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Pyelonephritis

Pyelonephritis

Pyelonephritis is a disease of the parenchyma of the kidneys and the calyx-pelvis system. Inflammation of the renal pelvis, called pyelitis, is no longer considered as an independent disease.

In acute pyelonephritis, the most likely pathway for the pathogen to enter the kidney is the hematogenous pathway. Infection can also get into the kidney if 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 unilateral and bilateral, acute and chronic, obstructive and non-obstructive, primary and secondary. Treatment for acute pyelonephritis is usually based on antibiotics or any antibacterial medication. The choice of the most optimal treatment is carried out by the doctor.

Pyelonephritis cannot be started or allowed to take its course (in principle, this is the same thing), since this is fraught with its transition to a chronic form (and it requires more prolonged and patient treatment), or the development of complications (which may require surgical intervention). The 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 is second only to diseases associated with the respiratory system. Statistics show that the female population is more susceptible to this disease. In girls and women, it occurs six times more often than in boys and men. Pyelonephritis is found in one in ten people; in frequency of occurrence, this disease is inferior to infectious and respiratory diseases.

Women are more susceptible to pyelonephritis. Indeed, among patients with this disease, it is the female part of the population that "leads". Often, pyelonephritis develops during pregnancy, which is associated with a violation of urine output. The latter can occur as a result of an objective increase in the size of the uterus and compression of the ureters by it. In addition, quite often pyelonephritis does not develop during pregnancy, and pregnancy itself helps to detect a hitherto invisible inflammatory process in the urinary system.

Microorganisms that cause inflammation in the kidney can enter it in three ways. It is hematogenous, urinogenic and ascending along the wall of the urinary tract. The hematogenous pathway is the pathway 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 we can talk about otitis media, caries, bronchitis, tonsillitis, sinusitis, etc. A prerequisite for the hematogenous pathway is the ingress of microorganisms into the kidney along with the blood stream, however, to keep the infection in the kidney (or kidneys ) a combination of factors favorable for microorganisms is necessary.

The latter include, as a rule, circulatory disorders in the kidney and impaired outflow of urine from the kidneys - both factors are important. However, in the absence of these conditions, some types of microorganisms are capable of causing inflammatory processes in a completely healthy kidney. For example, such microorganisms include several types of staphylococci.

After microorganisms enter the renal tissue, they accumulate on the vascular loops of the malpighian glomeruli (renal glomeruli, consisting of a branched capillary network). The actions of microbes lead to the destruction of the inner lining of the vessels. After the destruction has occurred, the microbes end up in the lumen of the renal tubules. They are then excreted in the urine. The inflammatory process in the kidney is localized just around these so-called microbial thrombi. The immediate acute period of the disease lasts about ten days.

The urinogenic pathway (or ascending) is associated with the ingress of microbes into the kidney tissue from the underlying urinary tract. This happens with the reverse flow of urine (as you know, during normal functioning of the urinary system, urine from the kidneys through the ureters enters the bladder - its reverse flow is impossible (during normal functioning). Otherwise (this is called cystic reflux), microbes from the bladder can penetrate the kidney, causing inflammation in it.Dynamics of urine movement may be impaired for other reasons, such as the presence of stones in the urinary tract, nephroptosis, hydronephrosis, kidney doubling, etc.

There is another way of possible entry of microorganisms into the kidney. This is an ascending path along the wall of the urinary tract, to be more precise, along the wall of the ureter. It should be borne in mind that inflammation in this case occurs not only in the kidney itself - inflammatory processes occur in the wall of the ureter. The latter fact can contribute to a failure in the correct movement of urine through the ureter. As a result, the infection is thrown into the kidney along with urine. Most often, there are hematogenous and urinogenic pathways of penetration of microorganisms that cause pyelonephritis into the kidney.

Pyelonephritis is an independent disease. Indeed, pyelonephritis can develop in humans as an independent disease. But there are cases when pyelonephritis occurs as a complication of other diseases. Often, pyelonephritis develops as a result of previous 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 is why it is incorrect to talk about the development of pyelonephritis only on the basis of the fact that microbes enter the kidney tissue. Firstly, pyelonephritis is facilitated by everything that can delay the outflow of urine - for example, inflammation of the ovaries in the female part of the population, prostate adenoma 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: the inflammation that pyelonephritis gives, contributes to the appearance of stones in the human body, the latter, in turn, impede the outflow of urine and thereby stimulate inflammatory processes in the renal pelvis. Secondly, factors contributing to the development of such a disease as pyelonephritis are also overwork, hypothermia, insufficient amount of vitamins, stress, etc.

There is unilateral and bilateral pyelonephritis. This classification is based on the number of kidneys to which inflammatory processes have spread. It should be noted that unilateral pyelonephritis is much more common. And it would be even more correct to call it not one-sided, but right-sided, since it is the right kidney that is more susceptible to pyelonephritis. The reason for this is in the anatomical and physiological characteristics of the right kidney, as a result of which processes of stagnation of urine are possible in it.

The onset of acute pyelonephritis is sudden. The disease begins with a sharp jump in body temperature up to 39-40 ° C. The patient has a feeling of weakness, a headache appears. Profuse perspiration is a characteristic feature. Nausea and vomiting are common. The intensity of pain in pyelonephritis (occurring in the lower back and in the hypochondrium) may be different. The pains are dull. If the course of pyelonephritis is not complicated, then urine flow is not disturbed.

For the diagnosis of acute pyelonephritis, laboratory data are important. A general analysis of blood and urine is performed (it turns out whether there are microorganisms). It is also important to determine whether microorganisms are susceptible to antibiotics. Ultrasound examination is often performed. Its purpose is to clarify the condition of the urinary tract.

