Treatment of chronic pyelonephritis in the acute stage. What is necessary for successful antibacterial therapy? What drug treatment is used for pyelonephritis?

Okorokov A. N.
Treatment of diseases of internal organs:
Practical guide. Volume 2.
Minsk - 1997.

Treatment of chronic pyelonephritis

Chronic pyelonephritis- a chronic nonspecific infectious-inflammatory process with predominant and initial damage to the interstitial tissue, pyelocaliceal system and renal tubules with subsequent involvement of the glomeruli and renal vessels.

Treatment program for chronic pyelonephritis.
1.
2.
3. (restoration of urine outflow and anti-infective therapy).
4.
5.
6.
7. .
8.
9.
10.
11.
12. .
13. Treatment of chronic renal failure (CRF).

1. Mode

The patient's regimen is determined by the severity of the condition, the phase of the disease (exacerbation or remission), clinical features, the presence or absence of intoxication, complications of chronic pyelonephritis, and the degree of chronic renal failure.

Indications for hospitalization of the patient are:

• severe exacerbation of the disease;
• development of difficult to correct arterial hypertension;
• progression of chronic renal failure;
• disturbance of urodynamics, requiring restoration of urine passage;
• clarification of the functional state of the kidneys;
• o development of an expert solution.

In any phase of the disease, patients should not be subjected to cooling; significant physical exercise.
In case of latent course of chronic pyelonephritis with normal level Blood pressure or mild arterial hypertension, as well as with preserved renal function, do not require regimen restrictions.
During exacerbations of the disease, the regime is limited, and patients with a high degree of activity and fever are prescribed bed rest. Visits to the dining room and toilet are allowed. In patients with high arterial hypertension and renal failure, it is advisable to limit physical activity.
As the exacerbation is eliminated, the symptoms of intoxication disappear, blood pressure normalizes, and the symptoms of chronic renal failure decrease or disappear, the patient’s regimen expands.
The entire period of treatment for exacerbation of chronic pyelonephritis until the regime is completely expanded takes about 4-6 weeks (S.I. Ryabov, 1982).

In case of chronic pyelonephritis, it is advisable to prescribe predominantly acidifying foods (bread, flour products, meat, eggs) for 2-3 days, then an alkalizing diet (vegetables, fruits, milk) for 2-3 days. This changes the pH of the urine, the interstitium of the kidneys and creates unfavorable conditions for microorganisms.

3. Etiological treatment

Etiological treatment includes eliminating the causes that caused the disruption of urine passage or renal circulation, especially venous circulation, as well as anti-infective therapy.

Restoration of urine outflow is achieved using surgical interventions (removal of prostate adenoma, kidney stones and urinary tract, nephropexy for nephroptosis, plastic surgery of the urethra or ureteropelvic segment, etc.), i.e. restoration of the passage of urine is necessary for the so-called secondary pyelonephritis. Without sufficiently restored urine passage, the use of anti-infective therapy does not provide stable and long-term remission of the disease.

Anti-infective therapy for chronic pyelonephritis is the most important measure for both the secondary and primary variants of the disease (not associated with impaired urine outflow through the urinary tract). The choice of drugs is made taking into account the type of pathogen and its sensitivity to antibiotics, the effectiveness of previous courses of treatment, nephrotoxicity of drugs, the state of kidney function, the severity of chronic renal failure, the influence of urine reaction on the activity of drugs.

Chronic pyelonephritis is caused by a wide variety of flora. The most common pathogen is Escherichia coli, in addition, the disease can be caused by enterococcus, Proteus vulgaris, staphylococcus, streptococcus, Pseudomonas aeruginosa, mycoplasma, and less commonly by fungi and viruses.

Often chronic pyelonephritis is caused by microbial associations. In some cases, the disease is caused by L-forms of bacteria, i.e. transformed microorganisms with loss of cell wall. The L-form is an adaptive form of microorganisms in response to chemotherapeutic agents. Shell-free L-forms are not available for the most commonly used antibacterial agents, but retain all the toxic-allergic properties and are able to support the inflammatory process (in this case, bacteria are not detected by conventional methods).

For the treatment of chronic pyelonephritis, various anti-infective drugs - uroantiseptics - are used.

The main causative agents of pyelonephritis are sensitive to the following uroantiseptics.
Escherichia coli: highly effective are chloramphenicol, ampicillin, cephalosporins, carbenicillin, gentamicin, tetracyclines, nalidixic acid, nitrofuran compounds, sulfonamides, phosphacin, nolicin, palin.
Enterobacter: highly effective chloramphenicol, gentamicin, palin; Tetracyclines, cephalosporins, nitrofurans, and nalidixic acid are moderately effective.
Proteus: ampicillin, gentamicin, carbenicillin, nolicin, palin are highly effective; Levomycetin, cephalosporins, nalidixic acid, nitrofurans, and sulfonamides are moderately effective.
Pseudomonas aeruginosa: gentamicin and carbenicillin are highly effective.
Enterococcus: ampicillin is highly effective; Carbenicillin, gentamicin, tetracyclines, and nitrofurans are moderately effective.
Staphylococcus aureus (does not form penicillinase): penicillin, ampicillin, cephalosporins, gentamicin are highly effective; Carbenicillin, nitrofurans, and sulfonamides are moderately effective.
Staphylococcus aureus (forming penicillinase): oxacillin, methicillin, cephalosporins, gentamicin are highly effective; Tetracyclines and nitrofurans are moderately effective.
Streptococcus: penicillin, carbenicillin, cephalosporins are highly effective; Ampicillin, tetracyclines, gentamicin, sulfonamides, nitrofurans are moderately effective.
Mycoplasma infection: tetracyclines and erythromycin are highly effective.

Active treatment with uroantiseptics must begin from the first days of exacerbation and continue until all signs of the inflammatory process are eliminated. After this, an anti-relapse course of treatment must be prescribed.

Basic rules of appointment antibacterial therapy:
1. Correspondence of the antibacterial agent and the sensitivity of the urine microflora to it.
2. The dosage of the drug should be made taking into account the state of kidney function and the degree of chronic renal failure.
3. The nephrotoxicity of antibiotics and other uroantiseptics should be taken into account and the least nephrotoxic ones should be prescribed.
4. If there is no therapeutic effect, the drug should be changed within 2-3 days from the start of treatment.
5. In case of a high degree of activity of the inflammatory process, severe intoxication, severe course of the disease, or ineffectiveness of monotherapy, it is necessary to combine uroantiseptic agents.
6. It is necessary to strive to achieve a urine reaction that is most favorable for the action of the antibacterial agent.

The following antibacterial agents are used in the treatment of chronic pyelonephritis: antibiotics ( table 1), sulfonamide drugs, nitrofuran compounds, fluoroquinolones, nitroxoline, nevigramon, gramurin, palin.

3.1. Antibiotics

Table 1. Antibiotics for the treatment of chronic pyelonephritis

A drug	Daily dose
Penicillin group
Benzylpenicillin	Intramuscularly 500,000-1,000,000 units every 4 hours
Methicillin
Oxacillin	Intramuscularly 1 g every 6 hours
Dicloxacillin	Intramuscularly 0.5 g every 4 hours
Cloxacillin	Intramuscularly 1 g every 4-6 hours
Ampicillin	Intramuscularly 1 g every 6 hours, orally 0.5-1 g 4 times a day
Amoxicillin	Orally 0.5 g every 8 hours
Augmentin (amoxicillin + clavulanate)	Intramuscularly 1.2 g 4 times a day
Unazine (ampicillin + sulbactam)	Orally 0.375-0.75 g 2 times a day, intramuscularly 1.5-3 g 3-4 times a day
Ampiox (ampicillin + oxacillin)	Orally 0.5-1 g 4 times a day, intramuscularly 0.5-2 g 4 times a day
Carbenicillin	Intramuscularly, intravenously 1-2 g 4 times a day
Azlocillin	Intramuscularly 2 g every 6 hours or intravenously drip
Cephalosporins
Cefazolin (kefzol)	Intramuscularly, intravenously 1-2 g every 8-12 hours
Cephalothin	Intramuscularly, intravenously 0.5-2 g every 4-6 hours
Cephalexin
Cefuroxime (ketocef)	Intramuscularly, intravenously 0.75-1.5 g 3 times a day
Cefuroxime-axetil	Orally 0.25-0.5 g 2 times a day
Cefaclor (ceclor)	Orally 0.25-0.5 g 3 times a day
Cefotaxime (claforan)	Intramuscularly, intravenously 1-2 g 3 times a day
Ceftizoxime (epoceline)	Intramuscularly, intravenously 1-4 g 2-3 times a day
Ceftazidime (Fortum)	Intramuscularly, intravenously 1-2 g 2-3 times a day
Cephobid (cefoperazone)	Intramuscularly, intravenously 2-4 g 2-3 times a day
Ceftriaxone (Longacef)	Intramuscularly, intravenously 0.5-1 g 1-2 times a day
Carbapenems
Imipinem + cilastatin (1:1)	Intravenous drip of 0.5-1 g per 100 ml of 5% glucose solution or intramuscularly of 0.5-0.75 g every 12 hours with lidocaine
Monobactams
Aztreonam (azaktam)	Intramuscularly, intravenously 1-2 g every 6-8 hours or 0.5-1 g every 8-12 hours
Aminoglycosides
Gentamicin (Garamycin)
Tobramycin (brulamycin)	Intramuscularly, intravenously 3-5 mg/kg per day in 2-3 injections
Sizomycin	Intramuscular, intravenous drip in 5% glucose solution
Amikacin	Intramuscularly, intravenously 15 mg/kg per day in 2 doses
Tetracyclines
Metacycline (Rondomycin)	Orally 0.3 g 2 times a day 1-1.5 hours before meals
Doxycycline (Vibramycin)	Orally, intravenously (drip) 0.1 g 2 times a day
Lincosamines
Lincomycin (lincocin)	Inside, intravenously, intramuscularly; orally 0.5 g 4 times a day; parenterally 0.6 g 2 times a day
Clindamycin (Dalacin)	Orally 0.15-0.45 g every 6 hours; intravenously, intramuscularly 0.6 g every 6-8 hours
Levomycetin group
Chloramphenicol (chloramphenicol)	Orally 0.5 g 4 times a day
Levomycetin succinate (chlorocide C)	Intramuscularly, intravenously 0.5-1 g 3 times a day
Fosfomycin (phosphocin)	Orally 0.5 g every 6 hours; intravenous stream, drip 2-4 g every 6-8 hours

3.1.1. Penicillin group drugs
In case of unknown etiology of chronic pyelonephritis (the causative agent has not been identified), it is better to choose penicillins with an extended spectrum of activity (ampicillin, amoxicillin) from the penicillin group of drugs. These drugs actively affect gram-negative flora, most gram-positive microorganisms, but staphylococci that produce penicillinase are not sensitive to them. In this case, they must be combined with oxacillin (Ampiox) or use highly effective combinations of ampicillin with beta-lactamase (penicillinase) inhibitors: unasin (ampicillin + sulbactam) or augmentin (amoxicillin + clavulanate). Carbenicillin and azlocillin have pronounced antipseudomonas activity.

