Pyelonephritis: symptoms and treatment in children and adults. Pyelonephritis: causes, types, symptoms, prevention and treatment Clinical forms of pyelonephritis

Pyelonephritis is an inflammatory disease that affects the kidneys; this occurs when a number of unfavorable factors are combined with the influence of certain microorganisms. Pyelonephritis, the symptoms of which are often absent, is dangerous precisely for this reason, because general well-being is not affected, and therefore no measures for treatment are taken. The disease can be unilateral or bilateral, as well as primary or secondary, that is, it develops either with previously healthy kidneys or with existing pathologies.

general description

In addition to these options, pyelonephritis, like many other diseases, can be acute or chronic. It is diagnosed in a wide variety of age groups, and it is noted that women of the young and middle age groups are affected almost six times more often than men. Children are no exception, in whom pyelonephritis is in second place in terms of prevalence after diseases in which the respiratory system “suffers” (in particular, this includes bronchitis, pneumonia, etc.).

What is noteworthy is that when considering the statistics of recent years on the frequency of diagnosing pyelonephritis, it was noted that there is an increase in it, especially for young children.

So, what, in essence, is pyelonephritis? With pyelonephritis, as we have already indicated, the kidneys are affected, and this result is mainly caused by exposure to bacteria. Microorganisms, once in the renal pelvis or in it itself by urinogenic or hematogenous routes, settle in the interstitial tissue of the kidney, as well as in the tissue of the renal sinus.

Hematogenous pyelonephritis is characterized by the fact that the foci of the inflammatory process are located mainly in the environment of the cortex, as well as surrounded by intralobular vessels. By affecting interstitial tissue, the inflammatory process affects primarily the tubular system. Urogenic (or ascending) pyelonephritis is characterized by damage to the kidney in the form of separate foci, like wedges, spreading to the surface of the kidney organ to the pelvis. The areas between these wedges contain normal renal tissue. If such a form of kidney damage as bilateral pyelonephritis is relevant, then the spread of the pathological process occurs unevenly, asymmetrically, which distinguishes the disease, for example, from nephrosclerosis or from.

There is no specific type of pathogen for this disease. As a reason that provokes the development of pyelonephritis, one can also identify microorganisms that are constantly present in the human body, and, again, microorganisms that enter the human body from the environment. Basically, the causative agents of pyelonephritis are certain types of microorganisms, which include various cocci and Escherichia coli. About 20% of cases of pyelonephritis are caused by exposure to a mixed infection.

An infection can enter the body, and the kidney in particular, in several main ways, namely:

• hematogenously, that is, through the bloodstream (and this path most often occurs in considering this disease);
• urogenously, that is, through contaminated urine;
• by the lymphogenous route, that is, through the lymph flow emanating from foci of infection in neighboring organs, or through the intestines.

General and local factors can provoke the development of pyelonephritis. Local factors include impaired urine passage, which is explained by the presence of certain obstacles in the way of its outflow from the kidneys. Here, narrowing of the ureters, urolithiasis (), and tumor formations affecting the kidneys may occur. As for general factors, here we can identify an objective state that is relevant to the patient’s body (changes due to constant stress, chronic fatigue, as well as weakness caused by one or another factor). This also includes an altered state of immunity, diseases in one area or another that affect the body’s protective functions, vitamin deficiency, etc.

Depending on the characteristics of the course of pyelonephritis, acute and chronic pyelonephritis are distinguished. If we dwell briefly on their specifics, we can indicate that acute pyelonephritis develops suddenly, literally within a few hours, possibly several days. Correct treatment of the disease determines its duration within 10-20 days, in particular, the duration of the disease is determined by the specific type of pathogen that provoked the disease. It usually ends with the patient’s absolute recovery.

As for chronic pyelonephritis, it can develop as a transitional form from acute pyelonephritis. In addition, pyelonephritis in chronic form can also manifest itself initially as a primary chronic disease. It also has its own characteristics. Thus, it is characterized by its own sluggish course, systematically subject to aggravation. In this form, bacterial inflammation of the tissues of the kidney organ is accompanied by a slow replacement of the normal tissues of the organ with connective tissue, which in itself is not functional. Quite often, the disease in this form is accompanied by complications such as arterial hypertension.

Acute pyelonephritis: symptoms

In this form, pyelonephritis occurs in combination with symptoms such as high fever and chills. Patients experience increased sweating (“heavy” sweat). The kidney on the affected side hurts. On the 3-5th day of the manifestation of the disease, by palpation it can be determined that the affected kidney is in an enlarged state, in addition, it is still painful. When donating blood for analysis these days, leukocytosis is detected, then, with concomitant severe intoxication, the possibility of leukocytosis disappearing is allowed. Also, by the third day, pus is detected in the urine (which is designated by the medical term pyuria); when taking a urine test, bacteriuria (excretion of bacteria in the urine) is detected, in which 1 ml of urine contains a value exceeding 100,000.

The appearance of chills and fever is accompanied by headache and joint pain. In parallel with these symptoms, there is an increase in pain in the lumbar region, mainly this pain still manifests itself on the side on which the kidney is affected. As symptoms preceding the development of pyelonephritis, in some cases symptoms may appear that indicate the presence of obstacles in the urinary tract, in particular painful urination, attacks of severe pain in the lumbar region, and discolored urine.

Additionally, symptoms of acute pyelonephritis may include such general symptoms as weakness, nausea and vomiting, and poor appetite. Pyelonephritis in children is characterized by the severity of intoxication, as well as the appearance of abdominal syndrome, which is accompanied by the appearance of pain not in the lower back, as in general with pyelonephritis, but, on the contrary, in the abdomen. Pyelonephritis in older people is often characterized by an atypical picture of the manifestation of this disease (symptoms that are uncharacteristic for this disease), or the clinical manifestations have an erased form.

