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Pyelonephritis – an illness which is suffered more by women. At pyelonephritis inflammatory process of one or both kidneys is shown. As a rule, the disease has the bacterial nature. Hit in kidneys of the person of microorganisms comes from the infection center in an organism with a blood-groove, or from a bladder and an urethra on ureters. In the latter case pyelonephritis of kidneys is shown as complication after cystitis or an urethritis.
Prevalence of a disease among girls and women is explained, first of all, by the fact that the urethra at female representatives is shorter, than at men. Very often symptoms of pyelonephritis are shown at people who have problems with work of immune system, at diabetics. The disease is often shown at children of preschool age. Quite often there is pyelonephritis at pregnant women, and also at those who already endured childbirth or begins sex life. At men the factor provoking development of pyelonephritis of kidneys it becomes frequent prostate adenoma. In view of problems with outflow of urine at the person in an organism the favorable situation for development of bacteria is created. Have pyelonephritis also sick with stones in kidneys. Such educations often become a certain shelter for bacteria which provoke afterwards an inflammation.
Pyelonephritis of kidneys can be subdivided on acute and chronic. Also there is primary and secondary form of an illness.
Acute pyelonephritis arises at the patient owing to impact on its organism of endogenous or exogenous microorganisms which get into kidneys. In this case crucial importance at a course of a disease has a number of factors: disturbance of a passage of urine in view of obstruction a stone and other reasons; disturbance of outflow of urine owing to adenoma, a prostate cancer, a phymosis, etc. Besides, developing of pyelonephritis defines the general condition of a human body. Body resistance is negatively influenced by the wrong approach to food, overcooling, overfatigue, a hypovitaminosis, frequent catarrhal diseases, illnesses of a number of systems of an organism.
Depending on a stage of a disease, existence of its complications pyelonephritis symptoms are shown. Definition of stages of an illness happens after studying of morphological changes in a kidney.
At an initial stage of an illness of people suffers from serous pyelonephritis which can proceed from six to thirty hours. Further the disease passes into the following stages of which existence of purulent, destructive changes is characteristic. As a rule, similar changes have accurate sequence. At first apostematous pyelonephritis, further — a kidney anthrax, kidney abscess is shown, and process of changes comes to an end with a purulent paranephritis.
At a stage of apostematous pyelonephritis at the person small multiple pustules on a surface of a kidney and in its cortical substance are shown. If these pustules in development begin to merge, or the microbic embolus appears in a final arterial vessel of a kidney, at the person the kidney anthrax is shown. Development of necrotic, ischemic, pyoinflammatory processes is characteristic of this state.
Owing to purulent fusion of a parenchyma kidney abscess is shown. The abscess which appeared in the center of an anthrax of a kidney or merge of apostemas is sometimes emptied in pararenal cellulose. After that the purulent paranephritis develops, sometimes there is also phlegmon of retroperitoneal space.
The most often purulent forms of pyelonephritis arise as a result of obstruction of upper uric ways.
At secondary acute pyelonephritis local symptoms of a disease are shown more clearly. At the same time in development of primary pyelonephritis, first of all, the general symptoms of an infection take place, and here symptoms of local character at first can not be shown in general. As a result, in the course of diagnosis mistakes are possible. Symptoms of pyelonephritis become generally noticeable for days. The patient complains of the general weakness and an indisposition against what there is a strong fever, body temperature can increase to 41 °C. The fever is characterized by a severe headache, vomiting and nausea. In a body there is notable muscular pain, sometimes the patient is annoyed by a diarrhea, tachycardia.
Secondary acute pyelonephritis begins with display of renal colic. After that the fever, strong heat against sharp jump of body temperature which can increase to 41 °C is shown. Further at the patient the symptoms similar to symptoms of secondary pyelonephritis develop. After temperature falls to normal or subnormal indicators, the person begins to sweat strongly. He feels a certain improvement, back pains become less intensive. However in this case imaginary improvement which the doctor cannot regard as treatment of the patient takes place. In case of existence of obstruction of upper uric ways the attack of pain and a fever will renew in several hours.
If at the patient the purulent form of pyelonephritis develops, then symptoms of an illness become even more expressed. At the same time lumbar pain from pristupoobrazny passes into a constant, it is accompanied by a fever and gektichesky fever. On the party where defeat is observed, muscles of a front abdominal wall and lumbar area are strained. The kidney is painful, at a palpation its increase is defined. In an organism intoxication accrues owing to what the condition of the person becomes worse. Ppostepenno is aggravated a condition of dehydration therefore at the person features are considerably pointed, the state becomes heavy, and in certain cases is followed by euphoria. However the described symptoms of pyelonephritis of kidneys at it is purulent - destructive changes in a kidney are expressed not always. If the person is weakened, sick, then clinically the state can be shown is perverted.