3.1.2. Drugs of the cephalosporin group
Cephalosporins are very active, have a powerful bactericidal effect, have a wide antimicrobial spectrum (actively affect gram-positive and gram-negative flora), but have little or no effect on enterococci. Active influence Of the cephalosporins, only ceftazidime (Fortum) and cefoperazone (cephobid) are effective against Pseudomonas aeruginosa.

3.1.3. Carbapenem drugs
Carbapenems have a wide spectrum of action (gram-positive and gram-negative flora, including Pseudomonas aeruginosa and staphylococci that produce penicillinase - beta-lactamase).
When treating pyelonephritis from drugs in this group, imipinem is used, but always in combination with cilastatin, since cilastatin is a dehydropeptidase inhibitor and inhibits the renal inactivation of imipinem.
Imipinem is a reserve antibiotic and is prescribed for severe infections caused by multi-resistant strains of microorganisms, as well as for mixed infections.

3.1.4. Monobactam preparations
Monobactams (monocyclic beta-lactams) have a powerful bactericidal effect against gram-negative flora and are highly resistant to the action of penicillinases (beta-lactamases). Drugs in this group include aztreonam (azactam).

3.1.5. Aminoglycoside preparations
Aminoglycosides have a powerful and faster bactericidal effect than beta-lactam antibiotics and have a wide antimicrobial spectrum (gram-positive, gram-negative flora, Pseudomonas aeruginosa). You should be aware of the possible nephrotoxic effect of aminoglycosides.

3.1.6. Lincosamine preparations
Lincosamines (lincomycin, clindamycin) have a bacteriostatic effect and have a fairly narrow spectrum of activity (gram-positive cocci - streptococci, staphylococci, including those that produce penicillinase; non-spore-forming anaerobes). Lincosamines are not active against enterococci and gram-negative flora. Resistance of microflora, especially staphylococci, quickly develops to lincosamines. In severe cases of chronic pyelonephritis, lincosamines should be combined with aminoglycosides (gentamicin) or other antibiotics acting on gram-negative bacteria.

3.1.7. Levomycetin
Levomycetin is a bacteriostatic antibiotic, active against gram-positive, gram-negative, aerobic, anaerobic bacteria, mycoplasmas, chlamydia. Pseudomonas aeruginosa is resistant to chloramphenicol.

3.1.8. Fosfomycin
Fosfomycin is a bactericidal antibiotic with wide range actions (acts on gram-positive and gram-negative microorganisms, also effective against pathogens resistant to other antibiotics). The drug is excreted unchanged in the urine, therefore it is very effective for pyelonephritis and is even considered a reserve drug for this disease.

3.1.9. Accounting for urine reaction
When prescribing antibiotics for pyelonephritis, the urine reaction should be taken into account.
With an acidic urine reaction, the effect of the following antibiotics is enhanced:
- penicillin and its semisynthetic preparations;
- tetracyclines;
- novobiocin.
When urine is alkaline, the effect of the following antibiotics is enhanced:
- erythromycin;
- oleandomycin;
- lincomycin, dalacin;
- aminoglycosides.
Drugs whose action does not depend on the reaction of the environment:
- chloramphenicol;
- ristomycin;
- vancomycin.

3.2. Sulfonamides

Sulfonamides are used less frequently than antibiotics in the treatment of patients with chronic pyelonephritis. They have bacteriostatic properties and act on gram-positive and gram-negative cocci, gram-negative “bacillus” (Escherichia coli), and chlamydia. However, enterococci, Pseudomonas aeruginosa, and anaerobes are not sensitive to sulfonamides. The effect of sulfonamides increases with alkaline urine.

Urosulfan - 1 g is prescribed 4-6 times a day, while a high concentration of the drug is created in the urine.

Combined preparations of sulfonamides with trimethoprim are characterized by synergism, a pronounced bactericidal effect and a wide spectrum of activity (gram-positive flora - streptococci, staphylococci, including penicillinase-producing ones; gram-negative flora - bacteria, chlamydia, mycoplasma). The drugs do not act on Pseudomonas aeruginosa and anaerobes.
Bactrim (Biseptol) is a combination of 5 parts sulfamethoxazole and 1 part trimethoprim. Prescribed orally in tablets of 0.48 g, 5-6 mg/kg per day (in 2 doses); intravenously in ampoules of 5 ml (0.4 g of sulfamethoxazole and 0.08 g of trimethoprim) in isotonic sodium chloride solution 2 times a day.
Groseptol (0.4 g of sulfamerazole and 0.08 g of trimethoprim in 1 tablet) is prescribed orally 2 times a day at an average dose of 5-6 mg/kg per day.
Lidaprim - combination drug, containing sulfametrol and trimethoprim.

These sulfonamides dissolve well in urine and almost do not precipitate in the form of crystals in the urinary tract, but it is still advisable to wash down each dose with soda water. It is also necessary to monitor the number of leukocytes in the blood during treatment, as leukopenia may develop.

3.3. Quinolones

Quinolones are based on 4-quinolone and are classified into two generations:
I generation:
- nalidixic acid (nevigramone);
- oxolinic acid (gramurin);
- pipemidic acid (palin).
II generation (fluoroquinolones):
- ciprofloxacin (ciprobay);
- ofloxacin (Tarivid);
- pefloxacin (abactal);
- norfloxacin (nolitsin);
- lomefloxacin (maxaquin);
- enoxacin (Penetrex).

3.3.1. I generation quinolones
Nalidixic acid (nevigramon, negram) - the drug is effective against urinary tract infections caused by gram-negative bacteria, except Pseudomonas aeruginosa. Ineffective against gram-positive bacteria (staphylococcus, streptococcus) and anaerobes. It has a bacteriostatic and bactericidal effect. When taking the drug orally, a high concentration of it is created in the urine.
When urine becomes alkaline, the antimicrobial effect of nalidixic acid increases.
Available in capsules and tablets of 0.5 g. Prescribed orally, 1-2 tablets 4 times a day for at least 7 days. At long-term treatment apply 0.5 g 4 times a day.
Possible side effects drug: nausea, vomiting, headache, dizziness, allergic reactions(dermatitis, increased body temperature, eosinophilia), increased skin sensitivity to sunlight (photodermatoses).
Contraindications to the use of nevigramon: liver dysfunction, renal failure.
Nalidixic acid should not be prescribed simultaneously with nitrofurans, as this reduces the antibacterial effect.

Oxolinic acid (gramurin) - according to the antimicrobial spectrum, gramurin is close to nalidixic acid, it is effective against gram-negative bacteria (Escherichia coli, Proteus), Staphylococcus aureus.
Available in tablets of 0.25 g. Prescribed 2 tablets 3 times a day after meals for at least 7-10 days (up to 2-4 weeks).
The side effects are the same as when treated with Nevigramon.

Pipemidic acid (palin) is effective against gram-negative flora, as well as pseudomonas, staphylococci.
Available in capsules of 0.2 g and tablets of 0.4 g. Prescribed 0.4 g 2 times a day for 10 days or more.
The drug is well tolerated, sometimes there is nausea and allergic skin reactions.

3.3.2. II generation quinolones (fluoroquinolones)
Fluoroquinolones are a new class of synthetic broad-spectrum antibacterial agents. Fluoroquinolones have a wide spectrum of action, they are active against gram-negative flora (Escherichia coli, Enterobacter, Pseudomonas aeruginosa), gram-positive bacteria (staphylococcus, streptococcus), legionella, mycoplasma. However, enterococci, chlamydia, and most anaerobes are insensitive to them. Fluoroquinolones penetrate well into various organs and tissues: lungs, kidneys, bones, prostate, and have a long half-life, so they can be used 1-2 times a day.
Side effects (allergic reactions, dyspeptic disorders, dysbacteriosis, agitation) are quite rare.

Ciprofloxacin (Ciprobay) is the “gold standard” among fluoroquinolones, because of its strength antimicrobial action superior to many antibiotics.
Available in tablets of 0.25 and 0.5 g and in bottles with an infusion solution containing 0.2 g of cyprobay. It is prescribed orally, regardless of food intake, 0.25-0.5 g 2 times a day; in case of very severe exacerbation of pyelonephritis, the drug is first administered intravenously in a drip of 0.2 g 2 times a day, and then oral administration is continued.

Ofloxacin (Tarivid) - available in tablets of 0.1 and 0.2 g and in vials for intravenous administration of 0.2 g.
Most often, ofloxacin is prescribed at a dose of 0.2 g 2 times a day orally; for very severe infections, the drug is first administered intravenously at a dose of 0.2 g 2 times a day, then switched to oral administration.

Pefloxacin (abactal) - available in tablets of 0.4 g and ampoules of 5 ml containing 400 mg of abactal. Prescribed orally 0.2 g 2 times a day with meals, with serious condition 400 mg is administered intravenously in 250 ml of 5% glucose solution (abactal cannot be dissolved in saline solutions) in the morning and evening, and then switch to oral administration.

Norfloxacin (nolicin) - available in tablets of 0.4 g, administered orally at 0.2-0.4 g 2 times a day, with acute infections urinary tract for 7-10 days, for chronic and recurrent infections - up to 3 months.

Lomefloxacin (Maxaquin) - available in tablets of 0.4 g, administered orally at 400 mg once a day for 7-10 days, severe cases can be used for a longer period (up to 2-3 months).

Enoxacin (Penetrex) - available in tablets of 0.2 and 0.4 g, administered orally at 0.2-0.4 g 2 times a day, cannot be combined with NSAIDs (convulsions may occur).

Due to the fact that fluoroquinolones have pronounced action against pathogens of urinary infections, they are considered as a means of choice in the treatment of chronic pyelonephritis. For uncomplicated urinary infections, a three-day course of treatment with fluoroquinolones is considered sufficient; for complicated urinary infections, treatment is continued for 7-10 days; for chronic urinary tract infections, longer use is possible (3-4 weeks).

It has been established that it is possible to combine fluoroquinolones with bactericidal antibiotics - antipseudomonas penicillins (carbenicillin, azlocillin), ceftazidime and imipenem. These combinations are prescribed when bacterial strains resistant to fluoroquinolone monotherapy appear.
It should be emphasized the low activity of fluoroquinolones against pneumococcus and anaerobes.