Acute pyelonephritis is treated with medication. The patient is recommended to undergo inpatient treatment, and bed rest is required. A patient with pyelonephritis is shown to drink plenty of fluids and a special diet. Of the medicines for this disease, antibiotics are usually prescribed (in cases where the susceptibility of microorganisms to them, or other antibacterial drugs is established. Directly treatment begins with the appointment of the most effective of all possible drugs - antibiotics of various groups, nitroxolinic acid, nitrofuranic Such therapy is carried out for six weeks. Its purpose, among other things, is to prevent the transition of an acute form of the disease into a chronic one. In addition, as you know, acute pyelonephritis can develop independently, but it can also be of a secondary nature. In the latter case, treatment includes the elimination of signs of the first disease, which led to the development of pyelonephritis.

Pyelonephritis is treated with surgery. Such treatment is also possible. However, it is used only in the case of the development of purulent processes in the kidney or the presence of a stone in the urinary tract - and even then not always. However, in these cases, surgical intervention can contribute to the speedy recovery of the patient.

Pyelonephritis can give quite formidable complications. Fortunately, they do not meet so often. Such complications include the kidney carbuncle, apostematous nephritis, and abscess. A kidney carbuncle is the appearance of a purulent-necrotic focus in the renal tissue - this is a rather serious complication that requires an emergency surgical operation. Apostematous nephritis is a complication of pyelonephritis associated with the development of small pustules under the kidney capsule, which are also called apostems (hence the name). There are quite a lot of these abscesses. The course of this complication is severe. If a patient with pyelonephritis is diagnosed with this complication, then he must urgently be operated on. Kidney abscess is also a possible complication of pyelonephritis. It is very rare. A kidney abscess - that is, a focus of purulent fusion of kidney tissue - must be treated surgically. These complications are accompanied by a deterioration in the general health of the patient. A patient may have sudden temperature jumps during the day: for example, 35 ° C in the morning, and 40 ° C in the evening (and above).

Acute pyelonephritis can become chronic. In the absence of treatment or incorrect (insufficient) treatment. It is in order to prevent the transition of the acute form of this disease into a chronic one that even a six-week treatment is carried out. It must be supervised by a physician. Therefore, in no case should the disease be allowed to take its course. Moreover, in the absence of timely treatment, the risk of developing suppurative processes in the kidney greatly increases. It can be a kidney carbuncle, an apostematous form of the disease or an abscess.

Chronic pyelonephritis is a consequence of untreated acute pyelonephritis. Statistics show that, as a rule, this is true. During the treatment of acute pyelonephritis, the acute inflammation was relieved, but a situation arises that the kidney was not brought to normal state and functioning. As a result, some pyelonephritis pathogens may remain in the kidney. In addition, if the treatment is not completed, then there may be problems with urine output.

Dull pain is a characteristic feature of chronic pyelonephritis. It should be reiterated that dull pains also occur in acute pyelonephritis. However, in the chronic form of this disease, pain occurs periodically (and can and quite often). Dull aching pains are especially pronounced in wet weather. Therefore, a particularly difficult period for patients with chronic pyelonephritis is autumn. Another feature of chronic pyelonephritis is the fact that exacerbations appear. They occur 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 the treatment of acute pyelonephritis. However, in principle, there are no fundamental features of treatment applicable to the chronic form of the disease.

Treatment of chronic pyelonephritis should pursue three goals. First, and this is the most important thing, 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 impaired outflow of urine and restore normal renal circulation. Secondly, a course of treatment with antibiotics or other antibacterial drugs. Naturally, you need to be guided by data on the sensitivity of microorganisms to antibiotics. Thirdly, and this is also not unimportant - it is required to increase the defenses of the human body. The achievement of these three goals is the basis for the recovery of a patient with chronic pyelonephritis.

Chronic pyelonephritis is characterized by the phases of its course. They are allocated on the basis of an indicator of the activity of the inflammatory process in the kidney (or kidneys). The following three phases of chronic pyelonephritis are distinguished.
The first phase is the phase of an active inflammatory process. An inflammatory process takes place in the kidneys, which the body fights against. 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 be up to six months. It is characterized by attenuation of the inflammatory process in the renal 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 the case of irrational or unsystematic treatment of it or lack of treatment as such.
The third phase is the remission phase. It is characterized by a situation when the data of all laboratory tests of the patient return to normal. But this does not mean that the person has recovered - as soon as a combination of factors unfavorable for the body and favorable for the progression of the disease arises, 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. We can say movement in a circle.

The main prevention of pyelonephritis is associated with the timely treatment of all diseases. Of course, it is impossible not to treat any disease - this is fraught with the development of complications. But in this case, we are talking about the treatment of those diseases, the course of which can contribute to the development of pyelonephritis. Of course, these include urolithiasis (if it is started, then there is a likelihood of the need for surgical intervention - in that situation if it is not possible to remove the stone from the urinary tract by any other means). You should not run a prostate adenoma.Yes, in general, you cannot joke with any diseases that are associated with impaired urinary excretion (I repeat once again that you cannot joke with any diseases at all). It is advisable for women during pregnancy to undergo regular examinations in order to prevent the development of pyelonephritis (especially its complications) or to stop its development at the initial stage. The latter is especially true for women with large fetuses, multiple births, and a narrow pelvis. They need to consult a specialist at least once a month.


Watch the video: Medical Surgical Nursing - Urinary Tract Infections UTIs and Pyelonephritis (May 2021).