Miscellaneous

Chronic pyelonephritis: symptoms, treatment, diet

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Chronic pyelonephritis - a disease characterized by periodic exacerbations. Under this disease understand nonspecific inflammatory process that affects the kidney parenchyma followed sclerosis. According to medical statistics, pyelonephritis affects about 20% of the population.

In children aged 2 to 15 years, they get sick more often girls, old age disease affects mostly men. Despite this, pyelonephritis is considered predominantly female disease due to the anatomical location of the urogenital organs and other functional features of the female body.

What it is?

Chronic pyelonephritis - a disease having the infectious-inflammatory in nature wherein pathological process involves calyx, renal tubules and renal pelvis with subsequent glomerular lesions and their vessels.

According to statistics, chronic pyelonephritis among all diseases of urogenital organs with inflammatory nonspecific nature is diagnosed in 60-65% of cases. And in 20-30% of cases it is consequence of the acute form of the disease.

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Causes

The main reasons are pyelonephritis microbes - Escherichia coli, Staphylococcus, Enterococcus, Proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis is particularly relevant stable to negative factors and antibiotic-shaped microbes. They can be stored for a long time in the cups and pelvis, with a decrease in immune defenses causing the activation of inflammation.

Why acute process becomes chronic?

The causes of chronic pyelonephritis can be considered:

  • substandard treatment of acute pyelonephritis, failure patient clinical guidelines doctor breakdown dispensary observation of a child or an adult;
  • late diagnosis and treatment of diseases breaking the flow of urine (urolithiasis, Nephroptosis, vesicoureteral reflux, congenital abnormalities of the urinary tract narrowing, benign prostatic hyperplasia);
  • the presence of concomitant chronic diseases that undermine the immune system, or are permanent foci of infection (obesity, diabetes, antritis, tonsillitis, Gall bladder, intestine, pancreas);
  • the ability of some agents to form L-shapes, which may be long in the renal tissue in an inactive state, but exacerbate while reducing the body's defenses or immune deficiency states.

Chronic pyelonephritis standard risk group there, but practitioners believe that the infection is most dangerous for:

  • pregnant women;
  • children up to three years, mostly on artificial feeding;
  • girls at first sex;
  • people in old age.

This is shown most patients prevention of chronic pyelonephritis.

Classification

Form of chronic pyelonephritis:

  1. Latent form. Symptoms are mild. The patient may disturb general weakness, fatigue, headache, sometimes can significantly increase the temperature. Typically, pain, swelling, and dysuria are absent, although some noted Pasternatskogo positive symptom (pain during effleurage on the lumbar region). In urinalysis revealed proteinuria small, leukocytes and bacteria in the urine may be released periodically. When latent course usually broken concentrating ability of the kidneys, therefore lowering characterized urine density and polyuria. Sometimes it is possible to detect mild anemia and slight increase in blood pressure.
  2. Relapsing form. Characterized by a change of periods of exacerbation and remission. May disturb the patient discomfort in the lower back, chills, fever. Appear dysuria (frequent urination, sometimes painful).
  3. Azotemicheskaya form. Are those cases in which the disease manifests itself in the form of chronic renal failure. They should be classified as an extension of an existing, but time does not detect latent disease progression. It azotemicheskaya form is characteristic of chronic renal failure.
  4. Idiopathic form. Dominated by hypertension. There are headache, dizziness, sleep disturbances, stabbing pain in the projection of the heart, frequent hypertensive crises, shortness of breath. Changes in urine expressed little and are not constant. Hypertension in pyelonephritis is often malignant character.
  5. Anemic form. Characterized by the fact that among the signs of the disease is dominated by symptoms of anemia - reducing the number of blood full of red blood cells. This form of the disease in patients with chronic pyelonephritis is more common, is more pronounced than in other diseases of the kidneys, and is usually hypochromic character. Violations of diuresis are weak.

