Pyelonephritis is an inflammation of the kidney tissue.
Primary (developed in a healthy kidney without disturbing the flow of urine)
Secondary (developed on the background of kidney disease, abnormal development or violation of urine outflow: narrowing of the ureter, benign prostatic hyperplasia, urolithiasis, urinary tract atony, reflux dyskinesias).
Phases: exacerbation (active pyelonephritis), remission (inactive pyelonephritis).
Localization: one-way (rarely), two-way.
Complications: uncomplicated, complicated-abscess ,sepsis.
Kidney function – intact, impaired function, renal failure.
Women suffer 2-5 times more often than men, girls 6 times more often than boys. In older men who have benign prostatic hyperplasia, pyelonephritis occurs more frequently than in younger men.
The cause of pyelonephritis is always an infection. Factors contributing to the development of an infectious process in the kidney:
- Violations of urine outflow (narrowing of the ureter, abnormal development of the kidneys, hydronephrosis , reflux, tumor, stones, etc.);
- Prior kidney disease, especially interstitial nephritis;
- Immunodeficiency states (treatment with cytostatics and / or prednisone, sugar diabetes, immunity defects);
- Hormonal imbalance (pregnancy, menopause, long-term use of contraceptives).
- More often proceeds with a bright clinical picture;
- Fever with chills, pouring sweat;
- Pain in the lumbar region;
- Urinary syndrome – abundant urination (more often) or a reduced volume of urination (less often) with loss of fluid through the lungs and skin, frequent and painful urination;
- Intoxication syndrome – headache, nausea, vomiting;
Chronic pyelonephritis in most patients (50-60%) has a hidden course. Manifests itself
- Low fever, sweating, chilling, aching pain, or a feeling of heaviness in the lumbar region.
- Urinary syndrome – an increased volume of urination, mainly at night, less frequent and painful urination.
Symptoms of intoxication – headache, nausea. Arterial hypertension (more than 70% of cases). Anemia (in some patients).
- Blood test;
- Analysis of urine;
- Bacteriological urine culture is obligatory;
- Ultrasound of the kidneys;
- Survey X-ray: an increase or decrease in one of the kidneys in the volume, the roughness of the contours, sometimes – the shadow of the stone;
- Excretory urography (contraindicated in the active phase);
- Radioisotope renography and scintigraphy.
Liquid consumption up to 2-2.5 l / day.
Antibacterial therapy for at least 2 weeks, courses of 7-10 days, empirical (before seeding the pathogen) and targeted (after determining the sensitivity of microflora to antibiotics).
– treatment begins with semi-synthetic penicillins (amoxicillin; alternative drugs – protected penicillins such as amoxicillin + clavulanic acid, ampicillin + sulbactam) or cephalosporins (cefalexin, cefuroxime, cefaclor).
Exacerbation of chronic pyelonephritis
– start with protected penicillins, drugs of choice – fluoroquinolones, co-trimoxazole, cephalosporins (all drugs for oral administration).
Anti-relapse therapy is carried out for 3-12 months. 7-10 days of each month, with purulent pyelonephritis – antibiotics (see above), with serous – uroantiseptics, alternately: nalidixic acid, 0.5-1 g 4 p. / day, nitrofurantoin, 0.15 g 3- 4 p. / Day., Nitroxoline at 0.1-0.2 g 4 p. / Day.
Also effective is the appointment of uroantisepsis 1 time per night: co-trimoxazole, trimethoprim or nitrofurantoin 100 mg per night or 3 p. / Week. (prophylactic).
- With anemia – iron preparations, blood transfusions, red blood cells.
- Surgery. In case of purulent pyelonephritis in case of failure of conservative therapy – renal decapsulation, pyelonephrostomy and drainage of the renal pelvis.
An essential part of pyelonephritis treatment is compliance. diets .
The prognosis worsens as the duration of pyelonephritis increases, with nosocomial pyelonephritis, microbial resistance to antibacterial agents, blockage of the urinary tract, the presence of purulent complications, immunodeficiency states, frequent relapses.
Full recovery in acute pyelonephritis is possible with early diagnosis, rational antibiotic therapy, and no aggravating factors.
10-20% of patients with chronic pyelonephritis develop chronic renal failure. In 10% of patients with arterial hypertension, its malignancy occurs.