Chronic pyelonephritis: symptoms

For quite a long time, pyelonephritis in this form proceeds without any symptoms, although exacerbations may periodically occur; in these cases, the same symptoms are relevant as with acute pyelonephritis.

Chronic pyelonephritis can manifest itself in two main forms, being latent or recurrent. Latent pyelonephritis develops against the background of acute pyelonephritis; it is characterized by an asymptomatic course, as well as a long-term, although insignificant in terms of temperature, increase in temperature. As for recurrent pyelonephritis, it is relevant for almost 80% of patients. Its characteristic features are weakness, fever and other general symptoms; there are also certain changes in the urine (which is determined based on its analysis). In the recurrent form of the disease, anemia, hypertension and renal failure often develop.

Thus, we can summarize exactly what symptoms appear in chronic pyelonephritis:

• dull pain in the lumbar region;
• general malaise (fever, high blood pressure, thirst);
• polyuria (increase in daily urine output, from 1.8 liters or more), pyuria, bacteriuria.

If pyelonephritis is detected in pregnant women, then in most cases it is its chronic form, or more precisely, its exacerbation with previously undiagnosed pyelonephritis. Pregnancy itself creates conditions under which the outflow of urine is disrupted. This is due, in particular, to an enlarged uterus, as well as to compression of the ureters that accompanies pregnancy.

Diagnosis

• Urinalysis (general) . This diagnostic method makes it possible to obtain certain ideas about the presence of an infection in the patient. It can be used to detect protein in the urine (proteinuria), signs indicating the presence of infection (leukocyturia), as well as bacteria.
• Ultrasound . In this case, the ultrasound examination method makes it possible to detect changes in the area of ​​the renal pelvis (in particular its expansion), changes in the tissues of the kidney organ (unusual tissues, areas with compactions).
• Urine culture . Sowing is done on a nutrient medium; after some time, a microscope can be used to detect the growth of a certain type of bacteria, due to which an inflammatory process has developed in the kidneys.
• CT . CT, or computed tomography, does not have any special advantages over the previously designated ultrasound research method; if it is used, it is to distinguish pyelonephritis from tumor lesions of the kidneys.
• Blood test (general) . This diagnostic method makes it possible to determine whether there is an inflammatory process as such, and also determines its features, which in general can be identified in a blood test.
• Radionuclide diagnostic methods . This type of method makes it possible to determine the characteristics of kidney function.

Treatment of pyelonephritis

The basic principles of treatment for this disease are drug therapy, surgical therapy and diet.

Drug therapy consists in particular of taking antibiotics. The duration of treatment with their use for acute pyelonephritis can range from 5 to 14 days. Drugs from the fluoroquinoline group or beta-lactams are used. Also used are cephalosporins (III-IV generations), ureidopenicillins, semisynthetic penicillins, beta-lactamase inhibitors, penems, and monobactams.

Treatment of the acute form of pyelonephritis is similar to the treatment of exacerbations of the chronic form of the disease. Treatment of chronic pyelonephritis consists of stopping exacerbations, as well as taking preventive measures against relapses. Antibiotics are also prescribed here, although the course of treatment is not as intense as during exacerbations.

As for the surgical treatment of pyelonephritis, it is used in cases where drug therapy is ineffective when the patient’s condition is stable and severe. Surgery is indicated for purulent forms of the disease (carbuncles, kidney apostemas). The main purpose of the operation is to stop the progression of the pathological purulent process in the kidney, as well as to restore the outflow of urine through the upper urinary tract (if there is such a disorder).

And finally, diet. In the acute form of pyelonephritis, a large volume of liquid (from 2 liters or more) is indicated for consumption. Fatty, spicy, fried foods are excluded. The diet should include as many fresh vegetables and fruits as possible. The chronic form of pyelonephritis (during non-aggravated periods) consists of certain dietary features. Thus, moderate restrictions apply to fish and meat broths and seasonings. Fish and meat must be boiled. The liquid should also be consumed in sufficient volumes - from 2 liters or more. Salt intake is moderately limited, especially if there is high blood pressure due to pyelonephritis. It is also important to provide the patient with enough vitamins.

It is impossible to treat pyelonephritis on your own, therefore, if symptoms indicating this disease appear, you should consult a nephrologist.

Pyelonephritis is a kidney disease of infectious etiology, accompanied by an inflammatory process. The causes of pyelonephritis are the penetration and reproduction in the kidney tissues of pathogenic bacteria located in the lower parts of the urinary system (bladder).

There are also hematogenous, lymphogenous routes of infection and the introduction of an infectious agent during injuries or medical procedures. In 90% of cases, the cause of pyelonephritis is the bacterium E. Coli or Escherichia coli. Pyelonephritis can affect people of different ages and genders, although it occurs 3-4 times more often in girls and women due to the structural features of the genitourinary organs, which cause easy penetration of bacteria into the kidneys through an ascending route of infection.

Risk factors for developing pyelonephritis

In addition to the structural features of the excretory system in women, there are non-sexual factors that increase the risk of pyelonephritis. These include:

• congenital or acquired anomalies, pathologies of the structure of the kidneys, bladder, urethra;
• states of immunodeficiency of various etiologies;
• urolithiasis;
• diabetes mellitus, increased sugar content in the urine creates favorable conditions for the proliferation of pathogenic organisms;
• age factor: the older the person, the higher the risks;
• injuries of the peritoneal organs, spinal cord;
• surgical operations and medical manipulations in the organs of the urinary system;
• chronic diseases of bacterial etiology, foci of infection in the body.

In men, pyelonephritis can be triggered by diseases of the prostate gland, accompanied by an increase in the size of the organ.

