Forms and symptoms of obstructive pyelonephritis: diagnosis of the disease and prevention. Obstructive and non-obstructive pyelonephritis: causes, symptoms Acute non-obstructive pyelonephritis on the right

The inflammatory process in the kidneys is sometimes not bacterial in nature, but occurs due to stagnation of urine caused by obstruction of the elements for the production and excretion of urine into the bladder.

Already later, against the background of congestion, a bacterial infection joins and complicates the course of the pathology.

Chronic obstructive pyelonephritis - frequent type the development of pathology, with the aggravation of the situation, the disease takes on an acute character and requires immediate surgical care.

Causes of the disease

Like non-obstructive pyelonephritis, the disease is characterized by problems with urination, and obstructions occur when:

congenital pathologies urinary tract - narrowness of the lumens of the ureter, deformation of the muscular layer of the walls;
stones in the pyelocaliceal system, which block the lumen of the ureters and disrupt the outflow of urine;
inflammatory processes that provoked non-obstructive chronic pyelonephritis, resulting in the formation of adhesions, narrowing of the lumen;

These reasons provoke problems with urination, as a result of which urine ceases to be excreted normally and stagnates in the kidneys.

Provoking factors for pyelonephritis are diabetes, hypothermia, prolonged use antibacterial drugs, chronic infections present in the body.

Classification of the pathological process

Doctors distinguish cases of obstructive pyelonephritis into two large groups:

acute obstructive pyelonephritis - occurs during primary obstruction of the urinary tract, the symptoms of the process are acute, proceed rapidly, treatment requires urgent care;
chronic type of pathology - occurs after untreated acute pyelonephritis, the disease proceeds with characteristic periods exacerbations and remissions.

In addition to this division, classification according to the localization of the lesion in the kidneys, left-sided or right-sided pyelonephritis.

Symptoms of pathology

A sign of renal obstruction is acute renal colic, accompanied by severe pain. Attacks with obstructive pyelonephritis are strong, pain paralyzes patients.

With renal colic in patients, the temperature rises to 39-40 ° C. The attack torments patients, they have headaches, dry mouth, weakness, vomiting and nausea.

Chills, fever and other signs of deterioration in health are felt. going down arterial pressure, cold sweat breaks out.

This indicates the development of a formidable complication - bacteriostatic shock, which leads to acute renal failure, and in the absence of immediate qualified assistance, this condition causes a fatal outcome.

The strength of sensations increases over time, the work of the heart worsens, patients suffer from squeezing or tingling sensations behind the sternum.

Beginning pain for a short time becomes unbearable, and the condition is noticeably aggravated. Therefore, at the first signs of renal colic, immediately consult a doctor.

Diagnosis of pathology

To make a diagnosis, the patient turns to a nephrologist or urologist. At the very beginning, doctors interview the patient, are interested in the time of onset of symptoms, the nature and duration of the pain attack.

Subsequently, the patient is referred to instrumental methods diagnostics that confirm or refute the original diagnosis.

For this, the following tests are assigned:

a general and biochemical blood test (erythrocyte sedimentation rate, leukocyte count, amount of fibrinogen and C-reactive protein are noted);
general analysis urine - the emphasis is on the content of leukocytes, which signals an inflammatory process in the kidneys;
urinalysis according to Zimnitsky;
bacterial culture of urine to determine the presence of bacteria and sensitivity to antibacterial drugs;
ultrasound diagnosis of the kidneys - visually sees the cause of obturation: lumen, stricture;
x-ray with a contrast agent - informative diagnostic methods;
retrograde cystourethrography - helps to determine non-obstructive associated with urine reflux;
magnetic resonance and CT scan- they see extrarenal causes that caused the pathology, tumors that compress the ureter and make it impossible for the normal course of urine from the kidneys.

Treatment of pathology

With obstructive pyelonephritis, medical care solves two problems:

They remove the bacterial infection, which will help achieve remission in pathology.
Restore the normal outflow of urine and eliminate those factors that interfered with the course.

To solve the first problem, the patient takes antibacterial drugs. Doctors prescribe for those patients who have acute non-obstructive pyelonephritis, but for patients with obstruction are also relevant.

During attacks, the patient is hospitalized, and drugs are prescribed intravenously or intramuscularly in order to quickly stop the infection.

Antibacterial drugs for obstructive pyelonephritis are second and third generation cephalosporins, penicillin group, fluoroquinolones.

The principle when choosing a drug for treating a patient is the sensitivity of the isolated pathogenic microflora to it as a result of urine analysis.

In addition to antibacterial drugs, painkillers, anti-inflammatory drugs, and medications are prescribed to normalize body temperature.

When eliminating the cause of obstruction, more often resort to surgical intervention. This is due to the fact that congenital or acquired pathologies of the urinary tract cannot be eliminated by conservative methods.

Therefore, the only right decision for the patient is to eliminate the cause promptly. In the presence of stones, lithotripsy is performed, and in case of narrowing of the ureter, plastic walls are performed, the area with adhesions is eliminated.

In case of a serious condition of the patient, a nephrostomy is applied for urgent removal of urine from the body, catheterization is performed Bladder. This will help eliminate swelling, relieve intrarenal pressure.

The prognosis is favorable, with early treatment to the clinic. If the pathology is eliminated as early as possible, then patients will not know what it is - renal colic, from which some patients even lose consciousness.

Prevention of obstructive pyelonephritis consists in the timely cure of urological pathologies, the elimination of foci of infection in the body. When the first signs of pathology are detected, a doctor's consultation is mandatory.

Video

Pyelonephritis - nonspecific inflammatory disease kidneys. There are two main forms: obstructive and non-obstructive. An ailment occurs against the background of other disorders, for example, with urolithiasis or a bacterial infection. Obstructive pyelonephritis is characterized by a deterioration in the outflow of urine through the urinary tract. In the chronic course of the pathology, the functioning of the kidney is severely impaired, and the risk of renal failure is high.

Obstructive pyelonephritis

Inflammation of the renal structures rarely develops on its own, more often it is a "background" condition that occurs with bacterial infections in the excretory system, urolithiasis, impaired protein metabolism and other pathologies. In non-obstructive pyelonephritis, the normal outflow of urine from the renal pelvis and ureters is preserved, and in the obstructive form it is disturbed.

Obstructive pyelonephritis develops slowly, affecting individual renal structures, so the disease is difficult to recognize immediately.

Urine outflow obstruction occurs when inflammation of the kidney tissue is so severe as to cause narrowing or spasm of the ureters.

It is important to understand that inflammation of the kidney structures is not always due to infectious diseases. For example, non-obstructive chronic pyelonephritis associated with reflux is formed due to pathologies in the development of the excretory system, and the course of chronic obstructive pyelonephritis is one of the complications of urolithiasis.

Forms of obstructive pyelonephritis

There are two main forms of obstructive pyelonephritis: acute and chronic. The first is characterized by the rapid development of obstruction - obstruction of the urinary tract against the background of acute infectious inflammation or under the influence of other factors.

The chronic form differs from the acute one in that it combines periods of relapse of the inflammatory process with remission, during which the patient's excretory system begins to function normally.

