Pyelonephritis is a nonspecific infectious kidney disease caused by various bacteria. The acute form of the disease is manifested by fever, symptoms of intoxication and pain in the lumbar region. Chronic pyelonephritis can be asymptomatic or accompanied by weakness, impaired appetite, increased urination and non-intense lower back pain. The diagnosis is made based on the results of laboratory tests (general and biochemical urine tests, bacposev), urography and ultrasound of the kidneys. Treatment – antibacterial therapy, immunostimulants.
ICD 10
N10 N11
Meaning
Pyelonephritis is a widespread pathology. Patients suffering from acute and chronic pyelonephritis account for about 2/3 of all urological patients. The disease can occur in an acute or chronic form, affecting one or both kidneys. Diagnosis and treatment is carried out by a specialist in the field of clinical urology and nephrology. In the absence of timely therapy, pyelonephritis can lead to severe complications such as kidney failure, carbuncle or kidney abscess, sepsis and bacterial shock.
Causes
The disease can occur at any age. Pyelonephritis develops more often:
- In children under the age of 7 years (the probability of pyelonephritis increases due to the peculiarities of anatomical development.
- In young women aged 18-30 years (the occurrence of pyelonephritis is associated with the onset of sexual activity, pregnancy and childbirth).
- In elderly men (with obstruction of the urinary tract due to the development of prostate adenoma).
Any organic or functional causes that interfere with the normal outflow of urine increase the likelihood of developing pathology. Pyelonephritis often appears in patients with urolithiasis. The adverse factors contributing to the occurrence of pyelonephritis include diabetes mellitus, immune disorders, chronic inflammatory diseases and frequent hypothermia. In some cases (usually in women) pyelonephritis develops after acute cystitis.
Asymptomatic course is often the cause of untimely diagnosis of chronic pyelonephritis. Patients begin to receive treatment when kidney function is already impaired. Since pathology very often occurs in patients suffering from urolithiasis, such patients need special therapy even in the absence of symptoms of pyelonephritis.
Pyelonephritis symptoms
Acute pyelonephritis
An acute process is characterized by a sudden onset with a sharp increase in temperature to 39-40 ° C. Hyperthermia is accompanied by profuse sweating, loss of appetite, pronounced weakness, headache, sometimes nausea and vomiting. Dull pains in the lumbar region of varying intensity, more often unilateral, appear simultaneously with an increase in temperature. Physical examination reveals soreness during pounding in the lumbar region (a positive symptom of Pasternatsky).
The uncomplicated form of acute pyelonephritis does not cause urination disorders. Urine becomes cloudy or acquires a reddish hue. Laboratory examination of urine reveals bacteriuria, minor proteinuria and microhematuria. The general blood test is characterized by leukocytosis and increased ESR. In about 30% of cases, an increase in nitrogenous slags is noted in the biochemical analysis of blood.
Chronic pyelonephritis
Chronic pyelonephritis often becomes the outcome of an untreated acute form. The development of a primary chronic process is possible. Sometimes pathology is detected by accident when examining urine. Patients complain of weakness, decreased appetite, headaches and frequent urination. Some patients are concerned about dull aching pain in the lumbar region, which increases in cold wet weather. The symptoms indicating an exacerbation coincide with the clinical picture of the acute process.
Complications
Bilateral acute pyelonephritis can cause acute renal failure. Sepsis and bacterial shock are among the most serious complications. In some cases, the acute form of the disease is complicated by paranephritis. It is possible to develop apostenomatous pyelonephritis (the formation of multiple small pustules on the surface of the kidney and in its cortical substance), kidney carbuncle (often occurs due to the fusion of pustules, characterized by the presence of purulent-inflammatory, necrotic and ischemic processes) kidney abscess (melting of the renal parenchyma) and necrosis of the renal papillae.
If treatment is not carried out, the terminal stage of a purulent-destructive acute process occurs. Pionephrosis develops, in which the kidney is completely subjected to purulent melting and is a focus consisting of cavities filled with urine, pus and tissue decay products. With the progression of chronic bilateral pyelonephritis, kidney function is gradually impaired, which leads to a decrease in the specific gravity of urine, arterial hypertension and the development of chronic renal failure.
