to the infection itself, but also to weakened immunity, which is responsible for preventing the spread of infectious agents throughout the body.

To strengthen immunity, immunomodulators are prescribed, among which are Imudon, IRS-19, Timogen.

Vitamin C (ascorbic acid) is considered a natural stimulant of immunity, a large amount of which can be found in, cranberries, dogwood, mountain ash, currants,.

2.6. Normalization of beneficial intestinal microflora

The disadvantage of antibiotic therapy is a number of side effects, one of which is the destruction of beneficial intestinal microflora, which is involved in the digestion and assimilation of food.

To restore the intestinal microflora, probiotics are prescribed - Linex, Bifiform, Acipol.

2.7. Other drugs and therapies

Treatment for pyelonephritis may additionally include the following medications:

• Anticoagulants - reduce blood clotting, preventing the formation of blood clots: "Heparin", "Hirudin", "Dicoumarin";
• Glucocorticoids (hormones) - are used to reduce the inflammatory process: "Dexamethasone", "Hydrocortisone".
• Antioxidants - are prescribed to normalize the state of biological membranes, which has a beneficial effect on the fastest recovery from diseases of the urinary system -, β-carotene, ubiquinone (coenzyme Q10), selenium and other substances;
• Oxidants - are prescribed when signs appear kidney failure- cocarboxylase, pyridoxal phosphate;
• For prescribe: beta-blockers ("Atenolol") or diuretics ("Furosemide");
• Hemodialysis - is prescribed if the kidneys do not cope with their function;
• To maintain the functioning of the kidney, functional passive gymnastics is sometimes used for them - 20 ml of furosemide is prescribed 1-2 times a week;
• Other drugs for the treatment of pyelonephritis are Canephron, Urolesan, Fitolizin.

3. Physiotherapy

Physiotherapeutic procedures (physiotherapy) for pyelonephritis help to eliminate the inflammatory process, relieve pain, normalize urine outflow, relax the muscles of the urinary tract, which generally leads to an improvement in the course of the disease and accelerate recovery. However, physiotherapy is not used in the following cases- active phase of pyelonephritis, terminal stage chronic form of the disease, polycystic kidney disease, as well as hydronephrosis in the stage of decompensation.

Among the physiotherapeutic procedures for pyelonephritis are:

• Electrophoresis using antimicrobials("Furadonin" and others);
• Magnetotherapy;
• ultrasound therapy;
• Microwave therapy;
• Amplipulse therapy;
• Laser therapy;
• Therapeutic baths, using carbon dioxide and sodium chloride.

The diet for pyelonephritis has the following goals:

• Reducing the burden on the kidneys and gastrointestinal tract;
• Normalization metabolic processes in the body of the patient;
• Lowering the patient's blood pressure to normal levels;
• Removal of edema;
• Removal of toxic substances from the body, in fact, this item duplicates the goal of detoxification therapy.

M.I. Pevzner developed a special therapeutic diet for the treatment of kidney diseases -, with nephritis - which are often used in the treatment of pyelonephritis.

The daily calorie content of the diet is 2400-2700 kcal.

Diet - 5-6 times a day.

Cooking method - steaming, boiling, baking.

Other features - the amount of protein is slightly reduced, and fats and carbohydrates are consumed as if normal condition health. The amount of salt should not exceed 6 g per day.

It is necessary to focus on drinking plenty of water - at least 2-2.5 liters of water per day. The more you drink, the faster the infection with toxins is eliminated from the body.

When choosing food, remember that alkalization of the body contributes to the faster destruction of the infection, while acidity - favorable conditions for its reproduction.

What can you eat with pyelonephritis? Not fatty varieties meat and fish (chicken, beef, hake), soups (with vegetables, milk, cereals), cereals, pasta, dairy products, butter, olive and sunflower oil, zucchini, pumpkin, carrots, beets, cucumbers, parsley, dill, unsalted yesterday's bread, watermelon, melon, pastries, weak tea, rosehip broth, cranberry and other fruit drinks, jelly, compote.
What can not be eaten with pyelonephritis? Rich broths, fatty meats and fish (carp, crucian carp, bream, pork), seafood, smoked meats, pickles, sauerkraut, pickles, semi-finished products (sausages, sausages, caviar), spinach, sorrel, radish, radish, onion, mushrooms, legumes (peas, beans, beans, chickpeas), margarine, alcoholic drinks, carbonated drinks, coffee, strong tea, cocoa.

Confectionery and pastries are limited. Eggs - no more than 1 per day.

4. Surgical treatment

Surgical treatment is advisable in the following cases:

• Obstruction of the urinary tract, in which percutaneous puncture nephrostomy is used;
• In violation of the outflow of urine from the affected kidney, ureteral catheterization is used;
• At purulent formations in the kidneys, the kidney is decapsulated;
• With apostematous pyelonephritis, decapsulation of the kidney is performed with opening of the apostem;
• When it is opened and excised;
• With an abscess, it is opened and the walls are excised;
• With sepsis, increasing renal failure, nephrectomy (removal of the kidney) is used.

Important! Before using folk remedies against pyelonephritis, be sure to consult your doctor!

Bearberry. The use of bearberry relieves the inflammatory process, normalizes the functioning of the kidneys, improves urination, inhibits the vital activity of bacterial microflora and removes toxins from the body. Exacerbation of pyelonephritis and others, as well as pregnancy, are a contraindication to taking funds with bearberry.

To prepare the product, you need 1 tbsp. pour a spoonful of dry raw materials with a glass of water and set aside the product overnight for infusion. In the morning, the infusion is filtered and drunk 1-2 tbsp. spoons 3 times a day, before meals. The course of treatment is from 1 to several months.

Harlay (spreading cornflower, prostrate cornflower). Harlay grass helps relieve pain in pyelonephritis, as well as accelerate the recovery of the kidneys and other organs of the urinary system.

For cooking healing agent it is necessary to pour a pinch of chopped grass into a small saucepan / scoop and pour it with a glass of water. Then, over low heat, bring the product to a boil, boil it for another 2-3 minutes, remove from heat, cover and set aside to cool and infuse for 30 minutes. Next, strain the remedy and drink 3 approaches, 10 minutes before meals. The course of treatment is a month, after a monthly break is made and the course is repeated. The chronic form of the disease may require taking this remedy for a year or two.