Causes of obstructive pyelonephritis

There are many reasons that provoke the development of pyelonephritis with urinary tract obstruction:

congenital or acquired as a result of injuries or previous diseases anomalies of the urinary system;
running urolithiasis disease when large deposits are formed that can clog the renal tubules;
exacerbation of pathologies of the excretory system during pregnancy, when the load on the kidneys and ureters increases;
adenoma or prostate cancer in men;
severe hypothermia of the kidneys, followed by the addition of a bacterial infection or the death of organ tissues;
type 1 or type 2 diabetes;
gout;
prolonged use of antibiotics;
protracted infectious diseases of other organ systems.

The exact cause of this disease should be established by a nephrologist after hardware diagnostics and laboratory tests. This is important in order to prescribe the correct therapy.

Symptoms of obstructive pyelonephritis

Symptoms of obstruction in inflammation of the kidneys do not occur immediately, the disease betrays itself at a time when the tissues are already severely damaged. The patient is tormented by such a symptom complex:

renal colic;
pain in the lumbar region (sometimes the patient clearly feels discomfort on one side);
persistent with chills;
intoxication of the body, which is manifested by swelling, dark circles localized under the eyes, yellowing or redness of the sclera, bad breath and sweat;
frequent headaches, sleep disturbance (insomnia or constant drowsiness);
constant feeling of thirst;
loss of appetite, nausea;
failures in heart rate, decreased endurance during physical activity;
weakness;
weight loss without dietary changes
pain when urinating in the lumbar region.

Individual symptoms related to the patient's initial physical health prior to the development of obstructive pyelonephritis may occur. The appearance of signs of the disease is affected by concomitant pathologies of the kidneys and other organs.

Acute obstructive pyelonephritis is more pronounced than the chronic or non-acute form. The patient experiences severe pain in the lower back, the temperature rises to 40 degrees, due to severe intoxication, vomiting, stool disorder and loss of consciousness, sweating are possible. Urination is very difficult. Most often, this type of inflammatory process is associated with kidney damage by a severe infection of a bacterial or viral nature.

Diagnosis of obstructive pyelonephritis

Diagnosis of obstructive pyelonephritis should be started at the first signs of it, in order to minimize the negative effects for the patient. This pathology is dangerous for its complications. The most important laboratory tests are as follows:

detailed blood test (calculation of immune and other blood cells) to confirm the inflammatory process in the body;
analysis of the composition of urine;
blood biochemistry;
bacterial culture of urine (allows you to detect the causative agent of the infection if it has caused pyelonephritis, as well as to track the presence of antibiotic resistance in this pathogen).

Instrumental methods will help to more accurately determine the location of the focus of obstructive pyelonephritis, the intensity of the lesion, the condition of the ureters. These include the following procedures:

Ultrasound of the pelvic organs;
X-ray examination of the kidneys (without contrast or contrast urography);
CT and MRI.

The complex of these procedures will help the doctor to accurately diagnose, determine the location of the focus of inflammation, find the cause of the pathology and choose a treatment. It is important to remember that you cannot try to get rid of this disease on your own - this can only aggravate the situation. No herbs or products will help eliminate, for example, an infection, and a lubricated clinical picture interfere with a correct diagnosis.

Treatment of obstructive pyelonephritis

Obstructive pyelonephritis is a reason for hospitalization of the patient. Often, treatment requires a course of antibacterial drugs, medications that restore the outflow of urine. Sometimes installation is required drainage tube, in severe cases, you can not do without a device that maintains the normal composition of the blood, if the functioning of the kidneys is severely impaired.

In addition to drugs that fight the cause of the disease, the therapeutic complex includes drugs that relieve symptoms - it gives the patient a lot of discomfort. These drugs include non-steroidal anti-inflammatory drugs, analgesics, antispasmodics, prebiotics in case of taking antibiotics, as well as vitamin and mineral complexes.

In addition to drug and hardware therapy, it is important to give the patient complete rest. Mandatory bed rest and the rejection of heavy physical activity. you also need to adjust, give preference to light food, completely eliminate any drinks containing sugar and caffeine, reduce the intake of salt, fat and protein.

The development of obstructive pyelonephritis may be asymptomatic. This disease slowly affects the kidneys, disrupting their functioning and the outflow of urine through the ureters. The causes of pyelonephritis are diverse, so the patient should be examined before prescribing therapy. The sooner the therapy begins, the less likely the complications, so you should not self-medicate, it is better to immediately consult a doctor.

Pyelonephritis is a non-specific inflammatory process that affects the tubular system of the kidneys. And although a person of any gender and age can suffer from this disease, from tiny babies to very elderly people, this disease is most often diagnosed in women. According to statistics, out of 100 people who have been diagnosed with pyelonephritis, 75 are the fair sex. And there are reasons for this.

Why are women more likely to experience pyelonephritis?

Acute and chronic disease is five times more common in women than in men. This is due to the anatomical feature of the structure of the genitourinary system. The urethra in women is formed differently than in men. Different types of infections penetrate into the female bladder much more easily and more often, which is why such a large percentage of pyelonephritis in women and girls. In most cases, pyelonephritis is characterized by the so-called "ascending" infection, in which pathogenic bacteria from the urinary tract, moving upwards, penetrate into the kidneys and already begin their "work" there. Sometimes the development of pyelonephritis does not make itself felt, and the patient does not have any discomfort, general state health is not deteriorating. It often happens that a woman learns about the pathological process in her body a few years after the onset of the disease. That is why it is very important to know the symptoms of pyelonephritis in order to undergo an examination as soon as possible and, if concerns are confirmed, to begin a comprehensive and effective treatment.

Symptoms of the development of pyelonephritis in women

Species and subspecies this disease there are many kidneys, but if briefly and generally, we can say that pyelonephritis is divided into two main types: acute and chronic. Each of these two types of the course of the disease has its own causes and, of course, symptoms.

Acute pyelonephritis and its symptoms

The acute course of pyelonephritis is divided in turn into obstructive pyelonephritis and non-obstructive. Non-obstructive pyelonephritis is characterized by a predominance common symptoms infection in the body. Obstructive pyelonephritis has more pronounced local symptoms.

Acute non-obstructive pyelonephritis

Able to develop at lightning speed (3-24 hours). The patient is overcome by general malaise, severe weakness, chills of the body. Body temperature rises sharply to critical levels of 40 degrees. Headaches hurt. Often there are malfunctions of cardio-vascular system tachycardia (rapid heartbeat) appears. Possible violations of the functioning of the gastrointestinal tract in the form of constipation, diarrhea and increased gas formation. Local symptoms of non-obstructive pyelonephritis are characterized by pain in lumbar the spine, which spreads depending on the course of the ureter to the thigh area, less often to the abdomen and back. The pain can be either constant, dull, or sharp and intense. The process of urination in most cases is not disturbed, however, the total daily amount of urine can be significantly reduced. This is due to intense sweating, which is unavoidable with a significant increase in body temperature.

Acute obstructive pyelonephritis

Always begins with renal colic. Along with this, fever begins with severe chills, pains in the head, which are of a sharp shooting character. Often there are vomiting and diarrhea. The patient is constantly thirsty. Body temperature rises quickly and critically. However, heavy sweating quickly lowers the temperature to normal or near normal levels. At this stage, overall health improves somewhat. This is the insidiousness of the disease: the patient decides that everything has returned to normal and does not rush for the help of a specialist. And at the same time, if you do not get qualified help, such attacks can be repeatedly repeated.

