Pyelonephritis

Pyelonephritis

is a disease of the kidney parenchyma and the bowl-and-pelvis system. Pyelonephritis is an inflammatory disease. It can develop as a result of ingestion of E. coli, Pseudomonas aeruginosa, Staphylococcus, etc. Inflammation of the renal pelvis, called pyelitis, is no longer considered an independent disease.

In acute pyelonephritis, the most likely route of penetration into the kidney of the causative agent of the disease is the hematogenous pathway. Infection can get into the kidney and in the event that the primary inflammatory focus is located both in the urinary tract, and in the genitals, and outside the urinary tract.

The classification of pyelonephritis can be based on several criteria: thus, pyelonephritis is divided into one-sided and two-sided, acute and chronic, obstructive and non-obstructive, primary and secondary. Treatment of acute pyelonephritis, as a rule, is based on antibiotics or on any antibacterial drugs. The choice of the most optimal treatment is performed by a doctor.

It is impossible to start or let it go (in principle, this is the same thing), because it is fraught with its transition to a chronic form (which requires more prolonged and patient treatment) or the development of complications (which may require surgical intervention). Prevention of pyelonephritis is largely associated with the timely treatment of diseases that can lead to it.

Pyelonephritis is a common kidney disease.

In fact, among children, pyelonephritis belongs to the second place after diseases associated with the respiratory system. Statistics show that this disease is more susceptible to the female population. In girls and women, it occurs six times more often than boys and men. Pyelonephritis is found in one out of ten people; on the frequency of occurrence of this disease is inferior to infectious and respiratory diseases.

Women are more prone to pyelonephritis.

Indeed, among the patients with this disease “leading” is the female part of the population. Often, pyelonephritis develops during pregnancy, which is associated with a violation of urine output. The latter can take place as a result of an objective increase in the uterus in size and squeezing it by the ureters. In addition, quite often pyelonephritis does not develop during pregnancy, and pregnancy itself helps to detect an inconspicuous inflammatory process in the urinary system.

Microorganisms that cause inflammation in the kidney can penetrate it in three ways.

It is hematogenous, urinogenous and ascending along the wall of the urinary tract. The hematogenous path is the path through the blood. In this case, the primary inflammatory focus is not in the kidney itself, but in another organ or in another part of the genitourinary system. If the infection is in another organ, then it can be about otitis, caries, bronchitis, tonsillitis, sinusitis, etc. An essential condition for the hematogenous pathway is the ingestion of microorganisms into the kidney along with the blood flow, but to delay infection in the kidney (or kidneys ) a combination of factors favorable for microorganisms is necessary.

The latter include, as a rule, a circulatory disorder in the kidney and an outflow of urine from the kidneys – both factors are important. However, in the absence of these conditions, certain types of microorganisms are capable of causing inflammatory processes in a completely healthy kidney. For example, several microorganisms can include several types of staphylococci.

After microorganisms enter the renal tissue, they accumulate on the vascular loops of Malpighian glomeruli (renal glomeruli consisting of a branched capillary network). The actions of microbes lead to the destruction of the inner shell of the vessels. After the destruction occurred, the microbes find themselves in the lumen of the renal tubules. Then they are excreted in the urine.Inflammatory process in the kidney is localized just around these, so-called, microbial blood clots. The acute period of the disease lasts about ten days.

The urinogenous pathway (or ascending) is associated with the entry of microbes into the renal tissue from the underlying urinary tract. This happens with the return current of the urine (as is well known, in the normal functioning of the urinary system, urine from the kidneys through the ureters enters the bladder – its reverse current is impossible (with normal functioning) .Otherwise (this is called a bubble reflux), microbes from the bladder can penetrate into the kidney, causing inflammation in it.The dynamics of urine may be disrupted for other reasons, including the presence of stones in the urinary tract, nephroptosis, hydronephrosis, kidney duplication and There is another way of possible entry of microorganisms into the kidney, this is the ascending path along the urinary tract wall, to be more precise, then along the ureter wall.It should be taken into account that the inflammation in this case occurs not only in the kidney itself – the inflammatory processes go in the wall of the ureter, the latter fact can contribute to a malfunction in the proper movement of the urine through the ureter, and as a consequence, the infection of the urine into the kidney is accompanied by a hematogenous and urinogenic pathway of microorganisms causing ielonefrit the kidney.

