What is acute pyelonephritis
Pyelonephritis is the most common pathology of the kidneys: in our country, they get sick twice as often as glomerulonephritis. Pyelonephritis mainly affects women. However, in the older age group, the disease is more common in men due to the prevalence of prostate adenoma, which creates obstacles for urine outflow and favorable conditions for the reproduction of bacteria.
Causes of acute pyelonephritis
Acute pyelonephritis develops as a result of the penetration of pathogenic microorganisms into the kidney tissue and the pelvis, usually through blood (hematogenous, descending path) or through the ureters (urinary, ascending path).
Hematogenous by acute pyelonephritis develops with various purulent and infectious diseases:
- chronic tonsillitis,
- prolonged septic endocarditis, etc.
The main etiological factor in this are staphylococci, streptococci and some other microbes.
The most frequent pathogen in the ascending pathway of infection is Escherichia coli and other bacteria of the intestinal flora.
Urinary tract diseases predispose to the development of acute pyelonephritis, in which there are difficulties in urine outflow, for example, congenital anomalies, stones, strictures and tumor-like formations in the urinary tract, as well as pregnancy, in which urinary excretion is difficult.
It should be noted that in the hematogenous penetration of the infection into the kidney, the processes of impaired urine play a large role, since usually in healthy, normally developed kidneys, the infection is not capable of causing an inflammatory process.
Symptoms of acute pyelonephritis
Morphological changes in acute pyelonephritis are characterized by inflammatory and purulent foci in the entire parenchyma of the affected kidney. In acute pyelonephritis characterized by inflammatory and purulent foci in the entire parenchyma of the affected kidney.
At the confluence of small purulent foci a large abscess can form – carbuncle. Carbuncle or small abscesses can sometimes be opened in the calyx or pelvis, leading to pyuria, or perirenal fiber, causing perinephritis.
In recovered patients, connective tissue scars are formed at the site of purulent foci. With a significant prevalence of the process or frequent repeated exacerbations of pyelonephritis, these scars lead to wrinkling of the kidney.
Acute pyelonephritis most often begins with chills with a rise in temperature of up to 39 ° C and higher, and soon pain in the lower back appears. Impermanent and painful urination is inconstantly observed, which almost always indicates attached inflammation of the bladder and urethra.
When questioning the patient, it is necessary to find out whether there have been recent overt purulent or infectious diseases, including the lower urinary tract, or whether acute pyelonephritis has been reported in the past. It is also important to clarify the nature of the main manifestations of the disease in the preceding days.
In the clinical picture of acute pyelonephritis conditionally allocate general and local symptoms of the disease.
Common ones include intermittent fever with chills and sweats, dehydration and intoxication of the body, dyspeptic symptoms, headaches and
Local symptoms of the disease are manifested by pains in the kidney area, which are noted by the patient himself or are found by tapping on the lower back on the affected side, examining Pasternack symptom or bimanual palpation of the kidney.
The pains are often dull, permanent and aggravated by movement and palpation. In some cases, the muscle tension of the abdominal wall can be determined on the side of the lesion and, on the 3-5th day of the disease, a painful infiltration in the kidney area.
Palpation of painful points is advisable: at the back at the level of the intersection of the XII rib with the outer edge of the long extensors of the back, at the front 3 cm to the right and left of the navel.
Descriptions of the symptoms of acute pyelonephritis
Diagnosis of acute pyelonephritis
The final diagnosis of acute pyelonephritis is established only in the hospital according to the results of a comprehensive examination, taking into account laboratory data, and, if necessary, instrumental studies.
From laboratory signs for pyelonephritis are characteristic:
- leukocyturia (pyuria),
- minor albuminuria,
A large amount of blood in the urine (gross hematuria) in combination with renal colic is observed only with the complication of acute pyelonephritis – necrosis of the renal papillae.
Pyuria or increased leukocyturia with prevalence of neutrophils in the urine sediment over the other formed elements is clearly determined using both general clinical analysis of urine and special research methods proposed by Addis-Kakovsky (in daily urine), Nechyporenko (in 1 ml of urine) and Amburzhe (for 1 minute). These methods are used in the hospital.
