Sharp pyelonephritis – nonspecific inflammatory defeat of interweft tissue of kidneys and cup systems. High fever with oznoba and sweating, a headache, mialgiya, artralgiya, a general malaise, waist pain, changes in urine as a leykotsituriya and a piuriya is characteristic of clinic of sharp pyelonephritis. Diagnosis of sharp pyelonephritis includes a microscopic and bacteriological research of urine, ultrasonography of kidneys; if necessary – carrying out excretory urography, radio isotope researches, tomographies. At sharp pyelonephritis the diet, plentiful drink, antibiotics, nitrofurans, spazmolitik is appointed. At obstructive pyelonephritis the nefrostomiya is shown; at it is purulent - destructive processes – a dekapsulyation of a kidney or a nefrektomiya.
Sharp pyelonephritis in urology is the most frequent disease of kidneys. Sharp pyelonephritis quite often arises at children's age when load of kidneys is very intensive, and their morfo-functional development is still incomplete. At adults sharp pyelonephritis meets at women aged up to 40 years more often.
Sharp pyelonephritis can be primary (not obstructive) and secondary (obstructive). Primary pyelonephritis proceeds against the background of normal outflow of urine from kidneys; secondary pyelonephritis is connected with violation of passability of the top uric ways owing to their external sdavleniye or obstruction. On the nature of inflammatory changes sharp pyelonephritis can carry serous or is purulent - destructive character (pyelonephritis apostematozny, abscess or an anthrax of a kidney). In hard cases sharp pyelonephritis can be complicated by a necrotic papillit - a sosochkovy necrosis. In sharp pyelonephritis it can be involved one or both kidneys.
Reasons of sharp pyelonephritis
Sharp pyelonephritis develops at endogenous or exogenous penetration of pathogenic microorganisms into a kidney. More often sharp pyelonephritis is caused by colibacillus (in 50% of cases), Proteus, a sinegnoyny stick, is more rare – stafilokokka or streptococci.
At primary sharp pyelonephritis the infection can get into a kidney in the hematogenic way from primary centers of an inflammation in urinogenital bodies (at an adneksita, cystitis, prostatitis, etc.) or from the remote bodies (at tonsillitis, caries, sinusitis, a furunkuleza, bronchitis, cholecystitis etc.). Less often infection happens on the ascending mechanism, on a wall or a gleam of a mochetochnik (at a puzyrno-mochetochnikovy reflux).
Secondary sharp pyelonephritis is connected with violation of a passage of urine against the background of a mochetochnik, obstruction of a mochetochnik a stone, and valves of an urethra, adenoma of a prostate gland, a prostate cancer, a fimoz, a neurogenetic bladder. As the contributing moments to development of sharp pyelonephritis serve overcooling, dehydration, hypovitaminosis, overfatigue, respiratory infections, pregnancy, diabetes.
The inflammation at sharp pyelonephritis is connected not only with a microbic invasion, but also hit of contents of a lokhanka in interstitsialny fabric that is caused by the return current of urine, i.e. a fornikalny reflux. Kidneys at sharp pyelonephritis are full-blooded, a little increased. Mucous kidney a lokhanok it is edematous, inflamed, an izjyazvlena; in lokhanka there can be an inflammatory exudate. Further in a brain and cortical layer of a kidney numerous abscesses or abscesses can be formed; it is sometimes noted it is purulent - destructive fusion of a kidney parenchyma.
Stages of sharp pyelonephritis
Stages of sharp pyelonephritis answer the morphological changes happening in a kidney. The initial phase of a serous inflammation is characterized by increase and tension of a kidney, hypostasis of okolopochechny cellulose, perivaskulyarny infiltration of interweft fabric. At timely corresponding treatment this stage of sharp pyelonephritis is exposed to the return development; otherwise – passes into a stage it is purulent - a destructive inflammation.
In a stage of sharp purulent pyelonephritis allocate phases of apostematozny pyelonephritis, an anthrax and abscess of a kidney. Apostematozny (pustulous) pyelonephritis proceeds with education in a cortical layer of a kidney of multiple small gnoynichok of 1-2 mm in size. In case of merge of gnoynichok the local nagnoitelny center - the kidney anthrax which does not have bent to the progressing abstsedirovaniye can be formed. An anthrax has the size from 0,3 to 2 cm, can be single or multiple. At purulent fusion of a parenchyma in the centers of merge of gnoynichok or an anthrax renal abscess is formed. Danger of abscess of a kidney consists in a possibility of depletion of the created abscess in paranefralny cellulose with development of purulent paranephrite or zabryushinny phlegmon.
At a favorable outcome of sharp pyelonephritis the infiltrative centers gradually resolve, being replaced with connecting fabric that is followed by formation of cicatricial retractions on the surface of a kidney. Hems have dark red in the beginning, then - white-gray color and the wedge-shaped form on a section reaching a lokhanka.
Symptoms of sharp pyelonephritis
The course of sharp pyelonephritis is characterized by local symptomatology and signs of the expressed general infectious process which differ depending on a stage and a form of a disease. Serous pyelonephritis proceeds more quietly; at purulent pyelonephritis pronounced clinical manifestations develop. At sharp not obstructive pyelonephritis the general symptoms of an infection prevail; at obstructive pyelonephritis – local symptomatology.
The clinic of sharp not obstructive pyelonephritis develops immediately (from several hours to one days). There is an indisposition, weakness, tremendous oznoba with substantial increase of temperature to 39-40 °C, plentiful sweating. Considerably worsens health a headache, tachycardia, an artralgiya, a mialgiya, nausea, a lock or a diarrhea, a meteorizm.