Exacerbation of chronic pyelonephritis clinical picture resembles an acute inflammation. As the progression of the process leading syndrome becomes hypertensive, which is manifested by headache, dizziness, blurred vision, pain in the heart. Sometimes, as a result of current long-term pyelonephritis develops anemia syndrome. The outcome of the disease there is chronic renal failure.

stage

In chronic pyelonephritis distinguish three stage progression:

  • initial degree characterized by the development of inflammation, edema of the connective tissue inner layer urinary organ, whereby the receptacles are compressed, there is atrophy of tubules, renal hemorrhage decreases;
  • detected by the second degree of renogram where there diffuse narrowing of renal blood channel, the size of the cortical substance becomes less interlobar artery absent;
  • third degree of narrowing is expressed in pyelonephritis and change in shape of the urinary organ blood vessels, renal tissue is replaced by scar, kidney becomes wrinkled.

symptoms

The degree of manifestation of symptoms of pyelonephritis depends on the localization of inflammation (one side or both kidney), the degree of inflammatory activity by attendant impediments to the flow of urine and previous treatment. In step manifestations remission can not be completely, or they may be minimal - slight change in the urinalysis.

The main symptoms of pyelonephritis in women and men:

  1. Deterioration of health, fatigue and weakness, more pronounced in the morning, depressed mood, headaches.
  2. An increase in temperature is not above 38 ° C, usually in the evening, for no apparent reason.
  3. Frequent urination, especially at night.
  4. Increased blood pressure. In the period of remission it can be the only symptom.
  5. A small swelling of the face, hands, more than in the morning, feet and legs - to the end of the day.
  6. Back pain often not intensive, aching, usually unbalanced. It is noticed that the pain often do not appear on the affected side, and on the opposite. It may be a feeling of discomfort, heaviness in the lower back, especially when walking or prolonged standing. Patients complain that the waist is cold, tend to dress warmer. Strong or cramping rather typical of urolithiasis. When low-lying or movable kidney, as well as children up to 10-12 years of pain can be localized in the abdomen.

In remission all symptoms of pyelonephritis are minimal, but the longer has pyelonephritis, the more likely hypertension, cardiac hypertrophy, chronic renal insufficiency and secondary dystrophic changes in the kidneys. In the later stages may occur polyneuritis, bone pain, hemorrhage, polyuria with up to 3 or more liters of urine with a thirst and dryness of the mouth, anemia.

complications

With the progression of chronic pyelonephritis develops chronic renal failure. It is manifested increase in the number of daily urine and particularly nocturnal portions, reduced urine density, thirst, dry mouth.

The sharp exacerbation of chronic pyelonephritis may be accompanied by the development of acute renal failure.

Diagnostics

Acute and chronic pyelonephritis is diagnosed based on the patient's symptoms and clinical picture of the disease. The doctor determines whether acute pyelonephritis attack tolerated, cystitis, inflammation of the urinary tract and kidneys in childhood or during pregnancy in women.

In a survey of male attention is transferred spine injury, inflammation of the bladder and urinary organs. The physician reveals the presence of factors that predispose to occurrence pyelonephritis - presence of chronic diseases (prostate adenoma, diabetes, and others.).

The differential diagnosis is carried out with a number of diseases:

  1. Hypertension. Disease susceptible to the elderly, changes in blood and urine is not.
  2. Chronic glomerulonephritis. If no active leukocyte pathologies and pathogenic microorganisms present but erythrocytes.
  3. renal amyloidosis. Bacteria and no signs of inflammation. Disease characterized by the presence of foci of infection and scant urine sediment.
  4. Diabetic glomerulosclerosis. Concomitant diabetes, show signs of angiopathy.

Examination of the patient with chronic pyelonephritis in this way will help prevent medical errors, and to appoint an effective treatment.

Than to treat chronic pyelonephritis?