Bacteriuria, often even with a general urine test, is often detected with pyelonephritis. Detection of 50,000 – 100,000 or more microbial bodies in 1 ml of urine confirms the diagnosis of the disease. A lesser degree of bacteriuria is usually noted in cases of non-renal urine infection. Albuminuria in acute pyelonephritis rarely exceeds 1-2 ppm.
It is characterized by unchanged specific gravity of urine (more than 1014), which is explained by the intact function of many tubules and oliguria, due to significant fluid loss through the skin and lungs, as well as increased catabolism during the febrile reaction, which ultimately leads to increased production of “renal slags”, which and cause a high proportion of urine.
In the peripheral blood in acute pyelonephritis, neutrophilic leukocytosis, a shift to the left and an increase in the ESR is detected.
Classification of acute pyelonephritis
It is accepted to distinguish several clinical forms of acute pyelonephritis:
Treatment of acute pyelonephritis
Acute pyelonephritis is a disease with which patients often seek medical help. The recovery of the patient depends largely on the correct recognition of the disease and appropriate medical tactics.
All patients with acute pyelonephritis should be referred as soon as possible to the urological hospital and hospitalized. In the acute febrile period and with pronounced symptoms of intoxication, the patient must comply with bed rest.
Which doctors to use for acute pyelonephritis
Assign diet number 7, containing digestible food with 4-5 meals a day with the exception of hot spices, products containing extractives (horseradish, radishes, onions, dill), coffee. The restriction of proteins in food is inappropriate.
During the day, the patient should drink 2-3 liters of liquid (milk drinks, compote, jelly, fruit juices, mineral water, etc.), but on condition of urine outflow and the absence of a tendency to its retention in the body (edema, ascites).
After the end of the acute period of the disease (normalization of temperature and urine test results), the patient can be transferred to a general diet with a restriction in the diet of spicy dishes.
The main place in the treatment of acute pyelonephritis is antibiotic therapy. Preparations are mainly used with bactericidal properties, a wide spectrum of action and excreted in the urine in high concentration:
- Furagin 0.05 to 2 tablets 3 times a day;
- Nalidixic acid derivatives (Nevigramone, 2 capsules, 4 times a day);
- 8-hydroxyquinoline (5-NOK, 2 tablets 4 times a day);
- antibiotics (erythromycin 0.25 g 4 times a day);
- sulfonamides (etazol 1 g once a day;
- sulfadimethoxin 0.5 g 2 times a day);
- complex drug Biseptol 2 tablets 2 times a day.
Solutions of methylene blue, cranberry extract, decoction of bear ears, etc., have a certain antibacterial activity.
The choice of an antibacterial drug is preferably carried out taking into account the data of bacteriological examination of urine and determining the sensitivity of its microflora (in the hospital).
During the acute manifestations of the disease, symptomatic remedies should be prescribed: antispastic (papaverine, 0.04 g, 3 times a day, cystenal, 3-4 drops, 3 times a day), desensitizing (diphenhydramine, 0.05 g, 2 times a day).
Medicinal herbs have a definite place in the treatment of pyelonephritis, they usually prescribe the following:
- St. John’s wort;
- Birch buds;
- diuretic tea;
- field horsetail;
- dog rose;
Decoctions or infusions of these herbs have desensitizing and diuretic effects, they are recommended to be taken in a tablespoon 3-4 times a day for 1-3 months or more.
With proper treatment, acute pyelonephritis can be stopped in the first days of the disease. Initially, the common signs of an infectious disease disappear: chills, fever, intoxication, then local manifestations and, much later, changes in urine.
With effective conservative treatment, antibacterial drugs are prescribed for a period of at least 4-6 weeks with a change every 7-10 days, despite the fact that the general and local manifestations, as well as changes in urine can disappear after a few days.
With ineffective antibacterial treatment of acute pyelonephritis, manifested by increasing toxicosis, severe pain in the kidneys, as well as the development of anuria, suspected ureteral blockage, with pyuria, which is determined by eye, kidney carbuncle, paranephritis, necrosis of the renal papillae, urgent consultation with the doctor and the kidney, paranephritis, necrosis of the renal papillae are needed – , surgical treatment to combat the inflammatory and purulent process in the affected kidney and prevent its spread to a healthy kidney.