Causes of pyelonephritis

Pyelonephritis is an infectious kidney disease of bacterial pathogenesis. The cause of pyelonephritis is the proliferation of pathogenic organisms due to stagnation of urine or when they penetrate into the kidney tissue in quantities excessive for local immunity.

Ascending path of infection in the etiology of pyelonephritis

Penetration of infection through the urethra into the bladder, its spread through the canals to the upper structures and, as a result, to the kidneys, is the most common cause of pyelonephritis.
The structure of the female body causes an increased incidence of infection of the urinary system: pyelonephritis in women is diagnosed 5 times more often than in men. The short and wide urethra and the proximity of the urethra to the genitals and anus facilitate the penetration of pathogens into the bladder and kidneys.
In men, the main reason for the development of pyelonephritis is an obstruction in the urethra, in organ tissues, which impedes the excretion of urine and contributes to its stagnation (kidney stones, urinary tract, proliferation of prostate tissue of various etiologies). Infectious agents multiply in the accumulated fluid, spreading to the organs of its production and filtration.
Obstacles to the outflow of urine in the form of cysts, stones, tumor formations, strictures, acquired and congenital, can cause the development of pyelonephritis in female patients, but the most typical for them is an ascending route of infection after contamination of the urethral area with E. coli.

Vesiculourethral reflux as a cause of pyelonephritis

Vesiculourethral reflux is characterized by the backflow of part of the excreted urine into the renal pelvis due to obstructed outflow through the ureters. This pathology as the cause of the inflammatory process in the kidneys is most typical for children with pyelonephritis: vesiculourethral reflux is diagnosed in almost half of children from 0 to 6 years old suffering from pyelonephritis as the cause of the disease. With the reflux effect, urine is thrown back from the bladder into the kidney or distributed from the renal pelvis to other parts of the organ. In older periods, this pathology accounts for only 4% of the causes of the disease.
Attacks of acute pyelonephritis in childhood have dangerous consequences for the kidneys in the form of scarring of organ tissue. Before puberty, attacks of acute pyelonephritis in children and the formation of scars are caused by the physiological characteristics of children:

• lower fluid pressure, compared to adults, required for the effect of reverse reflux of urine;
• inability to completely empty the bladder until an average of five years of age;
• reduced resistance of the child’s immune system during the first years of life, including to bacterial infections, against the background of insufficient personal hygiene and the absence of bactericidal components in the urine;
• difficulties in early diagnosis of the disease;
• more frequent, compared to adults, downward migration of pathogenic organisms: with scarlet fever, sore throat, caries, etc.

Scarring of tissue is a serious pathology that significantly reduces the functioning of the kidneys as an organ. In 12% of patients requiring hemodialysis due to irreversible changes in kidney tissue, the cause of tissue scarring is complications of pyelonephritis suffered in childhood.

Other routes of infection for pyelonephritis

Other variants of migration of bacteria and microorganisms into kidney tissue are much less common. There is a hematogenous route of infection along with the blood flow, lymphogenous, as well as direct introduction of the pathogen during instrumental manipulations, for example, catheterization of the bladder.

Infectious agents

The most common pathogenic microorganism in the pathogenesis of pyelonephritis is Escherichia coli, the bacterium E. Coli. Other causative agents of pyelonephritis include:

• staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
• Klebsiella pneumoniae;
• proteus (Proteus mirabilis);
• enterococci;
• pseudomonas (Pseudomonas aeruginosa);
• Enterobacter species;
• Pseudomonas aeruginosa;
• pathogenic fungal microorganisms.

The ascending migration of infection is most characterized by the presence of E. coli in the urine, which is determined by laboratory analysis. When the pathogen is directly introduced during instrumental manipulations, the most common causes of pyelonephritis are Klebsiella, Proteus, and Pseudomonas aeruginosa.

Symptoms of pyelonephritis

Symptoms of pyelonephritis vary depending on the form of the disease, its stage and the age of the patient.

Pyelonephritis in adults: signs and symptoms

Physiological differences in the structure of the male and female body affect not only the incidence rate, but also the course of the disease.

Symptoms of pyelonephritis in women

The disease manifests itself with different symptoms depending on the form of the disease. The acute form of pyelonephritis in women is often accompanied by such symptoms as:

• a sharp increase in body temperature to febrile levels (over 38°C);
• symptoms of body intoxication: nausea, chills, fever, headaches;
• possible change in the characteristics of urine, especially with the simultaneous presence of cystitis: loss of transparency, presence of inclusions of blood, pus, etc.

An important test for primary diagnosis is a positive response to the Pasternatsky test: when tapping in the kidney area, pain intensifies, hematuria is noted, and blood appears in the urine.

The chronic form of pyelonephritis in women outside periods of exacerbations has mild symptoms, manifested by the following symptoms:

• moderate pain in the lumbar region;
• minor symptoms of intoxication: weakness, headaches, loss of appetite;
• swelling after a night's sleep with difficulty passing urine.

Pyelonephritis and cystitis in women are often combined in one time period, and the symptoms of cystitis in their severity can significantly prevail over the clinical picture of the secondary disease, which can lead to insufficient diagnosis and lack of treatment for pyelonephritis.
Symptoms of cystitis in women include:

• discomfort, pain, burning sensation accompanying urination;
• frequent urge to go to the toilet, feeling of incomplete emptying of the bladder;
• pain in the lower abdomen, etc.

Pyelonephritis in pregnant women

Up to 4% of pregnant women, or almost every 20th woman, encounters manifestations of pyelonephritis in acute or chronic form during pregnancy. Most often, the disease develops in the middle of the second to early third trimester of pregnancy due to the growing pressure of the expanding uterus on the kidneys and ureters.

