Acute pyelonephritis treatment. Acute pyelonephritis is an insidious disease leading to the development of renal failure. Instrumental diagnostic methods

What is it - acute pyelonephritis is an inflammatory disease of the kidneys of an acute nature, in which the pyelocaliceal system and the renal parenchyma are affected.

The infection penetrates into the deep tissues of the pelvis and kidneys in a descending (through the blood) or ascending (through the ureter) route.

Hematogenous (or descending) route pathogenic bacteria enter the bloodstream with purulent diseases - bronchitis, osteomyelitis, and then spread throughout the body and penetrate the kidneys. The causative agents of infection in this case are staphylococci, streptococci and other bacteria.

Urinary (or ascending) way penetration of infection into the kidneys is associated with a disease of the urinary tract, in which urination is difficult (with abnormalities in the structure of the urinary tract, stones, tumors, pregnancy). Often the ascending path is associated with the entry of intestinal bacteria into the ureter.

In healthy kidneys, when an infection enters through the blood, an inflammatory process rarely develops. The descending and ascending type of infection spread is more often combined. Acute pyelonephritis is one of the most common kidney diseases (10-15% of all kidney diseases). Women of average, young age and children are more often ill.

Pyelonephritis is classified into types- unilateral (if one kidney is affected) and bilateral (if two kidneys are affected). Acute pyelonephritis can have two forms - primary, if the focus of infection develops in the urinary system, and secondary due to other infectious diseases in the body.

Distinguish pyelonephritis non-obstructive and obstructive(when the urinary tract is blocked). Acute pyelonephritis is serous or purulent.

In its turn purulent pyelonephritis is divided into the following types: focal, diffuse, with abscess. Up to 30% of patients suffer from purulent inflammatory processes in the kidneys.

This insidious disease poses a threat to human life and health, as serious complications can occur! That is why, at the first symptoms, consult a doctor, and do not self-medicate.

Causes of acute pyelonephritis

The cause may be inflammatory processes in any organ. Sometimes in winter, against the background of a cold, acute pyelonephritis develops, accompanied by the same general symptoms as, acute respiratory infections and.

Causes of the disease:

• hypothermia;
• diseases of the urinary system (, inflammation of the bladder, urethra);
• infectious diseases (, tonsillitis, runny nose, osteomyelitis, furunculosis);
• infections of the genitourinary system;
• intestinal bacterium;
• insufficient outflow of urine associated with an abnormal structure or other diseases;

Symptoms of pyelonephritis

There is severe nausea, vomiting, fever causes chills, headache and tremor. If the passage (outflow of urine) is disturbed, this leads to intoxication of the body.

In addition, acute pyelonephritis is accompanied by other signs - vomiting, weakness, severe sweating, dry mouth, weakness appear. A pyogenic infection that enters the urinary tract causes the appearance of pustules on the walls of the kidney. This leads to severe pain and. Urinalysis always shows the presence of mucus, pus, an increase in the number of leukocytes and ESR in the urine.

Clinical signs of acute pyelonephritis:

• severe pain or renal colic;
• high body temperature;
• chills, weakness, tachycardia, headache;
• nausea, vomiting;
• violation of the outflow of urine.

If acute pyelonephritis is suspected, urgent hospitalization is necessary. Only an extended examination will help establish the correct diagnosis, exclude a tumor and choose the necessary treatment tactics.

Diagnosis of pyelonephritis

• What is acute pyelonephritis
• Symptoms of acute pyelonephritis
• Treatment of acute pyelonephritis

What is acute pyelonephritis

Acute pyelonephritis can be primary (less often) and secondary (much more often). In the vast majority, one kidney is affected. Bilateral acute pyelonephritis is much less common than unilateral.

Pathogenesis (what happens?) during Acute pyelonephritis

Morphologically, both primary and secondary acute pyelonephritis can occur as a serous (more often) and gynoic (less often) inflammatory process with its predominant localization in the interstitial tissue.

In acute serous pyelonephritis, the kidney is enlarged, dark red. Due to the increase in intrarenal pressure during the dissection of the fibrous capsule, the kidney tissue protrudes (prolapses). Histologically, numerous perivascular infiltrates are found in the interstitial tissue.

Serous pyelonephritis is characterized by foci and polymorphism of the lesion: foci of inflammatory infiltration alternate with areas of unchanged (healthy) renal tissue. There is also swelling of the interstitial tissue with compression of the renal tubules. In most cases, there are phenomena of paranephritis, swelling of the perirenal tissue. With timely active treatment and a favorable course of the disease, it is possible to achieve a reverse development of the inflammatory process. In other cases, serous pyelonephritis becomes purulent with a more severe clinical picture and course.

Acute purulent pyelonephritis morphologically manifests itself in the form of pustular (apostematous) nephritis, solitary abscess and carbuncle of the kidney. In the case of penetration of the infection by the urogenous route, significant changes are observed in the pelvis and cups: their mucous membrane is hyperemic, the cavities are enlarged, and pus is contained in the lumen. Often there is necrosis of the papillae of the pyramids. Foci of purulent inflammation can merge with each other and lead to the destruction of the pyramids. In the future, the cortical substance of the kidney is also involved in the pathological process with the development of small abscesses (pustules) in it - apostematous nephritis.

With a hematogenous route of infection, multiple pustules ranging in size from a pinhead to a pea are first formed in the cortex, and then in the medulla of the kidney. At first they are in the interstitium, then they affect the tubules and finally the glomeruli. Pustules can be located in the form of single small abscesses or in groups. When removing the fibrous capsule, superficially located pustules are opened. Pas section they are visible in the cortex and in the medulla. The kidney is enlarged, dark cherry in color, the perirenal tissue is sharply edematous. Changes in the pelvis and cups are usually less pronounced than in urogenic purulent pyelonephritis. Merging with each other, small pustules form a larger abscess - a solitary abscess.

Kidney carbuncle is a large abscess (from a lentil grain to the size of a chicken egg), consisting of several or many small pustules that merge with each other. Outwardly, it resembles a carbuncle of the skin, by analogy with which it got its name. Sometimes it can be combined with apostematous nephritis; more often it is unilateral and solitary. Simultaneous development of carbuncles in both kidneys is rare (about 5% of cases). As with other forms of acute purulent pyelonephritis, purulent paranephritis may develop.

The considered variants of acute purulent pyelonephritis are different stages of the same purulent-inflammatory process. In addition, microscopically detected expansion of the tubules and collecting ducts, in the interstitial tissue - leukocyte (sometimes massive) infiltrates, in place of which, with a favorable course of the disease, scar tissue develops. When recovering from acute pyelonephritis, wrinkling of the kidney does not occur, since the development of cicatricial changes due to the death of renal tissue is not diffuse, but focal in nature.

Symptoms of acute pyelonephritis

The initial clinical manifestations of primary acute pyelonephritis usually occur after a few days or weeks (on average, after 2-4 weeks) after the attenuation of a focal infection (tonsillitis, exacerbation of chronic tonsillitis, mastitis, osteomyelitis, furunculosis, etc.).

