Pyelitis is an inflammatory process in the renal pelvis, initiated mainly by bacterial microflora. The symptoms are similar to those of pyelonephritis and are represented by pain in the projection of the kidney on the affected side, dysuria (frequent uncomfortable urination) and a temperature reaction. Diagnostics includes examination of urine and blood, culture sowing of urine with the determination of the pathogen and sensitivity to drugs, ultrasound of the kidneys, intravenous urography. Treatment involves antibacterial, anti-inflammatory, antispasmodic therapy, restoration of adequate urination.
ICD 10
N10 N11 N12
Meaning
Pyelitis (from the Greek “pyelos” – tub) is rare in isolation, in most cases it is combined with inflammation of the kidney parenchyma or is the initial stage of pyelonephritis. Pathology is more often encountered by girls aged 1 to 5 years and women, which is associated with anatomical features: a short and wide urethra contributes to the urinogenic spread of microorganisms. In men, pyelitis develops more often after operations on the organs of the genitourinary system, the peak incidence occurs at the age over 65 years. The lesion can be unilateral or bilateral. Early appointment of etiotropic therapy prevents the transition of inflammation from the renal pelvis to the parenchyma and calyx of the organ.
Causes
The main cause of inflammation of the renal pelvis is infection with bacteria, less often with viruses and fungi. Pathogens initiating the pathological process are represented by E. coli in 70-90% of cases, but pseudomonas, klebsiella, proteus are also detected in crops. Often the flora is mixed.
Infection of the pelvis in adults occurs more often in an ascending way. In children without obstructive conditions, the spread of infection with blood flow is considered predominant. Hematogenic dissemination of gram-positive bacteria in adults is facilitated by intravenous drug use, septic endocarditis. Conditions that can cause pyelitis include:
- Violation of the outflow of urine. Vesicoureteral reflux, pelvic-ureteral strictures, urolithiasis cause stagnation of urine, which contributes to the formation of foci of infection. Compression of the ureter may be from the outside, for example, with a tumor of the retroperitoneal space or Ormond’s disease. Obstruction of the lower urinary tract against the background of prostate cancer, bladder dysfunction can lead to pyelitis.
- Traumatization. Pyelitis can be complicated by catheterization (prolonged or intermittent), functioning artificial drains (epicystostomy, nephrostomy), medical manipulations (pyelocystoscopy, retrograde pyelography, pyelolithoextraction of stone). Sexual activity can lead to microtraumatization of the urethra, which contributes to colonization of the bladder by pathogens and increases the risk of spreading inflammation.
- Chronic urological pathology. The cause of pyelitis can be long-existing cystitis, prostatitis, orchitis. The involvement of renal pelvis in the process of chronic inflammatory pathology of the lower urinary tract is facilitated by irrational treatment, in which pathogens pass into a persistent state.
Weakening of the immune system (HIV, diabetes mellitus, taking hormones, cytostatics, etc.), old age, pregnancy are considered as factors that increase the risk of developing pyelitis. In patients with severe immunosuppression, atypical flora is present in the results of sowing: fungi, viruses.
Pathogenesis
For the development of pyelitis, one hit of microorganisms into the renal pelvis is not enough, as a rule, there is a combination of general (immunosuppression) and local (concomitant urological pathology) factors. With a difficult outflow of urine, there is an increase in hydrostatic pressure in the CHLS and the tubular apparatus of the kidneys. High pressure in the pelvis and low in the renal veins leads to compression of the latter with impaired blood supply and lymph circulation in the organ.
Venous fullness and stroma edema contribute to a further increase in intrarenal pressure. Tissue nutrition is disrupted, resistance to infection decreases, as a result of which bacteria begin to multiply actively. Some clinicians consider pyelitis to be a short-term condition in which the infection spreads to the parenchyma of the organ within a few hours with the development of acute pyelonephritis.
Symptoms
Clinical manifestations are represented by discomfort or pain in the lower back (on one or both sides), urination disorders (cuts, frequent urges with the release of small portions of urine). Most patients initially have symptoms of dysuria, and only after a few hours (days) there are complaints of unpleasant sensations in the kidney area (cystopyelitis). The urine released is cloudy, with an unpleasant smell, sometimes with an admixture of blood.