Under pressure, the outflow of urine slows down, stagnation occurs in the kidneys: the body is not able to promptly remove fluid with a growing concentration of pathogenic bacteria. Especially often, pyelonephritis in pregnant women develops against the background of acute or indolent cystitis.
The kidneys are one of the most important organs during gestation; they experience increased load, filtering increased volumes of fluid. For any symptoms indicating diseases or dysfunctions of the urinary tract, you should immediately consult a doctor.
Complications of pyelonephritis in pregnant women include anemia, sepsis, renal failure, and the likelihood of premature birth due to intoxication of the body.

Pyelonephritis during pregnancy is dangerous not only due to the usual complications, but also the development of gestosis, eclampsia, which is life-threatening for the mother and child. Self-treatment of exacerbations of chronic pyelonephritis during pregnancy is also unacceptable due to possible side effects for the fetus: previously effective drugs may be prohibited for use during pregnancy.
With timely initiation of therapy, pyelonephritis is cured without affecting the child’s health.

Symptoms of pyelonephritis in men

Due to the peculiarities of the anatomical structure of the urinary system, pyelonephritis in men is diagnosed several times less often than in women. Most often, the disease occurs in an erased, chronic form, developing against the background of obstructed urine outflow due to the formation of stones in the kidneys, ureters, and prostate tumors.
With this form of the disease, the symptoms are similar to those of chronic pyelonephritis in women: symptoms of general minor intoxication (general malaise, weakness, decreased appetite, etc.), disturbances in the urination process, mild pain in the lumbar region, thirst, dry mouth, profuse urination, morning swelling.
When kidney stones move, the symptoms of pyelonephritis are complemented by manifestations of renal colic: severe pain, hematuria.
The acute form of pyelonephritis in men is most often provoked by the downward spread of infection from the source of the inflammatory process (with sore throat, caries, etc.). Pyelonephritis in the acute stage in men manifests itself in the same way as in women, regardless of the path of migration of the pathogen: body hyperthermia, lower back pain, positive Pasternatsky’s symptom, possible changes in the composition of urine.

Pyelonephritis in childhood

The main symptom that occurs with acute pyelonephritis in childhood is a sudden increase in temperature to febrile levels. If, against the background of general health, the child’s temperature rises and for several days there are no symptoms characteristic of acute respiratory viral diseases, infectious diseases, or signs of a “cold,” it is necessary to immediately submit blood and urine samples to exclude or confirm the diagnosis of pyelonephritis.
Due to a sharp rise in temperature and general intoxication of the body, the child’s condition is unsatisfactory; hyperthermia is accompanied by chills, nausea, possible vomiting, drowsiness, and lack of appetite. Children may complain of headaches, pain in the lower back, in the iliac region.
The chronic form in children is diagnosed when an inflammatory process is detected for at least 6 months or in the presence of two or more episodes of acute pyelonephritis within six months. Symptoms of the chronic form may vary depending on the stage of the disease; the latent form may be asymptomatic, while negatively affecting the kidneys and contributing to the development of irreversible changes in their tissues.

Forms of pyelonephritis

Depending on the nature and course of the disease, the localization of the inflammatory process, several forms of the disease are distinguished.

Types of acute forms of pyelonephritis

The acute serous form is characterized by the formation of multiple foci of inflammation in the kidney tissues, an increase in the size of the organ, and swelling of the surrounding tissues. In the absence of therapy, serous inflammation progresses and turns into a purulent-destructive form of the disease.
The development of acute purulent inflammation of the kidneys has a high percentage of deaths, 1 out of 5 patients die. There are several stages in the development of this form of the disease:

• the stage of formation of apostemes, small abscess formations, in the tissues of the kidney;
• stage of carbuncle, the fusion of several apostemes into a single focus up to 2 cm in size. There may be several carbuncles;
• stage of purulent abscess that occurs when apostema and carbuncles merge. It is characterized by extensive damage, melting, and destruction of tissue at the site of infiltration.

The abscess is accompanied by extreme body temperature (40-41°C), acute pain, and a pronounced picture of intoxication. Breakthrough of the infiltrate into the retroperitoneal space most often leads to sepsis and death.

Chronic inflammatory process

To diagnose a chronic form of pyelonephritis, a long period of illness is required - from 6 months, or the detection of the acute stage at least twice during a given period of time. The acute form is considered a separate manifestation if the patient achieves complete clinical recovery within a two-month period after the start of therapy.

The cause of the development of the chronic form is most often incomplete cure during an acute inflammatory process. Less common is a self-emerging chronic process, provoked by the presence of foci of infection in the body or difficulties in the outflow of urine due to various reasons.

Primary and secondary forms of pyelonephritis

With pyelonephritis of the primary form, against the background of a decrease in local or general immunity, the development of an acute inflammatory process in the kidneys is observed due to the proliferation of pathogenic flora.
The secondary form is more often expressed as a chronic disease, occurring against the background of anatomical and/or functional disorders in the process of urine outflow.

Forms of pyelonephritis depending on the location of the inflammatory process

If one kidney is affected, unilateral pyelonephritis is diagnosed, which is much more common than bilateral. With bilateral pyelonephritis, the inflammatory process affects both kidneys, which often leads to the development of both acute and chronic renal failure.

Diagnosis of the disease

Data collection and diagnostics are carried out in accordance with the scheme for collecting information about the patient’s well-being and deviations of indicators from the norm:

• collecting anamnesis from the patient’s words and information from medical documents: the presence of current or past acute and chronic infectious diseases, structural pathologies, diseases of the genitourinary system;
• collecting information to compile a clinical picture of the disease: complaints of pain in the lumbar region, the appearance and smell of urine, frequency of urination, hyperthermia, signs of general malaise;
• examination of the patient;
• laboratory tests, instrumental diagnostics.

The list of laboratory tests includes the following studies:

• general and biochemical analysis of blood and urine;
• samples according to Zimnitsky and Nechiporenko;
• culture of urine microflora to determine sensitivity to antibiotics of different groups.