The disease is characterized by general and local symptoms. With primary purulent pyelonephritis and the hematogenous route of infection, the general symptoms of the disease are more pronounced, and with secondary pyelonephritis and the urogenic route of infection, local symptoms come to the fore. In typical cases, a triad of symptoms is characteristic: chills followed by fever, dysuric phenomena and pain in the lumbar region (on both sides - with bilateral and on one side - with unilateral pyelonephritis).

Acute pyelonephritis often begins with general symptoms due to intoxication: headache, weakness, general malaise, muscle and joint pain, chills with fever and subsequent profuse sweating. The severity of these clinical manifestations is different.

Purulent pyelonephritis is much more severe than serous, sometimes in the form of urosepsis and bacteremic shock. Chills are amazing, followed by an increase in temperature to 39-40 ° C, sometimes up to 41 ° C. After 1-2 hours, profuse sweat appears and the temperature drops for a short time. Chills with a sharp rise in temperature and profuse sweating are repeated daily, several times a day. Purulent pyelonephritis is characterized by a hectic-type temperature with daily fluctuations of up to 1-2 ° or more, but it can also remain persistently elevated. Repeated hectic temperature increase at certain intervals is due to the appearance of new pustules (in patients with apostematous pyelonephritis) or the formation of a new solitary abscess.

In the blood, there is a pronounced leukocytosis (up to 30-40 thousand or more) with a neutrophilic shift of the leukocyte formula to the left, an increase in ESR to 40-80 mm/h or more. However, a clear dependence of changes in the peripheral blood on the severity of clinical manifestations is not always observed: in severe cases of the disease, as well as in debilitated patients, leukocytosis may be moderate, insignificant or absent, and sometimes even leukopenia is noted.

Local symptoms of acute pyelonephritis (pain in the lumbar region, dysuric phenomena, changes in the urine) do not always occur at the onset of the disease and may have varying degrees of severity.

At the onset of the disease, pain in the lumbar region or in the upper abdomen is of uncertain nature and localization. Only after 2-3 days they take a clear localization in the region of the right or left kidney, often with irradiation to the right or left hypochondrium, to the inguinal region, to the genitals; aggravated at night, by coughing, by moving the corresponding leg. In some patients, in the first days of the disease, pain may be absent altogether and appear only after 3-5 days, and sometimes after 10-14 days. A positive symptom of Pasternatsky is noted, although not always, as well as soreness and protective tension of the abdominal muscles on the side of the affected kidney.

If the abscess is localized on the anterior surface of the kidney, the peritoneum may be involved in the inflammatory process with the development of peritoneal symptoms. In such cases, severe pain in combination with symptoms of peritoneal irritation often leads to an erroneous diagnosis of appendicitis, acute cholecystitis, pancreatitis, perforated gastric ulcer and other diseases, especially if there are no dysuric phenomena and pathological changes in the urine, as is often the case in the first days of the disease. With frequent and painful urination, the diagnosis of pyelonephritis is simplified.

The most important laboratory signs of acute pyelonephritis are proteinuria, leukocyturia, and significant (true) bacteriuria, especially if they are found simultaneously. Proteinuria in the vast majority of cases does not exceed 1.0 g / l (from traces to 0.033-0.099-1.0 g / l) and is represented mainly by albumins, less often by p-globulins. Sometimes it reaches 2-3 g / l, but may be absent. Leukocyturia (pyuria) is the most characteristic sign of pyelonephritis; it often reaches significant severity (leukocytes cover all fields of view or are found in clusters) and may be absent only if the inflammatory process is localized only in the cortical substance of the kidney or if the ureter is obstructed (blockage by a stone) in case of unilateral lesion. Sometimes it is transient. Often there is erythrocyturia, mainly in the form of microhematuria, less often - macrohematuria (with necrosis of the renal papillae, calculous pyelonephritis). The severe course of the disease is also accompanied by cylindruria (granular and waxy cylinders).

Bacteriuria is found in most cases, however, like leukocyturia, it is intermittent, so repeated urine tests for microflora are important. To confirm pyelonephritis, only the presence of true bacteriuria matters, that is, at least 50-100 thousand microbial bodies in 1 ml of urine.

Impaired kidney function with an increase in blood urea, creatinine, sometimes to a large extent, is possible (in about 1/3 of patients) with severe bilateral kidney damage, in rare cases and to a small extent - in patients with unilateral pyelonephritis.

Severe forms of pyelonephritis, especially bilateral, lead to liver damage and the development of hepatorenal syndrome with a violation of protein-forming, neutralizing, pigmentary (with the development of jaundice), prothrombin-forming and its other functions.

The course of acute pyelonephritis has some features depending on the age of the patient (in children, adults, the elderly and the elderly). The disease proceeds especially hard in patients weakened by previous chronic diseases, in particular diabetes mellitus.

Acute pyelonephritis can be complicated by paranephritis, subdiaphragmatic abscess, necrosis of the papillae of the kidneys with the development of acute renal failure, bacteremic shock, hepatorenal syndrome, less often - peritonitis and arterial hypertension.

With early recognition, timely and active treatment, acute pyelonephritis ends in recovery in about 60% of cases. In other cases, it acquires a chronic course with the development of chronic renal failure. They impede the final recovery and contribute to the transition of acute pyelonephritis to chronic late-started, insufficiently active and early-terminated treatment; resistance of microflora to antimicrobial agents; the presence of anomalies in the development of the urinary tract and kidneys, as well as calculi and other causes that disrupt the passage of urine; concomitant intercurrent diseases, often chronic, weakening the body's defenses, and some other factors.

Diagnosis of acute pyelonephritis

Essential in the diagnosis of acute pyelonephritis are ultrasonic, X-ray urological, radioisotope, endoscopic studies, in some cases - and renal angiography, computed tomography. So, with the help of ultrasound and plain X-ray urography, it is possible to establish the location, size, shape of the kidneys, the presence of stones and their localization. Excretory urography provides more valuable information about the state of the structure and function of the kidneys. If the excretory function of the diseased kidney is impaired, the pelvis and ureters on this side are filled with a contrast agent less intensively or their contrasting occurs with a delay, and if the kidney does not function, then they are not detected at all (symptom of "silent kidney"). Excretory urography also allows you to detect stones that are not visible on the survey urogram, as well as various anomalies in the development of the kidneys and urinary tract, pyelectasis, signs of dyskinesia of the cups and ureters, to judge the degree of patency of the latter. With a carbuncle of the kidney or severe inflammatory infiltration of the interstitial tissue, the deformation of the pelvis, narrowing, and sometimes amputation of one or more cups is determined.

Ascending pyelography is used in extreme cases, if other methods do not allow to clarify the nature and degree of structural and functional disorders of the affected kidney and decide on the need for surgical intervention.

Radioisotope renography provides valuable information about a unilateral or bilateral lesion, as judged by the state of the function of the left or right kidney, determined in turn by the nature and severity of the renogram segments (flattening of the curve, decrease in the secretory and excretory segments). In acute pyelonephritis, which arose for the first time, these changes are expressed to a slight or moderate degree.