Chronic pyelonephritis and its symptoms

Diagnosis of chronic pyelonephritis in women is difficult because in the vast majority of cases the disease does not manifest itself. However, this is only at first glance. Nevertheless, if you listen more carefully to your body, then it is quite possible to suspect a problem in time. There are some indirect symptoms that indicate the sluggish development of chronic pyelonephritis. Symptoms of chronic pyelonephritis include:

discomfort in the lumbar spine general malaise episodic nausea slight changes in the mode of emptying the bladder abrupt changes in body temperature

These are indirect symptoms. chronic course pyelonephritis. However, in rare cases, there is pain and a burning sensation directly in the kidney itself. Periodic increases in body temperature indicate that a serious, often irreversible, disorder has begun in the kidneys. inflammatory process. The symptoms of chronic pyelonephritis are quite wide and at the same time blurred. In individual cases, the patient may show symptoms that are characteristic of diseases such as peritonitis and cholecystitis.

Acute pyelonephritis is an acute nonspecific infectious inflammation of the pyelocaliceal system and tubulointerstitial zone of the kidneys. There are unilateral and bilateral, non-obstructive (primary) and obstructive (secondary), serous and purulent acute pyelonephritis (OP).

In the development of OP, the leading role is played by the gram-negative intestinal microflora (E. coli, enterococci, Proteus). Senile (senile) OP often causes Pseudomonas aeruginosa. A rarer and most pathogenic causative agent of OP is plasmacoagulating staphylococcus aureus.

The nephropathogenicity of these bacteria is associated with the phenomenon of adhesion, which prevents the leaching of microbes from the pyelocaliceal system, as well as with the phenomenon of physiological obstruction due to the release of endotoxin by these pathogens, which reduces the normal tone and peristalsis of the urinary tract.

Urodynamic disturbances in vesicoureteral reflux (VUR), lesions also contribute to urinogenic infection. spinal cord, prostate adenoma, a number of gynecological diseases, nephrolithiasis, anomalies in the development of the kidney, pregnancy. Hematogenous and lymphogenous routes of infection in OP are also possible.

Determined that favorable conditions for the development of infection in the interstitium, hypoxia of the renal tissue is created, which occurs with nephroptosis, hypertension, atherosclerosis and nephrosclerosis, electrolyte disturbances (hypokalemia), abuse non-narcotic analgesics, disorders of carbohydrate metabolism (diabetes mellitus).

Morphologically, in serous OP, focal neutrophilic infiltration of the medulla of the kidney and pyramids, pronounced interstitial edema of the stroma, and perivascular infiltration are detected.

With hematogenous spread of infection in the kidney in the form of infected emboli located in its vessels, pustules are formed in the cortical layer (apostematous nephritis, carbuncle of the kidney), purulent paranephritis and necrosis of the renal papillae may develop. Due to acute occlusion of the urinary tract, pelvic-renal reflux is formed, as a result of which endotoxin-saturated urine enters the bloodstream, which leads to bacteremic shock with DIC, urosepsis. Bacteremic shock, the lethality of which reaches 20%, develops in every tenth patient with obstructive OP, especially often with senile and gestational pyelonephritis.

Clinical picture of acute pyelonephritis

At various forms OP has characteristic symptoms.

Non-obstructive form of acute pyelonephritis

manifested by an acute increase in body temperature (up to 38-39 ° C) with chills, dull pain in the lower back, headache, nausea, myalgia. Dysuria and excretion of cloudy urine with an unpleasant odor are characteristic. On examination: normal blood pressure, neutrophilic leukocytosis, pyuria, bacteriuria, moderate (less than 1 g/l) proteinuria.

Obstructive form of acute pyelonephritis

usually debuts at the height of renal colic. The pains become intense, bursting, there is a stunning chill with a fever of 39-40 ° C (a sign of pelvic-renal reflux), intoxication intensifies. Detect sharply positive symptom Pasternatsky, increasing neutrophilic leukocytosis. Urinalysis may be normal with complete obstruction, which is confirmed by chromocystoscopy.

Purulent acute pyelonephritis

characterized by repeated (3-4 times a day) chills with heavy sweat, severe intoxication and leukocytosis (up to leukemoid numbers), local pain and muscle tension during bimanual palpation of the lumbar region. However, it should be emphasized that senile purulent OP often proceeds areactively, without high fever and severe pain, but at the same time general intoxication and severe complications join especially quickly.

Dangerous complications of purulent OP are the appearance of massive macrohematuria with secondary renal colic and the presence of necrotic tissues in the urine (necrotic papillitis), the sudden development of a deep collapse with signs of DIC, an increase in azotemia and jaundice (bacteremic shock).

Diagnosis of acute pyelonephritis

non-obstructive OP usually does not cause difficulties (lumbalgia, dysuria, pyuria). With obstructive purulent OP, when there may be no changes in the urine, differential diagnosis carried out with acute surgical (appendicitis, acute cholecystitis, pancreatic necrosis), infectious (typhoid, brucellosis, lobar pneumonia, subacute infectious endocarditis) and oncological (hemoblastoses, lymphogranulomatosis) diseases. Especially great difficulties are caused by the diagnosis of apostematous nephritis, in which kidney failure appears late (on the 2-3rd week of high fever). The resulting metastatic ulcers and associated liver damage (jaundice, hyperenzymemia) mask the primary focus in the kidney and often lead to death (from purulent meningitis, abscessing pneumonia) even before the onset of uremia.

Of great importance in the diagnosis are endoscopic (chromocystoscopy) and instrumental (intravenous urography, echography, computed radiography) methods. A purulent focus in the kidney helps to detect static nephroscintigraphy with gallium or labeled autoleukocytes. If a focus suspected of an abscess is detected in difficult-to-diagnose cases, aspiration biopsy this zone of the kidney under the control of sectoral ultrasound scanning.

Treatment of acute pyelonephritis

The decisive factor for successful treatment is the elimination of obstructions with the restoration of a normal passage of urine. Only after that start antibiotic therapy. In OP, antibiotics are prescribed as early as possible - before the results of urine culture are obtained. If it is not possible to determine the pH of the urine, choose a drug (or combination of drugs) that is effective for any urine reaction. In non-severe (serous) AP, oral therapy is possible: levomycetin in combination with furagin, monotherapy with ampicillin or cephalosporins. Correction of therapy is carried out after receiving the results of urine culture. Parenteral administration of antibiotics is started in case of no effect (and in severe cases of the disease - on the first day). A pronounced bactericidal effect gives a combination of ampicillin with furagin, carbenicillin with nalidixic acid, gentamicin with cephalosporins, especially with claforan.

If bacteremic shock develops, intravenous administration polyglucin, hemodez, sodium bicarbonate, pressor amines (dopamine, mezaton), prednisolone (300-1000 mg / day). If there are signs of DIC, heparin and rheopolyglucin infusions are prescribed.

Surgical treatment is carried out with apostematous nephritis, purulent paranephritis.

is a nonspecific inflammatory lesion of the kidney parenchyma. The pathology is characterized by high fever with chills and sweating, headache, myalgia, arthralgia, general malaise, back pain, changes in the urine by the type of leukocyturia and pyuria. Diagnosis includes microscopic and bacteriological examination of urine, ultrasound of the kidneys; if necessary, excretory urography, radioisotope studies, tomography. A diet, plenty of fluids, antibiotics, nitrofurans, antispasmodics are prescribed. With obstructive pyelonephritis, the installation of a ureteral stent catheter or puncture nephrostomy is indicated; with purulent-destructive processes - decapsulation of the kidney or nephrectomy.