Blood tests for pyelonephritis indicate the presence of bacterial inflammation: an increase in the concentration of leukocytes, the SOE indicator, characteristic changes in the biochemical composition.
A general urine test reveals changes in the specific gravity and number of leukocytes; inclusions of blood, pus, and protein may be present.
Biochemical analysis of urine shows an increased level of salt content.
Urine culture allows you to identify the causative agent of the disease and select the most effective drug for treatment.

For instrumental diagnostics, an ultrasound examination of the peritoneal organs is performed, concentrating on the kidneys and bladder. The method of excretory urography with the introduction of a contrast agent intravenously and computed tomography are also used.

Pyelonephritis: symptoms and treatment

In the case of pyelonephritis, symptoms and treatment vary depending on the pathogenesis, form, stage of the disease, the age of the patient and his individual characteristics. Although there are general recommendations for patients with pyelonephritis: warmth, rest, bed rest, drinking plenty of fluids (diuretic, anti-inflammatory herbal teas, lingonberry, cranberry juices, oatmeal broth, clean water, etc.) and taking antimicrobial drugs.

Treatment of pyelonephritis in adults

When suffering from pyelonephritis, women are strongly recommended to undergo examination by a gynecologist to identify a concomitant source of infection. In the presence of cystitis or inflammatory diseases of the genital area, treatment of pyelonephritis is complicated and can provoke the disease to become chronic.
Long-term therapy with antibiotics aimed at curing inflammatory processes in the kidneys, without attention to foci of infection, leads to loss of sensitivity of pathogenic bacteria and lack of effect from taking the drugs.

Treatment of pyelonephritis in men requires diagnosis by a urologist. Most often, pyelonephritis in older male patients occurs in a chronic form and is associated with stagnation of urine, difficulty in its outflow due to diseases of the genitourinary system: urolithiasis, prostatitis, prostate adenoma, etc. In such cases, treatment of the cause of stagnation is primary, since Without ensuring complete outflow of urine, inflammatory processes will continue to occur in the bladder and kidneys.

Choice of therapy in childhood

In childhood, the most common cause of the disease is congenital reflux, in which some of the urine is refluxed from the ureters and bladder into the kidneys. With this etiology of the disease, conservative therapy is carried out with antibiotics, uroseptics, NSAIDs, measures are taken to increase the general immunity of the body, and surgical techniques are used for surgical treatment.

Groups of antibiotics used to treat patients with pyelonephritis

Antibiotics are the basic group of drugs in the treatment of patients with pyelonephritis. Independent choice of medication or attempts at home treatment without the use of modern antimicrobial agents most often lead to the development of a chronic form of the disease and the development of pathogenic flora resistant to the effects of antimicrobial drugs.
Most often, pyelonephritis occurs when E. coli multiplies, a pathogen that responds well to semisynthetic penicillin in combination with clavunic acid (Augmentin), 1-3 generation cephalosporins.
The most common antimicrobial agents are the fluoroquinalone group (Nolicin) and ciprofloxacins (Ciprofloxacin, Cifran).
To prevent relapses in the chronic form, patients with pyelonephritis use derivatives of nalidixic acid (Nevigramon) and hydroxyquinoline (5-NOK).

Microorganisms often cause various diseases. Bacteria and viruses can cause disruption in the functioning of many organs. Pyelonephritis is a common pathology among adults and children. Kidney inflammation is a serious disease that requires close attention from a doctor and adequate treatment. The key to a favorable outcome in all cases is the correct determination of the cause of the disease and the predisposing factors that contributed to its development.

Main features of pyelonephritis

The kidneys are a paired organ located in the lumbar region. The main role of these anatomical formations is to free the blood from toxic substances formed during the life of organs and tissues. The kidneys carefully control the amount of water in the body and prevent increased levels of toxins and other chemicals.

Pyelonephritis is a kidney disease, the basis of which is the inflammatory process.

Inflammation of the cups and pelvis of the kidney - the basis of pyelonephritis

Pathological changes in this case affect the initial parts of the urinary system - the cups and pelvis, from which urine enters the ureters and subsequently into the bladder.

The disease can occur in various forms. An acute variant of pyelonephritis is often encountered, in which striking negative changes in tissues and pronounced clinical signs are observed. The chronic form in some cases is a consequence of initial inflammation, which over time becomes sluggish in nature with a series of exacerbations and subsidence of the pathological process.

Features of pyelonephritis - video

Microorganisms that cause kidney inflammation

The cause of pyelonephritis is pathogenic microbes. From birth, a person lives in close interaction with various bacteria and viruses, which are the most ancient forms of life. However, most of them do not have any negative effects. Only a certain group of microorganisms are pathogenic, capable of causing inflammation of the renal cups and pelvis in humans.

Bacteria are the most common cause of pyelonephritis. They are not always guests who enter the body from the outside. In most cases, a person lives with them in close proximity. Bacteria normally live in the oral cavity, on the surface of the skin, and inhabit the intestines. All of them are under careful control of the immune system, which does not allow them to penetrate beyond certain limits.

Beneficial bacteria help the body function

This balance benefits both the microscopic inhabitants and the larger human organism. The bacteria that make up the normal microflora are provided with food and a permanent place of residence. They daily train the immune system to recognize friends and foes, prevent the penetration of pathogens and help digestion in the intestines. However, among the undoubtedly beneficial bacteria there are species that are opportunistic. With any weakening of immune control, they can cause the development of the disease.

Bacteria are the only cell in which the processes of nutrition, reproduction, and metabolism occur. These microorganisms, as a rule, do not destroy kidney tissue, but they poison them with toxins released in large quantities. Bacteria can differ in shape, method of nutrition and chemical transformations that form the basis of metabolism. These properties make it possible to divide microorganisms into types.