The renal scan also helps to identify structural and functional disorders of the kidneys, since neohydrin is well absorbed only by functioning tissue. However, radioisotope diagnostic methods are only of auxiliary importance, since the detected changes in the structure and function of the kidneys are not strictly specific for acute pyelonephritis. These methods can be considered as a valuable addition to radiological, in particular to excretory urography.

Endoscopic methods of instrumental research (cystoscopy, chromocystoscopy), as well as retrograde (ascending) pyelography, are carried out in exceptional cases in the acute period of the disease, since even with the most careful observance of aseptic rules, an aggravation of the inflammatory process is possible. They are resorted to when other methods are not enough to clarify the diagnosis or when catheterization of the ureter is necessary as a therapeutic measure (to restore its patency in case of obstruction with calculi, mucus, etc.), and also when the issue of surgical intervention is decided in the absence of effect from conservative treatment.

Chromocystoscopy reveals a decrease or absence of the function of the kidney affected by the inflammatory process, which is determined by the time the paint appears from the mouths of the ureters, the intensity of the jet and the color of the urine, or by the absence of urine output from the mouth of one of the ureters. In addition, catheterization of the ureters makes it possible to obtain separate urine from both kidneys and conduct its study. Identification and elimination of the cause that prevents the normal passage of urine contributes to an increase in the effectiveness of antibiotic therapy for pyelonephritis.

acute pyelonephritis must be differentiated from diseases that proceed in the same way as pyelonephritis, with symptoms of general intoxication, high fever, and a severe general condition. If acute pyelonephritis with such a clinical picture is accompanied by severe headache and meningeal symptoms, it is mistakenly regarded, especially in the absence of local symptoms, as an acute infectious disease (typhoid and typhoid fever, paratyphoid fever, meningococcal infection, etc.), which gives rise to erroneous hospitalization such patients to the infectious diseases hospital. Great difficulties arise in the differential diagnosis between acute pyelonephritis and sepsis, since kidney damage can be one of the local manifestations of sepsis. At the same time, acute purulent pyelonephritis itself can serve as a source of infection and cause sepsis. Therefore, in the absence of other foci of infection, it should be thought that the clinic of sepsis is due to acute pyelonephritis.

Sometimes acute pyelonephritis can occur with a picture of an acute abdomen, peritoneal symptoms, local pain simulating acute cholecystitis, pancreatitis, appendicitis, perforated gastric and duodenal ulcers and other acute diseases of the abdominal organs, which often serves as a reason for referring such patients to surgical departments and performing unnecessary surgeries.

With a latent course of acute pyelonephritis, difficulties arise in the differential diagnosis with acute or chronic glomerulonephritis (see glomerulonephritis), which manifests itself only as an isolated urinary syndrome. The correct diagnosis of acute pyelonephritis is possible only after the exclusion of these diseases, for which it is necessary to know the clinical symptoms and diagnosis of the latter well.

Treatment of acute pyelonephritis

Patients with pyelonephritis are prescribed a complex treatment, which includes a regimen, diet, antibacterial, restorative and detoxifying agents, as well as measures aimed at eliminating the causes that prevent the normal passage of urine.

Patients with acute pyelonephritis need mandatory hospitalization: in urological departments - with secondary, especially purulent, and in nephrological (therapeutic) departments - with primary serous pyelonephritis. The terms of bed rest prescribed in the hospital depend on the severity of clinical manifestations and the characteristics of the course of the disease.

The diet should be varied with a sufficient content of proteins, fats and carbohydrates, highly fortified, with a total daily calorie content of up to 2000-2500 kcal on average. Easily digestible food is recommended - milk and dairy products, cereals, vegetable and fruit purees, white bread.

Since, unlike glomerulonephritis, acute pyelonephritis usually does not cause fluid retention in the body and there are no edema, significant restrictions on fluid and salt intake are not required. On the contrary, for the purpose of detoxification at high temperature and severe general condition, additional administration of liquid is recommended, including parenterally in the form of various solutions (intravenously drip gemodez, neocompensan, reopoliglyukin, polyglucin, glucose, isotonic sodium chloride solution, etc.). On average, the total amount of parenterally administered and/or ingested liquid during the day can be up to 2.5-3.0 liters, preferably in the form of various fresh natural juices, compotes, jelly, rosehip broth, tea, mineral waters (essentuki, Borjomi, Berezovskaya, etc.). Some clinicians (A. Ya. Pytel, 1972, 1977) consider it expedient to prescribe to patients, especially those with fever, cranberry juice, which contains a large amount of sodium benzoate, which is converted in the liver under the influence of glycine into hippuric acid. The latter, excreted by the kidneys, has a bactericidal effect on the microflora of the kidneys and urinary tract, thus enhancing the effect of antibiotics and other antimicrobial agents. The daily amount of table salt is 6-10 g.

From the diet it is necessary to exclude spicy dishes, meat broths, canned food, coffee, alcoholic beverages, various flavoring seasonings (pepper, mustard, onion, horseradish, etc.), irritating the urinary tract and kidneys.

Crucial in the treatment of acute pyelonephritis belongs to antimicrobial agents. The main rule of antibiotic therapy is the appointment of optimal (or maximum) doses, early onset and sufficient duration, compliance with the antibiotic and the sensitivity of the urine microflora to it. If the sensitivity of the microflora cannot be determined, treatment is carried out with antibiotics with a wide spectrum of antimicrobial action. The dose of the antibiotic should correspond to the severity of the clinical manifestations of the disease and its course. In severe forms of pyelonephritis, maximum doses of antibiotics are prescribed, often in combination with sulfonamides or nitrofuran preparations. When choosing an antibiotic, it is also necessary to take into account the possibility of its nephrotoxic action and the individual sensitivity of the patient's body to it. Since in the course of treatment a change in microflora may occur or its resistance to the prescribed antibiotic develops, it is necessary to repeat urine cultures (every 10-14 days) for microflora and determine its sensitivity to antibiotics.

Antibacterial therapy should be carried out for at least 2 weeks, and more often 4-6 weeks or more: until complete normalization of body temperature, peripheral blood, persistent disappearance of proteinuria, leukocyturia and bacteriuria) determined by repeated multiple urine tests. Siroko uses penicillin at a daily dose of 4-6 million units (in severe cases, up to 8-12 million units or more), semi-synthetic drugs of the penicillin series - oxacillin, ampicillin, methicillin, ampiox, etc. In colibacillary infection, levomycetin succinate is effective (0 .5 g 3 times a day intramuscularly or intravenously), gentamicin or garamycin (40-80 mg 3 times a day parenterally). With a mixed and antibiotic-resistant microflora, erythromycin, tseporin, kefzol, cyprobay, tarivid, lincomycin, ristomycin, rondomycin, vibramycin and other antibacterial drugs with a wide spectrum of antimicrobial action are prescribed in optimal doses. In severe cases, they resort to intravenous administration of antibiotics in optimal, and in the absence of effect - in maximum doses. In this case, it is necessary to take into account the possibility of nephrotoxic and ototoxic effects of some antibiotics, especially aminoglycosides. Due to the possibility of microbial resistance to antibiotics, it is advisable to change them after 10-14 days, which is especially important in the absence of conditions for examining urine for microflora and its sensitivity to antibiotics.