The temperature rises to 37.5-38 ° C, ureteral obstruction can be suspected with a terrific chill. Some patients, in addition to the above signs, note nausea, abdominal pain, stool disorders. Of the common symptoms, weakness, sweating, and lack of appetite are typical. In young children, pyelitis is accompanied by fever, vomiting, diarrhea, cramps, bloating. The child becomes sluggish, refuses to eat, cries when urinating. These symptoms are not pathognomonic for inflammation of the pelvis of the kidney and may be present in other serious urological or surgical pathology, which requires emergency treatment to specialists.
Complications
With an unfavorable course of events, acute purulent pyelonephritis, kidney abscess, pionephrosis joins. Long-term consequences include scarring of renal tissue (fibrosis), hypertension, and decreased renal function. By itself, pyelitis does not lead to the development of renal insufficiency, but in combination with severe ureteral obstruction or drug nephropathy, the chances of loss of kidney function in bilateral lesions increase. In children, with the generalization of the process, urosepsis is more often registered. In some cases, pyelitis with an undiagnosed cause of a violation of the passage of urine leads to hypoplasia and wrinkling of the kidney.
Diagnostics
With complaints, the patient turns to a urologist or nephrologist, who carry out the necessary diagnostics and determine further management tactics. If the symptoms are repeated repeatedly, it may be useful to consult a phthisiourologist to exclude a specific etiology of the process. The survey algorithm includes:
- Laboratory diagnostics. When prescribing tests, the main thing is the detection of inflammation in the urinary organs. With pyelitis, leukocyturia, bacteriuria, micro-macrohematuria, protein are detected in the urine test. Sowing of urine is prescribed to identify the pathogen and its sensitivity to drugs. In blood tests with pyelitis, there may be no pronounced changes, accelerated ESR with a shift of the leukocyte formula to the left is rather a predictor of the spread of inflammation.
- Instrumental diagnostics. Ultrasound of the kidneys is the initial method of examination for pyelitis. As a rule, ultrasound diagnostics are sufficient to assess the localization of the inflammatory process, its nature, detection of developmental anomalies and urolithiasis. According to indications (in case of suspected obstruction and to establish its cause, uninformative ultrasound, in the absence of the effect of treatment), CT (MRI) of the kidneys and pelvis, intravenous urography can be prescribed.
Differential diagnosis is carried out with appendicitis (with right-sided pyelitis), pelvic inflammatory diseases, acute abdomen. To exclude surgical pathology, a consultation with a surgeon, gynecologist is indicated. In elderly people, differential diagnosis is difficult, often the final diagnosis is made only during inpatient examination.
Treatment
The optimal duration of therapy is 10-14 days and depends on the relief of symptoms and normalization of instrumental and laboratory parameters. Some studies have shown that the frequency of infection recurrence increases with short courses of treatment. Hospitalization in the department of clinical urology is necessary for pyelitis with background pathologies accompanied by urinary disorders, with possible acute pyelonephritis in a child, with severe concomitant extragenital pathology that increases the risk of complications. The general treatment regimen includes:
- Antimicrobial therapy. Before receiving the results of bakposev, antibiotics with a wide spectrum of action are prescribed. Further, it is possible to use uroseptics, herbal diuretics. At the same time, they recommend an enhanced drinking regime, rational nutrition with the exception of acute, sour, salty, extractive broths, alcohol.
- Antispasmodics and drugs that improve blood circulation. To relieve pain, antispasmodic drugs are additionally prescribed, which relax the ureters and promote better urine discharge. Improvement of blood supply is necessary to enhance metabolic processes, increase the concentration of antibiotics and uroseptics in the focus of inflammation.
Prognosis and prevention
Most cases of pyelitis are cured against the background of rational antibacterial therapy completely, the prognosis for life is favorable. When performing surgical interventions that help eliminate obstacles to the outflow of urine, the prognosis is relatively favorable if there are minimal violations of the functional ability of the kidneys. With concomitant CRF, pyelitis of the only kidney, the prognosis is serious.
Prevention implies timely therapy of inflammatory diseases of the organs of the urogenital sphere, preventive measures for existing chronic pathologies: dispensary observation, taking herbal medicines, diet. A healthy lifestyle, avoiding hypothermia, and spa treatment during remission are important.