ICD-10

N10 Acute tubulointerstitial nephritis

General information

Acute pyelonephritis is the most common kidney disease in modern urology. Pathology often occurs in childhood when the load on the kidneys is very intense, and their morpho-functional development has not yet been completed. Girls are affected 10 times more often than boys. At the age of up to 40 years, women predominate among patients, in the older age group there is a predominance of male patients. One or both kidneys may be affected.

The reasons

Acute pyelonephritis develops with endogenous or exogenous penetration of pathogenic microorganisms into the kidney. Usually, the pathology is caused by Escherichia coli (in 50% of cases), Proteus, Pseudomonas aeruginosa, less often by staphylococci or streptococci. At primary process the infection can enter the kidney by the hematogenous route from the primary foci of inflammation in the genitourinary organs (with adnexitis, cystitis, prostatitis, etc.) or from distant organs. Less often, infection occurs by an ascending mechanism, along the wall or lumen of the ureter (with vesicoureteral reflux).

Secondary acute pyelonephritis is associated with a violation of the passage of urine against the background of ureteral strictures, obstruction of the ureter by a stone, strictures and valves of the urethra, prostate adenoma, prostate cancer, phimosis, neurogenic bladder. Predisposing factors for the development of this form of the disease are hypothermia, dehydration, hypovitaminosis, overwork, respiratory infections, pregnancy, diabetes.

Pathogenesis

Inflammation is associated not only with microbial invasion, but also with the ingress of the contents of the pelvis into the interstitial tissue, which is due to the reverse flow of urine, i.e., fornic reflux. The kidneys are plethoric, somewhat enlarged. The mucous membrane of the renal pelvis is edematous, inflamed, ulcerated; in the pelvis may be inflammatory exudate. In the future, numerous abscesses or abscesses can form in the medulla and cortical layer of the kidney; purulent-destructive fusion of the renal parenchyma is sometimes noted. The stages of acute pyelonephritis correspond to the morphological changes occurring in the kidney.

The initial phase of serous inflammation is characterized by an increase and tension of the kidney, swelling of the perirenal tissue, and perivascular infiltration of the interstitial tissue. With timely appropriate treatment, this stage is reversed; otherwise, it passes into the stage of purulent-destructive inflammation. In the stage of purulent inflammation, the phases of apostematous pyelonephritis, carbuncle and kidney abscess are distinguished. Apostematous (pustular) pyelonephritis occurs with the formation of multiple small pustules 1-2 mm in size in the cortical layer of the kidney.

In the case of fusion of pustules, a local suppurative focus may form - a carbuncle of the kidney, which does not have a tendency to progressive abscess formation. Carbuncles are 0.3 to 2 cm in size and may be single or multiple. With purulent fusion of the parenchyma, a renal abscess is formed. The danger of a kidney abscess lies in the possibility of emptying the formed abscess into the perirenal tissue with the development of purulent paranephritis or retroperitoneal phlegmon.

With a favorable outcome, infiltrative foci gradually resolve, being replaced by connective tissue, which is accompanied by the formation of cicatricial retractions on the surface of the kidney. The scars are initially dark red, then white-gray and wedge-shaped, reaching the pelvis in the section.

Classification

Acute pyelonephritis can be primary (non-obstructive) or secondary (obstructive). The primary variant of the disease occurs against the background of a normal outflow of urine from the kidneys; the secondary is associated with a violation of the patency of the upper urinary tract due to their external compression or obstruction. By the nature of inflammatory changes, the pathology can be serous or purulent-destructive in nature (apostematous pyelonephritis, abscess or carbuncle of the kidney).

Symptoms of acute pyelonephritis

The course is characterized by local symptoms and signs of a pronounced general infectious process, which differ depending on the stage and form of the disease. Serous pyelonephritis proceeds more quietly; with purulent inflammation, pronounced clinical manifestations. In an acute non-obstructive process, general symptoms of infection predominate; with obstructive - local symptoms.

The clinic of acute non-obstructive pyelonephritis develops at lightning speed (from several hours to one day). There is malaise, weakness, amazing chills with a significant increase in temperature up to 39-40 ° C, profuse sweating. Significantly worsens the state of health headache, tachycardia, arthralgia, myalgia, nausea, constipation or diarrhea, flatulence.

Of the local symptoms, pain in the lower back is noted, spreading along the ureter to the thigh area, sometimes to the abdomen and back. The nature of the pain can be constant dull or intense. Urination, as a rule, is not disturbed; daily diuresis decreases due to profuse loss of fluid with sweat. Patients may notice cloudy urine and an unusual odor.

Secondary pyelonephritis caused by urinary tract obstruction usually manifests with renal colic. At the height of the pain attack, fever with chills, headache, vomiting, and thirst occur. After profuse sweating, the temperature drops critically to subnormal or normal figures, which is accompanied by some improvement in well-being. However, if the urinary tract obstruction factor is not eliminated in the coming hours, then an attack of colic and a rise in temperature will recur.

Purulent forms of pathology occur with persistent pain in the lower back, hectic-type fever, chills, and sharp muscle tension. abdominal wall and lumbar region. Against the background of severe intoxication, confusion and delirium may occur.

Diagnostics

In the process of recognizing acute pyelonephritis, physical examination data are important. On palpation of the lumbar region and hypochondrium, the size of the kidney, consistency, surface structure, mobility, and pain are assessed. The kidney is usually enlarged, the muscles of the lower back and abdomen are tense, tapping the edge of the palm along the XII rib is painful, Pasternatsky's symptom is positive. In men, it is necessary to conduct a rectal examination of the prostate and palpation of the scrotum, in women - a vaginal examination. Differential diagnosis is carried out with appendicitis, cholecystitis, cholangitis, adnexitis.

Laboratory diagnostics. In the urine, there is total bacteriuria, slight proteinuria, leukocyturia, with a secondary lesion - erythrocyturia. Bacterial culture of urine allows you to determine the type of pathogen and its sensitivity to antimicrobial drugs. Blood parameters are characterized by anemia, leukocytosis, increase in ESR, toxic granularity of neutrophils.
Kidney ultrasound. It is used not only for diagnostics, but also for dynamic control of the treatment process. The value of echoscopy data lies in the possibility of visualizing destructive foci in the parenchyma, the state of perirenal tissue, and identifying the cause of upper urinary tract obstruction.
X-ray techniques. During survey urography, attention is drawn to an increase in the size of the kidneys, bulging of the contour with an abscess or carbuncle, and blurring of the outlines of the perirenal tissue. With the help of excretory urography, the restriction of the mobility of the kidney during breathing is determined, which is hallmark acute inflammatory process. Accurate identification of destructive foci, causes and level of obstruction in acute purulent pyelonephritis is possible with the help of CT of the kidneys.

Treatment of acute pyelonephritis

The patient is hospitalized; treatment is carried out under the supervision of a urologist. Therapeutic tactics for non-obstructive and obstructive acute pyelonephritis, serous and purulent-destructive forms are different. General measures include the appointment of bed rest, heavy drinking (up to 2–2.5 liters per day), a fruit and milk diet, and easily digestible protein nutrition.