Bacteria is a single-celled microorganism

Rod-shaped bacteria

The main causative agent of pyelonephritis is Escherichia coli, which normally inhabits the human digestive tract. This bacterium belongs to the opportunistic species and requires constant monitoring by the body's immune system.

Escherichia coli is the most common cause of pyelonephritis

Klebsiella is a rod-shaped bacterium. It lives mainly in the respiratory tract - pharynx, trachea, bronchi and lungs. However, in some cases it causes inflammation in the kidneys. Another type of stick is the proteus. It can live in the human intestine, but it rarely causes pyelonephritis.

Klebsiella causes infectious inflammation of the kidneys and respiratory tract

Pseudomonas aeruginosa is a pathogen that in most cases causes infectious diseases that develop within hospital walls. Pyelonephritis is no exception. These bacteria are massively resistant to antibiotics, making them extremely difficult to control.

Cocci

Another cause of pyelonephritis is cocci. Some of their species are absolutely useful and exist unhindered as part of the normal microflora. However, two representatives cause dramatic negative changes when they enter kidney tissue - streptococci and staphylococci. Under a microscope, they resemble balls collected in chains or clusters in the form of a bunch of grapes. These bacteria actively produce toxins that cause the development of symptoms of pyelonephritis.

Staphylococcus aureus often occurs in clusters

Pneumococcus is a type of streptococcus, which often causes not only pneumonia, but also the development of pyelonephritis. Kidney disease can be caused by Staphylococcus aureus. In addition, in this case, the inflammation is purulent in nature (apostematous nephritis, renal carbuncle, paranephritis).

Intracellular forms

Among bacteria there are a number of species leading a rather extravagant existence. They penetrate into the cell, are released from the outer shell and become inaccessible to the action of antimicrobial drugs. Such microorganisms include pathogens of genitourinary infections - chlamydia and mycoplasma.

Chlamydia and mycoplasma exist inside the cells of the host body

Viruses

Viruses are a special form of life. They do not know how to feed and reproduce on their own. They begin their life activity when they enter the human body. The virus penetrates the cell and forces it to perform only one task - to reproduce its own kind. This process most often leads to the death of body tissue. Viruses are extremely difficult to fight because antibiotics have no effect on them. The body's only chance is protection with the help of the interferon protein, which destroys the infectious agent inside the cell. Pyelonephritis can be caused by influenza viruses, parainfluenza, enteroviruses, rhinoviruses, and adenoviruses.

The virus contains an envelope and genetic material

Routes of infection into the kidneys

Microorganisms penetrate the renal cups and pelvis in several ways.

Rising Path

The most common of them is ascending. In this case, the bacteria live in the bladder, urethra, or intestines. Penetrating into the urine, the infectious agent moves towards the kidneys, where it causes the development of pyelonephritis. In this case, organ damage is preceded by other diseases - inflammation of the bladder (cystitis) or urethra (urethritis). The latter are often caused by sexually transmitted infections (chlamydia, mycoplasmosis).

Ascending infection penetrates into the kidneys from the ureters and bladder

Hematogenous route

Bacteria can penetrate into the renal pelvis along with the movement of blood through the vessels (hematogenously) from another pathological focus. A common cause is an infection that has become attached to the tonsils and causes the development of chronic inflammation - tonsillitis (tonsillitis). In carious teeth that need treatment, microorganisms live in large numbers, feeding on destroyed tissues - enamel and dentin. Chronic inflammation of the paranasal sinuses - sinusitis, ethmoiditis, frontal sinusitis, sphenoiditis, pansinusitis - can also become a source of infection with the development of pyelonephritis.

Bacterial or viral pneumonia - pneumonia - often becomes the source of infection that causes pyelonephritis. Pneumococci, staphylococci, and Klebsiella usually live in this focus. In addition, pyelonephritis develops against the background of the existence of any purulent process in the body. The latter can be localized in the skin (phlegmon), bones (osteomyelitis), joints (arthritis).

Viral pyelonephritis is most often the result of an infection that initially appeared in the nasopharynx, larynx, trachea and bronchi. Such diseases include influenza and all acute respiratory pathologies caused by rhinovirus, adenovirus, and parainfluenza virus.

Sources of infection in pyelonephritis - photo gallery

Pneumonia - inflammation of the lung tissue caused by microbes
Cellulitis - purulent inflammation of subcutaneous fat
Osteomyelitis is a source of infection in bone tissue
An inflamed joint can be a source of infection
The causative agents of acute respiratory infections belong to various types of viruses
Chronic tonsillitis - a source of streptococcal infection
Sinusitis is a source of chronic inflammation in the body

Invasive medical procedures

Bacteria and viruses can enter the kidneys during medical procedures. In doing so, they use tools as a launching pad. Such procedures include:

• crushing stones in the urinary system using a contact method (contact lithotripsy);
• examination of the bladder using a special device equipped with a video camera (cystoscopy);
• restoration of urine outflow using special silicone tubes - catheters or nephrostomes;
• surgeries on the genitourinary organs performed using a cystoscope.

Invasive urological procedures - photo gallery

Crushing stones with an instrument can cause the development of pyelonephritis
Cystoscopy may promote infection in the kidneys
Leaving a catheter in the urinary tract for a long time can cause pyelonephritis
Excision of an enlarged prostate gland can cause pyelonephritis

Pyelonephritis is not a contagious disease. However, its source can be foci of inflammation in which the infection came from another person (tonsils, paranasal sinuses, bladder, urethra).

Factors predisposing to the development of pyelonephritis

Kidney inflammation most often does not develop out of nowhere. By the time the disease appears, there are usually already some problems in the urinary system.