With prolonged treatment with antibiotics, it is necessary to prescribe antifungal drugs - nystatin, levorin, as well as vitamins (B1, B6, B12, C, P, PP, etc.) and antihistamines (diphenhydramine, pipolfen, suprastin, tavegil, etc.). In mild cases of the disease, and also if it is impossible to carry out or continue antibiotic treatment (due to their intolerance or fungal complications), sulfonamides are indicated - etazol, urosulfan, sulfadimethoxin, biseptol, bactrim and others in usual doses. According to available data, urosulfan is most active in staphylococcal and colibacillary infections, and etazol - in streptococcal infections. Contraindication to the appointment of these drugs - the presence of symptoms of renal and hepatic insufficiency. In combination with antibiotics, they significantly increase the therapeutic effect.

Nitrofuran derivatives - furagin, furadonin, furazolidone, etc. - also have a broad spectrum of antimicrobial action. It is very important that both gram-negative and gram-positive microflora are sensitive to them, and microbial resistance to them is less pronounced than antibiotics and rarely develops. Assign them inside at 0.1-0.15 g 3-4 times a day for 8-10 days, and if necessary to enhance the therapeutic effect, and intravenously. In order to prevent dyspeptic phenomena, these drugs, like some antibiotics (for example, levomycetin), can be administered in suppositories. They are most effective in combination with antibiotics, especially in the initial stage of acute pyelonephritis.

In the treatment of acute pyelonephritis, nalidixic acid preparations (negrams, negramon) are also used at a dose of 0.1-1.0 g 4 times a day for up to 10-14 days, to which gram-negative microflora, in particular E. coli, is usually sensitive. The combination of Nevigramone with antibiotics is more effective. However, drugs in this group are more often used as maintenance therapy after the elimination of the main manifestations of the disease.

Siroko is used, especially for prolonged pyelonephritis, 5-NOC (nitroxoline), which has a wide spectrum of action and high antimicrobial activity. Almost all bacteria that can cause pyelonephritis are sensitive to it.

The drug is well absorbed when taken orally (at a dose of 0.1 g 4 times a day), relatively quickly enters the bloodstream, is excreted from the body only by the kidneys, so a high concentration of it in the urine is quickly created. In addition, it usually does not give serious side effects (headache, rarely allergic skin rashes) and is well tolerated by patients throughout the course of treatment (2-4 weeks).

In case of individual intolerance to antibiotics, sulfanilamide and other drugs or resistance to them, salol and urotropin (40% solution of 5-10 ml intravenously) can be used.

However, in some cases with secondary pyelonephritis, even early and actively carried out antibiotic therapy, as well as a combination of antibiotics with other drugs (nitrofurans, sulfonamides, 5-NOC) is ineffective or not effective enough if the causes that disrupt the normal passage of urine are not eliminated. In such cases, the elimination of obstacles to the movement of urine is of paramount importance in the complex therapy of acute pyelonephritis. With obstruction of the upper urinary tract, catheterization of the ureters can be effective, with the help of which it is sometimes possible to eliminate the obstruction to the flow of urine (calculus, mucus clots, etc.). If it is not possible to restore urodynamics, and the patient's condition remains severe, the success of treatment can only be ensured by urgent surgical intervention. The operation is often resorted to with a solitary abscess, carbuncle of the kidney, apostematous nephritis (pyelostomy, decapsulation, opening of pustules, dissection of the carbuncle and, according to strict indications, nephrectomy).

Prevention of acute pyelonephritis

In preventing the occurrence of acute pyelonephritis, as well as acute glomerulonephritis, conservative or surgical sanitation of foci of streptococcal infection, as well as the treatment of infections of the bladder and urinary tract, is of great importance.

It is necessary to systematically monitor and examine pregnant women in the antenatal clinic for the timely detection of the pathology that has arisen in the kidneys and the adoption of urgent measures to eliminate it. Urine is recommended to be examined not only during pregnancy, but also after childbirth, since kidney disease that began during pregnancy can be latent, without clinical manifestations, and then after a few years lead to the development of chronic renal failure.

Due to the high frequency of relapses of acute pyelonephritis and in order to prevent its transition to chronic, it is necessary to conduct repeated courses of antimicrobial therapy in a hospital or on a long-term basis (at least 6 months). At the same time, it is recommended to alternate antibiotics with sulfonamides, including prolonged action, nitrofurans, nalidixic acid preparations, 5-NOC, etc.

One of the proposed schemes for prolonged treatment of acute pyelonephritis is as follows (G. Mazhdrakov, 1980). Initially, chloramphenicol is prescribed at 2.0 g per day for 7-10 days, then sulfanilamide preparations (urosulfan, etazol, sulfadimethoxin, biseptol, bactrim, etc.) in usual doses for 10-12 days, then nalidixic acid preparations (Negrams , nevigramon) 1 tablet 4 times a day for a period of 10-14 days and nitrofurans (furadonin, furadantin, furagin, etc.) 0.1 g 3 times a day for 8-10 days and finally 5-NOC 1 tablet 4 times within 10-14 days. After the course of therapy, urine is examined for the degree of bacteriuria, leukocyturia, proteinuria. While maintaining bacteriuria (more than 50-100 thousand microbial bodies in 1 ml of urine), leukocyturia and proteinuria, a similar course of treatment is repeated, but only 10-14 days of each month for 6-12 months. If possible, it is necessary to determine the microflora of urine and its sensitivity to a particular group of drugs (antibiotics, nitrofurans, etc.) and, depending on this, prescribe the appropriate drug. When conducting such long, repeated courses of treatment, one should take into account the individual sensitivity of each patient to the prescribed medications and the possibility of developing allergic reactions or pathological changes in the peripheral blood (leukopenia, agranulocytosis, etc.).

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- infectious purulent-inflammatory disease of the kidneys, accompanied by an infectious lesion of the pyelocaliceal system and tubules of the kidneys, which, in the absence of emergency medical care, can spread to glomeruli and vessels of the kidneys .

With the wrong treatment acute pyelonephritis goes into chronic pyelonephritis, which is sometimes aggravated by hypothermia, nervous stress, the presence of infectious diseases ( such as: sinusitis, tonsillitis (tonsillitis), stomatitis, dental caries, pneumonia, bronchitis, inflammatory processes in the genitals, cystitis).

Types and forms of acute pyelonephritis

Pyelonephritis is divided into primary pyelonephritis that emerged as an independent disease and secondary pyelonephritis, developed as a result of any previous damage to the kidneys and urinary tract.