Cranberry. Very useful is cranberry juice, which not only improves the general condition of the body due to the ascorbic acid and other vitamins contained in it, but also helps to restore the immune system with other systems. To prepare cranberry juice, you need to squeeze the juice from a glass of cranberries and pour it into another container. Pour the remaining cake with 500 ml of boiling water, put on the stove and boil for 5 minutes, cool. Next, you need to mix boiled cake with pre-squeezed juice and drink 1 glass of fruit drink per day.

Pyelonephritis is an inflammation of the kidneys that occurs in acute or chronic form. The disease is quite widespread and very dangerous to health. Symptoms of pyelonephritis include pain in the lumbar region, fever, severe general condition and chills. Occurs most often after hypothermia.

It can be primary, that is, it develops in healthy kidneys, or secondary, when the disease occurs against the background of already existing kidney diseases (glomerulonephritis, etc.). There are also acute and chronic pyelonephritis. Symptoms and treatment will directly depend on the form of the disease.

This is the most frequent illness kidneys in all age groups. More often they suffer from young and middle-aged women - 6 times more often than men. In children, after diseases of the respiratory system (,) takes second place.

Causes of pyelonephritis

Why does pyelonephritis develop, and what is it? The main cause of pyelonephritis is infection. Infection refers to bacteria such as E. coli, Proteus, Klebsiella, Staphylococcus and others. However, when these microbes enter the urinary system, the disease does not always develop.

In order for pyelonephritis to appear, contributing factors are also needed. These include:

1. Violation of the normal flow of urine (reflux of urine from the bladder to the kidney, "neurogenic bladder", prostate adenoma);
2. Violation of the blood supply to the kidney (deposition of plaques in the vessels, vasospasm with, diabetic angiopathy, local cooling);
3. Immune suppression (treatment with steroid hormones (prednisolone), cytostatics, immunodeficiency as a result);
4. Pollution of the urethra (non-compliance with personal hygiene, with incontinence of feces, urine, during sexual intercourse);
5. Other factors (decrease in secretion of mucus in the urinary system, weakening local immunity, impaired blood supply to the mucous membranes, urolithiasis, oncology, other diseases of this system, and in general any chronic diseases, reduced fluid intake, abnormal kidney anatomy).

Once in the kidney, microbes colonize the pelvicalyceal system, then the tubules, and from them - the interstitial tissue, causing inflammation in all these structures. Therefore, you should not put off the question of how to treat pyelonephritis, otherwise severe complications are possible.

Symptoms of pyelonephritis

In acute pyelonephritis, the symptoms are pronounced - it starts with chills, when measuring body temperature, the thermometer shows over 38 degrees. After a while, aching pain in the lower back appears, the lower back "pulls", and the pain is quite intense.

The patient is disturbed by the frequent urge to urinate, very painful and indicating accession and. Symptoms of pyelonephritis may be general or local manifestations. General signs This:

• High intermittent fever;
• Severe chills;
• Sweating, dehydration and thirst;
• Intoxication of the body occurs, as a result of which the head hurts, fatigue increases;
• Dyspeptic symptoms (nausea, no appetite, stomach ache, diarrhea appears).

Local signs of pyelonephritis:

1. Pain in the lumbar region, on the affected side. The nature of the pain is dull, but constant, aggravated by palpation or movement;
2. The muscles of the abdominal wall may be tense, especially on the affected side.

Sometimes the disease begins with acute cystitis - rapid and, pain in the bladder area, terminal hematuria (appearance of blood at the end of urination). In addition, general weakness, weakness, muscle and headache, lack of appetite, nausea, and vomiting are possible.

If these symptoms of pyelonephritis appear, you should consult a doctor as soon as possible. In the absence of competent therapy, the disease can turn into a chronic form, which is much more difficult to cure.

Complications

• acute or chronic renal failure;
• various suppurative diseases of the kidneys (kidney carbuncle, kidney abscess, etc.);

Treatment of pyelonephritis

In primary acute pyelonephritis, in most cases, the treatment is conservative, the patient must be hospitalized in a hospital.

The main therapeutic measure is the impact on the causative agent of the disease with antibiotics and chemical antibacterial drugs in accordance with the data of the antibiogram, detoxification and immunity-enhancing therapy in the presence of immunodeficiency.

In acute pyelonephritis, treatment should begin with the most effective antibiotics and chemical antibacterial drugs, to which the microflora of urine is sensitive, in order to eliminate the inflammatory process in the kidney as quickly as possible, preventing its transition to a purulent-destructive form. In secondary acute pyelonephritis, treatment should begin with the restoration of urine massage from the kidney, which is fundamental.

Treatment of the chronic form is fundamentally the same as the acute form, but longer and more laborious. At chronic pyelonephritis treatment should include the following main activities:

1. Elimination of the causes that caused the violation of the passage of urine or renal circulation, especially venous;
2. The appointment of antibacterial agents or chemotherapy drugs, taking into account the data of the antibiogram;
3. Increasing the immune reactivity of the body.

Restoration of the outflow of urine is achieved primarily by the use of one or another type surgical intervention(removal of prostate adenoma, kidney stones and urinary tract, nephropexy with, plastic of the urethra or ureteropelvic segment, etc.). Often, after these surgical interventions, it is relatively easy to obtain a stable remission of the disease without long-term antibacterial treatment. Without sufficiently restored urine massage application antibacterial drugs usually does not give long-term remission of the disease.

Antibiotics and chemical antibacterial drugs should be prescribed taking into account the sensitivity of the patient's urine microflora to antibacterial drugs. To obtain antibiogram data, antibacterial drugs with a wide spectrum of action are prescribed. Treatment for chronic pyelonephritis is systematic and long-term (at least 1 year). The initial continuous course of antibiotic treatment is 6–8 weeks, since during this time it is necessary to suppress the infectious agent in the kidney and resolve the purulent inflammatory process in it without complications in order to prevent the formation of cicatricial connective tissue. In the presence of chronic renal failure, the appointment of nephrotoxic antibacterial drugs should be carried out under constant monitoring of their pharmacokinetics (concentration in the blood of urine). With a decrease in the indicators of humoral and cellular immunity, various drugs are used to increase immunity.

After the patient reaches the stage of remission of the disease, antibiotic treatment should be continued in intermittent courses. The timing of interruptions in antibacterial treatment is set depending on the degree of kidney damage and the time of onset of the first signs of an exacerbation of the disease, i.e., the appearance of symptoms of the latent phase of the inflammatory process.

Antibiotics

Medicines are selected individually, taking into account the sensitivity of the microflora to them. The most commonly prescribed antibiotics for pyelonephritis are:

• penicillins with clavulanic acid;
• 2nd and 3rd generation cephalosporins;
• fluoroquinolones.

