Chronic pyelonephritis - causes, symptoms, diagnosis and treatment
Chronic pyelonephritis - Chronic nonspecific bacterial process occurring predominantly involving interstitial kidney tissue and renal pelvis complexes. Chronic pyelonephritis manifested malaise, dull pain in the lower back, low-grade fever, dysuric symptoms. In the process of diagnosis of chronic pyelonephritis conduct laboratory tests of urine and blood, renal ultrasound, retrograde pyelography, scintigraphy. Treatment consists of a diet and gentle treatment, the appointment of antimicrobial therapy, nitrofurans, vitamins, physiotherapy.
Chronic pyelonephritis
Urology chronic pyelonephritis is 60-65% of all cases of inflammatory diseases of urogenital organs. In 20-30% of cases, chronic inflammation is the outcome of acute pyelonephritis. Chronic pyelonephritis predominantly occurs in girls and women, which is associated with morphological and functional features of the female urethra, facilitating the penetration of microorganisms into the bladder and kidneys. Most chronic pyelonephritis is bilateral, but the degree of kidney damage may differ.
For the course of chronic pyelonephritis is characterized by alternating periods of exacerbation and subsided (remission) of the pathological process. Therefore, in the kidneys at the same time identifies polymorphic changes - inflammation of lesions in different stages, scar areas, zones intact parenchyma. Involvement in inflammation of all new sites functioning renal tissue causing its destruction and the development of chronic renal failure (CRF).
streptococci and microbial associations. A special role in the development of chronic pyelonephritis play L-form bacteria, resulting from ineffective antimicrobial therapy and changes in pH. Such different microorganisms resistant to therapy, difficulty of identification, the ability to continuously stored in the interstitial tissue and activated by exposure to certain conditions.
In most cases, chronic pyelonephritis is preceded by an acute attack. Chronic inflammation contribute to unresolved violations of the outflow of urine, caused by kidney stones, ureteral stricture, vesicoureteral reflux, nephroptosis, BPH, and so on. D. Maintain the inflammation in the kidneys can be other bacterial processes in the body (urethritis, prostatitis, cystitis, cholecystitis, appendicitis , enterocolitis, tonsillitis, otitis media, sinusitis, etc.), somatic diseases (diabetes, obesity), a chronic state of immune deficiency and intoxications. There are cases of pyelonephritis combination with chronic glomerulonephritis.
In young women the impetus to the development of chronic pyelonephritis may be the onset of sexual activity, pregnancy or childbirth. In young children, chronic pyelonephritis is frequently associated with congenital anomalies (ureterocele, diverticula of the bladder), in violation of urodynamics.
Hypertension is accompanied by dizziness, headache, hypertensive crises, sleep disorders, shortness of breath, pain in the heart. In chronic pyelonephritis hypertension often has a malignant character. Urinary syndrome usually is not expressed or intermittent flow.
Anemic variant of chronic pyelonephritis is characterized by the development of hypochromic anemia. Hypertensive syndrome is not expressed, uric - unstable and meager.
In azotemicheskuyu form of chronic pyelonephritis combined cases when the disease is detected only at the stage of CKD. Clinical and laboratory data azotemicheskoy forms similar to those in uremia.
urinalysis detected in chronic pyelonephritis leucocyturia, proteinuria, cylindruria. Urine as described in Addis Aleksander Kakowski characterized by a predominance of leukocytes on the other elements of the urinary sediment. Bacteriological urine culture helps to identify bacteriuria, pyelonephritis identification of pathogens and their susceptibility to antimicrobial agents. To assess renal function tests used Zimnitsky, Rehberg, biochemical blood and urine. In the blood in chronic pyelonephritis revealed hypochromic anemia, accelerated ESR, leukocytosis.
The degree of renal function is specified by means of cystochromoscopy, excretory and retrograde urography, nefrostsintigrafii. Reducing the size of the kidneys and the structural changes in the kidney tissue detected by ultrasound of the kidneys, CT, MRI. Instrumental methods in chronic pyelonephritis objectively indicate a decrease in kidney size, deformation pyelocaliceal structures, reduced secretory function of kidneys.
In clinically ambiguous cases of chronic pyelonephritis is a kidney biopsy. Meanwhile, the fence in the biopsy tissue unaffected kidney may give false-negative results with the morphological study of biopsy.
In the process of differential diagnosis excluded renal amyloidosis, chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis.
urologist (nephrologist).
Recommendations on diet include refusal of spicy food, spices, coffee, alcoholic beverages, fish and meat Navara. The diet should be fortified, with the content of dairy products, vegetable dishes, fruit, boiled fish and meat. In should be consumed per day for at least 1.5-2 liters of liquid to prevent excessive concentration and ensure urine washing urinary tract. In exacerbations of chronic pyelonephritis and its hypertensive form imposes restrictions on the reception of salt. In chronic pyelonephritis useful cranberry juice, watermelon, pumpkin, melon.
Exacerbation of chronic pyelonephritis requires the appointment of antibacterial therapy, taking into account microbial Flora (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) in conjunction with nitrofurans (furazolidone, furadonin) or drugs nalidixic acid (nevigramon, blacks). Systemic chemotherapy is continued until the termination of bacteriuria on laboratory results.
The comprehensive medical therapy of chronic pyelonephritis used vitamins, A, C; antihistamines (diazolin, pipolfen, suprastin),. In hypertensive shape appointed hypotensive and antispasmodic drugs; with anemic - iron supplementation, vitamin B12 folic acid.
Chronic pyelonephritis is a physiotherapy. Particularly well proven SMT-therapy, galvanization, electrophoresis, ultrasound, chloride sodium baths, etc
In the case of uremia hemodialysis is required. An advanced chronic pyelonephritis, is not amenable to conservative treatment and is accompanied by a unilateral renal scarring, hypertension, is the basis for nephrectomy.
hemorrhagic and ischemic stroke), heart failure.
Prevention of chronic pyelonephritis is timely and active treatment of acute urinary tract infections (urethritis, cystitis, acute pyelonephritis), readjustment of foci of infection (chronic tonsillitis, sinusitis, cholecystitis, etc.); Elimination of local violations of urodynamics (removing stones, strictures and dissection al.); correction of immunity.