Therapy should be directed at eliminating such problems:

  • elimination of the reasons which caused disruption of normal kidney function;
  • use of antibacterial drugs and other drugs;
  • increase immunity.

The most effective drugs are: Levofloxacin, Amoxicillin, Biseptol, furadonin, as well as their peers.

medication

Antibiotics during the exacerbation of the disease is prescribed for up to 8 weeks. Specific duration of therapy will be determined by the results of laboratory tests performed. If the patient's condition serious, he prescribed a combination of antibiotics, administered parenterally or intravenously and in high doses. One of the most effective and modern uroseptikov considered drug 5-NOC.

To self-medicate it is strictly prohibited, although drugs for the treatment of pyelonephritis there are many. This disease is the sole responsibility of specialists.

Usually these drugs are used for the treatment of chronic pyelonephritis:

  1. Nitrofurans - furazolidone, furadonin.
  2. Sulfonamides - Urosulfan, Etazol and others.
  3. Nalidixic Acid - Negri nevigramon.
  4. Cephalosporins - Kefzol, Tseporin, ceftriaxone, cefepime, cefixime, cefotaxime, and so forth.
  5. Semisynthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, sultamicilin.
  6. Fluoroquinolones: Levofloxacin, Ofloxacin, tsiprinol, moxifloxacin, and so on.
  7. Antioxidant therapy reduces to receive tocopherol, ascorbic acid, retinol, selenium, and so forth.
  8. By resorting aminoglycosides in severe disease - kanamycin, gentamicin, Kolimitsin, Tobramycin, Amikacin.

, The physician should be familiar before you opt for one or another of antibacterial drugs with indicators patients urine acidity, because it affects the efficiency of drug funds.

physiotherapy

Physical therapy techniques have the following effects:

  • strengthen the kidney blood circulation, increase the renal plasma flow that enhances the delivery to the kidneys antibacterial agents;
  • relieve spasms of smooth muscles of the renal pelvis and ureter, which promotes discharge of mucus, urinary crystals bacteria.

Physiotherapy is used in the treatment of chronic pyelonephritis.

Spa treatment

It makes sense, since the therapeutic effect of mineral water is quickly lost when bottling. Truskavets, Zheleznovodsk, Obukhovo, Cook, Karlovy Vary - which of these (and other) spa resorts to choose - it is a question of geographical proximity and financial capabilities.

Raw cold, smoking and alcohol adversely affect the course of pyelonephritis. A regular check-ups with the control urine tests and preventive treatments contribute to long-term remission and prevent the development of renal failure.

Diet and Nutrition rules

Chronic course of the disease requires serious attention to the diet. recommended:

  • cereals, dairy products and vegetarian dishes;
  • watermelon, cantaloupe and pumpkin dishes;
  • fluid intake increased to 2.5 liters;
  • included in the diet small amount of meat or fish broth;
  • fish and meat is not fatty varieties boil or cook only a couple;
  • fruits and vegetables fresh or boiled;
  • It should be excluded from the diet of horseradish, garlic and radish;
  • salt intake per day limit to 8 grams.

A balanced diet promotes rapid recovery. During exacerbation of the disease in the diet should include fresh fruits and vegetables, as well as not less than 2 liters of liquid. Are not allowed in the diet - fried, spicy, fatty and salty foods.

prevention

Even in the absence of signs of an active infection is necessary to periodically (1 every year or every six months) to investigate the function of the previously diseased kidneys. In the presence of frequent relapses in women recommended for prolonged use of antibiotics at low doses (or Biseptolum furadonina).

All pregnant women in the first trimester is necessary to conduct urine culture. If you detect bacteriuria were treated with penicillin or nitrofurans.

As prevention of exacerbations also recommends a 10-day courses antibacterial and then for 20 days pursuing a course of herbal medicine (decoction bear's ear, birch leaves, horsetail, juniper fruit, flowers cornflower). Such courses need to spend a few, every month is recommended to change the antibacterial agent.

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