Aminoglycosides are undesirable because of their nephrotoxic effects.

How to treat pyelonephritis with folk remedies

Home treatment of pyelonephritis with folk remedies must be accompanied by bed rest and health diet, consisting mainly of plant foods in raw, boiled or steam form.

1. During the period of exacerbation, such a collection helps. Mix equally taken white birch leaves, St. John's wort and knotweed grass, calendula flowers, fennel fruits (dill). Pour in a thermos 300 ml of boiling water 1 tbsp. l. collection, insist 1-1.5 hours, strain. Drink warm infusion in 3-4 doses 20 minutes before meals. The course is 3-5 weeks.
2. Outside of an exacerbation of the disease, use a different collection: knotweed herb - 3 parts; herb yasnotki (deaf nettle) and grass (straw) oats, leaves of sage officinalis and round-leaved wintergreen, rose hips and licorice roots - 2 parts each. Take 2 tbsp. l. collection, pour 0.5 l of boiling water in a thermos, leave for 2 hours and strain. Drink a third cup 4 times a day 15-20 minutes before meals. The course is 4-5 weeks, then a break for 7-10 days and repeat. In total - up to 5 courses (until stable results are obtained).

Diet

With inflammation of the kidneys, it is important to observe bed rest and a strict diet. Drink enough fluids to stop dehydration, which is especially important for pregnant women and people over 65.

With inflammatory processes in the kidneys, it is allowed: lean meat and fish, stale bread, vegetarian soups, vegetables, cereals, soft-boiled eggs, dairy products, sunflower oil. In small quantities, you can use onions, garlic, dill and parsley (dried), horseradish, fruits and berries, fruit and vegetable juices. Forbidden: meat and fish broths, smoked meats. You also need to reduce the consumption of spices and sweets.

Pyelonephritis is a disease in which the parenchyma, or otherwise the kidney, becomes inflamed. In most cases, this condition is triggered by bacteria invading the kidneys, which can reach them through the urethra, bladder, or blood vessels.

Important for successful treatment pyelonephritis is early diagnosis and adequate treatment. If the problem is neglected, a kidney infection may be necessary condition for permanent damage or uncontrolled spread of bacteria in the blood and dangerous sepsis, even life threatening.

According to the method of flow, pyelonephritis is divided into:

1. acute pyelonephritis - the period of the disease up to 3 months;
2. chronic pyelonephritis - in patients with pyelonephritis, the infection is active for more than 3 months. There are signs of exacerbation and lull symptoms. What is typical in this case is that it is always the same cause;
3. recurrent pyelonephritis - in this form there are acute infections, the basis of which is another pathogen.

Chronic pyelonephritis

The frequency of chronic pyelonephritis is higher than in other forms. The disease itself is an inflammation of the kidney tissue that results from urinary tract obstruction or urinary reflux.

In many patients, it first appeared in childhood. Lack of adequate treatment is a prerequisite for the disease to become chronic. At a late stage of the disease, an infected kidney significantly reduces its size, changes the color and surface of the organ, and the kidneys are severely deformed.

When recognizing chronic pyelonephritis, attention should be paid to a number of individual symptoms. Their diversity is due to various factors, predisposing factors and characteristics of the organism itself.

In order to determine with certainty that this is a chronic form of the disease, it is noted that periods of acute manifestation of the condition alternate with moments of calm symptoms. In matters of crisis, the patient complains of general fatigue, problems with urination, and pain in the waist area.

If no attention is paid to the condition, it is difficult for the infected kidney to function in the end stage of chronic pyelonephritis, which leads to kidney failure.

Causes of pyelonephritis

Most infections that affect the kidneys begin first in the lower urinary tract, in the urethra or in the bladder. Gradually, with reproduction, the bacteria rise up the urethra and reach the kidney. Among the most common causes of the disease is the bacterium Escherichia coli. Rarely - pathogens such as Proteus, Pseudomonas, Enterococcus, Stafilococ, Chlamydia and others.

Another possible scenario is the presence of an infection in the body, which reaches the kidney through the bloodstream and becomes a necessary condition for pyelonephritis. This happens relatively rarely, but the danger increases if the body has foreign body. A heart valve, artificial joint, or other infected person is taken as such.

IN rare cases pyelonephritis develops after kidney surgery.

Risk factors for pyelonephritis

Considering the most common causes of kidney infection, one can also determine following groups risk factors:

• Gender - Women are thought to be at greater risk of kidney infection than men. The reason lies in the anatomy of the excretory system in women. A woman's own urethra is much shorter than a man's, making it much easier for bacteria to move out of the external environment into the bladder. One more thing - the anatomical proximity of the urethra, vagina and anus also creates the conditions for an easier bladder infection and therefore for bacteria to enter the kidneys;
• urination problems - obstruction of the urinary tract and all other problems that interfere with normal urination and prevent complete emptying of the bladder can lead to inflammation of the kidney tissue. This group of factors includes abnormalities in the structure of the urinary tract, kidney stones, prostate enlargement in men, and others;
• weakened immune system - some diseases are considered a prerequisite for the development of pyelonephritis. Diabetes, HIV infection and others are similar. The target factor is also the deliberate weakening of the immune system, for example, by taking drugs after organ transplantation;
• damaged nerves are irregularly functioning nerves around the bladder or spinal cord that block the symptoms that accompany a bladder infection. Thus, the body does not respond to inflammation, which is easily transferred to the kidneys;
• catheter - extended catheter use is a prerequisite for infections urinary system;
• vesicourethral reflux - last but not least, a risk factor is the so-called vesicourethral reflux, in which a small amount of urine returns from the bladder towards the urethra and kidneys.

Symptoms of pyelonephritis

Pain is often present in pyelonephritis!

If you have a bladder infection and have not received adequate treatment, expect some of the characteristic features inflammation of the parenchyma in the kidneys in the near future. Among the most common symptoms of the disease are the following:

• increased body temperature;
• tingling pain in the back, waist, on one side of the body, or in the groin;
• severe pain in the abdomen;
• frequent, strong and uncontrollable urination urgency;
• pain, burning and other complaints during urination;
• blood or pus in the urine.

The symptoms listed above should be treated with due care. If adequate measures are not taken and timely treatment does not exist, there may be a number of complications, including:

• renal failure - pyelonephritis may be at the root of chronic renal failure;
• blood poisoning - due to the rich blood supply to the kidneys, the spread of bacteria multiplying in them quickly becomes colorless and can lead to complete blood poisoning;
• in pregnancy - the main risk during pregnancy of untreated kidney disease is premature birth of an underweight newborn.