Pyelonephritis is an independent disease.

Indeed, pyelonephritis can develop in a person as an independent disease. But cases when pyelonephritis arises as a complication of other diseases are not uncommon. Often, pyelonephritis develops as a result of inflammation in the lungs, genitals, in the abdominal cavity, as well as sinusitis, dental caries. That is, in this case, the cause of pyelonephritis is an infection.

Pyelonephritis develops under the influence of a number of factors.

That’s why it’s wrong to talk about the development of pyelonephritis only on the basis of the fact that microbes enter the renal tissue. First, pyelonephritis is promoted by all that is capable of delaying the outflow of urine – for example, inflammation of the ovaries in the female part of the population, adenoma of the prostate gland in the male part of the population, stones in the bladder and ureters, etc. Quite often, urolithiasis and pyelonephritis develop simultaneously, acting on each other, so to speak, complementary: inflammation, which gives pyelonephritis, contributes to the appearance in the human body of stones, the latter in turn complicate the outflow of urine and thereby stimulate inflammation processes in the renal pelvis. Secondly, factors contributing to the development of such a disease as pyelonephritis are also overwork, hypothermia, insufficient amounts of vitamins, stress, etc.

There is a one-sided and bilateral pyelonephritis.

This classification is based on the number of kidneys, to which the inflammatory processes have spread. It should be noted that unilateral pyelonephritis is much more common. And even more correctly it will be called not one-sided, but right-sided, since it is the right kidney that is more prone to the occurrence of pyelonephritis. The reason for this – in the anatomical and physiological features of the right kidney, as a result of which the processes of stagnation of urine are possible.

The onset of acute pyelonephritis is sudden.

The disease begins with a sharp jump in body temperature to 39-40 ° C. The patient has a feeling of weakness, there is a headache. A characteristic feature is profuse sweating. Nausea and vomiting often occur. The intensity of pain in pyelonephritis (occur in the lower back and in the hypochondrium) can be different. The pain is dull. If the course of pyelonephritis is not complicated, then the excretion of urine is not disturbed.

данные For laboratory diagnosis of acute pyelonephritis, laboratory data are important.

A general analysis of blood and urine (it is determined whether there are microorganisms).It is also important to determine whether microorganisms are sensitive to antibiotics. Quite often an ultrasound is performed. Its goal is to clarify the condition of the urinary tract.

Acute pyelonephritis is treated medically.

The patient is recommended to undergo in-patient treatment, and bed rest is required. The patient with pyelonephritis shows a plentiful drink and a special diet. Of the drugs for this disease, antibiotics are usually prescribed (in cases where susceptibility of microorganisms to them is established, or other antibacterial drugs.) Directly the treatment begins with the appointment of the most effective of all possible drugs – antibiotics of various groups, nitroxolinic acid, nitrofuran Such therapy is carried out for six weeks, and its goal is also to prevent the transition of the acute form of the disease to chronic. As you know, acute pyelonephritis can develop on its own, but it may also have a secondary nature.In the latter case, treatment also includes the removal of signs of the first disease that led to the development of pyelonephritis.

Pyelonephritis is treated surgically. However, it is used only in the case of development of purulent processes in the kidney or the presence of a stone in the urinary tract – and then not always. However, in these cases, surgical intervention can promote an early recovery uw patient.

Pyelonephritis can give quite formidable complications.

They are found, fortunately, not so often. To such complications can be attributed carbuncle of the kidney, apostematous nephritis, abscess. Carbuncle of the kidney is the appearance in the renal tissue of the purulent necrotic focus – this is a rather serious complication, requiring an emergency surgical operation. Apostematous nephritis is a complication of pyelonephritis, associated with the development of small pustules under the capsule, which are also called apostems (hence the name). These pustules have a fairly large number. The course of this complication is severe. If the patient has pyelonephritis this complication is revealed, then it is urgent for him to have an operation. Kidney abscess is also a possible complication of pyelonephritis. It occurs very infrequently. The abscess of the kidney – that is, the focus of purulent melting of the kidney tissue – must be treated surgically. These complications are accompanied by a deterioration in the general well-being of the patient. The patient may have sudden temperature fluctuations during the day: for example, in the morning 35 ° C, and in the evening 40 ° C (and above).