In the future, it is advisable to observe a lifestyle with limited exercise, prevent cooling and colds.
Persons who have experienced acute pyelonephritis must be under dynamic observation (clinical examination), since the disappearance of pyuria and bacteriuria does not always mean the elimination of the inflammatory process. In many cases, this only shows its decline.
Any extraneous (intercurrent) infection, weakening of the body due to overwork, malnutrition or other causes can lead to re-infection (reinfection) or exacerbation of a latent (low-intensity) infection in the kidney.
Regularly, at least 2 times a year, patients are subject to examination by a dentist, an otolaryngologist, and, if indicated, by other specialists. The prognosis of acute pyelonephritis with timely detection, proper treatment and subsequent follow-up is favorable.
Questions and answers on the topic Pyelonephritis
Question: Hello! 5 days ago, a kidney became very sick and there was a cutting pain when urinating with blood. The doctor diagnosed acute pyelonephritis. Prescribed kidney tea, gentamicin for i / m administration and nolitsin. I have been healing for 5 days now, but it is not getting any better. Only to urinate was rare and painless. And when will the blood in the urine cease to appear?
Answer: Duration of treatment varies from 5 to 15 days. It is important to understand that the symptoms of the disease may begin to disappear after a week of therapy, but this does not mean recovery, therefore, it is not recommended to stop treatment.
Question: Hello. My daughter is 1.9 months old. At the beginning of June, we had acute respiratory viral infections and then, two days later, the unas temperature rose to 39.5 and stayed for three days. Analyzes showed that we have acute pyelonephritis, spent 10 days in the hospital, immediately started coughing after discharge, the temperature was 37.9, sweating terribly, not eating, and generally it frightens me, I really don’t want to take antibiotics, please advise what to do.
Answer: Hello. Definitely need to consult a doctor to determine the cause of the temperature rise.
Question: My dad has CHD. Edemas went above the knees. Strong diuretics are prescribed by the local doctor. Do not help. With the next attack of suffocation caused an ambulance. They pumped out 1.8 liter of urinary fluid with a catheter, made an additional diagnosis – pyelonephritis. In the treatment of coronary artery disease, fluid intake is limited due to edema, with kidney increases. How to be?
Answer: Hello. The accumulation of urine in the bladder may be associated with prostate adenoma. With pyelonephritis, urine does not accumulate in such large quantities in the bladder. It is not entirely clear how ambulance doctors diagnosed pyelonephritis without additional tests. You need to go with your father to the urologist, who will help to understand this problem.
Question: And can pyelonephritis be inherited in future children?
Answer: Hello. No, this disease is not inherited.
Question: Hello! I suddenly fell ill, for a symptom it looks like it is pyelonephritis. That’s just a terrible condition in general, the temperature keeps
Answer: Hello. If you feel so bad, then you need to see a doctor who will give you a referral for hospitalization. It is impossible to prescribe effective treatment of pyelonephritis without tests.
Question: Hello, I have chronic pyelonephritis, swelling under the eyes is very disturbing, the liquid is poorly developed, tell me which drugs to drink to solve these problems, from liquid tea it is better to remove the liquid, but it is painful for convulsions.
Answer: Hello. We recommend that you take a biochemical blood test, as well as an analysis of the level of potassium, calcium, magnesium, sodium, and contact your doctor with the results. With the help of the analysis it will be possible to find out the possible cause of the appearance of bags under the eyes, as well as the cause of convulsions. Diuretic teas, as well as some diuretic drugs contribute to the removal of potassium, calcium and magnesium, which provokes seizures. If the analysis reveals a decrease in the level of these microelements, then the doctor will recommend appropriate preparations for their normalization.
Question: I have chronic pyelonephritis for 3 years now, sometimes I suffer from nagging pains and low temperature (37-37.3). Can I work out at the gym?
Answer: Hello. You may be allowed to exercise a little in the gym, but only during the period of subsidence of the symptoms of the disease, at normal body temperature.
Question: And pyelonephritis will not affect the further pregnancy of a woman? Infertility for example? Is that possible because of this disease?
Answer: Pyelonephritis does not lead to infertility.