Chronic pyelonephritis is rather eurysynusic illness. However to establish the similar diagnosis rather difficult in view of very few expressed all-clinical symptoms. In most cases chronic pyelonephritis is continuation of a piyeolonefrit acute. Especially often this disease arises at those patients at whom the urine passage broken on upper uric ways takes place. Such phenomenon is provoked by stones in ureters and kidneys, a chronic ischuria and other phenomena.
About a third of patients has chronic pyelonephritis since the childhood: the illness develops as a nonspecific slow inflammation of a parenchyma of pyelocaliceal system and a kidney. In most cases the illness is found many years later after it arises. Chronic pyelonephritis affects both one, and two kidneys.
Polymorphism and ochagovost of changes in tissue of kidneys is characteristic of this illness. Gradually the following sites of tissue of kidney are involved in an inflammation, therefore, gradually fabric perishes, and the chronic renal failure is shown.
Display of chronic pyelonephritis wavy: periodically there are exacerbations of an illness which are replaced by remissions. Depending on distribution of an inflammation to kidneys and its activities the clinical picture can vary. At active inflammatory process symptoms descents with symptoms of acute pyelonephritis. When there comes the period of remission, displays of pyelonephritis are expressed by nonspecific signs. So, the person can complain of a headache, lack of appetite, weakness, a fever, attacks of nausea and periodic jumps of body temperature to subfebrile. In certain cases in a waist there is dull ache.
At the subsequent progressing of a disease of people complains of attacks of arterial hypertension. Later ten - fifteen years from the beginning of a disease at the patient develop a chronic renal failure.
Diagnosis of pyelonephritis
Correctly to diagnose pyelonephritis of kidneys for the patient, the doctor, first of all, performs inspection of the patient, paying special attention to a condition of his skin, noting whether humidity and pallor of integuments takes place. Also the doctor notes a dry, coated tongue, defines existence of tachycardia, hypotonia.
In the course of laboratory blood analyses the leukocytosis, acceleration of SOE is found. If purulent forms of a disease take place, at the patient the disproteinemia, anemia, high level of urea and creatinine of blood serum is observed. Also in the course of diagnosis the analysis of urine is without fail carried out. It is important to conduct bacteriological research and to define sensitivity of microorganisms to drugs of antibacterial influence. Laboratory researches surely provide bacteriological crops of urine.
As additional diagnostic methods ultrasonography diagnosis of kidneys is often appointed. If at this inspection limited mobility of a kidney is observed, then such sign can be regarded as additional criterion in the course of diagnosis of acute pyelonephritis. Thanks to ultrasonography it is possible not only to diagnose a disease, but also to define those reasons which led to its emergence – existence of stones in kidneys, defects of an urinary system.
Also precisely it is possible to define destructive forms of a piyeolonefrit at children and adults by KT or MRT.
In the absence of an opportunity to execute ultrasonic diagnosis it is possible to differentiate primary and secondary pyelonephritis, based on results of a hromotsistoskopiya and excretory urography. At acute pyelonephritis it is important to carry out differential diagnosis with infectious diseases, acute illnesses of genitalias and abdominal organs.
It is very difficult to diagnose chronic pyelonephritis for the person, this form of an illness has long stage of latency. So it is important to study very much carefully results of laboratory researches even if visible external symptoms of an illness are absent.
In the course of ultrasonic research the only sign which is characteristic of a chronic form of an illness is existence of a granular kidney. In this state the kidney decreases, roughness of its contour is observed
For this state lowering of secretory function of a kidney is also characteristic.
Treatment of pyelonephritis
Display of acute pyelonephritis at children and adults is an occasion to immediate hospitalization of the patient and his subsequent treatment in the conditions of a hospital. However treatment of pyelonephritis of kidneys of primary and secondary form is carried out using different approaches. If at the patient reveal secondary pyelonephritis, the most important necessary action is recovery of outflow of urine from a kidney which was affected. If the disease began to be shown not earlier than two days and at the same time in a kidney is purulent - there are no destructive changes, then outflow of urine is recovered by means of pelvis catheterization.
After outflow of urine was recovered, and also at primary pyelonephritis pathogenetic treatment in which main point is use of antibacterial drugs is applied. It is important to appoint at the same time the antibacterial drugs having a broad spectrum of activity and influencing gram-negative flora.