Diagnostics
Diagnosis is usually not difficult for a urologist due to the presence of pronounced clinical symptoms. In the anamnesis, the presence of chronic diseases or recently transferred acute purulent processes is often noted. The clinical picture is formed by a characteristic combination of severe hyperthermia with lower back pain (more often unilateral), painful urination and changes in urine. Urine is cloudy or with a reddish tinge, has a pronounced fetid smell. Within the framework of diagnostic measures , the following are performed:
- Laboratory tests. Laboratory confirmation of the diagnosis is the detection of bacteria and small amounts of protein in the urine. To determine the pathogen, urine back-seeding is carried out. The presence of acute inflammation is indicated by leukocytosis and an increase in ESR in the blood test. With the help of special test kits, the identification of the microflora that caused the inflammation is carried out. The concentration capacity of the kidneys is evaluated using the Zimnitsky test.
- Radiation diagnostics. During the review urography, an increase in the volume of one kidney is detected. Excretory urography indicates a sharp restriction of the mobility of the kidney during the orthoprobe. With apostematous pyelonephritis, there is a decrease in excretory function on the side of the lesion (the shadow of the urinary tract appears late or absent). With a carbuncle or abscess on the excretory urogram, the swelling of the kidney contour, compression and deformation of the cups and pelvis are determined. The diagnosis of structural changes in renal tissue in pyelonephritis is carried out using ultrasound of the kidneys. Kidney CT is performed to exclude urolithiasis and anatomical abnormalities.
Treatment
Treatment of acute pyelonephritis
Uncomplicated acute process is treated conservatively in a hospital setting. Antibacterial therapy is being carried out. Medications are selected taking into account the sensitivity of bacteria found in the urine. In order to eliminate inflammatory phenomena as quickly as possible, preventing the transition of pyelonephritis into a purulent-destructive form, treatment begins with the most effective drug.
Detoxification therapy, correction of immunity is carried out. In case of fever, a diet with a reduced protein content is prescribed, after normalization of the patient’s temperature, he is transferred to a full-fledged diet with an increased fluid content. At the first stage of therapy of secondary acute pyelonephritis, obstacles that hinder the normal outflow of urine should be eliminated: as a rule, a ureteral catheter-stent is installed for this purpose. The appointment of antibacterial drugs with impaired passage of urine does not give the desired effect and can lead to the development of serious complications.
Treatment of chronic pyelonephritis
It is carried out according to the same principles as the therapy of the acute process, but differs in greater duration and labor intensity. The therapeutic program provides for the elimination of the causes that led to difficulty in the outflow of urine or caused renal circulatory disorders, antibacterial therapy and normalization of general immunity.
If there are obstacles, it is necessary to restore the normal passage of urine. Restoration of urine outflow is performed promptly (nephropexy with nephroptosis, removal of stones from the kidneys and urinary tract, removal of prostate adenoma, etc.). Removing obstacles that interfere with the passage of urine, in many cases, allows you to achieve a stable long-term remission. Antibacterial drugs are prescribed taking into account the data of the antibioticogram. Before determining the sensitivity of microorganisms, therapy with broad-spectrum antibacterial drugs is carried out.
Patients with chronic pyelonephritis require long-term systematic therapy for at least a year. Treatment begins with a continuous course of antibacterial therapy lasting 6-8 weeks. This technique allows you to eliminate the purulent process in the kidney without the development of complications and the formation of scar tissue. If kidney function is impaired, constant monitoring of the pharmacokinetics of nephrotoxic antibacterial drugs is required. To correct immunity, if necessary, immunostimulants and immunomodulators are used. After achieving remission, intermittent courses of antibacterial therapy are prescribed.
During remission, patients are shown sanatorium treatment (Jermuk, Zheleznovodsk, Truskavets, etc.). It should be remembered about the mandatory continuity of therapy. The antibacterial treatment started in the hospital should be continued on an outpatient basis. The treatment regimen prescribed by the sanatorium doctor should include taking antibacterial drugs recommended by a doctor who constantly monitors the patient. Phytotherapy is used as an additional treatment method.