Structural anomalies

Structural anomalies most often affect the kidneys and urinary tract. During the intrauterine development of the fetus, a malfunction occurs, as a result of which the child is born with some anatomical deviations from the norm. They often do not cause harm in themselves, but become a predisposing factor in the development of inflammation. Such anomalies include:

Anomalies in the anatomical structure of the kidneys can occur spontaneously or be part of hereditary diseases.

Urinary tract obstruction

Very often, pyelonephritis occurs against the background of an altered nature of the outflow of urine from the kidneys. In this case, it is called obstructive. Any obstacle (obstruction) in the path of urine will inevitably lead to the risk of developing inflammation of the cups and pelvis of the kidney:

A disturbance in the outflow of urine that exists for a long time will inevitably lead to stretching of the pelvis. This results in a condition called hydronephrosis. The enormous size of the pelvis leads to wrinkling of the renal cortex and serious disruption of the functioning of the organ.

Hydronephrosis - extreme dilatation of the renal pelvis

Decreased immunity

Immunity is the body’s main defender against uninvited guests, controlling the composition of normal microflora. Pyelonephritis often occurs against the background of decreased activity of barrier mechanisms. This situation can happen for various reasons:

Pyelonephritis is a kidney disease that requires timely diagnosis and treatment. An accurate determination of the type of pathogen that caused the inflammation will help the doctor select antimicrobial drugs. Elimination of predisposing factors helps speed up the recovery process and prevents the disease from becoming chronic.

Pyelonephritis can affect a person of any age and gender. However, more often it affects children under 7 years of age (which is associated with the anatomical features of the structure of the urinary system in children), girls and women aged 18-30 years (the development of the disease is facilitated by the onset of sexual activity, childbirth), and elderly men (suffering from prostate adenoma).

Factors contributing to the development of pyelonephritis include obstruction of the urinary tract during urolithiasis, frequent renal colic, prostate adenoma etc. Pyelonephritis is divided into acute and chronic.

Chronic pyelonephritis is a consequence of ineffective treatment of acute pyelonephritis or the presence of any chronic diseases.

Causes

The causative agents of pyelonephritis are bacteria of the genus Escherichia, Proteus, Staphylococcus, Enterococcus, etc. There are ascending (through the urinary tract) and hematogenous (transfer of bacteria through the bloodstream from another source of infection) route of infection.

Symptoms of pyelonephritis

The clinical picture of acute or exacerbation of chronic pyelonephritis, as a rule, develops quickly, within several hours. Fever up to 38-39°C with chills and muscle aches is typical. After some time, pain in the lumbar region occurs.

Complications

• acute or chronic renal failure;
• various suppurative kidney diseases (kidney carbuncle, kidney abscess, etc.);
• sepsis.

Diagnostics

In the diagnosis of acute pyelonephritis, laboratory methods are of great importance: general blood tests, urine testing for the presence of microorganisms and determination of the sensitivity of microorganisms to antibiotics. To clarify the condition of the urinary tract, an ultrasound examination of the kidneys is performed.

What can you do

If these symptoms appear, you should consult a doctor as soon as possible. In the absence of proper therapy, the disease can become chronic, which is much more difficult to cure. The most correct thing would be to call a doctor at home.

Do not self-medicate. Symptoms of pyelonephritis are not specific, and you can easily make a mistake in diagnosis. Under no circumstances take antibacterial drugs before the doctor arrives. Even a single dose of antibiotics can change blood and urine test results.

How can a doctor help?

Treatment of acute pyelonephritis is usually carried out in a hospital. Bed rest, diet, and drinking plenty of fluids are recommended. Antibiotics or other antibacterial drugs must be prescribed. When choosing therapy, they are guided by the results of an analysis of the sensitivity of microorganisms found in urine to antibiotics.

In order to prevent the transition of acute pyelonephritis to chronic, antibacterial therapy is continued for 6 weeks. With timely treatment, the patient's condition improves within one to two weeks. However, antibacterial drugs should be taken for the entire prescribed period.

If pyelonephritis develops against the background of another disease of the kidneys or urinary system, treatment of the underlying disease must be prescribed.

Pyelonephritis is a kidney disease that is characterized by inflammation of the kidneys due to a bacterial infection. Pyelonephritis - can be unilateral or bilateral, that is, it affects one or both kidneys. Unilateral pyelonephritis is much more common. Pyelonephritis can be primary, that is, it develops in healthy kidneys, or secondary, when the disease occurs against the background of existing kidney diseases (glomerulonephritis, urolithiasis, etc.).

Also, pyelonephritis can be acute and chronic. Pyelonephritis is the most common kidney disease in all age groups. More often, young and middle-aged women suffer from pyelonephritis - 6 times more often than men. In children, after respiratory diseases (bronchitis, pneumonia), pyelonephritis takes second place. According to epidemiological studies, the prevalence of pyelonephritis in children ranges from 0.4% to 5.4%. In recent years, the incidence of pyelonephritis has tended to increase, especially in young children. Read more about pyelonephritis in children in our article Features of pyelonephritis in children

What is pyelonephritis? Pyelonephritis is characterized by kidney damage. As a rule, the cause of pyelonephritis is various microbes (bacteria). There is no specific pathogen for this disease. The cause of the disease can be microorganisms that constantly live in the human body, as well as microbes that enter the body from the environment.

Causative agents of pyelonephritis most often are intestinal microorganisms (Escherichia coli and various cocci). In approximately 20% of cases, the cause of pyelonephritis can be a mixed infection. The infection enters the kidney in various ways:

• with the bloodstream (the most common route of penetration)
• urogenic, with a flow of contaminated urine
• lymphogenous, with lymph flow from foci of infection from neighboring organs or from the intestines.

Factors contributing to the development of pyelonephritis.

All factors contributing to the development of pyelonephritis can be divided into general and local.