3.4. Nitrofuran compounds

Nitrofuran compounds have a wide spectrum of activity (gram-positive cocci - streptococci, staphylococci; gram-negative bacilli - Escherichia coli, Proteus, Klebsiella, Enterobacter). Anaerobes and Pseudomonas are insensitive to nitrofuran compounds.
During treatment, nitrofuran compounds may have undesirable side effects: dyspeptic disorders;
hepatotoxicity; neurotoxicity (damage to the central and peripheral nervous system), especially with renal failure and long-term treatment (more than 1.5 months).
Contraindications to the use of nitrofuran compounds: severe liver pathology, renal failure, diseases of the nervous system.
The following nitrofuran compounds are most often used in the treatment of chronic pyelonephritis.

Furadonin - available in tablets of 0.1 g; is well absorbed from the gastrointestinal tract, creates low concentrations in the blood, high concentrations in the urine. Prescribed orally 0.1-0.15 g 3-4 times a day during or after meals. The duration of the course of treatment is 5-8 days; if there is no effect during this period, it is not advisable to continue treatment. The effect of furadonin is enhanced by acidic urine and weakened by urine pH > 8.
The drug is recommended for chronic pyelonephritis, but is not advisable for acute pyelonephritis, since it does not create a high concentration in the kidney tissue.

Furagin - compared to furadonin, is better absorbed from the gastrointestinal tract and is better tolerated, but its concentrations in urine are lower. Available in tablets and capsules of 0.05 g and in powder form in jars of 100 g.
Used orally at 0.15-0.2 g 3 times a day. The duration of treatment is 7-10 days. If necessary, the course of treatment is repeated after 10-15 days.
In severe exacerbation of chronic pyelonephritis, soluble furagin or solafur can be administered intravenously (300-500 ml of a 0.1% solution during the day).

Nitrofuran compounds are well combined with antibiotics aminoglycosides, cephalosporins, but are not combined with penicillins and chloramphenicol.

3.5. Quinolines (8-hydroxyquinoline derivatives)

Nitroxoline (5-NOC) - is available in tablets of 0.05 g. It has a wide spectrum of antibacterial action, i.e. affects gram-negative and gram-positive flora, is rapidly absorbed in the gastrointestinal tract, excreted unchanged by the kidneys and creates a high concentration in the urine.
It is prescribed orally 2 tablets 4 times a day for at least 2-3 weeks. In resistant cases, 3-4 tablets are prescribed 4 times a day. As needed, it can be used for a long time in courses of 2 weeks per month.
The toxicity of the drug is negligible, possible side effects; gastrointestinal disorders, skin rashes. When treated with 5-NOC, urine becomes saffron yellow.

When treating patients with chronic pyelonephritis, the nephrotoxicity of drugs should be taken into account and preference should be given to the least nephrotoxic ones - penicillin and semisynthetic penicillins, carbenicillin, cephalosporins, chloramphenicol, erythromycin. The group of aminoglycosides is the most nephrotoxic.

If it is impossible to determine the causative agent of chronic pyelonephritis or before obtaining antibiogram data, broad-spectrum antibacterial drugs should be prescribed: ampiox, carbenicillin, cephalosporins, quinolones, nitroxoline.

With the development of chronic renal failure, the doses of urinary antiseptics are reduced and the intervals are increased (see "Treatment of chronic renal failure"). Aminoglycosides are not prescribed for chronic renal failure; nitrofuran compounds and nalidixic acid can be prescribed for chronic renal failure only in the latent and compensated stages.

Taking into account the need for dose adjustment in chronic renal failure, four groups of antibacterial agents can be distinguished:

• antibiotics that can be used in usual doses: dicloxacillin, erythromycin, chloramphenicol, oleandomycin;
• antibiotics, the dose of which is reduced by 30% when the urea content in the blood increases by more than 2.5 times compared to the norm: penicillin, ampicillin, oxacillin, methicillin; these drugs are not nephrotoxic, but in chronic renal failure they accumulate and cause side effects;
• antibacterial drugs, the use of which in chronic renal failure requires mandatory dose adjustment and administration intervals: gentamicin, carbenicillin, streptomycin, kanamycin, biseptol;
• antibacterial agents, the use of which is not recommended for severe chronic renal failure: tetracyclines (except doxycycline), nitrofurans, nevigramon.

Treatment with antibacterial agents for chronic pyelonephritis is carried out systematically and for a long time. Initial course antibacterial treatment is 6-8 weeks, during which time it is necessary to achieve suppression of the infectious agent in the kidney. As a rule, during this period it is possible to achieve the elimination of clinical and laboratory manifestations of the activity of the inflammatory process. In severe cases of the inflammatory process, various combinations of antibacterial agents are used. A combination of penicillin and its semisynthetic drugs is effective. Nalidixic acid preparations can be combined with antibiotics (carbenicillin, aminoglycosides, cephalosporins). 5-NOK is combined with antibiotics. Bactericidal antibiotics (penicillins and cephalosporins, penicillins and aminoglycosides) combine well and mutually enhance the effect.

After the patient reaches remission, antibacterial treatment should be continued in intermittent courses. Repeated courses Antibacterial therapy for patients with chronic pyelonephritis must be prescribed 3-5 days before the expected appearance of signs of exacerbation of the disease so that the remission phase is constantly maintained for a long time. Repeated courses of antibacterial treatment are carried out for 8-10 days with drugs to which the sensitivity of the causative agent of the disease was previously revealed, since there is no bacteriuria in the latent phase of inflammation and during remission.

Methods of anti-relapse courses for chronic pyelonephritis are outlined below.

A. Ya. Pytel recommends treating chronic pyelonephritis in two stages. During the first period, treatment is carried out continuously, replacing the antibacterial drug with another every 7-10 days until the permanent disappearance of leukocyturia and bacteriuria occurs (for a period of at least 2 months). After this, intermittent treatment with antibacterial drugs is carried out for 4-5 months for 15 days at intervals of 15-20 days. In case of stable long-term remission (after 3-6 months of treatment), antibacterial agents may not be prescribed. After this, anti-relapse treatment is carried out - sequential (3-4 times a year) course use of antibacterial agents, antiseptics, and medicinal plants.

4. Use of NSAIDs

IN last years the possibility of using NSAIDs for chronic pyelonephritis is being discussed. These drugs have an anti-inflammatory effect due to a decrease in the energy supply to the site of inflammation, reduce capillary permeability, stabilize lysosome membranes, cause a mild immunosuppressant effect, antipyretic and analgesic effect.
Besides, use of NSAIDs is aimed at reducing reactive phenomena caused by the infectious process, preventing proliferation, and destroying fibrous barriers so that antibacterial drugs reach the inflammatory focus. However, it has been established that long-term use of indomethacin can cause necrosis of the renal papillae and impaired hemodynamics of the kidney (Yu. A. Pytel).
Of the NSAIDs, the most appropriate is to take voltaren (diclofenac sodium), which has a powerful anti-inflammatory effect and is the least toxic. Voltaren is prescribed 0.25 g 3-4 times a day after meals for 3-4 weeks.

5.Improving renal blood flow

Impaired renal blood flow plays an important role in the pathogenesis of chronic pyelonephritis. It has been established that with this disease there is an uneven distribution of renal blood flow, which is expressed in hypoxia of the cortex and phlebostasis in the medullary substance (Yu. A. Pytel, I. I. Zolotarev, 1974). In this regard, in the complex therapy of chronic pyelonephritis, it is necessary to use drugs that correct circulatory disorders in the kidney. For this purpose, the following means are used.

Trental (pentoxifylline) - increases the elasticity of red blood cells, reduces platelet aggregation, enhances glomerular filtration, has a mild diuretic effect, increases the delivery of oxygen to the area of ​​tissue affected by ischemia, as well as the pulse blood supply to the kidney.
Trental is prescribed orally at 0.2-0.4 g 3 times a day after meals, after 1-2 weeks the dose is reduced to 0.1 g 3 times a day. The duration of treatment is 3-4 weeks.

Curantil - reduces platelet aggregation, improves microcirculation, prescribed 0.025 g 3-4 times a day for 3-4 weeks.

Venoruton (troxevasin) - reduces capillary permeability and edema, inhibits platelet and erythrocyte aggregation, reduces ischemic tissue damage, increases capillary blood flow and venous outflow from the kidney. Venoruton is a semi-synthetic derivative of rutin. The drug is available in capsules of 0.3 g and ampoules of 5 ml of 10% solution.
Yu. A. Pytel and Yu. M. Esilevsky propose, in order to reduce the treatment time for exacerbation of chronic pyelonephritis, to prescribe venoruton intravenously in addition to antibacterial therapy at a dose of 10-15 mg/kg for 5 days, then orally at a dose of 5 mg/kg 2 times a day day throughout the course of treatment.

Heparin - reduces platelet aggregation, improves microcirculation, has anti-inflammatory and anti-complementary, immunosuppressant effects, inhibits the cytotoxic effect of T-lymphocytes, and in small doses protects the vascular intima from the damaging effects of endotoxin.
In the absence of contraindications (hemorrhagic diathesis, stomach ulcers and duodenum) you can prescribe heparin against the background of complex therapy of chronic pyelonephritis, 5000 units 2-3 times a day under the skin of the abdomen for 2-3 weeks, followed by a gradual reduction in the dose over 7-10 days until complete withdrawal.

6. Functional passive kidney exercises

The essence of functional passive kidney exercises is the periodic alternation of functional load (due to the administration of saluretic) and a state of relative rest. Saluretics, causing polyuria, contribute to the maximum mobilization of all the reserve capabilities of the kidney by including a large number of nephrons in the activity (under normal physiological conditions, only 50-85% of the glomeruli are in an active state). With functional passive exercises of the kidneys, not only diuresis is increased, but also renal blood flow. Due to the resulting hypovolemia, the concentration of antibacterial substances in the blood serum and in the kidney tissue increases, and their effectiveness in the area of ​​inflammation increases.

Lasix is ​​usually used as a means of functional passive kidney exercises (Yu. A. Pytel, I. I. Zolotarev, 1983). Prescribed 2-3 times a week 20 mg of Lasix intravenously or 40 mg of furosemide orally with monitoring of daily diuresis, electrolyte levels in the blood serum and biochemical blood parameters.

Negative reactions that may occur during passive kidney exercises:

• long-term use of the method can lead to depletion of the reserve capacity of the kidneys, which is manifested by a deterioration in their function;
• uncontrolled passive kidney exercises can lead to water and electrolyte imbalance;
• Passive kidney exercises are contraindicated if there is a violation of the passage of urine from the upper urinary tract.

7. Herbal medicine

In the complex therapy of chronic pyelonephritis, drugs are used that have an anti-inflammatory, diuretic, and, in the case of hematuria, a hemostatic effect ( table 2).