There are two forms of acute pyelonephritis: serous and purulent. Serous pyelonephritis develops relatively slowly and proceeds more easily than purulent pyelonephritis, which is characterized by a rapid and severe course of the disease. With incorrect or untimely treatment, acute pyelonephritis turns into apostematous pyelonephritis, kidney carbuncle or kidney abscess. Apostematous nephritis and carbuncle of the kidney are the subsequent stages of acute purulent pyelonephritis.

Causes of acute pyelonephritis

The most common causes of occurrence secondary acute pyelonephritis are conditions associated with difficulty urinating:

• stones in the kidneys and in the ureters;
• anomalies in the development of the urinary tract;
• narrowing of the ureter and urethra;
• bladder stones or swelling;
• vesicoureteral reflux in children (a pathological condition in which urine is thrown back from the bladder into the ureter);
• prostatitis and prostate adenoma in men;
• pregnancy in women.

In women, it occurs five times more often than in men, which is associated with the peculiarities of the anatomical structure of the female genitourinary system (a short urethra, located near the vagina and rectum, which contributes to the penetration of infection into the kidneys by an ascending route).

The occurrence of pyelonephritis contribute to:

• lack of vitamins and minerals in food;
• overwork, stress, frequent lack of sleep;
• hypothermia (especially in the lumbar region), wet feet;
• severe illness with prolonged bed rest;
• diseases associated with circulatory disorders;
• immunodeficiency states;
• diabetes.

characterized by rapid development and severe course with signs of intoxication, high body temperature, fever and urination disorders.

The disease affects the kidney tissue itself and the urinary system (renal calyces, pelvis). The development of the disease primarily depends on the general condition and resistance of the body to infections.

Usually the disease begins acutely, the temperature rises, chills, sweating, pain in the lumbar region, thirst, painful urination appear.

Acute pyelonephritis is characterized by the following symptoms:

• lower back pain;
• muscle and joint pain;
• fever, chills;
• temperature rise to 39-40 °C;
• frequent and painful urination;
• profuse sweating;
• lack of appetite, nausea, vomiting;
• dry mouth;
• the general serious condition of the patient.

Low back pain in acute pyelonephritis can be both unilateral and bilateral, usually they increase with walking, movement and decrease at rest. In addition, the patient may experience pain in the upper abdomen and pain in the abdominal cavity on the right and left along the ureters.

In the case of the development of purulent pyelonephritis, pus clots can clog the ureters, causing symptoms characteristic of renal colic.

With the transition of inflammation to the perirenal tissue, muscle clamps can occur in the form of tension in the lumbar muscle and bringing the limbs to the body from the affected side (psoas-symptom).

It should be noted that the symptoms listed above are not always present in the picture of the disease, in addition, there are forms of pyelonephritis with an asymptomatic course, therefore, to clarify the diagnosis, it is necessary to do tests.

Edema and high blood pressure are not typical for pyelonephritis and can serve as symptoms of autoimmune inflammation of the kidneys - glomerulonephritis.

Causative agents of acute pyelonephritis

In acute pyelonephritis, the most common causative agents of infection are Enterococcus, Escherichia coli, Proteus, Pseudomonas aeruginosa and Klebsiella. Pathogens enter the kidneys either through the blood and lymph (in infectious diseases of other organs), or ascending from the lower urinary tract (Enterococcus, Proteus, Staphylococcus, Streptococcus, Escherichia coli, etc.).

Diagnosis of acute pyelonephritis

"Tapping" on the lower back in acute pyelonephritis is painful. In the blood, the content of leukocytes increases, in the urine - a large number of leukocytes, protein, erythrocytes. Recognition is carried out on the basis of clinical data; data from excretory urography and cystoscopy also help.

At the first symptoms acute pyelonephritis medical attention should be sought immediately, as acute pyelonephritis is a life-threatening disease that can be fatal. In addition, the symptoms of acute pyelonephritis can be confused with the symptoms of diseases such as appendicitis, peritonitis, and others requiring urgent surgical intervention.

For diagnostics acute pyelonephritis must pass general urine analysis on leukocytes, and if their number is increased, do a urine culture for bacteria, which allows you to determine the causative agent of the infection and its sensitivity to antibiotics.

To distinguish acute pyelonephritis from acute cystitis do the so-called three glass urine sample with pyelonephritis in the third sample, the number of shaped elements is less). In addition, unlike cystitis, in acute pyelonephritis, urination difficulties are less pronounced and, as a rule, there are no pains at the end of urination.

Patients with pyelonephritis carry out general and biochemical blood tests. A complete blood count indicates inflammatory changes, and a biochemical analysis may show the development kidney failure.

Patients with suspected acute pyelonephritis undergo an ultrasound of the kidneys to exclude a purulent process and the presence of stones in the kidneys and ureters. If blood is found in the urine, excretory urography is prescribed with intravenous administration of a radiopaque substance.

In addition, diagnostic methods such as chromocystoscopy, echography, and computed X-ray tomography are used. In difficult cases, an aspiration biopsy of the kidney is performed under the control of sectoral ultrasound scanning.

At complicated acute pyelonephritis urgent hospitalization is required. Bed rest. With the development of apostematous nephritis and carbuncle of the kidney - surgical treatment.

Uncomplicated forms acute pyelonephritis usually treated at home under medical supervision. Patients are prescribed bed rest and a sparing diet, excluding jet and salty foods, plentiful (at least 2-3 liters per day) drink, wrapping the lumbar region, taking antibiotics and nitrofurans. If antibiotics are chosen correctly, recovery occurs in 5-7 days.

With severe pain in the kidneys, analgesics and anti-inflammatory drugs are prescribed. With urinary retention, frequent nighttime urination, nighttime and daytime urinary incontinence, pain and pain during urination, rectal suppositories with belladonna, papaverine and luminal are recommended. To accelerate reparative processes, vitamin complexes containing vitamin A, such as Aevit, should be taken.

Local heating of the lower back with heating pads, as well as sollux and diathermy, have a good effect on the kidneys. Sollux- This is an infrared irradiator, consisting of an incandescent lamp placed in a special reflector. Infrared radiation penetrates deeply into the tissues of the body, warming up not only the skin, but also the subcutaneous tissues. Diathermy- exposure to the patient's body with an alternating electric current, which leads to an increase in the temperature of body tissues and heating of the affected organ.

Treatment of acute pyelonephritis must be carried out within a few months after the onset of remission and improvement in the patient's condition, otherwise the acute form of pyelonephritis may become chronic. Antibiotics and antibacterial drugs for acute pyelonephritis are prescribed for one and a half months or more. Even if there are no obvious signs of the disease, one should not think that everything is over and you can calm down. Pyelonephritis is an insidious and dangerous disease that must be cured to the end, having completed a full course of antibacterial treatment and conducting continuous (at least 4-6 months a year) supporting herbal medicine with medicinal preparations and herbal remedies, such as Kanefron-N, Fitolizin, Urolesan, etc.

Diet for acute pyelonephritis

Nutrition for acute pyelonephritis is based on a sparing diet, from which everything spicy, smoked meats, canned food, pickles, alcohol and other foods that irritate kidney tissue are excluded. Patients are recommended a milk-vegetarian diet. You can eat cottage cheese, kefir, light flour dishes, raw and boiled fruits. You should limit the amount of table salt to 4-6 g per day.