Pyelonephritis in a child

In infants and children in early age observed pyelonephritis with mild fever, vomiting. There is complete fatigue and lack of weight. The child indicates pain in the abdomen through anxiety.

If it is a very young child, kidney infection may also occur with weight loss, unreasonable agitation, seizures, darkening of the complexion or skin coloration in a white or yellow tint, swelling of the abdomen. You must immediately consult a doctor.

In older children, the main symptoms of inflammation of the kidney tissue are pain in the abdomen and waist, frequent urination, burning or pinching during urination. Complaints are supplemented by high fever, alternating constipation with diarrheal stools, lack of appetite, and headaches.

How to determine pyelonephritis

If you've had pain in your waist or groin, if you've got a fever, or if you've had a burning sensation while urinating, you're probably already convinced that you should go to the doctor's office. As soon as the specialist analyzes the symptoms that you have indicated, he will most likely diagnose pyelonephritis. Physical examination, urinalysis, and others are indicated as an accompanying diagnostic method. Urine itself is examined both microbiologically and under a microscope. The first test detects the presence of bacteria and it is important to combine this with pathogen susceptibility testing. this antibiotic. Under a microscope, a urine sample is monitored for white and red blood cell counts, and for the presence of epithelial cells and protein.

Frequent imaging is an abdominal ultrasonography. It controls the changes that occur in acute pyelonephritis. It should be borne in mind that the absence of changes in the kidneys does not exclude the presence of a kidney infection in all cases.

As possible methods detection of pyelonephritis is also shown more CT scan, magnetic resonance imaging and venous urography.

Treatment of pyelonephritis

First of all - when it comes to the treatment of pyelonephritis, antibiotics are recommended. This is no coincidence - it is the antibiotic that can neutralize the harmful bacteria that cause kidney infections.

As a rule, just a few days after the start of antibiotic therapy, the general condition of the patient improves. In rare cases, a course of treatment lasting a week or more is required. It is extremely important not to stop taking medications after the symptoms disappear, as this can lead to resistance to other pathogens present in the body.

If the diagnosis is late and the patient's condition is already severe, it may be necessary to treat with intravenous antibiotics.

Surgical intervention for pyelonephritis is also not excluded. This is the case with defects in the structure of the organs of the urinary system, which provoke frequently recurring infections of the kidneys. Surgery is also necessary in case of large kidney abscesses leading to purulent outbreaks.

The main objectives of the treatment of pyelonephritis may be the following:

• timely accurate diagnosis and appropriate initiation of treatment;
• elimination of predisposing factors, as far as possible;
• prescribing antibiotics according to antibiotic results;
• simultaneous treatment and relapses in the presence of rabbits;
• general strengthening of the body and strengthening of immune defenses.

Antibiotics for pyelonephritis

The most commonly assigned groups are:

• aminoglycosides - this group includes amikacin, tobramycin, gentamicin and others;
• beta-lactams - amoxicillin, zinaz and others;
• quinolones - ciprofloxacin, ofloxacin and others;
• macrolides;
• polymyxins and others.
• ciprofloxacin

Ciprofloxacin

One of the most commonly prescribed antibiotics for urinary tract infections is ciprofloxacin. It belongs to the group of fluoroquinolones, and its action is aimed directly at eliminating the cause of the infection. The data show that a course of treatment with ciprofloxacin for 7 days would be as effective in pyelonephritis as therapy with the same product for 14 days. It is usually taken from 5 to 21 days, and it is up to the doctor to determine the duration of treatment.

Gentamicin

Further, as a commonly prescribed antibiotic for pyelonephritis, gentamicin is mentioned. It should be borne in mind that patients with concomitant disease kidney and hearing impairment should be very careful while taking this medicine.

In severe cases of infection, treatment with gentamicin begins as intravenous therapy, then progresses to muscle injection. The dose is obtained by dissolving in saline.

Amoxicillin

The group of penicillin drugs includes amoxicillin, which is also used to treat inflammation of the parenchyma in the kidneys. Recommended daily dose the drug is up to 3000 mg, divided into several receivers. The dose is determined based on the individual condition.

Osmamox and Amoxicl are similar products containing amoxicillin.

Levofloxacin

For the treatment of pyelonephritis, the antibiotic Levofloxacin or a similar product Tavanic is also often prescribed. They belong to quinol drugs and act against bacteria, causing infection in the human body.

Tobramycin

An antibiotic of the aminoglycoside group, Tobramycin is also prescribed for kidney infections depending on the results of the antibiotic. It is administered as an injectable solution that destroys the pathogens from which the disease arises.

Other drugs for the treatment of pyelonephritis

We have already mentioned that the main attention in the treatment of pyelonephritis is given to antibiotic therapy.

However, another group of drugs that many consider antibiotics also work for kidney problems. We are talking about chemotherapy drugs. The difference between the two classes of drugs is that while antibiotics are made from living microorganisms, chemotherapeutics are completely synthetic.

The most popular product of this group, which is applicable to pyelonephritis, is Biseptol. It is most often prescribed for acute illness and may be extended. The choice falls on this drug when single-component therapy is ineffective or there is no oral treatment.

Nitrox also belongs to the group of chemotherapeutic agents. It is used to treat kidney disorders, including pyelonephritis, caused by viral or fungal infections. It is also often prescribed to prevent relapse.

Nolicin contains norfloxacin and acts directly on the bacteria that cause kidney inflammation. It can also be used prophylactically.

uro-waxom is a drug commonly used for pyelonephritis. Its action, however, is aimed at increasing the immune capacity of the body and limiting infections of the urinary tract and urinary tract in general. It is used in frequent repeated infections, as well as with antibiotic therapy for higher efficiency.

Homeopathy for pyelonephritis

We will also briefly mention some of the homeopathic products that are used for diseases of the urinary system, especially for kidney infection. As with other homeopathic treatments, it is also important to take the appropriate prescriptions regularly.

Apis- homeopathic product mainly used for urinary retention, but also for pain and discomfort during urination. The effect of therapy is the urgency of urination.

Arnica- its action is aimed at reducing pain during urination.

Berberis- Most often for the treatment of pyelonephritis, it is prescribed together with Calcarea Sulfurica. The combination of drugs is suitable in cases where the intensity of pain increases.

Pyelonephritis is a non-specific inflammatory disease of the kidneys of bacterial etiology, characterized by damage to the renal pelvis (pyelitis), calyces and parenchyma of the kidney.