Table 2. Medicinal plants used for chronic pyelonephritis

Plant name	Action
	diuretic	bactericidal	astringent	hemostatic
Althea Cowberry Black elderberry Elecampane St. John's wort Corn silk Nettle Angelica root Birch leaves Wheatgrass kidney tea Horsetail Chamomile Rowan bearberry Cornflower flowers Cranberry Strawberry leaf	- ++ ++ ++ + ++ - ++ ++ ++ +++ +++ - ++ +++ ++ + +	++ ++ + + +++ ++ ++ - - - - + ++ + ++ + + -	- - + - ++ + + - - - - + - + + - - -	- - - + + + +++ - - - - ++ - ++ - - - ++

Bearberry ( bear ears) - contains arbutin, which is broken down in the body into hydroquinone (an antiseptic that has an antibacterial effect in the urinary tract) and glucose. Used in the form of decoctions (30 g per 500 ml) 2 tablespoons 5-6 times a day. Bearberry exhibits its effect in an alkaline environment, so taking the decoction should be combined with ingesting alkaline mineral waters (Borjomi) and soda solutions. To alkalize urine, use apples, pears, and raspberries.

Lingonberry leaves have antimicrobial and diuretic effects. The latter is due to the presence of hydroquinone in lingonberry leaves. Used as a decoction (2 tablespoons per 1.5 cups of water). Prescribed 2 tablespoons 5-6 times a day. Just like bearberry, it works better in an alkaline environment. Alkalinization of urine is carried out in the same way as described above.

Cranberry juice, fruit drink (contains sodium benzoate) - has antiseptic effect(synthesis in the liver from hippuric acid benzoate increases, which, when excreted in the urine, causes a bacteriostatic effect). Take 2-4 glasses per day.

For the treatment of chronic pyelonephritis, the following preparations are recommended (E. A. Ladynina, R. S. Morozova, 1987).

Collection No. 1

Collection No. 2

Collection No. 3

With exacerbation of chronic pyelonephritis, accompanied by alkaline reaction, it is advisable to use the following fee:

Collection No. 4

The following collection is recommended as maintenance antibiotic therapy:

Collection No. 5

It is considered appropriate for chronic pyelonephritis to prescribe combinations of herbs as follows: one diuretic and two bactericidal for 10 days (for example, cornflower flowers - lingonberry leaves - bearberry leaves), and then two diuretics and one bactericidal (for example, cornflower flowers - birch leaves - leaves bearberry). Treatment medicinal plants It takes a long time - months and even years.
During the entire autumn season, it is advisable to eat watermelons due to their pronounced diuretic effect.

Along with taking infusions, baths with medicinal plants are useful:

Collection No. 6(for Bath)

8. Increasing the general reactivity of the body and immunomodulatory therapy

In order to increase the body's reactivity and to quickly stop an exacerbation, the following are recommended:

• multivitamin complexes;
• adaptogens (ginseng tincture, Chinese lemongrass 30-40 drops 3 times a day) during the entire period of treatment for an exacerbation;
• methyluracil 1 g 4 times a day for 15 days.

In recent years, a greater role has been established autoimmune mechanisms in the development of chronic pyelonephritis. Autoimmune reactions are promoted by a deficiency of T-suppressor function of lymphocytes. For elimination immune disorders immunomodulators are used. They are prescribed for long-term, poorly controlled exacerbation of chronic pyelonephritis. Used as immunomodulators the following drugs.

Levamisole (decaris) - stimulates the function of phagocytosis, normalizes the function of T- and B-lymphocytes, increases the interferon-producing ability of T-lymphocytes. Prescribed 150 mg once every 3 days for 2-3 weeks under the control of the number of leukocytes in the blood (there is a danger of leukopenia).

Timalin - normalizes the function of T- and B-lymphocytes, administered intramuscularly at 10-20 mg once a day for 5 days.

T-activin - the mechanism of action is the same, applied intramuscularly at 100 mcg once a day for 5-6 days.

By reducing the severity of autoimmune reactions and normalizing the functioning of the immune system, immunomodulators contribute to the rapid relief of exacerbations of chronic pyelonephritis and reduce the number of relapses. During treatment with immunomodulators, it is necessary to monitor the immune status.

9. Physiotherapeutic treatment

Physiotherapeutic treatment is used in complex therapy of chronic pyelonephritis.
Physiotherapeutic techniques have the following effects:
- increase blood supply to the kidney, increase renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
- relieve spasm of the smooth muscles of the renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

The following physiotherapy procedures are used.
1. Electrophoresis of furadonin on the kidney area. The solution for electrophoresis contains: furadonin - 1 g, 1N NaOH solution - 2.5 g, distilled water - 100 ml. The drug moves from the cathode to the anode. The course of treatment consists of 8-10 procedures.
2. Electrophoresis of erythromycin on the kidney area. The solution for electrophoresis contains: erythromycin - 100,000 units, ethyl alcohol 70% - 100 g. The drug moves from the anode to the cathode.
3. Calcium chloride electrophoresis on the kidney area.
4. USV at a dose of 0.2-0.4 W/cm 2 in pulse mode for 10-15 minutes in the absence of urolithiasis.
5. Centimeter waves (“Luch-58”) to the kidney area, 6-8 procedures per course of treatment.
6. Thermal treatments on the area of ​​the diseased kidney: diathermy, therapeutic mud, diathermo mud, ozokerite and paraffin applications.

10. Symptomatic treatment

With the development of arterial hypertension, antihypertensive drugs are prescribed (reserpine, adelfan, brinerdine, cristepine, dopegit), with the development of anemia - iron-containing drugs, with severe intoxication - intravenous drip infusion of hemodez, neocompensan.

11. Spa treatment

The main sanatorium-resort factor for chronic pyelonephritis is mineral waters, which are used internally and in the form of mineral baths.

Mineral waters have an anti-inflammatory effect, improve renal plasma flow, glomerular filtration, have a diuretic effect, promote the excretion of salts, and affect urine pH (shift the urine reaction to the alkaline side).

The following resorts with mineral waters are used: Zheleznovodsk, Truskavets, Jermuk, Sairme, Berezovsky mineral waters, Slavyanovsky and Smirnovsky mineral springs.

Mineral water "Naftusya" of the Truskavets resort reduces spasms of smooth muscles renal pelvis and ureters, which promotes the passage of small stones. In addition, it also has an anti-inflammatory effect.

"Smirnovskaya", "Slavyanovskaya" mineral waters are hydrocarbonate-sulfate-sodium-calcium, which determines their anti-inflammatory effect.

Taking mineral waters internally helps reduce inflammation in the kidneys and urinary tract, “washing out” mucus, microbes, small stones, and “sand” from them.

At resorts, treatment with mineral waters is combined with physiotherapeutic treatment.

Contraindications to sanatorium-resort treatment are:
- high arterial hypertension;
- severe anemia;
- Chronic renal failure.

12. Planned anti-relapse treatment

The goal of planned anti-relapse treatment is to prevent the development of relapse and exacerbation of chronic pyelonephritis. There is no unified system of anti-relapse treatment.

O. L. Tiktinsky (1974) recommends the following method of anti-relapse treatment:
1st week - biseptol (1-2 tablets at night);
2nd week - herbal uroantiseptic;
3rd week - 2 tablets of 5-NOK at night;
4th week - chloramphenicol (1 tablet at night).
In subsequent months, maintaining the specified sequence, you can replace the drugs with similar ones from the same group. If there is no exacerbation within 3 months, you can switch to herbal uroantiseptics for 2 weeks a month. A similar cycle is repeated, after which, in the absence of exacerbation, breaks in treatment lasting 1-2 weeks are possible.

There is another option for anti-relapse treatment:
1st week - cranberry juice, rosehip decoctions, multivitamins;
2nd and 3rd weeks - medicinal mixtures (horsetail, juniper fruits, licorice root, birch leaves, bearberry, lingonberry, celandine herb);
4th week - antibacterial drug, changing every month.

Chronic pyelonephritis is considered one of the most common diseases among girls and women. Symptoms and treatment depend on the degree of neglect of the pathology. This article discusses its main causes, signs and stages of development.

Description of the disease

Is an infectious process inflammatory in nature, formed in the kidney tissues. This disease develops due to the active activity of various types of bacteria. It is predominantly common among the fair sex. This is explained by the morpho-functional characteristics of the urethra. Thanks to her special structure the penetration of microorganisms into internal organs is significantly facilitated. Pathology can develop in certain periods female cycle (defloration, pregnancy, menopause).

What is the difference between chronic pyelonephritis? The stage of remission and subsequent exacerbation - these two stages usually alternate with each other. Therefore, various polymorphic changes (foci of inflammation, scar zones, areas of unchanged parenchyma) can be simultaneously detected in the kidneys. Involvement of more and more new areas in this pathological process healthy tissue organ causes its gradual death and the formation of renal failure.

The disease itself does not cause serious discomfort to a person, but it can cause the development of very serious complications. First of all, the inflammatory process does not allow the kidneys to fully perform their functions. main function. As a result, the patient’s usual water-salt metabolism is disrupted and edema appears. In addition, against the background of inflammation, other urological pathologies may occur. The most dangerous consequence is the addition of a purulent infection, which is very difficult to fight.

Main reasons

The etiological factor causing this disease is microbial flora. As a rule, these are the so-called colibacillary bacteria (Escherichia coli), enterococci, staphylococci. A special role in the development of the inflammatory process belongs to L-forms of bacteria, which are formed as a result of ineffective antimicrobial therapy or changes in the pH of the environment. Such microorganisms are difficult to identify, activate under certain conditions, and are resistant to treatment.

Very often, chronic pyelonephritis is preceded by a stage of exacerbation of the pathology. Chronic inflammation is promoted by failure to promptly correct urine outflow disturbances due to stones in prostate adenomas. Such a pathological process in the body can be supported by other diseases of a bacterial nature (otitis media, prostatitis, urethritis, cholecystitis, appendicitis, etc.), general somatic ailments (diabetes mellitus, obesity), as well as immunodeficiency.

Young ladies have an impetus for development of this disease may be the onset of sexual activity, childbirth and pregnancy. Quite often, doctors diagnose and among young patients chronic can be caused by disturbances in the functioning of the body at the congenital level, which change the usual urodynamics (ureterocele, bladder diverticula).

Clinical signs

Symptoms of the disease are nonspecific, and lately asymptomatic disease has become increasingly common. A patient who has previously dealt with acute pyelonephritis or other urological pathologies must be responsible for their own health and listen to the body. Often the occurrence of the disease is a consequence of a violation of the body’s immune response, which accompanies diabetes mellitus and tuberculosis. A weakening of the defenses is also observed due to insufficient intake of vitamins and minerals. Despite the specificity of clinical manifestations, a number of signs of this disease can be identified that require special attention:

• Temperature rise in evening time for no apparent reason.
• Headache.
• Increased fatigue, weakness.
• Frequent urge to urinate.
• Painful discomfort in the lumbar region, which manifests itself when walking.
• Changes in the color and smell of urine, cloudiness.