A diet with a large amount of easily digestible proteins, fats and carbohydrates, vitamins and mineral salts. Plentiful drink (cranberry, lingonberry juice, rosehip broth, weak tea, mineral water, etc.).

An obligatory element of the diet for acute pyelonephritis is drinking plenty of water, which helps flush out mucus and bacteria from the kidneys. It is necessary to drink one glass of liquid every 2 hours, so that it is from 2 to 2.5 liters per day. You can independently prepare infusions of medicinal herbs and brew pharmacy kidney teas, cranberry juice helps well, which prevents adhesion (sticking) of bacteria to the walls of the urinary tract.

Treatment of acute pyelonephritis with folk remedies

For treatment acute pyelonephritis folk methods are widely used. Phytotherapy is carried out in several courses. The first course of treatment of pyelonephritis with herbs is carried out until the disappearance of all clinical symptoms of the disease and the normalization of urine tests. Then you should take a break for one month and, changing the herbal collection, conduct two two-month courses at intervals of 3 weeks.

Recipes of herbal preparations for the treatment of acute pyelonephritis

1. Take in equal proportions the leaves of common lingonberry, wild strawberry and coltsfoot, blue cornflower flowers, Veronica grass and stinging nettle, flax seeds. Grind everything, mix thoroughly. Put in a thermos 2 tbsp. l. collection, pour 0.5 liters of boiling water, leave for 8 hours, strain and drink warm, 2/3 cup 4 times a day after meals.
2. Take in equal proportions the fruits of anise, birch leaves, budry grass, St. John's wort, five-lobed motherwort, tricolor violet and horsetail. Plants chop, mix. Pour 2 tbsp. l. collect 2 cups boiling water and boil for 5 minutes. Then insist for an hour in the heat, strain and drink warm half a glass 4 times a day for half an hour before meals.
3. Take in equal proportions the leaves of birch, plantain and bearberry, the grass of the highlander bird, dioica nettle, meadowsweet, goose cinquefoil, shepherd's purse, wormwood, motherwort and sage, wild strawberry plant, oat straw, couch grass rhizome, chamomile flowers, fennel fruits. Grind vegetable raw materials, mix thoroughly, 3 tsp. collection, pour 0.5 liters of boiling water, heat in a water bath for 15 minutes, leave for an hour in heat and strain. Drink warm 1/4 cup 4 times a day after meals.
4. Take in equal proportions the grass of the highlander bird, yarrow and yasnitka, juniper fruits, oat straw, licorice rhizome, bearberry and sage leaves. Grind all plants, mix. Pour 3 tsp. collection with a glass of boiling water, insist for 4 hours, then bring to a boil and steam for 10 minutes in a water bath. Then insist for an hour in the heat, strain and drink warm half a glass 4 times a day 20 minutes after eating.
5. Take in equal proportions the leaves of birch and round-leaved wintergreen, grass of heather, sweet clover, meadowsweet and shepherd's purse, flowers of calendula and tansy. Grind all plants, mix thoroughly. Pour 2 cups boiling water over 2 tbsp. l. collection, boil for 5 minutes, leave warm for an hour, strain and drink warm 1/2 cup 4 times a day for half an hour before meals.
6. Take in equal proportions birch leaves, St. Grind all plants, mix thoroughly. Pour Pour 2 cups boiling water over 2 tbsp. l. collection, wrap and insist in warmth for 1 hour, strain and drink warm 1/2 cup 4 times a day half an hour before meals.

Treatment of complicated acute pyelonephritis

In complicated forms of pyelonephritis, hospitalization is required. In case of complications, repeated blood and urine tests are performed, an ultrasound examination of the kidneys and ureters is done. Patients with a serous form of pyelonephritis are hospitalized in a therapeutic department, where antibiotics, sulfa drugs and antibacterial agents are prescribed. Patients with purulent or secondary pyelonephritis are hospitalized in the urological department, where they conduct an additional examination. If the kidney is found to be covered in pustules, the doctor may suggest surgery to open up the pustules and clean out the kidney and surrounding tissues. Sometimes, in more serious cases, the kidney has to be removed. Indications for surgical treatment may also be abscess, carbuncle of the kidney, apostematous form of pyelonephritis.

Prevention of acute pyelonephritis

Prevention of acute pyelonephritis consists in maintaining proper personal hygiene, timely emptying of the bladder and intestines, combating constipation, sanitation and timely treatment of caries, chronic tonsillitis, sinusitis, chronic cholecystitis, chronic colitis, as well as diseases of the genitourinary system that cause urinary retention in the kidneys and ureters. Pregnant women, especially those with multiple pregnancies, polyhydramnios, large fetuses and narrow pelvis, need to do a bacteriological analysis of urine and a study of urodynamics at least once a month. After discharge from the hospital, those who have had acute pyelonephritis should do a general urine test every month for six months and be observed by a doctor.

Kidney diseases are increasingly common in medical practice. They can develop for many reasons. This includes an unhealthy lifestyle, inflammatory diseases of neighboring organs, an infection of the genitourinary system, and so on. This article will focus on such a pathology as acute pyelonephritis. The symptoms and treatment of the disease are well known and described. In this article, we will find out the features of the correction of this pathology. It is also worth mentioning what is acute in children.

Common Kidney Diseases

The inflammatory process in the shell of the organ and the pyelocaliceal system is called pyelonephritis. This pathology can take various forms. At the moment, the following manifestations are known to medicine:

• acute and treatment will be described below);
• chronic inflammation (often has no manifestations);
• acute pathology (asymptomatic course of the disease, followed by the addition of symptoms).

All these forms bring a lot of discomfort to a person. That is why it is so important to diagnose in time and prescribe the right treatment. Otherwise, the patient may face serious complications that will lead to hospitalization and surgery.

Acute pyelonephritis

The symptoms and treatment of this disease can be different. When prescribing therapy, it is imperative to take into account the patient's complaints. In some cases, the pathology develops from an already existing disease. In this case, it is necessary to treat not only the inflammatory process, but also its cause.

Pathology develops mainly due to the multiplication of bacteria. These include microorganisms of Escherichia coli, Proteus, Pseudomonas aeruginosa, enterococci, staphylococci, and so on. Less commonly, pathology develops due to viral damage to the organ.

Pathology most often develops due to bacteria entering the kidney from neighboring organs. Less commonly, a patient has a so-called ascending acute pyelonephritis. Symptoms and treatment are somewhat different. In this case, pathogenic microorganisms penetrate through the urethra into the bladder and only then affect the renal system.

Signs of the disease

Depending on what acute pyelonephritis has symptoms, appropriate treatment is prescribed. Remember that the correction should not be carried out independently. Only a qualified specialist will be able to choose the right drugs and their regimen.

Symptoms of pathology can be different. Most often, a high temperature rises and there is pain in the peritoneum. However, these symptoms may be conditional and do not always indicate an acute inflammatory process in the kidney. Consider the main signs of pathology.