In view of the structural features of the female body, pyelonephritis is 6 times more common in women than in men. The most common causative agents of the inflammatory process in the kidney are Escherichia coli (E. coli), Proteus (Proteus), enterococci (Enterococcus), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and staphylococcus (Staphylococcus).

If we talk about the frequency of occurrence of this disease, it should be noted that among the adult population it is approximately 10 out of 1000 people, and among children - 10 out of 2000. Most of the cases belong to the middle age group - from 26 to 44 years. An interesting fact is that more than 70% of all patients are young women who fell ill shortly after the first sexual intercourse. Among children's diseases, inflammation of the kidneys securely holds the 2nd position immediately after various respiratory diseases (bronchitis, pneumonia, etc.).

What it is?

Pyelonephritis is a nonspecific inflammatory process with predominant lesion tubular system of the kidney, predominantly of bacterial etiology, characterized by damage to the renal pelvis (pyelitis), calyces and parenchyma of the kidney (mainly its interstitial tissue).

Based on puncture and excision biopsy of the renal tissue, three main variants of the course of the disease are revealed: acute, chronic and chronic with exacerbation.

Causes of pyelonephritis

In women, due to anatomical features, the ascending (urinogenic) route of infection in the pelvis and renal tissue comes first - due to, and anomalies in the structure urinary system, long-term presence of a catheter for excretion of urine. It is also possible hematogenous (with blood flow) spread of infection, when any focus can become a potential source - transferred purulent mastitis, inflammation of the ear and even inflammation of the dental canal (pulpitis).

The main microbe that causes pyelonephritis is Escherichia coli (up to 75% of all cases). The remaining 25% of cases are associated with the entry into the urinary tract of Klebsiella, Proteus, Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, fungal infection, chlamydia, salmonella, etc.

Risk factors in the occurrence of pyelonephritis in women are all protracted pathological processes of any localization, occurring with a decrease general immunity body: diabetes, bone marrow disease, neurological problems (multiple sclerosis), HIV infection, condition after chemotherapy or organ transplant.

Interesting facts about pyelonephritis:

• In the United States of America, 1 in 7,000 people gets sick every year. 192,000 patients need and receive hospitalization every year.
• It has been established that female representatives suffer from pyelonephritis more often than men by 5 times. acute form The disease is diagnosed more often in women of reproductive age who are sexually active.
• With adequate treatment, up to 95% of all patients notice a significant improvement in the first two days.
• You should not refuse to drink plenty of water due to pain during emptying of the bladder, as this is the only way to remove bacteria from the body. You should urinate as often as possible so that there is no such serious complication as blood poisoning, as a result of which a person may die.
• Abundant fluid intake is an essential condition for the treatment of the disease. For drinking it is necessary to use clean water, which normalizes the balance in the body, thins the blood, promotes the speedy removal of pathogenic microorganisms and toxic products of their vital activity. The effect is achieved by increasing the number of urination as a result of heavy drinking.
• Alcoholic drinks, coffee, carbonated water - all this is prohibited in pyelonephritis. It is believed that cranberry juice can help in the fight against the disease. It is consumed in pure form or diluted with water.
• Pyelonephritis affects children, both girls (in 3% of cases) and boys (in 1% of cases). In childhood, the disease is dangerous for its complications. Thus, cicatricial changes in the kidney parenchyma are diagnosed in 17% of children who have been ill, hypertension in 10-20% of children.

Chronic pyelonephritis

This is an inflammatory process in the kidneys, during which scarring of the kidney parenchyma occurs.

In case no sudden pain(as in the acute course of the disease). The disease is often accompanied by arterial hypertension. The most common reason patients seek medical advice is poor results. laboratory research. If the patient has inflammation of both kidneys, polyuria and nocturia (nighttime urination) occur, associated with impaired urine concentration.

Chronic pyelonephritis is associated with a violation of the outflow of urine. Violation of the outflow of urine causes the occurrence of its certain volume in the bladder, despite frequent urination. This condition contributes to the development of infection. If left untreated, complications can occur, such as kidney failure.

Pyelonephritis - symptoms in women

The weaker sex is more susceptible to such a disease, but only in the first two age periods, i.e. up to about 45-50 years. Everything is explained by the structure of the urethra - it is short and is located next to the intestine and genital tract.

This increases the risk of developing pyelonephritis - symptoms in women appear as follows:

• nausea or vomiting;
• poor appetite;
• weakness and high fever;
• frequent trips to the toilet;
• cloudy or bloody urine and pain when urinating;
• pain in the lower back, worse in cold weather;
• colic and pain in the lower abdomen;
• unusual discharge.

Pyelonephritis in pregnant women

Unfortunately, pregnant women are very likely to develop a dangerous infectious kidney disease. In about seven percent of cases, a woman during pregnancy becomes ill with a similar ailment.

Often, symptoms appear, starting from the second trimester. Often the symptoms are not taken seriously, leading to complications such as sepsis, kidney failure, and premature birth, anemia. Bacteriuria in pregnant women can occur without vivid symptoms if a woman gives birth to a child not for the first time. In mothers with many children, as a rule, signs of pyelonephritis appear only in the later stages.

Infectious kidney disease of an inflammatory nature is very insidious. The whole problem lies in the frequent asymptomatic course of the disease. As a result, a person does not apply for medical care and may suffer from serious complications. There are frequent cases of death of pregnant women from pyelonephritis for this very reason.

Symptoms

The most common symptoms of acute pyelonephritis include:

1. Pain in the lumbar region on the affected side. In non-obstructive pyelonephritis, the pain is usually dull, aching character, can be low or reach high intensity, take on a paroxysmal character (for example, with obstruction of the ureter by a stone with the development of the so-called calculous pyelonephritis).
2. Dysuric phenomena are not typical for pyelonephritis itself, but can occur with urethritis and cystitis, which led to the development of ascending pyelonephritis.

General symptoms are characterized by the development of intoxication syndrome:

• fever up to 38-40 ° C;
• chills;
• general weakness;
• loss of appetite;
• nausea, sometimes vomiting.

For children, the severity of the intoxication syndrome is characteristic, and the development of the so-called. abdominal syndrome (severe pain not in the lumbar region, but in the abdomen).

In elderly and senile people, an atypical clinical picture often develops either with an erased clinic or with pronounced common manifestations and the absence of local symptoms.

