In view of the structural features of the female body pyelonephritis 6 times more common in women than in men. The most common causative agents of inflammation in the kidney are Escherichia coli (E.coli), Proteus (Proteus), enterococci (Enterococcus), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and Staphylococcus (Staphylococcus).
If we talk about the frequency of occurrence of this disease, it should be noted that it is about 10 out of 1000 people, and among the children of the adult population -. 10 of 2000. Most of the cases refers to the average age group - from 26 to 44 years. An interesting fact is that more than 70% of all patients are young women who become ill shortly after the first sexual intercourse. Among children's renal inflammation diseases securely holds the second position immediately after various respiratory diseases (bronchitis, pneumonia, etc.).
What it is?
Pyelonephritis - nonspecific inflammation mainly affecting the kidney tubule system, preferably bacterial etiology, characterized by lesions of the renal pelvis (pyelitis), cups and kidney parenchyma (mainly its interstitial tissue).
Based needle biopsy and excision of kidney tissue reveals three major variants of the disease: acute, chronic and chronic blowup.
Causes of pyelonephritis
In women, due to anatomical features, the first place goes upward (urinogenny) path of infection in the pelvis and kidney tissue - due cystitis, urethritis, vaginitis, colitis, urolithiasis structure and abnormalities of the urinary system, long-term presence of the catheter to drain urine. It is also possible hematogenous (through the blood), the spread of infection, when a potential source could be any center - transferred purulent mastitis, angina, felon, Ear inflammation and even inflammation of the tooth channel (pulpitis).
The main microbe causing pyelonephritis is E. coli (75% of all cases). The remaining 25% of cases are associated with a hit in the urinary tract Klebsiella, Proteus, Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, fungal infection, Chlamydia, Salmonella, etc.
Risk factors in the occurrence of pyelonephritis in women are all protracted pathological processes of any localization, proceeding with a reduction in overall immunity organism: diabetes, bone marrow diseases, neurological problems (multiple sclerosis), HIV infection, post-chemotherapy or transplantation authorities.
It is interesting
Interesting facts about pyelonephritis:
- In the United States every year gets sick, 1 out of 7000. In need of hospitalization and receive this assistance each year 192,000 patients.
- It was found that female representatives are suffering from pyelonephritis more often than men 5 times. The acute form of the disease is diagnosed more often in women of reproductive age, sexually active.
- With adequate treatment to 95% of patients report significant improvement in the first two days.
- We should not give up because of the copious drinking painful sensations during bladder emptying, as the only way to rid the body of bacteria. It should urinate as often as possible, that there was no such serious complications such as infection of the blood, causing a person can die.
- Abundant fluid intake is an essential condition for the treatment of disease. For a drink you must use clean water, which normalizes the balance in the body, thins the blood, It contributes to the speedy removal of pathogens and their toxic products life. The effect is achieved by increasing the amount of urination resulting copious drinking.
- Alcoholic beverages, coffee, sparkling water - all this is banned in pyelonephritis. It is believed that help in the fight against the disease can cranberry juice. Its consume in pure form or diluted with water.
- Pyelonephritis affects children, and as the girls (in 3% of cases) and boys (1% of cases). In children, the disease is dangerous for its complications. Thus, parenchymal renal scarring diagnosed in 17% of recovered children, hypertension, in 10-20% of children.
Chronic pyelonephritis
It is an inflammatory process in the kidneys, in which there is scarring of the kidney parenchyma.
When chronic pyelonephritis not observed sudden pain (as in acute disease course). The disease is often accompanied by hypertension. The most common reason why patients seek medical advice are the poor results of laboratory tests. If the patient has inflammation of both kidneys, there is polyuria and nocturia (nighttime urination) associated with impaired concentration urine.
Chronic pyelonephritis is associated with the violation of the outflow of urine. violation of the outflow of urine causes the occurrence of a certain amount of it in the bladder, in spite of frequent urination. This condition contributes to the development of infection. If left untreated, complications may occur, for example, renal failure.
Pyelonephritis - Symptoms in women
The weaker sex is more susceptible to this disease, but only in the first two age periods, ie, about 45-50 years. Everything is explained the structure of the urethra - it is short and close to the bowel and sexual ways.
This increases the risk of pyelonephritis - symptoms in women are shown as follows:
- nausea or vomiting;
- poor appetite;
- weakness and high temperature;
- Frequent trips to the bathroom;
- turbid or blood urine when urinating and cramps;
- aches in the back, increasing in cold weather;
- cramps and pain in the abdomen;
- unusual discharge.
Pyelonephritis in pregnant women
Unfortunately, it is more likely to develop dangerous infectious renal disease in pregnancy. Around seven per cent of women during pregnancy sick like illness.
Often the symptoms are manifested, it begins in the second trimester. symptoms often are not taken seriously, which leads to complications such as sepsis, renal failure, and premature labor, anemia. Bacteriuria in pregnancy can occur without symptoms bright, if a woman gives birth to a child is not the first time. In large families, as a rule, signs of pyelonephritis appear only in the later stages.