Fever, or hyperthermia

Acute pyelonephritis is often manifested by fever. In this case, the person does not feel other signs of a cold.

The patient begins to chill, sweating increases. In some cases, seizures or delusions may occur. If such acute pyelonephritis in children has symptoms, and treatment is not carried out immediately, the consequences can be dire. In children, these conditions can be especially dangerous. Elderly people are also at risk.

pain symptom

Acute pyelonephritis (symptoms) often begins with pain. Subfebrile temperature is maintained. Unpleasant sensations can be pressing, bursting or pulling. However, more often they are sharp with backaches.

Also, the pain can be girdle and affect the lower abdomen. In some cases, acute pyelonephritis has symptoms in women in the form of cutting sensations during urination and immediately after it. This may indicate the accession of cystitis. In this case, we are talking about an ascending pathology.

General deterioration in well-being

Pathology is often manifested by general malaise. In this case, the patient's digestion is disturbed. Most often, nausea and loss of appetite are observed. In more severe situations, diarrhea and vomiting may join.

It also increases blood pressure, which in itself leads to the addition of headaches, tinnitus. Sometimes the patient may lose consciousness. This condition is especially dangerous for pregnant women and young children. What are the symptoms of acute pyelonephritis in infants?

Signs of pathology in children

Often, kids can't talk about what's bothering them. In this case, parents will have to guess on the coffee grounds. Pathology in newborns and infants is manifested by severe anxiety, crying. Also, when the temperature rises, parents do not show signs of a cold. The baby presses her legs to her tummy and cries angrily. Outwardly, this manifestation is similar to ordinary colic, but unlike gas formation, pyelonephritis does not go away on its own. At the same time, over time, the condition of the baby only worsens.

How to diagnose pathology?

If there is a suspicion of acute and treatment should be related. Several methods are used for diagnosis.

• Questioning and inspection. This method cannot provide reliable information about the disease. The doctor examines the patient and learns about the symptoms that bother him. During palpation, the pain may increase. This indirectly indicates pathology.
• ultrasound. This method is more accurate. During the study, the specialist examines the walls of the organ and determines the degree of expansion of the pelvicalyceal system. The data obtained may indicate a disease.
• Laboratory research. These include general blood and urine tests, as well as biochemistry. Often, if a pathology is suspected, bacterial urine culture is performed. Based on the results, it is possible to determine the microorganisms present and to identify their sensitivity to certain antibiotics.
• Radiography. This manipulation is performed much less frequently. However, it can give an accurate picture of the condition of the kidneys. During the diagnosis, a contrast solution is used, which is injected into the kidney. After that, the image of the organ is displayed on

Acute pyelonephritis: treatment at home

This pathology is mainly treated in the walls of the hospital. However, many patients refuse hospitalization for various reasons. It must be remembered that this can lead to the development of complications.

• Most often it implies such a pathology as acute pyelonephritis, antibiotic treatment. However, before prescribing drugs, it is necessary to conduct laboratory tests. Otherwise, you can only aggravate your situation. With improper use of antibacterial drugs, bacteria develop resistance to an antimicrobial agent and a person's immune defense decreases.
• It is also described in some detail by the healthy lifestyle magazine. There are indicated folk remedies for correction. Some of them can be quite useful. However, you should not take risks without the participation of a doctor to carry out such manipulations.
• Be sure to be associated with a disease such as acute pyelonephritis, symptoms and treatment. Diet and a certain regimen are additional methods of correction. They will help to alleviate the patient's condition and speed up recovery.

Let us consider in detail what acute pyelonephritis treatment has at home.

The use of antimicrobial drugs

Quite often, it is carried out with a disease such as acute pyelonephritis, treatment. At the same time, a preliminary analysis for the sensitivity of microorganisms is not performed. Such a correction may not be very effective and lead to more advanced pathology.

The most correct appointment will be a recommendation given after a preliminary analysis. At the same time, the sensitivity of certain bacteria to certain medicines is clarified. Most often, doctors prescribe the following medications: Ofloxacin, Norfloxacin, Ciprofloxacin, Amoxicillin and others.

In most cases, the effect of drugs is noticeable already one week after treatment. Within a month of such therapy, complete recovery occurs. However, doctors strongly recommend continuing treatment for up to two months. Long-term exposure allows you to destroy all pathological microorganisms and prevent the transition of the disease into a chronic form.

Use of immunomodulators

This should not be done on your own. Such a correction is always combined with the use of strong drugs. Acute pyelonephritis cannot be cured with immunostimulating drugs alone.

Immunomodulators allow you to quickly cope with the pathology and improve the condition of the body after prolonged use of antibiotics. These means include the following: "Interferon", "Fiferon", "Likopid", "Canephron", "Isoprinosine", "Decaris", "Prodigeosan" and so on. Correction can be carried out for quite a long time (up to several months). In this case, one medication is replaced by another for a more effective action.

The use of diuretics in the treatment of pathology

Often, medicines that have a diuretic effect are used to correct the pathology. Most often these are teas from medicinal herbs, for example: "Brusniver", "Kidney tea" and so on.

You can also use solutions and capsule forms of drugs. Most often it is Cyston, Canephron and others. It is worth noting that these medicines can be used during pregnancy. However, before that, it is still worth getting expert advice.

Surgical treatment of pyelonephritis

In more advanced situations, surgical intervention is used. It is performed under general anesthesia and can be of two types: organ-preserving or organ-removing. In the first case, the affected kidney is decapsulated. At the same time, the walls of the organ are dissected and purulent and pathological formations are removed. The doctor tries to preserve healthy tissues as much as possible and not disturb the blood flow in them. The prognosis of such treatment is usually favorable. At the same time, it is necessary to comply with the prescription data for the patient.

Complete is performed when it is not possible to leave the organ. In this case, donor material can be used. However, there is no guarantee that it will take root. A person can live quite normally with one kidney. In this case, it will be necessary to control the state of the body more carefully.

Therapeutic exercises for illness

You can treat pyelonephritis at home with the help of special exercises. Most often they are prescribed to expectant mothers. After all, it is this group of women that is prone to the development of the inflammatory process due to the increased pressure of the uterus on the organs.

Doctors recommend several times a day to take a knee-elbow position. This allows you to facilitate the work of the kidneys and reduce pressure on them. Also, if you have unilateral acute pyelonephritis, then you should lie down and sleep only on the opposite side. Thus, you can avoid increased pressure on the diseased organ and improve the outflow of urine from it.

Diet for acute pyelonephritis

For the treatment of acute pyelonephritis, a diet and appropriate regimen can be applied. Most often, doctors recommend that you observe complete rest during an illness. Especially if there are symptoms such as high fever, increased pressure, weakness and chills.

The diet also implies a large intake of fluids. The patient needs to increase the amount of fluid consumed to two or even three liters per day. Such an impact will be positive only if the outflow of urine is not disturbed. In addition to plain clean water, you can drink cranberry and lingonberry fruit drinks. Such drinks perfectly cleanse the urinary tract from pathogenic microbes.