Possible Complications

In the absence of adequate therapy, pyelonephritis threatens with the following consequences:

• (to protect the body from intoxication, it is necessary to regularly resort to the use of an artificial kidney device);
• sepsis (in case of penetration of bacteria into the bloodstream);
• chronization of the process (painful exacerbations are periodically observed);
• severe kidney damage;
• development of urolithiasis (renal colic is periodically observed);
• death (as a result of blood poisoning - sepsis or kidney failure).

Diagnostics

1. Biochemistry of blood. Reveals an increased number of urea, creatinine, potassium. The content of an increased amount of potassium characterizes the development of renal failure.
2. Blood study. It will show the course of the inflammatory process in the body (acceleration of ESR, the presence of a large number leukocytes).
3. Urine culture. The liquid is sown on a special nutrient medium. After a while, the growth of a certain bacterium that provoked inflammation will be indicated. Thanks to sowing, the doctor will be able to choose the right antibiotic therapy.
4. Analysis of urine. In the case of pyelonephritis, urine will be alkaline, with a pH of 6.2-6.9. In addition, the shade of the liquid is evaluated. In the presence of pyelonephritis, urine acquires a dark, sometimes even reddish color. It often contains protein.
5. Research on Nechiporenko. This method allows you to identify a significant predominance of leukocytes in the urine over erythrocytes.
6. prednisone test. The event allows you to diagnose a pathology that is characterized by a latent course. The patient is administered the drug Prednisolone intravenously in combination with sodium chloride. After 1 hour after this, the woman needs to collect urine, then after 2 and 3 hours. And after a day. Urine is sent for a detailed study. Increased amount leukocytes will indicate the course of pyelonephritis.
7. Zemnitsky's test. The method allows you to detect a reduced density of urine. With pyelonephritis, nocturnal diuresis (the amount of urine excreted) prevails over daytime.

To confirm pyelonephritis and differentiate it from other pathologies, the doctor will prescribe the following measures:

1. excretory urography. Allows you to detect the mobility of the kidney. The study characterizes the condition of the cups, the tone of the urinary tract.
2. Ultrasonography. To get an idea of ​​the size of the kidneys, their structure, density, the presence of calculi in them, an ultrasound is taken. In the case of a chronic process, the echogenicity (the ability to reflect ultrasound) of the parenchyma is increased, in the acute phase it is unevenly reduced.
3. Cystometry. This study allows you to identify pathologies of the bladder. The principle of examination is based on determining the volume of the urea.
4. Cystography. This is an x-ray contrast study that can detect vesicoureteral reflux or intravesical obstruction.
5. CT scan. Detailed study of the structure of the kidney. Unlike ultrasound, it allows you to determine the condition of the pelvis, vascular pedicle and perinephric tissue.

How to treat pyelonephritis?

At home, pyelonephritis in women and men is treated with antibacterial and symptomatic therapy in combination. To eliminate the symptoms of the disease, the following conditions must be met:

1. It is important to observe the drinking regimen throughout the entire period of treatment.
2. For the first few days, the patient must observe bed rest, that is, be warm in a horizontal position.
3. To reduce body temperature and eliminate pain, it is necessary to use NSAIDs, including: Diclofenac, Metamizole. In childhood, paracetamol is indicated.

Given the infectious nature of the disease, the presence of predisposing factors, the main clinical symptoms the main therapeutic areas are:

• infection control (antibacterial drugs);
• elimination of obstruction of the ureters or renal pelvis, as well as other anatomical or neurogenic obstructions that make normal outflow of urine impossible;
• decrease in the severity of intoxication syndrome (drink more fluids, bed rest, antipyretics);
• power correction.

Particular attention in the treatment is given to the diet, with which you can have a gentle effect on inflamed kidneys, normalize metabolism, remove toxins from the body, restore diuresis, and lower blood pressure.

If an exacerbation of a chronic disease or primary acute pyelonephritis occurs against a background of high temperature, accompanied by a drop in pressure, severe pain, suppuration and impaired normal outflow urine, surgery is required. The patient must be hospitalized if treatment is not possible. medicines at home (vomiting after taking pills from pyelonephritis), as well as with severe intoxication. In other situations, at the discretion of the doctor, treatment can be carried out on an outpatient basis.

Antibacterial therapy

It is desirable that the antibiotic be selected on the basis of the results of bacteriological culture of urine with the determination of the sensitivity of the pathogen to various drugs. In the case of acute pyelonephritis, immediately after the seeding, a broad-spectrum antibiotic from the fluoroquinol group, for example, Tsiprolet, may be prescribed and adjusted according to the results of the seeding. Antibacterial therapy should continue for at least 2-3 weeks.

New in the treatment of pyelonephritis

1) A group of first-line antibiotics - fluoroquinolones.

• The drugs of choice are Cefixime (400 mg per day) and Levofloxacin (0.5-0.75 1 time per day) in tablets.
• Ciprofloxacin 0.5-0.75 twice daily and Norfloxacin 400 mg twice daily remain relevant only in previously untreated patients.

2) 2nd line antibiotics (alternative) - Amoxicillin with clavulanic acid (625 mg) 3 times a day. With culture-proven sensitivity, Ceftibuten 400 mg once daily can be used.

3) Pyelonephritis in pregnant women is no longer treated with amoxicillin, and, regardless of the gestational age, the following drugs are prescribed:

• Cefibuten 400 mg once a day or
• Cefixime 400 mg once a day or
• Cefatoxime 3-8 g per day in 3-4 injections intramuscularly or intravenously or
• Ceftriaxone 1-2 g per day once intramuscularly or intravenously.

4) In severe pyelonephritis requiring hospitalization, therapy in a hospital is carried out with carbopenems (Ertapenem, Miranem) intramuscularly or intravenously. After the patient has been observed for three days normal temperature, therapy can be continued oral medications. An alternative to carbopenems are Levofloxacin and Amikacin.

Diet for pyelonephritis

In the acute stage, the diet should be as sparing as possible. It is necessary to drastically reduce salt intake (no more than 5-10 grams per day, with high blood pressure - 2-3 grams), and completely exclude spicy, spicy, smoked and canned foods, strong meat broths, spices, coffee and alcohol.

Allowed: egg white, dairy products, vegetarian (vegetable) dishes, boiled or steamed. As the inflammation subsides, fish and lean meat are introduced into the diet. It is recommended to consume juices, compotes, gourds, vegetables, fruits, and also drink 2-2.5 liquids daily (in the absence of edema).

During the remission period, it is allowed to gradually introduce some spices, garlic and onions into the diet in small portions. Very useful for patients suffering from chronic pyelonephritis, cranberry juice, stimulating the production of hippuric acid (an effective bacteriostatic agent). Allowed foods: fruits, vegetables, cereals, eggs, lean boiled meat and fish, low-fat dairy products.