Acute pyelonephritis is able to go into a chronic form.

In the absence of treatment or inappropriate (insufficient) treatment. It is with the goal of preventing the transition of the acute form of this disease to chronic and possibly even six-week treatment. It should be conducted under the supervision of a doctor. Therefore, in no case can not let the disease run its course. Moreover, in the absence of timely treatment, the risk of developing suppuration in the kidney is greatly increased. This can be a kidney carbuncle, an apostematous form of the disease or an abscess.

Chronic pyelonephritis – a consequence until the end of the untreated acute pyelonephritis.

Statistics show that, as a rule, this is indeed the case. During the treatment of acute pyelonephritis, acute inflammation was removed, but a situation arises that before the normal state and functioning of the kidney was not brought. As a result, in the kidney, there may be some pathogens of pyelonephritis. In addition, if treatment is not completed, there may be problems with the release of urine.

Blunt pain is a characteristic feature of chronic pyelonephritis.

It should be reiterated that dull pain occurs in acute pyelonephritis. However, in the chronic form of the disease, pain occurs periodically (and quite often). Especially aching blunt pains are expressed in wet weather.Therefore, an especially difficult period for patients with chronic pyelonephritis is autumn. Another feature of chronic pyelonephritis is the occurrence of exacerbations. They arise from time to time (in different patients in different ways) and resemble the symptoms of acute pyelonephritis. It should be remembered that the treatment of chronic pyelonephritis is a longer process than treatment of acute pyelonephritis. However, in principle, there are no principal features of treatment applicable to the chronic form of the disease.

Treatment of chronic pyelonephritis should pursue the achievement of three goals.

First, and most importantly, it is necessary to eliminate all the causes that contributed to the development of chronic pyelonephritis. That is, it is necessary to cope with the problem of the outflow of urine and restore normal renal circulation. Secondly, to conduct a course of treatment with antibiotics or other antibacterial drugs. Naturally, one should be guided by data on the sensitivity of microorganisms to antibiotics. Thirdly, and it is also not unimportant – it is required to increase the protective forces of the human body. Achieving these three goals is the basis for the recovery of the patient with chronic pyelonephritis.

For chronic pyelonephritis, the phases of its course are characteristic.

They are allocated on the basis of the activity index of the inflammatory process in the kidney (or kidney). The following three phases of chronic pyelonephritis are distinguished.
The first phase is the phase of an active inflammatory process. In the kidneys there is an inflammatory process with which the body is struggling. This phase is characterized by changes in the composition of urine – there are bacteria and leukocytes, as well as blood – in particular, an increase in the level of ESR. All this reflects the inflammatory process in the human body.
The second phase is latent. Its duration can reach up to six months. It is characterized by the attenuation of the inflammatory process in the kidney tissue. Urine and blood tests show a decrease in the number of bacteria, leukocytes (in the urine), a decrease in the level of ESR (in the blood). It should be noted that acute pyelonephritis can go into the latent phase of the course in case of irrational or unsystematic treatment or lack of treatment as such.
The third phase is the phase of remission. For her, the situation is peculiar when the data of all laboratory tests of the patient come back to normal. But this does not mean that the person has recovered – as soon as a combination of unfavorable factors for the organism and favorable factors for the progression of the disease occurs, the inflammatory process will resume and everything will start all over again – the phase of the active inflammatory process, the latent phase and again the phase of remission. You can say the motion in a circle.

The main prevention of pyelonephritis is associated with the timely treatment of all diseases.

Of course, it’s impossible to not treat any disease – it is fraught with the development of complications. But in this case we are talking about the treatment of those diseases, during which it can promote the development of pyelonephritis. Of course, they include urolithiasis (if it is started, that is, the probability of the need for surgical intervention – in this situation, if you can not by any other methods remove the stone from the urinary tract). Do not start the prostate adenoma. Yes, in general, you can not joke with any diseases that are associated with a violation of the excretion of urine (I repeat once again that you can not joke at all with any diseases). Women during pregnancy are advised to undergo a regular checkup to prevent the development of pyelonephritis (especially its complications) or to stop its development at the initial stage. Especially the latter concerns women with large fetuses, multiple births, with a narrow pelvis. They need to consult a specialist at least once a month.

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