All of the above signs indicate chronic pyelonephritis. The symptoms and treatment of the disease are general in nature, this has already been discussed in the article. Often patients perceive such clinical manifestations for the most common cold and begin treatment with appropriate medications. Such therapy can really relieve symptoms and improve the patient’s condition at first. And the inflammatory process will continue to develop. That is why in this case it is recommended to seek advice from a specialist rather than try to overcome the disease on your own.

It is easy to confuse the symptoms of exacerbation of pyelonephritis with ARVI, because they are inherent in many inflammatory processes in the body. As a rule, if a person has already been diagnosed with a chronic form, he understands the signs associated with the disease. In this case, the patient may experience the following conditions:

• Dysuria.
• Head and
• Febrile temperature.
• Cloudiness of urine (proteinuria) and the appearance of an uncharacteristic odor.
• Hematuria.

Classification

How is chronic pyelonephritis classified? The stages of the disease are distinguished depending on the manifestation of the inflammatory process. At the first stage, active inflammation with pronounced symptoms is observed. The second stage is characterized by a pathological process. It can only be detected after a series of laboratory tests. The patient's condition is accompanied by the following symptoms: fatigue, chills, and a slight increase in temperature. The third stage of development is chronic pyelonephritis in remission. What does it mean? If over the next five years there is no exacerbation of the disease, the doctor confirms a complete cure.

In addition, pyelonephritis can be unilateral or bilateral, depending on the number of affected organs.

Based on the severity of the disease, the following forms are distinguished:

1. Pyelonephritis without complications.
2. Pyelonephritis complicated by tumors, congenital anomalies, urolithiasis, diabetes mellitus, HIV infection.
3. Anemia.
4. Secondary reno-parenchymal arterial hypertension.

Pyelonephritis and pregnancy

Many pregnant women who have had to deal with this disease worry about how it can affect the baby’s health. All those who let this pathology take its course and do not seek qualified help may face very serious problems. Why is chronic pyelonephritis dangerous during pregnancy?

The consequences of the disease primarily affect the fetus. The child may be seriously harmed by developing intrauterine infection. As a rule, such kidney pathology becomes the cause of spontaneous abortion or premature birth. The consequences of infection for children manifest themselves in different ways. Some are diagnosed with the most common conjunctivitis, which does not pose a threat to life, while others have severe infectious lesions systems of internal organs.

During pregnancy with this disease there is also a risk of intrauterine hypoxia. This means that the fetus receives less oxygen than it actually needs. As a result, a child is born with low weight and insufficient development. Based on all of the above, we can come to the conclusion that chronic pyelonephritis should not be left to chance.

Symptoms and treatment of the disease should be determined exclusively by a specialist. If an inflammatory process is detected, the doctor prescribes antibiotics to the expectant mother. Of course, it is undesirable to take such medications while carrying a baby. However, a specialist can select remedies that will not cause serious harm to the fetus and will help the mother cope with the disease. Also in this kind of situation, painkillers, antispasmodics, vitamins, sedatives, carry out physiotherapeutic procedures.

Establishing diagnosis

Quite often it is difficult to confirm chronic pyelonephritis. Symptoms in women can vary; moreover, cases of latent disease are not uncommon. The diagnosis is usually made taking into account the medical history, results laboratory research, as well as the presence of a characteristic clinical picture. Additionally, the following diagnostic methods may be required:

• General urine/blood test.
• Quantitative determination of cells (Stenheimer-Malbin method).
• Examination of urinary sediment.
• Determination of electrolyte content in urine and blood.
• X-ray of the kidneys.
• Radioisotope renography.
• Kidney biopsy.

Chronic and treatment

Drug therapy for the disease should be aimed at eliminating its main causative agent. For this purpose, antibiotics and uroseptics are prescribed. It is considered optimal to conduct a urine culture to determine sensitivity to antibiotics before starting therapy. In this case, the choice of drugs will be more accurate. As a rule, the following drugs are used for treatment:

• Penicillins with a broad spectrum of action (Amoxicillin, Azlocillin).
• Second and third generation cephalosporins.
• Fluoroquinolones (“Levofloxacin”, “Ofloxacin”, “Ciprofloxacin”). Drugs in this group are prohibited for use by pregnant and lactating women.
• Nitrofurans (“Furadonin”, “Furamag”). Sometimes patients experience side effects such as nausea, a bitter taste in the mouth, and vomiting.
• Sulfonamide drugs (“Biseptol”).

The duration of therapy is at least 14 days. If symptoms of the disease persist, the course of treatment may increase to one month. It is advisable to periodically repeat urine cultures and change medications.

Chronic pyelonephritis: diet

Regardless of the stage of the disease, patients are advised to follow a special diet. It implies the exclusion from the diet of spicy foods and spices, alcoholic beverages, coffee, meat and fish broths. On the other hand, nutrition should be as fortified and balanced as possible. It is allowed to consume almost all fruits and vegetables (preferably raw), eggs, boiled meat/fish ( low-fat varieties), dairy products.

It is very important to pay attention to your drinking regime. It is recommended to drink at least two liters of still water per day to prevent excessive concentration of urine. It is useful to drink the most common cranberry juice, because these berries contain natural antibacterial substances that help fight pathologies such as chronic pyelonephritis.

The diet during the period of exacerbation of the disease is somewhat different. At this time, it is recommended to reduce fluid intake, as the outflow of urine slows down significantly. It is equally important to limit consumption table salt(up to 4 g per day).

Help from traditional medicine

Herbal medicine can be used as an additional treatment to the main one. You should not try to use it yourself traditional medicine overcome chronic pyelonephritis. Treatment with antibiotics is usually more effective and safer for human health.

Medicinal plants used for this disease most often have a diuretic effect. The course of treatment can range from several months to one and a half years. This duration helps prevent the development of complications and re-entry of infections.

Treatment with herbs involves taking them orally and using baths. For example, taking a bath with parsley has not only an anti-inflammatory, but also a cleansing effect. It increases blood flow and helps eliminate existing toxins. Chamomile has an antibacterial and at the same time calming effect on all internal organ systems. St. John's wort - great helper in the fight against various types of infections.

Sometimes in patients the disease is accompanied by the formation of polyps (small growths). In this case, it is recommended to take celandine, but do not abuse it. For a glass of boiling water you only need one teaspoon of herb. It is recommended to drink this infusion in small sips throughout the day. Celandine has an anti-inflammatory effect and is an excellent remedy in the fight against many cancer diseases.

Some experts advise drinking tea with blueberry and lingonberry leaves before bed. Blueberries are rich in vitamins and minerals, and lingonberries are excellent natural antiseptic. This tea helps strengthen the immune system, increase the level of hemoglobin in the blood and reduce pain discomfort in the lumbar area.

Once again, it should be noted that you should not try to overcome chronic pyelonephritis on your own. Symptoms and herbal treatment are two mutually dependent factors that the doctor must pay attention to. Each patient has clinical manifestations of the disease, the degree of their severity may vary. Moreover, not in every case does herbal medicine have a positive effect; sometimes it significantly aggravates the health condition.

Prevention

How can chronic pyelonephritis be prevented? How long do people with this diagnosis live?

Prevention of disease primarily means timely treatment all diseases of a urological nature. Here we are talking, first of all, about competent drug therapy. Many patients resort to traditional medicine or prefer to be treated on the advice of friends and relatives. This approach is highly undesirable. The whole point is that in this way you can harm your own health, and the disease itself will progress.

It is equally important to maintain the correct amount (about two liters of fluid per day). If possible, hypothermia and taking non-steroidal analgesics should be avoided. It is not recommended to endure a small need; it is necessary to empty the bladder every time before going to bed and after the next sexual intercourse.

This article provides information about the dangers of chronic pyelonephritis during pregnancy. Symptoms in women of this disease during the period of carrying a fetus inside the womb should alert and become a reason to consult a doctor. Only a specialist can recommend a truly effective and safe treatment. In order not to encounter this pathology during pregnancy, it is recommended to check your body before planning it. If you have any ailments, you must undergo a course of treatment. A very important role in the prevention of pyelonephritis at this time belongs to compliance. Of course, you should lead an active and healthy lifestyle.

As for the question of life expectancy with this disease, there is no clear answer. If the patient strictly follows all the doctor’s recommendations, eats properly and monitors his condition, he can live a long and happy life. If the disease is aggravated by constant alcohol intoxication and lack of proper therapy, then the likelihood of death increases several times.

Conclusion

It is important to remember that only qualified specialist can recommend how to cure chronic pyelonephritis. Symptoms, diagnosis, causes of the disease - all these factors are an important component of timely therapy. Be healthy!

What it is?

Chronic pyelonephritis is the most common form of kidney disease and occurs in all age categories of the population. It is characterized by inflammatory processes in the tissue membranes of the kidneys (parenchyma) and in the pyelocaliceal system, which is responsible for the functions of accumulation and excretion of urine.

The disease is often discovered unexpectedly in patients, due to a general deterioration of their condition or based on the results of a urine test. Since the chronic form of pyelonephritis quite often develops without acute symptoms, and patients do not even suspect its presence.

Causes of development of chronic pyelonephritis

Many diseases that occur latently (secretly) can become active under favorable circumstances. Chronic pyelonephritis, which was suffered in childhood or adolescence, is more likely to return with functional pathological processes in the urinary system caused by:

• imbalance between the intake and expenditure of vitamins in the body (hypovitaminosis);
• a consequence of hypothermia (hypothermia);
• decreased protective functions of the immune system;
• a consequence of physiological or psychological states(fatigue or tiredness);
• influence of focal chronic infections(tonsillitis, inflammatory processes uterus and appendages, etc.);
• untreated acute inflammatory processes.

In young children, the manifestation of chronic pyelonephritis is a consequence of obstructive uropathy - conditions blocking the functions of the ureter.

In men, pathology develops with absolute and relative androgen deficiency caused by hormonal changes, or due to prostate adenoma.

The causes of the development of chronic pyelonephritis in women are associated with certain anatomical features organism due to:

• short urethra (urethra);
• the constant presence of microorganisms from the rectum and vagina in the outer third of the urethra;
• failure to completely empty the bladder;
• the possibility of infection entering the bladder during sexual intercourse.

In many women, the disease can become more active due to pregnancy. During this period, a natural decrease in the immune factor occurs so that fetal antigens are not rejected by the mother’s body.

The fight against pathogenic microorganisms is not at the proper level, which serves as a predisposing factor to the development of chronic pyelonephritis during pregnancy.

Weak symptomatic signs, underestimation of the danger of the disease, and a non-serious attitude towards treatment create the preconditions for the transition of pyelonephritis to the chronic form of the disease.

Signs of chronic pyelonephritis are divided into local and general.