Forecast

There are two types of exits from pyelonephritis - full recovery or chronic status. With timely treatment, the prognosis is mostly favorable. In most cases, relief comes after 3-5 days drug therapy. The body temperature decreases, the pain subsides, the general condition of the patient returns to normal. With a favorable course of treatment, a person leaves the hospital after 10-12 days.

In the presence of remission of pyelonephritis, antibiotics are prescribed for 6 days. When acute pyelonephritis becomes chronic and there are complications, the prognosis is poor. In this case, there is a high probability of renal failure, pyonephrosis, arterial hypertension, etc.

It is very important after the cure to follow the rules recommended by the doctor, regularly take urine tests and take preventive measures. The sooner the patient seeks help from a doctor, the higher the chances of a timely cure and the absence of complications.

Prevention

In order not to bring yourself to pyelonephritis - prevention should be carried out taking into account certain rules:

1. Usage medicinal herbs as a preventive measure.
2. If pathological process infectious etiology located in any other organs, it must be sanitized, since bacteria can spread to the kidneys with the help of blood.
3. Getting rid of bad habits, since alcohol and smoking significantly reduce the immune properties of the body, which inhibits the ability to respond to the penetration of bacteria and viruses into the body.
4. The body must get enough rest and sleep, as an exhausted body is not able to fight a bacterial infection.
5. Persons who are at risk of developing the disease should regularly conduct laboratory and instrumental research methods in order to prevent pyelonephritis.

Compliance with these rules does not provide significant work, you should only carefully pay attention to your own health to carry out treatment at the early stages of the pathological process.

Pyelonephritis is an infectious pathology of the kidneys, which is more often catarrhal (superficial inflammation of the mucosa). With this disease, the pyelocaliceal system, tubules and epithelial tissues become inflamed. The glomeruli are not affected, so uncomplicated pyelonephritis does not affect kidney function. The disease often affects one organ, but there is also bilateral infection.

The causative agents of pyelonephritis can be bacteria, viruses, fungi. The infection penetrates the kidneys from the outside or enters the urinary system with blood flow from its own focus of inflammation in the body. So, for example, an unsanitized oral cavity can become the cause of pyelonephritis. The disease can occur in acute or chronic form.

The disease can be called female, since the weaker sex is susceptible to infection five times more often than men. This difference is due to the difference in the structure of the male and female urinary system. Pathogenic microorganisms enter the kidneys mainly in an ascending way - from the bladder through the ureter to the pelvis, then into the calyces and deep into the connective tissue.

The physiology of a man protects him from the penetration of pathogens from the outside. The barriers are a long, tortuous, and narrow urethra, as well as an isolated location of the urethra.

In women, in 90% of cases, the pathogen infectious process is Escherichia coli. This is due to the proximity of the opening of the urethra and anus. The female urethra is wider, and its length is about 2 cm on average. In close proximity is the entrance to the vagina. Together, this creates favorable conditions for the penetration of bacteria or fungi into the bladder. One has only to add non-compliance with hygiene, hypothermia, synthetic underwear, daily.

The remaining 10% of infections are caused by various viruses and bacteria. Such as: chlamydia, enterococcus, Pseudomonas aeruginosa, fungal infections, Staphylococcus aureus, salmonella.

Risk factors

By themselves, the causative agents of pyelonephritis are constantly present in the human body. The question is, when their number exceeds the boundaries of “permitted” and the body ceases to cope with their vital activity, an inflammatory process occurs.

Causes of pyelonephritis in women:

• Weakened immunity due to hypothermia, poor nutrition, chronic fatigue, stress. Each of these factors can serve as a trigger for kidney inflammation in a woman. When adding several of them, the likelihood of illness increases significantly.
• Hormonal changes during menopause, pregnancy.
• Availability chronic pathologies urinary tract or bladder.
• The presence of chronic foci of infection in the body. These are: caries, bronchopulmonary pathologies, tonsillitis.
• Kidney disease.
• Congenital pathologies of the development or structure of the urinary system.
• Old age and associated pathological changes (omission, prolapse of the vagina, uterus, dry mucous membranes, polymicrobial flora).
• Diabetes, obesity, thyroid disease.
• Traumatization of the urinary tract during diagnostic or therapeutic manipulations. The introduction of a catheter almost always leads to acute pyelonephritis.

The causes in men lie most often in the already existing pathologies of the bladder. Inflammation of the kidneys here occurs against the background of problems in prostate is an adenoma, a prostatitis. These diseases are internal sources of infection and provoke a mechanical obstruction to the outflow of urine. The combination of these factors leads to inflammation of the kidneys.

Clinical picture

Distinguish between primary and secondary pyelonephritis. Its complicated course and uncomplicated. The disease can develop independently on initially healthy organs, or it can be a secondary infection on pathologically altered kidneys. Depending on what features accompany the inflammatory process, the clinical picture of the disease also changes.

Symptoms of acute pyelonephritis are manifested brightly. This:

• temperature increase;
• manifestations of infectious intoxication: loss of appetite, nausea, lethargy, general malaise;
• irritability, tearfulness;
• palpitations, hot flashes;
• "Kenal" swelling - face, arms, legs (as opposed to "heart", when the lower half of the body swells, especially the lower leg);
• pain in the lower back, increasing with movement, physical effort;
• frequent urge to urinate.

Exacerbation of chronic pyelonephritis can be almost asymptomatic, especially against the background of existing chronic diseases and age. Here, swelling, pain, fatigue, apathy can be ignored by the patient. These symptoms are often attributed to age, weather, and insomnia. Back pain is explained by osteochondrosis.

At the same time, the blurred clinical picture is complemented by the absence of changes in blood and urine parameters when there is no bacterial culture.

Symptoms of chronic pyelonephritis:

• pain in the lower back or side;
• increased blood pressure;
• frequent urge to go to the toilet.

Pain syndrome in pyelonephritis

Back pain with pyelonephritis is not explained by the fact that "the kidneys hurt." It should be understood that there are no nerve endings in the pelvis, cups, tubules of the kidneys and they cannot hurt. Acute inflammation provokes an increase in the volume of the kidneys, which stretches fibrous membrane organ and here arises sharp pain. A similar mechanism in purulent inflammation.

The chronic course of the disease leads to the occurrence of adhesions between the fibrous and adipose tissue of the kidney membranes. Nerve endings are "bound" and give a long pain syndrome. Often the pain is cross, and the patient complains on the opposite side of the diseased organ.