From local symptoms at sharp pyelonephritis the waist pain extending on the course of a mochetochnik to the area of a hip, sometimes – in a stomach and a back is noted. On character pain can be constant stupid or intensive. The urination is, as a rule, not broken; the daily diuresis decreases due to plentiful loss of liquid with then. Patients can pay attention to turbidity of urine and its unusual smell.
The secondary sharp pyelonephritis caused by obstruction of uric ways usually demonstrates from renal colic. At height of a painful attack there is fever with a fever, a headache, vomiting, thirst. After plentiful sweating temperature critically decreases to subnormal or normal figures that is followed by some improvement of health. However if the factor of obstruction of uric ways is not liquidated in the next few hours, then the attack of colic and rise in temperature will repeat again.
Purulent forms of sharp pyelonephritis proceed with persistent waist pain, fever of gektichesky type, oznobama, sharp tension of muscles of a belly wall and lumbar area. Against the background of the expressed intoxication confusion of consciousness and nonsense can be noted.
Diagnosis of sharp pyelonephritis
In the course of recognition of sharp pyelonephritis data of fizikalny inspection are important. At a palpation of lumbar area and a podreberye estimate the kidney sizes, a consistence, structure of a surface, mobility, morbidity. At sharp pyelonephritis the kidney is usually increased, muscles of a waist and a stomach are strained, the pokolachivaniye a palm edge on the XII edge – is painful, Pasternatsky's symptom is positive. At sharp pyelonephritis at men carrying out rectal survey of a prostate and a palpation of a scrotum, at women - a vaginal research is necessary.
In urine at sharp pyelonephritis the total bakteriuriya, an insignificant proteinuria, a leykotsituriya is noted, at secondary defeat – an eritrotsituriya. Bacterial crops of urine allow to decide on a type of the activator and its sensitivity to antimicrobic medicines. Indicators of blood are characterized by anemia, leykotsitozy, increase in SOE, toxic granularity of neutrophils.
Ultrasonography of kidneys at sharp pyelonephritis is used not only at diagnostics, but also for dynamic control of process of treatment. The value of data of an ekhoskopiya consists in a possibility of visualization of the destructive centers in a parenchyma, conditions of paranefralny cellulose, identification of the reason of obstruction of the top uric ways. Exact identification of the destructive centers, reasons and level of obstruction at sharp purulent pyelonephritis is possible by means of MPT or KT of kidneys. At survey urography increase in the sizes of kidneys, a contour vybukhaniye at abscess or an anthrax pays attention, an illegibility of outlines of paranefralny cellulose.
By means of excretory urography restriction of mobility of a kidney at breath is defined that is a characteristic symptom of sharp pyelonephritis. At serious condition of the patient or a renal failure resort to carrying out a retrograde piyeloureterografiya. The selective kidney angiography, a radio nuclide nefrostsintigrafiya at sharp pyelonephritis, mainly, are applied to specification of the diagnosis as auxiliary methods. Differential diagnosis of sharp pyelonephritis is carried out with appendicitis, cholecystitis, holangity, adneksity.
Treatment of sharp pyelonephritis
At detection of sharp pyelonephritis hospitalization of the patient is carried out; treatment is performed under control of the nephrologist. Therapeutic tactics at not obstructive and obstructive sharp pyelonephritis, serous it is also purulent - to a destructive form differs. Purpose of a bed rest, plentiful drink (to 2–2,5 l a day), a fruit milk diet, digestible proteinaceous food belongs to the general actions.
At primary sharp pyelonephritis pathogenetic therapy which basis is made by antibiotics, active concerning gramotritsatelny flora, - tsefalosporina, aminoglycosides, ftorkhinolona begins at once. At the choice of antimicrobic medicine results of an antibiotikogramma are also considered. NPVS, nitrofurans, immunoproofreaders, dezintoksikatsionny therapy, UFOK, physical therapy (SMV-therapy, an electrophoresis, UVCh) are in addition appointed.
At detection of sharp obstructive pyelonephritis as a prime measure serves the decompression - restoration of an urodinamika in the affected kidney. The lokhanka kateterization by a mochetochnikovy catheter or a catheter-stentom, in certain cases – punktsionny imposing of a chreskozhny nefrostoma is for this purpose undertaken.
It is in the presence purulent - the destructive centers resort to a dekapsulyation of a kidney and imposing of a nefrostoma by means of what reduction of intra kidney pressure, hypostasis of interweft fabric, expansion of a gleam of kidney vessels is reached. At detection of the created abscesses their opening is made. In case of total defeat of a kidney parenchyma and impossibility of organ-preserving tactics the nefrektomiya is carried out.
Forecast and prevention of sharp pyelonephritis
Timely adequate therapy allows to reach treatment of sharp pyelonephritis at most of patients within 2-3 weeks. In a third of cases transition of sharp pyelonephritis to a chronic form (chronic pyelonephritis) with the subsequent sklerozirovaniye of a kidney and development of nefrogenny arterial hypertension is noted.
Paranephrite, retroperitonitis, , a renal failure, bakteriotoksichesky shock, interstitsialny pneumonia, meningitis can occur among complications of sharp pyelonephritis. Heavy septic complications worsen the forecast and quite often become the reason of a lethal outcome.
Prevention of sharp pyelonephritis is sanitation of the centers of a chronic inflammation which can be sources of a potential hematogenic drift of activators in kidneys; elimination of the reasons of possible obstruction of uric ways; respect for hygiene of urinogenital bodies for prevention of the ascending spread of an infection; observance of conditions of an asepsis and antiseptics when carrying out urological manipulations.