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Pyelonephritis

Pyelonephritis – the nonspecific infectious disease of kidneys caused by various bacteria. The patients having sharp and chronic pyelonephritis make about 2/3 all urological patients. Pyelonephritis can proceed in a sharp or chronic form, affect one or both kidneys. The asymptomatic course of a disease or weak expressiveness of symptomatology at chronic pyelonephritis often dulls vigilance of patients who underestimate disease severity and insufficiently seriously treat treatment. Diagnosis of pyelonephritis and its treatment are performed by the doctor the nephrologist. In case of lack of timely therapy of pyelonephritis it can lead to such heavy complications as a renal failure, to an anthrax or abscess of a kidney, sepsis and bacterial shock.

Pyelonephritis

Pyelonephritis – the nonspecific infectious disease of kidneys caused by various bacteria. The patients having sharp and chronic pyelonephritis make about 2/3 all urological patients. Pyelonephritis can proceed in a sharp or chronic form, affect one or both kidneys. The asymptomatic course of a disease or weak expressiveness of symptomatology at chronic pyelonephritis often dulls vigilance of patients who underestimate disease severity and insufficiently seriously treat treatment. Diagnosis of pyelonephritis and its treatment are performed by the doctor the nephrologist. In case of lack of timely therapy of pyelonephritis it can lead to such heavy complications as a renal failure, to an anthrax or abscess of a kidney, sepsis and bacterial shock.

Pyelonephritis reasons

The disease can arise at any age. More often pyelonephritis develops:

  • at children under 7 years (the probability of emergence of pyelonephritis increases because of features of anatomic development);
  • at young women at the age of 18-30 years (developing of pyelonephritis is connected with the beginning of sex life, pregnancy and childbirth);
  • at elderly men (at obstruction of urinary tract owing to development of adenoma of a prostate gland).

Any organic or functional reasons interfering normal outflow of urine increase probability of development of a disease. Quite often pyelonephritis develops at patients with an urolithic disease.

Diabetes, immune violations, chronic inflammatory diseases and frequent overcoolings belongs to the adverse factors promoting developing of pyelonephritis. In some cases (usually at women) pyelonephritis develops after the postponed sharp cystitis.

The asymptomatic course of a disease is the reason of untimely diagnosis of chronic pyelonephritis. Patients begin to receive treatment when function of kidneys is already broken. As the disease very often arises at the patients having an urolithic disease therefore such patients need special treatment even in the absence of pyelonephritis symptomatology.

Pyelonephritis symptoms

The sudden beginning with sharp temperature increase to 39-40 °C is characteristic of sharp pyelonephritis. The hyperthermia is followed by plentiful sweating, the loss of appetite expressed by weakness, a headache, sometimes – nausea and vomiting. Dull aches in lumbar area (intensity of pains can differ), are more often unilateral, develop along with temperature increase. Fizikalny inspection reveals morbidity at a pokolachivaniye in a waist (a positive symptom of Pasternatsky). The uncomplicated form of sharp pyelonephritis does not cause violations of an urination. Urine becomes muddy or gets a reddish shade. At a laboratory research of urine the bakteriuriya, an insignificant proteinuria and a mikrogematuriya comes to light. Of the general blood test it is characteristic and increase in SOE. Approximately in 30% of cases in biochemical blood test increase in nitrogenous slags is noted.

Chronic pyelonephritis it becomes frequent the result of undertreated sharp process. Development of primary chronic pyelonephritis is possible, at the same time sharp pyelonephritis in the anamnesis of the patient is absent. Sometimes chronic pyelonephritis is found incidentally at an urine research. Patients with chronic pyelonephritis show complaints to weakness, a loss of appetite, headaches and the speeded-up urination. Some patients are disturbed by the dull aching aches in lumbar area amplifying during cold wet weather. When progressing chronic bilateral pyelonephritis function of kidneys is gradually broken that leads to decrease in specific weight of urine, arterial hypertension and development of a renal failure. The symptoms testifying to an exacerbation of chronic pyelonephritis coincide with a clinical picture of sharp process.

Pyelonephritis complications

Bilateral sharp pyelonephritis can become the reason of a sharp renal failure. It is necessary to carry sepsis and bacterial shock to number of the most terrible complications.

In certain cases sharp pyelonephritis is complicated by paranephrite. Development of apostenomatozny pyelonephritis (formation of multiple small gnoynichok on the surface of a kidney and in its cortical substance), a kidney anthrax (quite often arises owing to merge of gnoynichok, it is characterized by existence of pyoinflammatory, necrotic and ischemic processes) kidney abscess (fusion of a kidney parenchyma) and a necrosis of kidney nipples is possible. At emergence it is purulent - destructive changes in a kidney kidney operation is shown.