Local symptoms of chronic pyelonephritis in women are more pronounced. It appears in patients with a secondary form of the disease caused by exacerbation of chronic pyelonephritis, caused by a number of diseases that provoke disturbances in the outflow of urine from the kidneys - urolithiasis (urolithiasis), prostatic hyperplasia, hormone-dependent tumors of the uterus, nephroptosis (prolapsed kidney), etc.

Patients experience periodic throbbing or aching pain, not associated with activity, and more often at rest.

The general symptoms of the disease are divided into early signs and later. Early symptoms are not associated with impaired renal function.

Manifest:

• rapid fatigue;
• episodic asthenia (weakness);
• lack of appetite;
• poor tolerance to habitual stress, which can be caused by venous congestion of the kidney;
• slight rise in blood pressure and temperature.

Possible complications

A sudden sharp exacerbation of pathological processes can cause acute renal failure, and the progression of the disease leads to the development of chronic renal failure (syndrome of irreversible renal dysfunction). Manifest:

• unpleasant or painful sensations in the lower back;
• dry mouth and heartburn;
• low level of psychological activity;
• puffiness of the face and pale skin;
• excretion of more than 3 liters of urine (urine) per day.

Late signs diseases, as a rule, indicate the presence of chronic renal failure and are characteristic of bilateral kidney damage.

Of great importance when drawing up a treatment protocol is the clinical picture, which reflects the course of chronic pyelonephritis, symptoms, diagnostic indicators and stages of the pathological process.

Stages of the disease

1. In the initial stage of the disease, inflammatory processes and swelling of the connective tissues (interstitial) of the inner layer (medullary) of the kidneys are observed, causing compression of blood vessels, a decrease in renal blood flow, and the development of tubular atrophy.
2. The second stage is characterized by diffuse narrowing of the arterial renal bed, the absence of interlobar arteries and a decrease in the size of the cortex, which is determined by the nephrogram.
3. The last, third stage is caused by narrowing and deformation of all renal vessels, replacement of renal tissue with scar tissue, and the formation of a wrinkled kidney.

Diagnosis of chronic pyelonephritis

Urine, in the chronic form of pyelonephritis, is one of the components diagnostic examination. It is examined for leukocytes and red blood cells, the presence of protein, salts and bacteria. Additional methods include:

• Assessing the condition of the kidneys using excretory urography;
• Identification of the pathogen and testing its sensitivity to drugs using the tank culture method;
• Assessment of structural changes in the kidneys using ultrasound;
• CT and MRI detecting urolithiasis (urolithiasis) and tumor neoplasms.

Treatment of chronic pyelonephritis, drugs

Treatment of any form of pyelonephritis is aimed at eliminating the causes of obstruction to the outflow of urine. Surgery for urolithiasis, prostate adenoma or surgical correction pathologies of the ureter, make it possible, if not to get rid of the disease, then to ensure long-term remission of the disease.

Drugs for the chronic form of pyelonephritis are selected based on the results of tank culture. These are usually antibacterial drugs.

Further treatment regimen includes:

1. Elimination of the cause of pathological processes in the kidneys (restoration of urine flow, elimination of circulatory problems).
2. Selection of effective antibacterial treatment for nephrotoxic therapy.
3. Prescription of immunomodulatory and immunostimulating drugs for immune correction.

In case of insolvency conservative therapy Treatment of chronic pyelonephritis is prescribed with surgical techniques aimed at restoring the outflow of urine. One of the main components of the treatment process is diet.

A balanced diet promotes rapid recovery. In case of exacerbation of the disease, the diet should include fresh fruits and vegetables, as well as at least 2 liters of liquid. Fried, spicy, fatty and salty foods are not allowed in the diet.

The chronic course of the disease requires serious attention to diet. Recommended:

• include a small amount of meat or fish broth in the diet;
• Boil fish and meat of non-fatty varieties, or cook only by steaming;
• fresh and boiled vegetables and fruits;
• cereals, dairy products and vegetarian dishes;
• watermelons, melons and pumpkin dishes;
• increase fluid intake to 2.5 liters;
• Horseradish, garlic and radish should be excluded from the diet;
• Limit salt intake per day to 8 grams.

Forms of manifestation of the disease

Clinical medicine distinguishes various forms of manifestation of the disease.

By origin:

• in the form of a primary form, not associated with previous urological pathology;
• secondary form of the disease caused by urological pathologies.

According to the location of the inflammation process:

• unilateral or bilateral localization;
• total damage (of the entire kidney);
• segmental localization (damage to a segment or a specific area).

According to the stage of the disease:

• exacerbation stage;
• remission stage.

According to the severity of inflammatory processes caused by:

• active phase of inflammation;
• latent (secret) phase of inflammation;
• weakening/reducing the inflammation process - remission.

According to clinical forms manifestations:

• latent or recurrent;
• hypertensive, anemic and azotemic;
• hematuric, nephrotic and septic.

According to the degree of nephron damage (degree of chronic renal failure)

Prevention

The main rule for the prevention of chronic pyelonephritis is the timely treatment of diseases that provoke the development of disturbances in the normal movement of urine.

Significantly reduces the risk of developing a long-term pathological process - compliance with hygiene rules and timely medical examinations. So that the kidneys are always in healthy condition, you should not cross the boundaries of hypothermia.

Treatment of chronic pyelonephritis should be aimed at pathogenetic mechanisms diseases. The general treatment plan should include several areas:

• remove infectious pathogens;
• normalize urine flow;
• increase the patient’s own immunity;
• eliminate the danger of chronic foci of infection and the possibility of re-infection by hematogenous and lymphogenous routes.

At the same time, we must not forget about the natural mechanisms of protection of the urinary tract. Only their failure causes bacterial aggression. Proper treatment of chronic pyelonephritis should not disrupt the natural properties of the body, but maintain and restore the desired balance.

How does the body get rid of infection in the urinary tract?

Natural defense mechanisms can be supported by careful attitude towards your health, diet, folk remedies from medicinal plants. The kidneys have several options that make the spread of infection much more difficult. Each needs to be addressed to help control inflammation.

• An increase in urinary volume causes mechanical flushing of the tract and washes away excess bacteria. This means that in order to cure the disease you need to drink more fluids and use medicinal herbs that increase diuresis.
• An increase in acidity (pH less than 7), an increased content of urea and organic acids in the urine prevent the proliferation of microorganisms. Therefore, dietary adjustments affect bacterial viability.
• Immune cells are located not only in the blood, but also in the submucosal layer of the urinary tract.
• The vagina in women and the prostate in men produce a secreting substance that inhibits the spread of bacterial flora. Therefore, when choosing local contraceptives, adults should not forget to maintain the balance of microorganisms and use proven means for douching and daily toileting.

Using means to activate the immune system in chronic pyelonephritis, we achieve local destruction of harmful pathogens

Treatment for chronic pyelonephritis necessarily includes an integrated approach with gradual use possibilities of inpatient volume and therapy at home.

What is necessary for successful antibacterial therapy?

Antibacterial therapy is of primary importance in the treatment of kidney inflammation. One of the reasons for the chronicity of the process is considered to be insufficient or inadequate use of antimicrobial drugs in the acute stage of the disease.

Therefore, in order to get rid of pyelonephritis forever, you need to follow the principles of using antibacterial agents.

Treatment standards require:

• prescribe medications as early as possible;
• The duration of the course should be selected individually depending on the activity of pathogenic microorganisms and the severity of inflammation;
• strictly take into account the identified sensitivity of the microflora, according to the conclusion obtained by the tank method. urine culture;
• If necessary, combine antibacterial drugs using compatibility properties;
• replace medications if low sensitivity is detected;
• to prevent negative effects, fungal growth, use antifungal drugs in cases of long-term treatment;
• simultaneously prescribe vitamins and immunostimulants.

In the treatment of pyelonephritis, choose the drug around which bacteria do not grow

If these principles are not observed, the desired result cannot be achieved from antibacterial therapy, as well as with persistent obstacles to the outflow of urine.

In the later stages of the disease, sclerotic changes occur in the kidney tissues, blood flow in the glomeruli and the filtration process are disrupted. Therefore, it is impossible to create a sufficient concentration of antibacterial agents. Their effectiveness drops sharply, despite high doses.

If treatment is delayed, microorganisms degenerate into drug-resistant strains and form microbial associations with different sensitivities.

Preparations for antibacterial treatment

Chronic pyelonephritis, according to developed recommendations, must be treated simultaneously with a combination of several groups of drugs:

• antibiotics;
• sulfonamides (Urosulfan, Sulfadimethoxine);
• nitrofurans (Furagin, Furazolidone);
• preparations from nalidixic acid (Nilidixan, Nevigramon);
• hydroxyquinoline derivatives (5-NOK, Nitroxoline);
• combined agents such as Biseptol, Bactrim (sulfamethoxazole + trimethoprim).

A drug with the greatest flora sensitivity and the least toxic effect on renal tissue is selected for each patient.

Drugs with minimal toxicity include:

• antibiotics of the penicillin group (Ampicillin, Oxacillin);
• Erythromycin;
• Levomycetin;
• cephalosporins (Tseporin, Kefzol).

The following are considered moderately toxic:

• nitrofurans;
• 5-NOK;
• nalidixic acid and its derivatives.

To highly toxic drugs include aminoglycoside antibiotics (Kanamycin, Kolimycin, Gentamicin).

They are used only in severe cases, in the presence of resistance to other drugs, and in short courses (5–7 days).

When choosing the most effective antibiotic, one must take into account such a property as the dependence of activity on the reaction of urine:

• Gentamicin and Erythromycin - act most effectively in an environment with an alkaline reaction at pH 7.5 - 8. When using them, milk and predominantly plant based diet, alkalizing mineral waters (Borjomi).
• Ampicillin and 5-NOK differ in activity in an acidic environment at pH 5–5.5.
• Cephalosporins, Levomycetin, tetracyclines are quite effective in both alkaline and acidic urine at pH 2–9.

The most active uroseptics with a wide spectrum of action are:

• 5-NOK,
• Levomycetin,
• Gentamicin.

Gentamicin is excreted up to 90% in the urine and reaches the kidneys unchanged, therefore creating a locally high concentration.

Gentamicin is used intramuscularly and intravenously

Antibiotics are combined with drugs of other effects. They reinforce each other, accelerating the anti-inflammatory effect. Doctors often resort to the following combinations:

• antibiotic + sulfonamide;
• antibiotic + nitrofuran (Furagin);
• all together + 5-NOK.

Medicines made from nalidixic acid are not recommended to be combined with nitrofurans (they weaken the effect, add up the toxic effect), and are contraindicated during pregnancy in the first trimester and in children under two years of age. These products are characterized by the least ability to produce resistant types of microbes. In addition to Nevigramon, the group includes:

• Nagram,
• Negro,
• Cystidix,
• Nilidixan,
• Nalix,
• Notricel,
• Nalidin,
• Nalidixin,
• Nalix,
• Naligram,
• Naxuril,
• Nogram.