In the primary variant of inflammation, pathogenetic therapy immediately begins, which is based on antibiotics that are active against gram-negative flora - cephalosporins, aminoglycosides, fluoroquinolones. When choosing antimicrobial drug the results of the antibiogram are also taken into account. Additionally, NSAIDs, nitrofurans, immunocorrectors, detoxification therapy are prescribed.

When an obstruction is detected, the primary measure is decompression - the restoration of urodynamics in the affected kidney. For this purpose, catheterization of the pelvis with a ureteral catheter or stent catheter is undertaken, in some cases, puncture imposition of a percutaneous nephrostomy.

In the presence of purulent-destructive foci, they resort to decapsulation of the kidney and the imposition of a nephrostomy, with the help of which a decrease in intrarenal pressure is achieved. Upon detection of formed abscesses, they are opened. In case of total damage to the renal parenchyma and the impossibility of organ-preserving tactics, nephrectomy is performed.

Forecast and prevention

Timely adequate therapy allows to achieve a cure for acute pyelonephritis in most patients within 2-3 weeks. In a third of cases, there is a transition to chronic form(chronic pyelonephritis) with subsequent sclerosis of the kidney and the development of nephrogenic arterial hypertension. Among the complications, paranephritis, retroperitonitis, urosepsis, renal failure, bacteriotoxic shock, interstitial pneumonia, meningitis can occur. Severe septic complications worsen the prognosis and often cause death.

Prevention is the rehabilitation of foci of chronic inflammation, which can serve as sources of potential hematogenous introduction of pathogens into the kidneys; elimination of the causes of possible obstruction of the urinary tract; observance of hygiene of the genitourinary organs to prevent the upward spread of infection; observance of the conditions of asepsis and antisepsis during urological manipulations.

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Classmates

Obstructive pyelonephritis is an extremely dangerous infectious disease of the kidneys that develops against the background of acute violation outflow of urine through the pyelocaliceal system and the rapid reproduction of bacterial microflora. This disease is quite common. Obstructive, as well as non-obstructive pyelonephritis can develop in both children and adults. People with a weakened immune system are most susceptible to this disease.

The peak incidence usually occurs in spring and autumn, when there is an increase in the number of cases of SARS and influenza. Against the background of these respiratory infections, human immunity is significantly reduced, so the bacteria that are always present on the mucous membranes of the genitourinary system get the opportunity to multiply, causing inflammatory damage to the kidneys. There are many other factors that greatly contribute to the appearance of this pathological condition.

Many different factors that contribute to the difficulty of outflow of urine create conditions for the development of this infectious disease. Stagnant processes lead to an increase in the number of bacteria that provoke inflammatory tissue damage. Pyelonephritis often occurs against the background of congenital anomalies in the development of the kidneys and urinary tract. Usually, such pathologies begin to manifest themselves with inflammation already in early childhood.

Urolithiasis also often predisposes to the development of pyelonephritis, and then obstruction. Stones that form in the kidneys, under certain circumstances, can descend into the ureter, partially or completely blocking the outflow of urine. In men, pyelonephritis often develops against the background of adenoma or prostate cancer. In women, pregnancy can be a provoking factor for such kidney damage, since an increase in the uterus contributes to a change in the position of this paired organ, and sometimes causes compression of the ureters. In addition, there are factors that contribute to chronic obstructive pyelonephritis, including:

diabetes;
thyroid disease;
long-term use of antibiotics;
hypothermia.

Previously performed operations on the urinary tract can create conditions for the development of such damage to the tissues of the kidneys. In addition, kidney injury can contribute to the appearance of obstructive pyelonephritis. A decrease in immunity of any etiology can provoke the development of this pathological condition.

In most cases, this disease manifests itself acutely. There is a rapid increase in body temperature up to +40 ° C. The main symptom of this disorder is renal colic - sharp pain in the waist. Due to inflammation of the tissues of the kidneys, problems with urination are usually observed. Patients complain of chills and increased sweating. As a rule, general weakness is rapidly increasing. As the disease progresses, the following symptoms may appear:

strong thirst;
vomit;
nausea;
feeling of dryness in the blood;
headache.

The intensity of the signs of this pathological condition usually increases over 3-4 days. This is due to the fact that toxins build up in the body, which, due to impaired kidney function, cannot be excreted in the urine. To avoid the development of serious complications, it is necessary to consult a doctor at the first symptoms. If treatment was not started in a timely manner, this disease becomes chronic, which is characterized by alternating periods of relapse and remission. This outcome is considered extremely unfavorable, as it further leads to renal failure.

Diagnostics

First of all, the patient is examined, an anamnesis is taken and the symptoms are assessed. Even this is enough for a specialist to suspect the development of obstructive pyelonephritis. Usually, to confirm the diagnosis, studies such as:

general and biochemical analysis blood and urine;
urine culture;
urography;
angiography;
nephroscintigraphy;
radiography.

The nephrologist independently decides which tests are required to make a diagnosis. Self-medication can pose a serious health hazard. After the complex diagnostics doctor may prescribe necessary drugs to suppress the inflammatory process.

Treatment of obstructive pyelonephritis

In an acute period, it is required complex therapy to avoid the transition of the disease into a chronic form. First of all, a diet is prescribed - table number 7a. Drink at least 2-2.5 liters of fluid per day. This will quickly eliminate the pathogenic microflora and suppress the inflammatory process. To relieve pain and improve local blood circulation, the doctor may recommend thermal procedures.

Among other things, a directed drug therapy. In the first days of the acute period of obstructive pyelonephritis, there is an extremely strong pain syndrome. To eliminate it, the nephrologist may prescribe antispasmodics. Targeted antibiotic therapy is required to control infection.

Usually, obstructive pyelonephritis is treated with drugs such as:

Benzylpenicillin;
Oxacillin;
Ampicillin;
Ampicillin sodium salt;
Streptomycin;
Tetracycline;
Metacycline;
Morphocycline;
Tetraolean;
Olethetrin;
Gentamicin;
Cephaloridine.

The course of antibiotic therapy should be at least 4 weeks. It should not be interrupted, as this can contribute to the transition of the disease into a chronic form. Such medicines usually administered intravenously or intramuscularly. In addition, drugs are prescribed to lower body temperature. Vitamin complexes can also be prescribed, which help to increase immunity. However, if conservative methods of treatment do not allow to achieve a pronounced effect, surgery may be indicated. Usually, such therapy is required in the presence of stones and various anomalies of the urinary tract.

Treatment of chronic obstructive pyelonephritis presents a certain difficulty. It involves maintaining the normal functioning of the kidneys and stopping all symptoms during an exacerbation. This disease requires special attention and frequent courses of antibiotic therapy and supportive care.

Acute pyelonephritis- non-specific inflammatory lesion of the interstitial tissue of the kidneys and pyelocaliceal system. The clinic of acute pyelonephritis is characterized by high fever with chills and sweating, headache, myalgia, arthralgia, general malaise, back pain, changes in the urine by the type of leukocyturia and pyuria. Diagnosis of acute pyelonephritis includes microscopic and bacteriological examination of urine, ultrasound of the kidneys; if necessary, excretory urography, radioisotope studies, tomography. In acute pyelonephritis, a diet, plenty of fluids, antibiotics, nitrofurans, antispasmodics are prescribed. In obstructive pyelonephritis, nephrostomy is indicated; with purulent-destructive processes - decapsulation of the kidney or nephrectomy.