Infectious inflammatory kidney disease is very insidious. The problem is the frequent asymptomatic disease. As a result, people do not seek timely medical care and may suffer from serious complications. There are many cases of pregnant women dying of a pyelonephritis for this reason.
symptoms
The most common symptoms include acute pyelonephritis:
- Pain in the lumbar region on the affected side. When obstructive pyelonephritis pain usually obtuse, aching, can be low or high reach intensity take paroxysmal in nature (e.g., ureteral obstruction stone developmental m. n. calculous pyelonephritis).
- Dysuria for proper pyelonephritis are not typical, but can occur in urethritis and cystitis, which led to the development of ascending pyelonephritis.
General symptoms of intoxication syndrome is characterized by the development of:
- Fever up to 38-40 ° C;
- chills;
- general weakness;
- loss of appetite;
- nausea and sometimes vomiting.
For children is characterized by the severity of intoxication syndrome, and is characterized by the development of t. N. abdominal syndrome (severe pain in the lumbar region is not, and in the abdomen).
Individuals elderly often develops atypical clinical presentation or obliterated from the clinic or with severe general symptoms and the absence of local symptoms.
possible complications
In the absence of adequate therapy pyelonephritis face the following consequences:
- kidney failure (To protect the body from toxicity must regularly resort to the use of an artificial kidney device);
- septicemia (in case of penetration of bacteria into the bloodstream);
- chronization process (painful acute periodically observed);
- severe kidney damage;
- developing urolithiasis (renal colic periodically observed);
- fatal (resulting in blood poisoning - sepsis or kidney failure).
Diagnostics
The doctor will recommend the patient undergo instrumental diagnostics and laboratory research. These measures will help to properly diagnose and differentiate pyelonephritis from pathologies with similar symptoms.
Initially the patient will recommend to pass these tests:
- Blood biochemistry. Reveals an increased number of urea, creatinine, potassium. The content of potassium increased quantity characterizes the development of renal failure.
- Blood analysis. It will flow in the body of the inflammatory process (ESR acceleration, the presence of large amounts of leukocytes).
- Urine culture. Liquid is planted on a special culture medium. Through time is indicated growth of certain bacteria, triggering inflammation. Due sowing doctor will be able to choose the right antibiotic.
- Analysis of urine. In the case of the urine will vary pyelonephritis alkaline reaction, in which the pH is 6,2-6,9. Furthermore, estimated fluid hue. In the presence of pyelonephritis urine becomes dark, sometimes reddish color. Its composition is often the protein is present.
- Study on Nechiporenko. This method reveals a significant predominance of leukocytes in urine of red blood cells.
- Prednisolone test. The event allows you to diagnose pathology, different hidden leaks. The patient was intravenously administered drug prednisolone in combination with sodium chloride. After 1 hour, then the woman is necessary to collect the urine and then after 2 and 3 hours. And at the end of the day. The urine is sent to a detailed investigation. The increased number of leukocytes indicate a flow of pyelonephritis.
- Sample Zemnitsky. The method allows detection of decreased urine density. Pyelonephritis nocturnal diuresis (urine volume) prevails over the day.
To confirm pyelonephritis and differentiation of it from other pathologies doctor may prescribe the following measures:
- Excretory urography. It can detect kidney mobility. The study characterizes the state of the cups, the tone of the urinary tract.
- Ultrasonography. To get an idea of the size of the kidneys, their structure, density, the presence of these stones taken ultrasound. In the case of chronic echogenicity process (the ability to reflect ultrasound) parenchyma increased, in the acute phase - nonuniformly reduced.
- Cystometry. This study reveals the pathology of the bladder. survey is based on the principle of determining mochevika volume.
- Cystography. This radiopaque study allows to identify vesicoureteral reflux or intravesical obstruction.
- CT scan. A detailed study of the structure of the kidney. Unlike ultrasound to determine the state of the pelvis, the pedicle and perirenal fat.
In addition, women are strongly advised to visit a gynecologist. A doctor will take swabs to clarify the causative agent and determination of pathologies accompanying pyelonephritis.
Than to treat pyelonephritis?
At home, pyelonephritis in women and men treated with antibiotic and symptomatic therapy in the complex. To eliminate the symptoms of the disease is necessary to observe the following conditions:
- It is important to keep drinking regime during the entire treatment period.
- The first few days the patient must comply with bed rest, that is, be warm horizontal.
- To reduce body temperature and eliminate the pain, it is necessary the use of NSAIDs, including Diclofenac, Metamizole. The childhood shows paracetamol.
Considering the contagious nature of the disease, the presence of predisposing factors, the main clinical symptoms, the main therapeutic areas are:
- infection control (antibiotics);
- removal of ureteral obstruction, or renal pelvis, as well as other anatomical or neurogenic barriers that make it impossible to the normal outflow of urine;
- decrease the severity of intoxication (drink more fluids, bed rest, antipyretics);
- Power correction.