If treatment is not carried out, there comes the terminal stage is purulent - destructive pyelonephritis. Develops at which the kidney completely is exposed to purulent fusion and represents the center consisting of the cavities filled with urine, pus and products of fabric disintegration.

Diagnosis of pyelonephritis

Diagnosis "sharp pyelonephritis" usually does not represent difficulties for the nephrologist because of existence of pronounced clinical symptoms.

In the anamnesis existence of chronic diseases or recently postponed sharp purulent processes is often noted. The clinical picture is formed by a combination, characteristic of pyelonephritis, of the expressed hyperthermia to waist pain (a thicket unilateral), painful urinations and changes of urine. Urine muddy or with a reddish shade, has the expressed fetid smell.

As laboratory confirmation of the diagnosis serves detection in urine of bacteria and small amounts of protein. For definition of the activator carry out urine. Existence of an acute inflammation is demonstrated also by increase in SOE in the general blood test. By means of special test sets identification of the microflora which caused an inflammation is carried out.

When carrying out survey urography increase in volume of one kidney comes to light. The excretory urography demonstrates sharp restriction of mobility of a kidney when conducting orthotest. At apostematozny pyelonephritis decrease in secretory function on the party of defeat is noted (the shadow of urinary tract appears with lateness or is absent). At an anthrax or abscess on an excretory urogramma the kidney contour vybukhaniye, a sdavleniye and deformation of cups and a lokhanka comes to light.

Diagnostics of structural changes at pyelonephritis is carried out by means of ultrasonography of kidneys. Concentration ability of kidneys is estimated by means of Zimntsky's test. For an exception of an urolithic disease and anatomic anomalies carry out KT of kidneys.

Treatment of pyelonephritis

Uncomplicated sharp pyelonephritis is treated conservatively in the conditions of office of urology of a hospital. Antibacterial therapy is carried out. Medicines are selected taking into account sensitivity of the bacteria found in urine. As fast as possible to liquidate the inflammatory phenomena, without having allowed transition of pyelonephritis in it is purulent - a destructive form, treatment is begun with the most effective medicine.

Dezintoksikatsionny therapy, immunity correction is carried out. At fever the diet with the lowered content of proteins is appointed, after normalization of temperature of the patient transfer to good nutrition with the increased content of liquid. At the first stage of therapy of secondary sharp pyelonephritis it is necessary to eliminate the obstacles complicating normal outflow of urine. Purpose of antibacterial medicines at the broken passage of urine does not give desirable effect and can lead to development of serious complications.

Treatment of chronic pyelonephritis is carried out by the same principles, as therapy of sharp process, but differs in the bigger duration and labor input. Therapy of chronic pyelonephritis includes the following medical events:

  • elimination of the reasons which led to difficulty of outflow of urine or was caused by violations of kidney blood circulation;
  • antibacterial therapy (treatment is appointed taking into account sensitivity of microorganisms);
  • normalization of the general immunity.

In the presence of obstacles it is necessary to restore a normal passage of urine. Restoration of outflow of urine is made quickly (a nefropeksiya at a nefroptoza, removal of stones from kidneys and urinary tract, removal of adenoma of a prostate gland etc.). Removal of obstacles, disturbing an urine passage, in many cases allows to reach permanent long remission.

Antibacterial medicines at treatment of chronic pyelonephritis are appointed taking into account data of an antibiotikogramma. Before definition of sensitivity of microorganisms therapy is carried out by antibacterial medicines of a broad spectrum of activity.

Patients with chronic pyelonephritis need long systematic therapy not less than a year. Treatment is begun with a continuous course of antibacterial therapy lasting 6-8 weeks. Such technique allows to eliminate purulent process in a kidney without development of complications and formation of cicatricial fabric. If function of kidneys is broken, constant control of pharmacokinetics of nefrotoksichny antibacterial medicines is required. If necessary apply immunostimulators and immunomodulators to immunity correction. After achievement of remission to the patient faltering courses of antibacterial therapy are appointed.

Sick chronic pyelonephritis during remission showed sanatorium treatment (Dzhermuk, Zheleznovodsk, Truskavets, etc.). It is necessary to remember obligatory continuity of therapy. The antibacterial treatment begun in a hospital needs to be continued on an outpatient basis. The scheme of treatment appointed by the doctor of sanatorium has to include reception of the antibacterial medicines recommended by the doctor who is constantly observing the patient. As an additional method of treatment phytotherapy is applied.

Pyelonephritis - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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