Acute pyelonephritis

Acute pyelonephritis in urology is the most common kidney disease. Acute pyelonephritis often occurs in childhood, when the load on the kidneys is very intense, and their morpho-functional development is still incomplete. In adults, acute pyelonephritis is more common in women under the age of 40.

Acute pyelonephritis can be primary (non-obstructive) or secondary (obstructive). Primary pyelonephritis occurs against the background of a normal outflow of urine from the kidneys; secondary pyelonephritis is associated with impaired patency of the upper urinary tract due to their external compression or obstruction. By the nature of inflammatory changes, acute pyelonephritis can be serous or purulent-destructive in nature (apostematous pyelonephritis, abscess or carbuncle of the kidney). In severe cases, acute pyelonephritis may be complicated by necrotizing papillitis - papillary necrosis. Acute pyelonephritis may involve one or both kidneys.

Causes of acute pyelonephritis

Acute pyelonephritis develops with endogenous or exogenous penetration of pathogenic microorganisms into the kidney. More often, acute pyelonephritis is caused by Escherichia coli (in 50% of cases), Proteus, Pseudomonas aeruginosa, less often by staphylococci or streptococci.

In primary acute pyelonephritis, the infection can enter the kidney by the hematogenous route from the primary foci of inflammation in the genitourinary organs (with adnexitis, cystitis, prostatitis, etc.) or from distant organs (with tonsillitis, caries, sinusitis, furunculosis, bronchitis, cholecystitis, etc.) .). Less often, infection occurs by an ascending mechanism, along the wall or lumen of the ureter (with vesicoureteral reflux).

Secondary acute pyelonephritis is associated with a violation of the passage of urine on the background of ureteral strictures, ureteral obstruction by a stone, strictures and valves of the urethra, prostate adenoma, prostate cancer, phimosis, neurogenic bladder. Predisposing factors for the development of acute pyelonephritis are hypothermia, dehydration, hypovitaminosis, overwork, respiratory infections, pregnancy, diabetes mellitus.

Inflammation in acute pyelonephritis is associated not only with microbial invasion, but also with the ingress of the contents of the pelvis into the interstitial tissue, which is due to the reverse flow of urine, i.e., fornic reflux. The kidneys in acute pyelonephritis are plethoric, somewhat enlarged. The mucous membrane of the renal pelvis is edematous, inflamed, ulcerated; in the pelvis may be inflammatory exudate. In the future, numerous abscesses or abscesses can form in the medulla and cortical layer of the kidney; purulent-destructive fusion of the renal parenchyma is sometimes noted.

Stages of acute pyelonephritis

The stages of acute pyelonephritis correspond to the morphological changes occurring in the kidney.

In the stage of acute purulent pyelonephritis, the phases of apostematous pyelonephritis, carbuncle and kidney abscess are distinguished. Apostematous (pustular) pyelonephritis occurs with the formation of multiple small pustules 1-2 mm in size in the cortical layer of the kidney. In the case of fusion of pustules, a local suppurative focus may form - the carbuncle of the kidney, which does not have a tendency to progressive abscessing. Carbuncles are 0.3 to 2 cm in size and may be single or multiple. With purulent fusion of the parenchyma, a renal abscess is formed in the foci of fusion of pustules or carbuncles. The danger of a kidney abscess lies in the possibility of emptying the formed abscess into the perirenal tissue with the development of purulent paranephritis or retroperitoneal phlegmon.

With a favorable outcome of acute pyelonephritis, infiltrative foci gradually resolve, being replaced by connective tissue, which is accompanied by the formation of cicatricial retractions on the surface of the kidney. The scars are initially dark red, then white-gray and wedge-shaped, reaching the pelvis on a cut.

The course of acute pyelonephritis is characterized by local symptoms and signs of a pronounced general infectious process, which differ depending on the stage and form of the disease. Serous pyelonephritis proceeds more quietly; with purulent pyelonephritis, pronounced clinical manifestations develop. In acute non-obstructive pyelonephritis, general symptoms of infection predominate; with obstructive pyelonephritis - local symptoms.

Of the local symptoms in acute pyelonephritis, there is pain in the lower back, spreading along the ureter to the thigh area, sometimes to the abdomen and back. The nature of the pain can be constant dull or intense. Urination, as a rule, is not disturbed; daily diuresis decreases due to profuse loss of fluid with sweat. Patients may notice cloudy urine and an unusual odor.

Secondary acute pyelonephritis caused by urinary tract obstruction usually manifests with renal colic. At the height of the pain attack, fever with chills, headache, vomiting, and thirst occur. After profuse sweating, the temperature drops critically to subnormal or normal figures, which is accompanied by some improvement in well-being. However, if the urinary tract obstruction factor is not eliminated in the coming hours, then an attack of colic and a rise in temperature will recur.

Purulent forms of acute pyelonephritis occur with persistent pain in the lower back, hectic-type fever, chills, sharp muscle tension in the abdominal wall and lumbar region. Against the background of severe intoxication, confusion and delirium may occur.

In the process of recognizing acute pyelonephritis, physical examination data are important. On palpation of the lumbar region and hypochondrium, the size of the kidney, consistency, surface structure, mobility, and pain are assessed. In acute pyelonephritis, the kidney is usually enlarged, the muscles of the lower back and abdomen are tense, tapping the edge of the palm along the XII rib is painful, Pasternatsky's symptom is positive. In acute pyelonephritis in men, it is necessary to conduct a rectal examination of the prostate and palpation of the scrotum, in women - a vaginal examination.

In the urine with acute pyelonephritis, total bacteriuria, slight proteinuria, leukocyturia are noted, with secondary damage - erythrocyturia. Bacterial culture of urine allows you to determine the type of pathogen and its sensitivity to antimicrobial drugs. Blood parameters are characterized by anemia, leukocytosis, increased ESR, toxic granularity of neutrophils.

Ultrasound of the kidneys in acute pyelonephritis is used not only for diagnosis, but also for the dynamic control of the treatment process. The value of echoscopy data lies in the possibility of visualizing destructive foci in the parenchyma, the state of perirenal tissue, and identifying the cause of upper urinary tract obstruction. Accurate identification of destructive foci, causes and level of obstruction in acute purulent pyelonephritis is possible with the help of MRI or CT of the kidneys.

During survey urography, attention is drawn to an increase in the size of the kidneys, bulging of the contour with an abscess or carbuncle, and blurring of the outlines of the perirenal tissue.

With the help of excretory urography, the restriction of the mobility of the kidney during breathing is determined, which is a characteristic sign of acute pyelonephritis. In a serious condition of the patient or renal failure, retrograde pyeloureterography is performed.

Selective renal angiography, radionuclide nephroscintigraphy in acute pyelonephritis are mainly used to clarify the diagnosis as ancillary methods. Differential diagnosis of acute pyelonephritis is carried out with appendicitis, cholecystitis, cholangitis, adnexitis.