Examples of effective combinations include:

• Carbenicillin or an antibiotic from the aminoglycoside group + nalidixic acid;
• Gentamicin + Kefzol;
• antibiotics-cephalosporins + nitrofurans;
• Penicillin or Erythromycin + 5-NOK.

It is known that nitroxolines (5-NOC) are inhibited by the use of drugs that reduce the acidity of gastric juice, therefore, with the concomitant treatment of stomach diseases, this should be remembered

The duration of antibiotic therapy lasts from four to eight weeks.

How can we judge the success of antibacterial therapy?

The criteria for obtaining a positive result are:

• elimination of clinical symptoms of inflammation ( elevated temperature, pain syndrome, dysuric phenomena);
• changes in control blood and urine tests to normal values ​​(leukocytes and Blood ESR, absence of protein, bacteria in the urine, disappearance of active leukocytes and leukocytosis in the sediment).

ABOUT clinical signs exacerbations of chronic pyelonephritis can be found out.

Outpatient treatment after relapse of the disease

Relapses of chronic pyelonephritis appear in 60–80% of patients even after effective treatment. Therefore, at home, it is recommended to carry out long-term anti-relapse therapy.

The drugs are selected and alternated in courses. The doctor necessarily focuses on the level of leukocyturia, bacteriuria, protein levels in the blood and urine. Various authors suggest duration outpatient treatment keep from six months to two years.

The monthly medication regimen looks like this:

• for the first 7–10 days an antibiotic is prescribed, alternating next period with other antimicrobial drugs (Urosulfan, 5-NOK);
• For the remaining 20 days, it is recommended to take folk remedies.

Tea made from lingonberry leaves washes the urinary tract well

The entire cycle is repeated under the supervision of a doctor and tests.

Bactrim (Biseptol) is contraindicated in cases where the patient has:

• leukopenia, agranulocytosis;
• aplastic and B 12-deficient anemia;
• impaired renal excretory function.

It is not used:

• in the treatment of children under 3 months of age;
• during pregnancy and lactation.

Folk remedies in the treatment of pyelonephritis

At home, folk remedy therapy includes decoctions and infusions of plant materials that have a diuretic effect, a slight bacteriostatic effect, and increase the tone of the bladder and tract.

A self-prepared drink does not interfere with the action of medications, flushes the kidneys and removes bacteria. Before use, it is better to consult your doctor.

The most popular purpose of bearberry is; it is also known as “bear ears.” You can brew it in a thermos (2 tablespoons of dry herbs per liter of boiling water) for half an hour. After straining, you can drink a partial glass three times a day. To improve the taste, it is recommended to add honey. Cannot be used during pregnancy (the tone of the uterus increases).

A decoction of corn silk is prepared at home by pre-boiling for 5–7 minutes. Then it is infused and taken as bearberry.

Pyelonephritis in children is treated by adding delicious cranberry juice, a decoction of rose hips, and figs to their drink.

You can prepare a combined decoction of viburnum berries, sea buckthorn and rose hips. It is left in a thermos overnight. These products not only have a bactericidal effect, but also activate the immune system and contain the necessary vitamins.

It is useful for pregnant women to brew lingonberry leaves and rose hips.

What other medications are prescribed for pyelonephritis?

To reduce allergenic manifestations, patients are prescribed antihistamines:

• Diphenhydramine,
• Tavegil,
• Suprastin,
• Loratadine.

In the treatment of renal hypertension, strong antihypertensive drugs from the group of β-blockers and combinations with calcium channel blockers are used. The appearance of signs of heart failure requires careful use of glycosides in drops and tablets (Digoxin, Celanide). Attacks of suffocation are relieved by intravenous administration of Strophanthin, Korglikon.

When is surgical treatment used?

Surgical treatment is used in advanced stages of chronic pyelonephritis, when the patient is admitted to the urology department with the following complications:

• encysted abscesses in the kidneys (abscesses, carbuncles);
• paranephritis - inflammation extends beyond the boundaries of the renal tissue into the perinephric tissue;
• urosepsis with bacteremic shock (bacterial decay products are absorbed into the blood);
• hydronephrosis;
• urolithiasis;
• sclerosis of the affected kidney.

Most often, nephrectomy (removal of the diseased organ) is indicated if it is unilaterally affected.

Rarely, in the presence of a congenital defect in the form of duplication of the kidney and ureters, partial resection of the necrotic area is performed after opening the capsule. At the same time, stones that obstruct the passage of urine (in the pelvis, ureter) are removed. The question of the viability of the kidney and the preservation of functions is resolved during the examination.

In practical application, urologists have an operation to restore the blood supply to the kidney by wrapping it with an omentum. It is indicated for the treatment of renal hypertension.

Nephrectomy has long been considered contraindicated in cases of bilateral disease and severe concomitant diseases that increase the risk of intervention. She is currently being replaced by a transplant after both of hers were removed. Before surgery, the patient undergoes systematic hemodialysis.

To reduce symptoms of intoxication, the patient is given the following in the preoperative period:

• Hemodez,
• plasma,
• isotonic solutions,
• if necessary, red blood cell mass.

Against a high background blood pressure antihypertensive drugs are needed.

During resection, the renal artery is temporarily clamped. At the end of the operation, a drainage tube is inserted into the perinephric space to drain blood and administer antibiotics. It is removed after 10 days.

To prevent a fistula from forming from urine being sucked into the wound, operating surgeons carefully check the suturing of the walls of the cups and vessels; for this it is better to use chrome-plated catgut.

The prognosis for the patient's life is always favorable. Not in every case it is possible to eliminate hypertension. IN postoperative period with a single kidney remaining, the patient should be under the supervision of a urologist at the clinic and undergo preventive treatment and examination. Overstrain of one organ significantly increases the risk of infection.

Spa treatment

Treatment is indicated at balneological resorts with natural healing springs. These include: Truskavets, Zheleznovodsk, Kislovodsk, Sairme.

Drinking natural mineral waters helps flush out toxins and bacteria from the kidneys and restore local immunity.

Bottled water from the store most often does not contain bioactive components, is a product of chemical mixing of ingredients, and therefore does not have such strength.

In the presence of hypertension, anemia, or renal failure, spa treatment is not indicated; it has no effect.

Measures for the treatment of chronic pyelonephritis are more effective the earlier their use is started. Refusal of medical care seriously worsens the patient's life prognosis.

is a disease of an infectious-inflammatory nature in which the calyces, pelvis and tubules of the kidneys are involved in the pathological process with subsequent damage to their glomeruli and vessels.

According to available statistics, chronic pyelonephritis among all diseases of the genitourinary organs with an inflammatory nonspecific nature is diagnosed in 60-65% of cases. Moreover, in 20-30% of cases it is a consequence of acute pyelonephritis.

Most often, women and girls are susceptible to the development of chronic pyelonephritis, which is due to the structural features of their urethra. As a result, it is much easier for pathogenic microorganisms to penetrate the bladder and kidneys. Mainly in the pathological process chronic two kidneys are involved, which is the difference between chronic and acute pyelonephritis. Organs may not be affected equally. The acute course of the disease is characterized by a sharp increase in symptoms and rapid development of the disease. While chronic pyelonephritis can often occur latently, making itself felt only during periods of exacerbation, which are then replaced by remission.

If complete recovery from acute pyelonephritis does not occur within three months, then it makes sense to talk about chronic pyelonephritis. Therefore, the chronic form of the disease, according to some data, is somewhat more common than the acute one.

Symptoms of chronic pyelonephritis

The course of the disease and symptoms of chronic pyelonephritis largely depend on the localization of inflammation, the degree of involvement of one or two kidneys in the pathological process, the presence of urinary tract obstruction, and the presence of concomitant infections.

Over the course of many years, the disease can be sluggish, with the interstitial tissue of the kidney involved in inflammation. Symptoms are most pronounced during an exacerbation of the disease and can be almost invisible to a person during remission of pyelonephritis.

Primary pyelonephritis gives a more pronounced clinical picture than secondary. The following symptoms may indicate an exacerbation of chronic pyelonephritis:

Increase in body temperature to high values, sometimes up to 39 degrees.

The appearance of pain in the lumbar region on both one and both sides.

The occurrence of dysuric phenomena.

Deterioration general well-being sick.

Lack of appetite.

The occurrence of headaches.

Abdominal pain, vomiting and nausea occur more often in childhood than in adult patients.

The patient's appearance changes somewhat. He can notice these changes on his own, or the doctor will pay attention to them during the examination. The face becomes somewhat puffy, swelling of the eyelids may be observed (read also:). Skin pale, bags under the eyes are common, they are especially noticeable after sleep.

During the period of remission, diagnosing the disease is much more difficult. This is especially true for primary chronic pyelonephritis, which is characterized by a latent course.

Possible symptoms of this course of the disease are as follows:

Pain in the lumbar region rarely occurs. They are insignificant and not constant. The nature of the pain is nagging or aching.

Dysuric phenomena are most often absent, and if they do appear, they are very weak and proceed almost unnoticed by the patient himself.

Body temperature, as a rule, remains normal, although in the evening it may rise slightly to 37.1 degrees.

As the disease progresses, dysuric phenomena increase, the skin begins to peel, becomes dry, and its color changes to grayish-yellow.

The tongue of patients with long-term chronic pyelonephritis is covered with a dark coating, the lips and oral mucosa are dry.

In such patients, arterial hypertension is often associated with a marked increase in diastolic pressure. Possible nosebleeds.

Advanced stages of chronic pyelonephritis are characterized by bone pain, polyuria with the release of up to 3 liters of urine per day, and severe thirst.

There can be only one etiological cause of chronic pyelonephritis - it is damage to the kidneys by microbial flora. However, in order for it to enter the organ and begin to actively reproduce, provocative factors are needed. Most often, inflammation is caused by infection with paraintestinal or Escherichia coli, enterococci, Proteus, Pseudomonas aeruginosa, streptococci, as well as microbial associations. Of particular importance in the development of the chronic form of the disease are L-forms of bacteria that multiply and exhibit pathogenic activity due to insufficient antimicrobial therapy or when the acidity of urine changes. Such microorganisms exhibit particular resistance to drugs, are difficult to identify, and can simply exist in the interstitial tissue of the kidneys for a long period of time and be active under the influence of factors favorable to them.

Most often, the development of chronic pyelonephritis is preceded by acute inflammation of the kidneys.

Additional stimulating reasons for chronicizing the process are:

Undiagnosed and untreated causes leading to impaired urine outflow. This may be urolithiasis, urinary tract strictures, prostate adenoma, nephroptosis, vesicoureteral reflux.

Violation of the terms of treatment of acute pyelonephritis, or incorrectly selected therapy. Lack of systemic dispensary monitoring of a patient who has suffered acute inflammation.