Drugs at treatment of pyelonephritis enter parenterally, using at the same time the maximum therapeutic dose. In the course of complex treatment of pyelonephritis also other drugs are appointed: non-steroidal anti-inflammatory drugs, drugs which activate blood circulation are also applied methods of intoksikatsionny therapy. If at the correct approach to treatment for one and a half days the effect of improvement is not observed, then the doctor draws a conclusion about existence of progressing is purulent - destructive process in a kidney. This direct indication to open surgical intervention.
Operation is performed for the purpose of a suspension of pyoinflammatory process or prevention of complications, having provided improvement krovo-and lymphokineses in a kidney. Decapsulation of a kidney is for this purpose carried out. This method promotes reduction of intra renal pressure, expansion of a gleam of vessels. If in it is purulent - destructive process is involved 2/3 and more renal parenchyma, then performance of a nephrectomy in the course of operation is possible.
As recovery treatment after operation therapy is carried out by antibacterial, anti-inflammatory, disintoxication agents.
In an initiation of treatment of chronic pyelonephritis it is important to find out what cause of infringement of a passage of urine and disturbance of blood circulation. Considering results of bacteriological researches, the doctor appoints antibacterial agents. Several courses of treatment are for this purpose applied, at the same time every time is used other drug in view of fast emergence of resistant strains of microbes. Besides, for therapy of pyelonephritis sulfanamide drugs, means of a plant origin, a complex of vitamins, immunocorrective means are used. Treatment of chronic pyelonephritis continues not less than two months. If chronic pyelonephritis does not respond to treatment, the patient needs to carry out a nephrectomy.
There is also a number of national methods which in addition use in the course of treatment of pyelonephritis. As a rule, it is grass broths which leaves of blackberry, a bearberry, a flax seed, a leaf of a birch, nettle, a horsetail grass enter. Broths accept in a warm look several times a day.
Complications of pyelonephritis
As complications of pyelonephritis at children and adults acute pyelonephritis in an opposite kidney, sepsis, bakteriotoksichesky shock can develop.
The most serious complication of acute pyelonephritis is bakteriotoksichesky shock owing to which from 45 to 55% of patients die. This disease is shown at purpose of antibacterial agents at nevostanovlenny outflow of urine.
At this state at the person arterial pressure to critical indicators sharply falls, return of blood to heart decreases, there is a destruction of erythrocytes and thrombocytes. As a result there are processes leading to development of multiorgan insufficiency.
At chronic pyelonephritis as complications there is nephrogenic arterial hypertension and a chronic renal failure.
Pyelonephritis at pregnant women
Pyelonephritis at pregnant women often arises as a result of the intensive growth of a uterus which in process of increase presses on ureters and complicates urine outflow. Besides, pyelonephritis at pregnant women is shown more often in view of noticeable hormonal changes in the woman's organism. Owing to intensive hormonal changes the peristaltics of ureters can be at a loss considerably.
Besides daily activity is important for the correct functioning of mochevydelny system that is not always characteristic of the woman bearing the child.
Most often pyelonephritis is shown at those pregnant women who had cystitis or pyelonephritis earlier.
It is important to consider that pyelonephritis negatively influences course of pregnancy and a fruit. This disease can provoke anemia, late toxicosis and even abortion. Therefore at the shown pyelonephritis symptoms it is important to the woman bearing the child to ask for medical assistance at once.
All women who had pyelonephritis during pregnancy stay under the subsequent supervision of the doctor and after the delivery.
Diet at pyelonephritis
The diet at pyelonephritis assumes careful selection of a food allowance in the course of treatment of an illness, and after recovery. In the first days of an illness patients with an acute form of pyelonephritis are offered to use only berries, fruit, melon, some vegetables puree. It is gradually possible to enter proteinaceous products later, however the diet at pyelonephritis assumes energy value of food not higher than 1800-2000 kcal.
In the very first days of an illness it is important to use not less than two liters of liquid — rather weak tea, grass broths, juice of fruit diluted with water. It is recommended to use fruit drinks from cowberry and a cranberry.
The electrolyte-deficient diet at pyelonephritis is not obligatory, however the use of salt needs to be limited to 6 g a day. It is important to eat food with the high content of vitamins.
At the same time the disease of chronic pyelonephritis does not assume a special diet. However it is important to follow the principles of healthy food, to use a lot of liquid, not to limit the salt use. For improvement of an organism it is periodically possible to arrange fasting days.
Prevention of pyelonephritis
For prevention of developing of pyelonephritis it is necessary to pay, first of all, special attention to treatment of those diseases which become the reason of this illness. These are stones in kidneys, prostate adenoma. It is also necessary to approach competently therapy of cystitis, the infection sometimes passes into kidneys from the inflamed mochevik. To warn pyelonephritis at pregnant women, to them is regularly shown to make tests of urine throughout all duration of gestation.
Section: Infectious diseases