Treatment of acute pyelonephritis

If acute pyelonephritis is detected, the patient is hospitalized; treatment is carried out under the supervision of a nephrologist. Therapeutic tactics for non-obstructive and obstructive acute pyelonephritis, serous and purulent-destructive forms are different. General measures include the appointment of bed rest, heavy drinking (up to 2–2.5 liters per day), a fruit and milk diet, and easily digestible protein nutrition.

In primary acute pyelonephritis, pathogenetic therapy begins immediately, based on antibiotics that are active against gram-negative flora - cephalosporins, aminoglycosides, fluoroquinolones. When choosing an antimicrobial drug, the results of the antibiogram are also taken into account. Additionally, NSAIDs, nitrofurans, immunocorrectors, detoxification therapy, UVB, physiotherapy (SMW-therapy, electrophoresis, UHF) are prescribed.

When acute obstructive pyelonephritis is detected, the primary measure is decompression - the restoration of urodynamics in the affected kidney. For this purpose, catheterization of the pelvis with a ureteral catheter or a stent catheter is undertaken, in some cases, a puncture imposition of a percutaneous nephrostomy.

In the presence of purulent-destructive foci, they resort to decapsulation of the kidney and the imposition of a nephrostomy, thereby achieving a decrease in intrarenal pressure, swelling of the interstitial tissue, and expansion of the lumen of the renal vessels. Upon detection of formed abscesses, they are opened. In case of total damage to the renal parenchyma and the impossibility of organ-preserving tactics, nephrectomy is performed.

Forecast and prevention of acute pyelonephritis

Timely adequate therapy allows to achieve a cure for acute pyelonephritis in most patients within 2-3 weeks. In a third of cases, there is a transition of acute pyelonephritis to a chronic form (chronic pyelonephritis), followed by sclerosis of the kidney and the development of nephrogenic arterial hypertension.

Among the complications of acute pyelonephritis, paranephritis, retroperitonitis, urosepsis, renal failure, bacteriotoxic shock, interstitial pneumonia, meningitis can occur. Severe septic complications worsen the prognosis and often cause death.

Prevention of acute pyelonephritis is the rehabilitation of foci of chronic inflammation, which can serve as sources of potential hematogenous introduction of pathogens into the kidneys; elimination of the causes of possible obstruction of the urinary tract; observance of hygiene of the genitourinary organs to prevent the upward spread of infection; observance of the conditions of asepsis and antisepsis during urological manipulations.

Acute pyelonephritis is an inflammatory disease that affects the intermediate tissue of the kidneys, calyces and pelvis. The disease can be triggered by infectious and non-infectious causes.

Urologists say that pyelonephritis of various etiologies is one of the most common diseases, while this pathology is most often diagnosed in children (due to an unformed urinary system) and in women (due to the peculiarities of the structure of the genitourinary system, which make it easier for infections to enter the kidneys ).

Acute pyelonephritis: what is it and how does it differ from a chronic inflammatory process?

The acute inflammatory process of the pyelocaliceal system differs from chronic pyelonephritis in the following features of the course:

in acute pyelonephritis, the inflammatory process develops rapidly, while in chronic disease progresses more slowly
clinical signs of the disease in an acute form are pronounced, and with chronic inflammation kidney symptoms are blurred or absent;
acute inflammatory process with proper and timely treatment ends with the complete recovery of the patient or the transition to a chronic form, while chronic pyelonephritis is characterized by frequent relapses;
chronic inflammatory process in the kidneys is more difficult to treat with antibiotic therapy, since microorganisms are resistant to most drugs.

The inflammatory process in an acute form captures only 1 kidney or both at once.

Symptoms of acute pyelonephritis

Symptoms of acute pyelonephritis in women, children and men largely depend on the neglect of the inflammatory process, the presence of other diseases and the stage.

The following stages of the inflammatory process in the kidneys are distinguished:

Stage of serous inflammation- characterized by an increase in the size of the affected organ (one kidney or both), edema of the perirenal tissue.
Stage of purulent inflammation:

aposematous inflammation;
kidney carbuncle;
kidney abscess.

The stage of purulent inflammation of the kidney is characterized by the formation of pustules in the cortical layer, which, in the absence of adequate therapy, merge with each other and form a carbuncle. There may be several such carbuncles, they merge with each other, pus melts the tissues of the kidney, as a result of which an abscess of the organ develops.

Important! If at the stage of serous inflammation the patient is diagnosed correctly and adequately treated, pyelonephritis successfully resolves within 14-20 days and does not affect the patient's performance and future life.

Non-obstructive acute pyelonephritis: symptoms

With the development of the inflammatory process, the patient has the following signs of acute pyelonephritis:

the onset is acute, the symptoms develop rapidly - sometimes in a few hours, but more often 1-2 days;
increase in body temperature to 39.5-40.0 degrees;
weakness and malaise;
nausea, vomiting sometimes;
increased sweating, tachycardia, severe headaches, sometimes blood pressure rises;
dull pain in the lumbar region on one side or both, depending on the prevalence of the inflammatory process - pain can radiate to the perineum, back, abdomen;
a slight decrease in daily diuresis, oliguria - this syndrome is due to increased sweating;
cloudy urine with an unpleasant odor;
dysuric symptoms in women are usually absent, the child may have complaints of feeling incomplete emptying Bladder.

Secondary acute pyelonephritis: symptoms

Secondary acute pyelonephritis develops in most cases against the background of existing diseases of the urinary tract. Often, symptoms result from urinary obstruction and obstruction of the urinary tract.

The patient has:

acute pain in the lumbar region of the type of renal colic, often associated with obstruction of the urinary tract;
increase in body temperature up to 39.0 degrees, fever;
increased thirst;
nausea and vomiting.

Important! If the causes of obstruction are identified and this factor is eliminated, then the patient's condition returns to normal, all signs of pyelonephritis disappear. If the cause is not established, then a few hours after the subsidence acute clinic all symptoms return again with a vengeance.

Purulent acute pyelonephritis: symptoms

Signs of acute pyelonephritis with purulent lesions of the kidney parenchyma are as follows:

persistent unbearable dull pain in the lumbar region radiating to the back, abdomen, thigh;
fever of the hectic type (fluctuations in body temperature up to 3-4 degrees, occur several times a day) - that is, from 40.0 degrees the temperature drops to 37.0 and rises again to 40.0 and so 2-3 times a day;
severe intoxication of the body - nausea, vomiting, weakness, headaches;
urine is excreted in a small amount cloudy with a sharp unpleasant odor.

Reasons for the development of the disease

The main reason for the development of pyelonephritis is the penetration of pathological microorganisms into the parenchyma of the kidneys. The most common causative agents of an acute inflammatory process are coli, staphylococcus, streptococcus, Pseudomonas aeruginosa, amoeba proteus. Slightly less commonly, pyelonephritis is caused by viruses and fungi.

According to statistics, during the examination of the patient, more often several associated bacteria that provoke the development of inflammation are detected. Signs of acute pyelonephritis occur if the infectious agent has entered the kidneys and began to actively multiply and release toxic substances.

This happens in two ways:

Hematogenous- the infection enters the kidneys with blood flow from other internal organs where the inflammatory process takes place. Most often this is facilitated by timely untreated cystitis, urethritis, adnexitis, prostatitis. The distant causes of the development of the disease are untreated sinusitis, sinusitis, tonsillitis, bronchitis and even neglected carious cavities of the teeth.
Urinogenic (or ascending)- this route of penetration of the pathogen into the kidneys is the most common. The infection enters the kidneys from the lower urinary tract (urethra, bladder, ureters).

