home Audience 4 Symptoms and treatment of chronic pyelonephritis. Chronic pyelonephritis: is this disease curable? Differences from the acute form, prognosis

Symptoms and treatment of chronic pyelonephritis. Chronic pyelonephritis: is this disease curable? Differences from the acute form, prognosis

Pyelonephritis – inflammatory disease kidneys involving the pyelocaliceal system. Pyelonephritis is caused by infections, changes hormonal levels, disturbances in the outflow of urine, etc. As a rule, the disease is unilateral and over time can lead to deformation of the kidney. Chronic pyelonephritis characterized by periods of remission and exacerbations, so it is very important to do everything possible to ensure that the period of remission lasts as long as possible. To do this, you must follow the following rules:

diet. If such a patient does not have complications in the form of increased blood pressure, renal failure, then it is enough just to minimize the consumption of fats, the amount of protein consumed and slow carbohydrates must be balanced. It is recommended to eat foods rich in fiber: vegetables and fruits.

It is also necessary to comply drinking regime. If there are no contraindications, then it is recommended to drink about 3 liters of liquid. But it must be taken into account that soups, juices, and liquid contained in fruits are also taken into account. It is useful to eat melons, watermelons, and drink cranberry juice.

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Questions and answers on: chronic pyelonephritis remission

2013-01-25 07:25:53

Anya asks:

Pregnancy 37 weeks diagnosed with Chronic pyelonephritis, remission. ICD. Anemia mild degree. Can I give birth on my own?

2013-02-27 12:07:29

Lily asks:

Hello, I had the following diagnosis: the left kidney is 11.1*7.3 p-1.6, homogeneous, the entire sinus is occupied by an echo-negative formation 5.9*5.8 cm with clear, even contours. Left kidney cyst. Chronic pyelonephritis in the stage of incomplete remission. Under local anesthesia Sol. Novocaini 0.5%-20ml. Under ultrasound, I underwent percutaneous igneopuncture of the cyst. Received up to 130ml. straw-yellow liquid. 30 ml was injected into the cyst cavity. sclerosant (95% alcohol) followed by its evacuation. Afterwards I was prescribed amoxiclav for 10 days. After 6 months had passed, I underwent an ultrasound examination, and the cyst remained as it was, only another smaller one formed nearby. What should I do and how should I treat it? Now it really bothers me when I bend over or when I sleep on my stomach. When you start to roll over on your side, it seems as if it is folded into a figure eight. And you also say that it can rupture when squeezed, what symptoms should there be in this case or does the person die immediately?

Answers Klofa Taras Grigorievich:

Good afternoon, no. Doesn't die, there is pain and clinic acute abdomen. But that rarely happens. Recurrent cysts are subject to surgical treatment (laparoscopically today).

2011-07-03 19:42:10

Natalia asks:

Hello, chronic pyelonephritis 15 years old (pharmacist). I took antibacterial + herbal medicine. Since November 2010, I have not been able to achieve remission, my immunity has been reduced by antibiotics (+ chronic bronchitis). 20 days ago, a sore throat provoked a severe exacerbation, I took ciprofloxacin 1.0 per day, ceftazidime 2.0 -10 days (sensitive to my E. coli), nitroxoline, no-shpu, artichoke, canephron, cranberry. General urine tests, according to Nechiporenko - normal. Ultrasound - normal. There is a nagging discomfort in the kidney area, there may be chills in the evening. The nephrologist left nitroxoline, canephron, artichoke, cranberry for a month at night , laktovit. I have a hard time believing in the effect of nitroxoline; furagin causes dyspepsia, nausea. It is possible to buy Uro-Vaxom or Urivak (more wide range), I ask for your opinion and they also advise you to do UVB of the blood. I also read about Sextafage. Thank you!

Answers Zhiravetsky Taras Mironovich:

Hello. I do not recommend doing ultraviolet irradiation of the blood; I recommend doing a urine culture; if the result is negative, then do kidney tests with uric acid. Regarding the selection of an antibiotic, there are many modern drugs on the market in our country; consult a doctor after a urine test.