Changes in the bladder and urine

About 30% of patients with pyelonephritis have acute or chronic cystitis. Hence the frequent urge to go to the toilet, pain and pain during urination, a change in the color of urine, the appearance of a "fishy" smell. Here there is an overlay of symptoms, changing the clinical picture.

In connection with a concomitant infection of the lower part of the urinary system, laboratory parameters of urine also change. Protein, leukocytes, pathological bacterial flora are determined.

When can pyelonephritis be suspected?

Chronic pyelonephritis always begins with an acute one. The first signs of the disease, in which you need to see a doctor:

• An increase in temperature against the backdrop of pain in the lower back.
• Body aches without symptoms of catarrhal cold.
• Unmotivated lethargy, apathy, feeling of fatigue.
• Swelling of the face, hands, feet.

It should be understood that pyelonephritis is not dangerous in itself, but the occurrence of complications in the absence of adequate therapy.

Pyelonephritis and pregnancy

Pregnancy is a special period in a woman's life when her body experiences unusual stress. The kidneys are in a vulnerable position especially as the excretion system is forced to work in dual mode. Pyelonephritis during pregnancy can cause intrauterine malformations in a child due to intoxication of the body.

The risk of a disease in a pregnant woman increases due to atony of the urinary canal, a decrease in immunity. Examination of the kidneys in pregnant women is carried out immediately after contacting the antenatal clinic. and repeat throughout, until childbirth. Often, signs of the inflammatory process are limited to manifestations of periodic pain or pain in the lower abdomen. Any discomfort a woman must necessarily voice at a gynecologist's appointment.

Complications of pyelonephritis

Acute pyelonephritis responds well to therapy and in most cases passes without affecting the functional abilities of the kidneys. If treatment is not started on time or the wrong tactics are chosen, acute inflammation turns into a chronic focus of infection.

A complication of the acute form of the disease is its transition to a chronic process. A complication of chronic pyelonephritis is the transition of inflammation from the epithelial tissue to the renal glomeruli. Damage to the glomeruli leads to a decrease in the filtration capacity of the kidneys. In the future, structural changes in the tissues of organs also develop.

According to the severity of complications are distinguished:

• abscess - purulent inflammation;
• sepsis is an infection of the blood.

Prolonged and sluggish inflammation leads to chronic renal failure.

Diagnostics

Diagnostic measures begin with a survey, examination of the patient. Pasternatsky's symptom (pain when tapping the back in the region of the kidneys) is not the leading one in diagnosis today. Similar pains can occur with cholecystitis, pancreatitis.

Ultrasound of the kidneys is prescribed necessarily bilateral, as well as x-rays. If necessary, an X-ray with a contrast agent is taken.

Diagnosis of pyelonephritis includes the study of urine and blood.

Urine indicators indicating inflammation:

• leukocytes more than 8 in p / sp
• bakposev more than 105
• erythrocytes more than 40%

The results of the examination for pyelonephritis directly determine the tactics of treatment and the choice of medications.

Treatment

Treatment of chronic and acute pyelonephritis is carried out according to different schemes. In the treatment of the acute form of the disease, symptomatic relief and relief come first. general condition sick.

Here they assign:

• antipyretic drugs;
• antispasmodics to relieve pain.

To improve renal circulation, the patient is put to bed for the first two or three days. Plentiful drinking, rest and a sparing diet are shown for the entire duration of treatment.

After receiving the tests, antibiotics are prescribed. The choice mainly falls on the drugs of the new generation of a wide spectrum of action. These are cephalosporins, gentamicin, nitrofurans. If antibiotic therapy does not bring visible results after a few days, then the antibiotics are changed.

Treatment of pyelonephritis in women is carried out in complex therapy with the treatment of the genital area, since genital infections are often primary. The acute form of the disease is cured within 2 weeks. Therapy for chronic pyelonephritis can take up to a year.

Treatment of chronic pyelonephritis begins with antibiotic therapy to stop the inflammatory process. Treatment does not require hospitalization and is carried out under the guidance of a doctor, but at home. Often the patient works and lives a normal life.

Antibacterial therapy begins with the administration of drugs of choice to prevent the development of inflammation. In the future, the appointment is adjusted depending on the results of analyzes for bacterial culture. In chronic pyelonephritis, drugs are prescribed orally. Injections are used in case of severe nausea, vomiting.

A big problem in the treatment of pyelonephritis in women is the increasing tolerance of patients to antibiotics. Consideration should be given to the insensitivity of E. coli to drugs penicillin series. Do not prescribe drugs for the treatment of the inflammatory process in the kidneys, which are classically treated urological diseases- biseptol and 5-nok.

In addition to antibiotics, a good effect in complex therapy is given by:

• non-steroidal anti-inflammatory drugs;
• medicines that increase tone and immunity;
• vitamins.

Patients are shown a sparing diet. Protein foods and salt are limited in the diet. Heavy food, spices, alcohol are completely excluded.

Folk recipes

Traditional medicine suggests using decoctions and infusions of medicinal herbs for the treatment of pyelonephritis. These are anti-inflammatory:

• chamomile;
• yarrow;
• plantain;
• cornflower.

It is better to prepare infusions in a thermos. For 2 st. spoons medicinal raw materials take 200 ml of boiling water, pour for an hour. You should drink several sips throughout the day.

Therapy gives good results folk remedies oats and bearberry. Here, the raw materials should be boiled for 30 minutes, evaporating the broth. Proportions for the preparation of a decoction: 1 tbsp. l. raw materials in a glass of water. The resulting broth is divided into 3 parts and drunk per day.

Rosehip, currant leaves and nettle are recommended as antibacterial and restorative therapy. You can drink it like tea.

Forecast and prevention

The prognosis for pyelonephritis is favorable. With timely diagnosis and correct treatment tactics, the disease resolves without consequences for the kidneys. The control of the state after the acute stage of the disease is shown annually. If within a year after the disease there was no relapse, the tests give a negative result for bacteriological culture, then the patient is considered completely healthy.

Preventive measures for kidney health come down to removing from life the risk factors that provoke the disease:

• do not supercool, including locally, in the lumbar region;
• observe personal hygiene;
• control the health of the genitourinary system;
• regularly take urine tests, a swab from the vagina;
• get enough rest, eat well;
• avoid frequent excesses in food, alcohol;
• drink from 1.5 liters of water daily;
• do not take antibiotics and non-steroidal anti-inflammatory drugs on their own.

If you had pyelonephritis, then be sure to take a blood and urine test once a year.