Particular attention is paid to the treatment of diet, with the help of which you can have a gentle effect on inflamed kidney and normalize metabolism withdraw toxins from the body, to recover diuresis, decrease blood pressure.
If exacerbation of chronic disease, or acute pyelonephritis primary flows against high temperature, accompanied by a drop in pressure, severe pain, suppuration and disruption of the normal flow of urine, require prompt intervention. The patient must be hospitalized at impossibility of drug therapy means in the home (vomiting after receiving tablets from pyelonephritis) and when expressed intoxication. In other situations, in the discretion of the physician, treatment may be performed on an outpatient basis.
antibiotic therapy
It is desirable that the antibiotic was selected based on the results of bacteriological urine culture with the definition of susceptibility to various drugs. In the case of acute pyelonephritis, immediately after sowing date can be assigned to a broad spectrum antibiotic of group ftorohinolov example Tsiprolet, and adjusted according to the results of sowing. Antibiotic therapy should be continued for at least 2-3 weeks.
New in the treatment of pyelonephritis
New European guidelines for the treatment of acute uncomplicated pyelonephritis:
1) The group of first-line antibiotics - fluoroquinolones.
- Drugs of choice - Cefixime (400 mg daily) and levofloxacin (0.5-0.75 times a day 1) in tablets.
- Ciprofloxacin 0.5-0.75 twice a day and Norfloxacin 400 mg twice a day still relevant only for previously untreated patients.
2) Antibiotics number 2 (alternative) - Amoksiksitsillin with clavulanic acid (625 mg) 3 times a day. In crops proved sensitivity can be used ceftibuten 400 mg 1 time per day.
3) pyelonephritis in pregnant women are no longer treated with amoxicillin, and, regardless of gestational age, appointed the following drugs:
- Tsefibuten 400 mg 1 time per day, or
- Cefixime 400 mg 1 time per day, or
- Cefotaxime 3-8 g per day in 3-4 administration intramuscularly or intravenously, or
- Ceftriaxone 1-2 g per day intramuscularly or intravenously.
4) Upon pyelonephritis severe requiring hospitalization therapy in hospital carried carbapenem (Ertapenem, Mirani) intramuscularly or intravenously. After a period of three days the patient has a normal temperature, treatment can be continued with oral medications. An alternative to carbapenems are Levofloxacin and Amikacin.
Diet with pyelonephritis
In the acute stage of the diet should be as gentle. It is necessary to drastically reduce salt intake (no more than 5-10 grams. a day with a high blood pressure - 2-3 grams), and to completely eliminate from the diet of sharp, spicy, smoked and canned food, strong meat broth, spices, coffee and alcohol..
During an exacerbation is strictly forbidden in cooking use animal fats (vegetable oils only, and no more than 15 grams per day of butter).
Permission is granted to: egg whites, dairy products, vegetarian (vegetable) dishes, boiled or steamed. As the inflammation subsided in the diet is introduced fish and lean meat. It is recommended to consume juices, fruit, melons, vegetables, fruits, as well as to drink 2-2.5 fluid daily (in the absence of edema).
In remission in diet allowed gradually, in small portions to introduce some spices, garlic and onions. It is very useful for patients suffering from chronic pyelonephritis, cranberry juice, which stimulates the production of hippuric acid (effective bacteriostatic agents). Allowed foods: fruits, vegetables, cereals, eggs, lean boiled meat and fish, low fat dairy products.
Forecast
There are two types of outputs from pyelonephritis - a full recovery or chronicity status. With timely treatment, the prognosis - mainly favorable. In most cases, relief comes after 3-5 days of drug therapy. The body temperature is reduced, the pain subside, the general condition of the patient to normal. With a favorable course of treatment a person leaves the hospital in 10-12 days.
In the presence of pyelonephritis remission receiving assigned antimicrobials for 6 days. When acute pyelonephritis becomes chronic and there are complications, prognosis - unfavorable. In this case, a high probability of occurrence of renal failure, pyonephrosis, hypertension, and others.
It is important to adhere to the rules after the treatment recommended by your doctor regularly pass urine and take preventive measures. The sooner a patient asks for help to the doctor, the higher the chances of timely cure and no complications.
prevention
To not bring themselves to pyelonephritis - prevention must take into account certain rules:
- The use of medicinal herbs as prophylaxis.
- If the pathological process of infectious etiology is in any other organs it is necessary to sanitize, because with a blood bacteria can spread to the kidneys.
- Getting rid of the bad habits as well as alcohol and smoking greatly reduce the immune properties of an organism that inhibits the ability to respond to penetration of bacteria and viruses into the body.
- The body has to get enough rest and sleep, and exhausted as the body can not fight the bacterial infection.
- Persons who are at risk of developing the disease is necessary in order to carry out regular laboratory and instrumental methods of research with the aim of preventing pyelonephritis.
Compliance with these rules does not provide a significant labor should only be careful to pay attention to their own health to carry out the treatment in the early stages of the pathological process.