1. General factors. Common factors include: the state of the body (chronic fatigue, weakness, chronic stress), decreased immunity, the presence of any diseases that reduce the body’s defenses, lack of vitamins, etc.

2. Local factors. Of the local factors, the most important is impaired urine passage, that is, the presence of obstacles to the outflow of urine from the kidneys (urolithiasis, narrowing of the ureters, kidney tumors).

What can pyelonephritis be?

Depending on the course, the following forms of pyelonephritis are distinguished:

1. Acute pyelonephritis

2. Chronic pyelonephritis

Acute pyelonephritis occurs suddenly (over several hours or days). With proper treatment, the disease lasts from 10 to 20 days (depending on the causative agent of the disease) and, as a rule, ends with complete recovery.

Chronic pyelonephritis may be a consequence of the transition of acute pyelonephritis to the chronic stage or arise from the very beginning as a primary chronic process. Chronic pyelonephritis is a sluggish, periodically exacerbating bacterial inflammation of the kidney tissue. Chronic pyelonephritis leads to the gradual replacement of kidney tissue with non-functional connective tissue. Chronic pyelonephritis is often complicated by arterial hypertension and renal failure.

Symptoms and signs of pyelonephritis

Acute pyelonephritis is characterized by high body temperature, pain in the lumbar region and changes in urine analysis. At first, chills, high fever, joint pain, and headache may appear. Simultaneously with the temperature, pain in the lumbar region increases, often on one side. Sometimes, the development of pyelonephritis is preceded by some symptoms indicating the presence of obstructions in the urinary tract (pain when urinating, change in the color of urine, attacks of severe pain in the lumbar region). Thus, the main symptoms of acute pyelonephritis are:

• Pain in the lumbar region on the affected side. With pyelonephritis, lower back pain can be dull or sharp. Sometimes the pain can be localized on one of the flanks of the abdominal cavity (in the side) and radiate to the groin area (in the lower abdomen). With pyelonephritis, lower back pain increases when bending forward.
• Change in the color of urine: the urine is cloudy and even reddish in color. With pyelonephritis, urine has a strong foul odor.
• Fever up to 38-40 °C.
• Chills
• General weakness
• Decreased appetite
• Nausea, sometimes vomiting

Symptoms of chronic pyelonephritis

Chronic pyelonephritis can be asymptomatic for a long time, periodically accompanied by exacerbation, which is characterized by symptoms of acute pyelonephritis. There are two forms of chronic pyelonephritis:

• latent form - develops after acute pyelonephritis and is characterized by an asymptomatic course, a slight but prolonged increase in temperature.
• the recurrent form occurs in about 80% of patients and is manifested by general symptoms (fever, weakness, etc.) and changes in the urine. The recurrent form of pyelonephritis often leads to the development of hypertension, anemia, and renal failure.
• According to the European Association of Hemodialysis and Kidney Transplantation, chronic pyelonephritis ranks third among the causes of renal failure in children, behind glomerulonephritis, hereditary and congenital nephropathies.

Methods for diagnosing pyelonephritis

Lab tests	Surveys
A general urine test helps to draw a conclusion about the presence of infection. It detects proteinuria (protein in the urine), leukocyturia (signs of infection) and bacteria.	Ultrasound examination (ultrasound). With ultrasound in patients with pyelonephritis, one can observe expansion of the renal pelvis, heterogeneity of kidney tissue with areas of compaction.
Urine culture - urine is sown on a nutrient medium, and after some time, under a microscope, the growth of a certain type of bacteria that causes inflammation is revealed.	CT scan. This method does not have significant advantages over ultrasound and is used mainly to distinguish pyelonephritis from kidney tumors.
A general blood test shows the presence of an inflammatory process and clarifies its nature.	Radionuclide diagnostic methods. Using these methods, it is possible to determine kidney function.

Treatment of pyelonephritis

The main methods of treating pyelonephritis include:

• Diet
• Drug treatment
• Surgery

Diet for pyelonephritis

In acute pyelonephritis, it is recommended to consume large amounts of fluid (more than 2 liters), exclude spicy, fatty, fried foods, and increase the content of fresh fruits and vegetables in the patient’s diet. For chronic pyelonephritis, without its exacerbation, a diet with the following features is indicated:

• moderately limit meat and fish broths, seasonings, meat and fish are used mainly after boiling.
• the amount of fluid should be at least 2 liters per day.
• increased intake of vitamins is required
• table salt consumption is moderately limited (up to 8 g per day), especially with arterial hypertension accompanying pyelonephritis.

Medicines for pyelonephritis

One of the main directions in the treatment of pyelonephritis is antibiotic therapy (treatment with antibiotics). In acute pyelonephritis, the duration of treatment with antibiotics ranges from 5 days to 2 weeks. Modern drugs include fluoroquinolones (tavanic 250-500 mg once daily) or β-lactams. III and IV generations of cephalosporins, semisynthetic or ureidopenicillins, monobactams, penems and β-lactamase inhibitors are also used: Ceftriaxone (2 g once a day intramuscularly), Cefazolin (1 g 3 times a day), Amoxicillin (0.5 - 1 g 3 times a day intramuscularly, 0.25 or 0.5 g 3 times a day orally), Ipipenem/cilastin (0.5 g/0.5 g 3 times a day intramuscularly), Amoxicillin/clavulanic acid (Amoxiclav, Augmentin; 1 g 3 times a day intravenously, 0.25-0.5 g 3 times a day orally), Ampicillin/sulbactam (Sultasin). Treatment of acute pyelonephritis and exacerbations of chronic pyelonephritis are similar. For chronic pyelonephritis, treatment is aimed at stopping exacerbations and preventing relapses. To do this, it is recommended to use preventive courses of antibiotic treatment that are less intense than those prescribed in case of exacerbations.