Compliance with the diet involves the rejection of smoked and salty. Such products contribute to fluid retention in the body. This can only make the situation worse. At the time of exacerbation of the disease, it is recommended to completely eliminate salt from your diet.

It is also necessary to exclude sweets, bakery products and any allergens from the menu. It is strictly forbidden to eat tomatoes in any form, tomato. Give up alcohol. Meat and fatty broths should be excluded from the patient's diet. What can you eat with acute pyelonephritis?

Give preference to light vegetable soups and steam products. Eat small meals, but more often. Between each meal, drink several glasses of water and the above fruit drinks. Avoid coffee and strong tea. These drinks can only aggravate the condition by a large increase in blood pressure.

The use of herbs: folk methods of correction

Treating acute pyelonephritis with herbs is quite dangerous. However, many patients resort to this method.

Remember that some herbs may be contraindicated for a particular patient. That is why before using them, you should still contact the doctors to obtain permission for such treatment.

Summing up and conclusion of the article

You now have much knowledge about such a disease as acute pyelonephritis (symptoms, treatment with herbs and other methods). Remember that pathology is quite dangerous and can lead to serious complications. That is why her treatment should be carried out within the walls of the hospital, and not engage in self-appointment. The disease is especially dangerous for young children and the elderly. To prescribe the right appointments, you should first undergo an examination. A catheter is used for urinary obstruction.

Monitor the condition of your kidneys. If one of the symptoms appears, do not delay the time, contact the specialists! Only in this case is it likely that the pathology will not turn into a more serious form. Good health to you!

Pyelonephritis is an acute or chronic kidney disease that develops as a result of exposure to the kidney of some causes (factors) that lead to inflammation of one of its structures, called the pyelocaliceal system (the structure of the kidney in which urine is accumulated and excreted) and adjacent to this structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.

The definition of "Pyelonephritis" comes from the Greek words ( pyelos- translates as, pelvis, and nephros-bud). Inflammation of the structures of the kidney occurs in turn or simultaneously, it depends on the cause of the developed pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 39 0 C, nausea, vomiting, impaired urination), with proper treatment after 10-20 days, the patient recovers completely.

Chronic pyelonephritis is characterized by exacerbations (most often in the cold season), and remissions (subsidence of symptoms). Its symptoms are mild, most often, it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, abnormalities of the urinary system, prostate adenoma, and others).

Women, especially young and middle-aged women, get sick more often than males, approximately in a ratio of 6: 1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men are more likely to develop pyelonephritis at an older age, this is most often associated with the presence of prostate adenoma. Children also get sick, more often at an early age (up to 5-7 years), compared with older children, this is due to the low resistance of the body to various infections.

Kidney Anatomy

The kidney is a paired organ, in the form of a bean, dark brown in color, located in the lumbar region, on the sides of the spine.

The mass of one kidney is 120 - 200 g. The tissue of each of the kidneys consists of a medulla (in the form of pyramids) located in the center, and a cortical located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyxes (average 2-4 in one kidney). In the future, the large renal calyces pass into one large renal pelvis (a cavity in the kidney, funnel-shaped), which, in turn, passes into the next organ of the urinary system, which is called the ureter. From the ureter, urine enters the bladder (a reservoir for collecting urine), and from it through the urethra out.

Causes and risk factors in the development of pyelonephritis

Symptoms of pyelonephritis

• burning and pain during urination, due to inflammation in the urinary tract;
• the need to urinate more often than usual, in small portions;
• beer-colored urine (dark and cloudy), is the result of the presence of a large number of bacteria in the urine,
• foul-smelling urine
• often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).

1. Pasternatsky's symptom is positive - with a light blow with the edge of the palm on the lumbar region, pain appears.
2. Edema, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appear on the face (under the eyes), legs, or other parts of the body. Edema appears in the morning, soft pasty consistency, symmetrical (on the left and right sides of the body of the same size).

Diagnosis of pyelonephritis

Indicators of a general urine test for pyelonephritis:

• High level of leukocytes (normal in men 0-3 leukocytes in the field of view, in women up to 0-6);
• Bacteria in urine >100,000 per ml; the excreted urine is normal, it must be sterile, but hygienic conditions are often not observed during its collection, therefore, the presence of bacteria up to 100,000 is allowed;
• Urine density
• Ph urine - alkaline (normally acidic);
• The presence of protein, glucose (normally they are absent).

Urinalysis according to Nechiporenko:

• Leukocytes are increased (normal up to 2000/ml);
• Erythrocytes are increased (normal up to 1000/ml);
• The presence of cylinders (they are normally absent).

Ultrasound of the kidneys: is the most reliable method to determine the presence of pyelonephritis. Determines the different sizes of the kidneys, a decrease in the size of the affected kidney, deformation of the pelvicalyceal system, the detection of a stone or tumor, if any.

Excretory urography, is also a reliable method for detecting pyelonephritis, but compared to ultrasound, you can visualize the urinary tract (ureter, bladder), and if there is a blockage (stone, tumor), determine its level.

CT scan, is the method of choice, using this method it is possible to assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)

Treatment of pyelonephritis

Medical treatment of pyelonephritis

1. antibiotics, are prescribed for pyelonephritis, according to the results of bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.

• Penicillins(Amoxicillin, Augmentin). Amoxicillin inside, 0.5 g 3 times a day;
• Cephalosporins(Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
• Aminoglycosides(Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg / kg 2 times a day;
• Tetracyclines (Doxycycline, orally 0.1 g 2 times a day);
• Levomycetin group(Chloramphenicol, orally 0.5 g 4 times a day).

• Sulfonamides(Urosulfan, inside 1 g 4 times a day);
• Nitrofurans(Furagin, inside 0.2 g 3 times a day);
• Quinolones(Nitroxoline, inside 0.1 g 4 times a day).

1. Diuretic drugs: are prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and are not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
2. Immunomodulators: increase the body's reactivity in case of illness, and to prevent exacerbation of chronic pyelonephritis.

• Timalin, intramuscularly 10-20 mg 1 time per day, 5 days;
• T-activin, intramuscularly, 100 mcg once a day, 5 days;

1. Multivitamins , (Duovit, 1 tablet 1 time per day) Ginseng tincture - 30 drops 3 times a day are also used to improve immunity.
2. Non-steroidal anti-inflammatory drugs (Voltaren), have an anti-inflammatory effect. Voltaren inside, 0.25 g 3 times a day, after meals.
3. To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantyl, 0.025 g 3 times a day.

Phytotherapy for pyelonephritis

Cranberry juice, has an antimicrobial effect, drink 1 glass 3 times a day.

A decoction of Bearberry, has an antimicrobial effect, take 2 tablespoons 5 times a day.

Boil 200 g of oats in one liter of milk, drink ¼ cup 3 times a day.
Kidney collection No. 1: A decoction of the mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.

Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, cowberry. Finely grind all these herbs, pour 2 tablespoons of water and boil for 20 minutes, take half a cup 4 times a day.