Predisposing factors for the development of acute pyelonephritis are:

thrush in women or intestinal dysbacteriosis;
hormonal imbalance - women often experience pyelonephritis in the second half of pregnancy and during menopause;
estrogen deficiency in female body, which leads to a violation of the acid-base balance in the vagina;
active sex life and frequent change of sexual partners - this causes inflammation of the urethra and bladder, from where the infection easily enters the kidneys;
venereal diseases, including hidden ones;
diabetes;
general hypothermia of the body;
immunodeficiency states - hypovitaminosis, postponed courses radiotherapy, poor unbalanced diet;
urolithiasis disease;
prostate adenoma in men.

Important! The risk of developing acute pyelonephritis increases if a person has several predisposing factors at once.

Prognosis and possible complications of the disease

The recovery of the patient with proper therapy occurs in 3-4 weeks. If the patient does not pay attention to the symptoms and the treatment of pyelonephritis was not carried out or the onset was too late, then the progressive pathological process in the kidneys often leads to life threatening complications:

Why are women more likely to experience pyelonephritis?

Acute and chronic disease is five times more common in women than in men. This is due to the anatomical feature of the structure of the genitourinary system. The urethra in women is formed differently than in men. Different types of infections penetrate into the female bladder much more easily and more often, which is why such a large percentage of pyelonephritis in women and girls. In most cases, pyelonephritis is characterized by the so-called "ascending" infection, in which pathogenic bacteria from the urinary tract, moving upwards, penetrate into the kidneys and already begin their "work" there. Sometimes the development of pyelonephritis does not make itself felt, and the patient does not have any discomfort, the general state of health does not worsen. It often happens that a woman learns about the pathological process in her body a few years after the onset of the disease. That is why it is very important to know the symptoms of pyelonephritis in order to undergo an examination as soon as possible and, if concerns are confirmed, to begin a comprehensive and effective treatment.

Symptoms of the development of pyelonephritis in women

There are many types and subspecies of this kidney disease, but briefly and generally, we can say that pyelonephritis is divided into two main types: acute and chronic. Each of these two types of the course of the disease has its own causes and, of course, symptoms.

Acute pyelonephritis and its symptoms

The acute course of pyelonephritis is divided in turn into obstructive pyelonephritis and non-obstructive. Non-obstructive pyelonephritis is characterized by the predominance of general symptoms of infection in the body. Obstructive pyelonephritis has more pronounced local symptoms.

Acute non-obstructive pyelonephritis

Able to develop at lightning speed (3-24 hours). The patient is overcome by general malaise, severe weakness, chills of the body. Body temperature rises sharply to critical levels of 40 degrees. Headaches hurt. Often there are malfunctions in the work of the cardiovascular system, tachycardia (rapid heartbeat) appears. Possible violations of the functioning of the gastrointestinal tract in the form of constipation, diarrhea and increased gas formation. Local symptoms of non-obstructive pyelonephritis are characterized by pain in the lumbar spine, which spreads depending on the course of the ureter to the thigh area, less often to the abdomen and back. The pain can be either constant, dull, or sharp and intense. The process of urination in most cases is not disturbed, however, the total daily amount of urine can be significantly reduced. This is due to intense sweating, which is unavoidable with a significant increase in body temperature.

Acute obstructive pyelonephritis

Chronic pyelonephritis and its symptoms

discomfort in the lumbar spine general malaise episodic nausea slight changes in the mode of emptying the bladder abrupt changes in body temperature

These are indirect symptoms of the chronic course of pyelonephritis. However, in rare cases, there is pain and a burning sensation directly in the kidney itself. Periodic increases in body temperature indicate that a serious, often irreversible inflammatory process has begun in the kidneys. The symptoms of chronic pyelonephritis are quite wide and at the same time blurred. In individual cases, the patient may show symptoms that are characteristic of diseases such as peritonitis and cholecystitis.

Urodynamic disturbances in vesicoureteral reflux (VUR), spinal cord lesions, prostate adenoma, a number of gynecological diseases, nephrolithiasis, anomalies in the development of the kidney, and pregnancy also contribute to the urinogenic drift of the infection. Hematogenous and lymphogenous routes of infection in OP are also possible.

It has been established that favorable conditions for the development of infection in the interstitium are created by hypoxia of the renal tissue that occurs with nephroptosis, hypertension, atherosclerosis and nephrosclerosis, electrolyte disturbances (hypokalemia), abuse of non-narcotic analgesics, disorders of carbohydrate metabolism (diabetes mellitus).

Morphologically, in serous OP, focal neutrophilic infiltration of the medulla of the kidney and pyramids, pronounced interstitial edema of the stroma, and perivascular infiltration are detected.

Clinical picture of acute pyelonephritis

In various forms of OP, characteristic symptoms are observed.

Non-obstructive form of acute pyelonephritis

Obstructive form of acute pyelonephritis

usually debuts at the height of renal colic. The pains become intense, bursting, there is a stunning chill with a fever of 39-40 ° C (a sign of pelvic-renal reflux), intoxication intensifies. A sharply positive symptom of Pasternatsky, an increasing neutrophilic leukocytosis, is detected. Urinalysis may be normal with complete obstruction, which is confirmed by chromocystoscopy.

Purulent acute pyelonephritis

characterized by repeated (3-4 times a day) chills with heavy sweat, severe intoxication and leukocytosis (up to leukemoid numbers), local pain and muscle tension during bimanual palpation of the lumbar region. However, it should be emphasized that senile purulent OP often proceeds areactively, without high fever and severe pain, but at the same time, general intoxication and severe complications join especially quickly.

Diagnosis of acute pyelonephritis

non-obstructive OP usually does not cause difficulties (lumbalgia, dysuria, pyuria). In case of obstructive purulent OP, when there may be no changes in the urine, differential diagnosis is carried out with acute surgical (appendicitis, acute cholecystitis, pancreatic necrosis), infectious (typhoid, brucellosis, lobar pneumonia, subacute infectious endocarditis) and oncological (hemoblastosis, lymphogranulomatosis) diseases. Particularly difficult is the diagnosis of apostematous nephritis, in which renal failure appears late (at the 2-3rd week of high fever). The resulting metastatic abscesses and associated liver damage (jaundice, hyperenzymemia) mask the primary focus in the kidney and often lead to death (from purulent meningitis, abscessing pneumonia) even before the onset of uremia.

Of great importance in the diagnosis are endoscopic (chromocystoscopy) and instrumental (intravenous urography, echography, computed radiography) methods. A purulent focus in the kidney helps to detect static nephroscintigraphy with gallium or labeled autoleukocytes. If a focus suspicious of an abscess is detected in difficult-to-diagnose cases, an aspiration biopsy of this zone of the kidney is performed under the control of sectoral ultrasound scanning.

Treatment of acute pyelonephritis

In the case of the development of bacteremic shock, intravenous administration of polyglucin, gemodez, sodium bicarbonate, pressor amines (dopamine, mezaton), prednisolone (300-1000 mg / day) is necessary. If there are signs of DIC, heparin and rheopolyglucin infusions are prescribed.

Surgical treatment is carried out with apostematous nephritis, purulent paranephritis.

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