Formation of L-bacteria and protoplasts, which can exist for a long time in kidney tissue.

Decreased immune strength of the body. Immunodeficiency states.

In childhood, the disease often develops after suffering from acute respiratory viral infections, scarlet fever, tonsillitis, pneumonia, measles, etc.

Availability chronic illness. Diabetes mellitus, obesity, tonsillitis, gastrointestinal diseases.

In women in at a young age The stimulus for the development of a chronic form of the disease can be regular sexual activity, its beginning, the period of pregnancy and childbirth.

Possible reason development of the disease - undetected congenital malformations: bladder diverticula, ureterocele, which disrupt normal urodynamics.

Recent studies indicate a significant role in the development of the disease of secondary sensitization of the body, as well as the development of autoimmune reactions.

Sometimes the impetus for the development of a chronic form of the disease is hypothermia.

Stages of chronic pyelonephritis

There are four stages of chronic pyelonephritis:

At the first stage of development of the disease, the glomeruli of the kidneys are intact, that is, they are not involved in the pathological process, and the atrophy of the collecting ducts is uniform.

At the second stage of development of the disease, some glomeruli become hyalinized and empty, the vessels undergo obliteration and significantly narrow. Scar-sclerotic changes in the tubules and interstitial tissue increase.

At the third stage of the disease, the death of most glomeruli occurs, the tubules become severely atrophied, and the interstitial and connective tissue continues to grow.

At the fourth stage of development of chronic pyelonephritis, most of the glomeruli die, the kidney becomes smaller in size, and its tissue is replaced by scar tissue. The organ looks like a small wrinkled substrate with a bumpy surface.

Complications and consequences of chronic pyelonephritis

Possible consequences Chronic pyelonephritis may be secondary kidney shrinkage or pyonephrosis. Pyonephrosis is a disease that develops at the final stage of purulent pyelonephritis. In childhood, this outcome of the disease is extremely rare; it is more typical for people aged 30 to 50 years.

Complications of chronic pyelonephritis may be as follows:

Acute renal failure. This condition, which can be reversed, occurs suddenly and is characterized by severe impairment or complete cessation of kidney function.

Chronic renal failure. This condition is a gradual decline in the functioning of the organ against the background of pyelonephritis, caused by the death of nephrons.

Paranephritis. This complication is a process of purulent inflammation of the located perinephric tissue.

Urosepsis. One of the most severe complications a disease in which an infection from the kidney spreads throughout the body. This condition poses a direct threat to the patient’s life and often ends in death.

Diagnosis of chronic pyelonephritis

Diagnosis of chronic pyelonephritis should be comprehensive. To make a diagnosis, the results of laboratory and instrumental studies will be required.

Doctors refer patients for the following laboratory tests:

UAC. A chronic course of the disease will be indicated by anemia, an increase in the number of leukocytes, a shift in the blood count to the left, as well as an increased erythrocyte sedimentation rate.

OAM. Based on the results of the analysis, an alkaline environment will be revealed. The urine is cloudy and its density is reduced. The presence of casts is possible, sometimes bacteriuria is detected, and the number of leukocytes is increased.

The Nechiporenko test will reveal the predominance of leukocytes over red blood cells, in addition, active leukocytes will be detected in the urine.

Performing a prednisolone and pyrogenal test, when the subject is administered prednisolone and after certain periods of time several portions of urine are collected.

The Zimnitsky test will reveal a decrease in density in various portions of urine that are collected throughout the day.

The LBC will reveal an increased amount of sialic acids, seromucoid, fibrin, and urea.

In addition, to confirm the diagnosis and study the condition of the organ, it is necessary to perform some instrumental examinations, the choice of which remains with the doctor:

Performing a survey X-ray examination of the kidney area. At chronic course kidney disease will be reduced in size (either both, or one).

Performing chromocyotoscopy. If there is chronic pyelonephritis, the doctor will note a violation of the excretory function of the kidneys - one or two-sided.

Performing excretory or retrograde pyelography will detect existing deformations and pathological changes in the calyces and pelvis of organs.

Ultrasound of the kidneys can detect organ asymmetry, deformation, and heterogeneity.

Radioisotope scanning also reveals kidney asymmetry and diffuse changes.

Detailed structural changes in the organ can be detected by highly informative studies such as CT and MRI.

Kidney biopsy and biopsy examination are performed in clinically unclear cases of the disease.

It is important to exclude diseases such as renal amyloidosis, chronic glomerulonephritis, hypertension, diabetic glomerulosclerosis, which can give a similar clinical picture.

Treatment of chronic pyelonephritis cannot be complete without an individual approach to the patient and without carrying out comprehensive measures aimed at his recovery. It includes following a diet and drinking regimen, taking medications, as well as eliminating causes that may interfere with the normal flow of urine.

In the acute stage of chronic pyelonephritis, the patient should be admitted to a hospital for treatment and observation. Patients with primary pyelonephritis are sent to a therapeutic or specialized nephrology department, and with secondary pyelonephritis, to a urological department.

The duration of bed rest directly depends on the severity of the disease and the effectiveness of the treatment. Diet is an indispensable aspect complex treatment chronic pyelonephritis.

Edema, as a rule, does not occur in such patients, so their drinking regime should not be limited. The priority drinks are plain water, fortified drinks, cranberry juice, juices, compotes, and jelly. The volume of fluid entering the body during the day can be equal to 2000 ml. Reducing its amount is possible according to doctor's indications, in the presence of arterial hypertension, and in case of urinary passage disorders. In this case, limit salt intake, up to its complete elimination.

The decisive point in the treatment of chronic pyelonephritis is the prescription of antibiotics. They are prescribed as early as possible and for a long period after the sensitivity of bacterial agents to specific drugs that have been cultured from urine has been established. The effect cannot be achieved if antibiotics are prescribed too late, for a short period of time, or if there are any obstacles to the normal passage of urine.

If the disease is diagnosed at a late stage, then even high doses of antimicrobial drugs are often not effective enough. In addition, against the background of existing disorders in the functioning of the kidneys, there is a risk of developing severe side effects even from the most effective drugs. The likelihood of developing resistance also increases many times.

The following drugs are used to treat chronic pyelonephritis:

Semi-synthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.

Cephalosporins - Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.

Nalidixic acid – Negram, Nevigramon.

Aminoglycosides are used in severe cases of the disease - Kanamycin, Gentamicin, Kolimycin, Tobramycin, Amikacin.

Fluoroquinolones: Levofloxacin, Ofloxacin, Tsiprinol, Moxifloxacin, etc.

Nitrofurans – Furazolidone, Furadonin.

Sulfonamides - Urosulfan, Etazol, etc.

Antioxidant therapy comes down to taking Tocopherol, Ascorbic acid, Retinol, Selena, etc.

Before choosing one or the other antibacterial drug, the doctor should familiarize himself with the acidity of the patients’ urine, as it affects the effectiveness of medications.

Antibiotics during exacerbation of the disease are prescribed for up to 8 weeks. The specific duration of therapy will be determined based on the results of laboratory tests performed. If the patient’s condition is severe, then he is prescribed combinations of antibacterial agents, they are administered parenterally, or intravenously and intravenously. large doses. One of the most effective modern uroseptics is the drug 5-NOK.

Self-medication is strictly prohibited, although there are many drugs for the treatment of pyelonephritis. This disease is solely within the competence of specialists.

The success of the treatment can be judged by the following criteria:

Absence of dysuric phenomena;

Normalization of blood and urine parameters;

Normalization of body temperature;

Disappearance of leukocyturia, bacteriuria, proteinuria.

However, even despite successful implementation therapy for chronic pyelonephritis, a relapse of the disease is possible, which will occur with a probability of 60% to 80%. Therefore, doctors carry out many months of anti-relapse therapy, which is completely justified when chronic process kidney inflammation.

If allergic reactions occur during treatment, then it is necessary to perform antihistamine therapy, which boils down to taking drugs such as: Tavegil, pipolfen, Suprastin, Diazolin, etc.

When blood tests reveal anemia, patients are prescribed iron supplements, vitamin B12, and folic acid.

In addition, patients are shown Spa treatment in balneological sanatoriums.

Proper nutrition for chronic pyelonephritis is a prerequisite for complete treatment. It involves the exclusion from the diet of spicy foods, all rich broths, various seasonings to enhance the taste, as well as strong coffee and alcohol.

The calorie content of food should not be underestimated; an adult should consume up to 2500 kcal per day. The diet should be balanced in the amount of proteins, fats and carbohydrates and have the maximum set of vitamins.

A vegetable-dairy diet with the addition of meat and fish dishes is considered optimal for chronic pyelonephritis.

It is necessary to include a variety of vegetables in your daily diet: potatoes, zucchini, beets, cabbage, as well as various fruits. Eggs, dairy products and milk itself must be present on the table.

If you have iron deficiency, you need to eat more apples, strawberries, and pomegranates. At any stage of chronic pyelonephritis, the diet should be enriched with watermelons, melons, cucumbers, and pumpkin. These products have a diuretic effect and allow you to quickly cope with the disease.

Prevention of chronic pyelonephritis

Prevention of patients with pyelonephritis comes down to timely and thorough treatment of patients at the stage of acute pyelonephritis. Such patients should be registered at the dispensary.

There are recommendations for the employment of patients with chronic pyelonephritis: patients are not recommended to be employed in enterprises that require heavy physical labor, which contribute to being in constant nervous tension. It is important to avoid hypothermia in and outside the workplace, avoid working on your feet and at night, and avoid working in hot workshops.

You should follow a diet with limited salt as recommended by doctors.

The success of preventive measures for secondary pyelonephritis depends on the complete elimination of the cause that led to the development of the disease. It is important to remove any obstructions to the normal flow of urine.

It is important to identify and treat hidden foci of infection and intercurrent diseases.

After discharge from the hospital, patients must be registered with a dispensary for a period of at least one year. If after this time bacteriuria, leukocyturia and proteinuria are not detected, then the patient is removed from the register. If signs of the disease persist, the observation period for such patients should be extended to three years.

If primary pyelonephritis is detected in patients, then the treatment is long-term, with periodic placement in a hospital.

Correcting the immune system and maintaining it normal is no less important. This requires maintaining a healthy lifestyle, prolonged exposure to fresh air, and dosed physical activity as prescribed by a doctor.

Staying in specialized sanatorium-resort institutions can reduce the number of exacerbations of the disease.

Prevention of the disease in pregnant women and children, as well as in patients with weakened immune systems, deserves special attention.

At latent course Patients with illness do not lose their ability to work for a long time. Other forms of pyelonephritis can have a significant impact on a person’s performance, since there is a threat of rapid complications.

Education: A diploma in the specialty “Andrology” was obtained after completing a residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education at the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were also completed here in 2010.