Pyelonephritis - an inflammation of the kidney tissue.
Kinds
The primary (developed in the healthy kidney without breaking the urine flow)
Secondary (developed on the background of kidney disease, developmental abnormalities or disorders of urine outflow: narrowing of the ureter, benign prostatic hyperplasia, urolithiasis disease, Atony of the urinary tract, reflux dyskinesia).
Phases: exacerbation (active pyelonephritis), remission (inactive pyelonephritis).
Localization: unilateral (rarely), two-way.
Complications: uncomplicated, complicated - abscess, sepsis.
Kidney Function - Intact, dysfunction, renal failure.
Women suffer 2-5 times more often than men, girls - in 6 times more often than boys. In older men with benign prostatic hyperplasia, pyelonephritis occurs more frequently than in the young.
Causes
The cause of pyelonephritis is always infection. Factors contributing to the development of infection in the kidney:
- Violation of the outflow of urine (narrowing of the ureter, renal abnormalities development hydronephrosis, Reflux, tumors, stones, etc.).;
- Prior renal disease, especially interstitial nephritis;
- Immunodeficiency states (treatment with cytostatics and / or prednisone, sugar diabetes, Immunity defects);
- Hormonal imbalances (pregnancy, menopause, prolonged use of contraceptives).
symptoms of pyelonephritis
acute pyelonephritis
- Most often it occurs with a bright clinical picture;
- Fever with chills, drenching sweat;
- Pain in the lumbar region;
- Urinary syndrome - excessive urination (more frequently) or a reduced volume of urination (less often) the loss of fluid through the lungs and skin, frequent and painful urination;
- Intoxication syndrome - headache, nausea, vomiting;
Chronic pyelonephritis in most patients (50-60%) is hidden within. manifested
- Low temperature, sweating, chilling, or aching sensation of heaviness in the lumbar region.
- Urinary syndrome - increased voiding volume, preferably at night, less frequent and painful urination.
Intoxication symptoms - headache, nausea. Arterial hypertension (More than 70% of cases). Anemia (in some patients).
Diagnostics
- Blood analysis;
- Analysis of urine;
- Required bacteriological urine culture;
- renal ultrasound;
- Panoramic radiography increase or decrease from one kidney in a volume tuberosity circuits, sometimes - shadow stone;
- descending urography (Contraindicated in the active phase);
- Radioisotope and renografiya scintigraphy.
treatment of pyelonephritis
Fluid intake 2-2.5 l / day.
Antibiotic therapy for at least 2 weeks courses of 7-10 days, empirical (before seeding pathogen) and targeted (after determining the sensitivity of microorganisms to antibiotics).
acute pyelonephritis
- treatment begins with a semi-synthetic penicillins (amoxicillin; Alternative formulations - protected penicillins type amoxicillin + clavulanic acid, sulbactam + ampicillin) and cephalosporins (cefalexin, cefuroxime, cefaclor).
Exacerbation of chronic pyelonephritis
- start with the protected penicillin, drugs of choice - fluoroquinolones, cotrimoxazole, cephalosporins (all preparations for oral administration).
Preventive treatment is carried out for 3-12 months. 7-10 days of each month, with purulent pyelonephritis - antibiotics (see. above), serous - uroantiseptikami alternately: nalidixic acid 0.5-1 g 4 / day, nitrofurantoin 0.15 g 3-4 p / d nitroksolin of 0.1-0.2... r 4 p. / day.
Effectively the appointment uroantiseptikov 1 times at night: co-trimoxazole, trimethoprim or nitrofurantoin 100 mg at night or 3 p / week.. (Prophylactically).
- Immunotherapy.
- When anemia - iron supplements, blood transfusion, red blood cell mass.
- Surgery. When purulent pyelonephritis in the case of failure of conservative therapy - renipuncture, pielonefrostoma and drainage of the renal pelvis.
An integral part of the effective treatment is compliance pyelonephritis diet.
Course and prognosis
Prognosis worsens with increasing duration pyelonephritis, with nosocomial pyelonephritis, resistance to microbes antibacterial agents, obstruction of the urinary tract, the presence of purulent complications, immunodeficiency, frequent relapses.
Complete recovery in acute pyelonephritis possible the early diagnosis, rational antibiotic without aggravating factors.
In 10-20% of patients develop chronic pyelonephritis chronic renal failure. In 10% of patients with hypertension there is its malignancy.