2011-05-10 16:29:43

Oleg asks:

Hello. I have been suffering from chronic glomeluronephritis and urinary syndrome since I was 2 years old. Now I'm 35 years old. The last exacerbation with significant swelling and protein release occurred at the age of 7 years. Then until the age of 25 - complete remission. From the age of 25 until now, my health has worsened: my blood pressure gradually increased to almost constant values of 160-170/100-110 mmHg, general weakness, constant fatigue, fatigue, headaches, constant palpitations, pain in the heart area. There was swelling of the whole body with a weight increase of 10 - 15 kg, and then weight loss, chronic pyelonephritis and urolithiasis developed.
Constant daily diuresis is 3 liters or more, although I consume less than 3 liters of fluid per day. Ud. urine weight according to Zimnitsky - 1003 - 1010. Blood sugar, urine - no. Cardiogram - disturbance of repolarization processes in the LV. Hypertensive angiopathy retinas of both eyes. But chronic renal failure is 0 st. (protein - n/a, creatinine color - 89 mmol/l, urea color - 5.4 mmol/l, Rehberg test - 269.99 ml/min).
Will I develop chronic renal failure if this state And approximately at what age will I develop chronic renal failure?
How to delay the onset of chronic renal failure?

Answers Ivanov Dmitry Dmitrievich:

Dear Oleg,

Judging by the amount of urine excreted, the relative density of urine and the Rehberg test, you have hyperfiltration against the background of elevated blood pressure – i.e. preclinical renal dysfunction. The first thing to do is to normalize blood pressure, for which they are used. ACE inhibitors or ARB or PIR (aliskiren). You are indicated for combination therapy with a diuretic, for example, Enap 10 mg twice in combination with xipamide 10 mg/day, or olmesartan + 20/12.5 or noliprel-forte or rasilez 150 + losartan 50 mg. Target blood pressure is less than 140/90-130/80. When blood pressure normalizes, the amount of urine will decrease. And there we will make forecasts.

2011-03-16 12:13:56

Anna asks:

Hello!
Since childhood I have had chronic pyelonephritis. On this moment I am 28 weeks pregnant, doctors diagnose chronic pyelonephritis in remission. The last blood test turned out to be not very good (Stabs - 18 (normal 1-6)) and my kidneys hurt a little. The therapist at the antenatal clinic prescribed me to take Canephron 3 times a day. 50 drops per day and said that while the inflammatory process is ongoing, it can be combined with Urolesan (Urolesan 2 times a day, 1 teaspoon).
Please tell me whether it is possible to combine these two drugs and whether this will harm the child?
Thank you in advance. With uv. Anna.

Answers Klofa Taras Grigorievich:

Hello! Because these drugs plant origin, then they should not cause harm to the child or you. And you can combine them.

2010-03-17 15:55:44

Anna asks:

Good afternoon
My son is 9 months old. At 5 months we suffered from acute pyelonephritis. An ultrasound of the kidneys was done.
Here are the data from the first ultrasound: Ultrasound of the kidneys 12/04/2009 - the kidneys are located normally. The shape is normal, the contours are smooth and clear. Dimensions: right kidney - 4.6 * 2.1 left kidney - 5.8 * 2.6 parenchyma thickness: right - 0.66, left - 0.8. Left pelvis – 0.57. The cups are not widened, emphasized. The walls of the pelvis are thickened to 1.8 mm. Conclusion: jade on the left. Treatment with ampisulbin was carried out. A week later, urine tests were normal. There was a recommendation to take urine tests every 10 days and repeat an ultrasound. The tests are currently normal (general, Nechiporenko and sterility testing). Repeated ultrasound of the kidneys 02/08/2010: Left kidney: Location: normal Mobility: preserved Shape: bean-shaped Contours: smooth Dimensions: 64*26 mm Thickness of the parenchyma: 10 mm Structure of the parenchyma: homogeneous Echogenicity of the parenchyma: average Sinus: not dilated PHL: dilated pelvis 6 mm Ureter: not dilated Stones: no Right kidney: Location: normal Mobility: preserved Shape: bean-shaped Contours: smooth Dimensions: 44*18 mm Thickness of the parenchyma: 7 mm Structure of the parenchyma: homogeneous Echogenicity of the parenchyma: average Sinus: not dilated FLS: not dilated Ureter: not dilated Concrements: no Conclusion: Pyeelectasis of the left kidney, hypoplasia right kidney.
After the second ultrasound, on the recommendation of the nephrologist, we conducted an additional examination.
03.03.1010 Vaccine cystography.
Hyperpneumatization of the intestine is determined, non-fusion of the arch SI (option age norm). After administration of contrast through the catheter, a shadow is detected Bladder. Its position and size are normal, its contours are clear, its structure is homogeneous. At rest, there was no evidence of passive reflux. When urinating, contrast is detected to flow into the right ureter, the diameter of which is expanded. Contrasted urethra, its shape is amphora-shaped. Conclusion: vesicoureteral reflux on the right. Radiation exposure - 2-0.4 M3V.
Kidney ultrasound 03/04/2010
Left kidney:
Location: normal
Mobility: preserved
Shape: bean-shaped
Contours: smooth
Dimensions: 72*27 mm A/Renalis LSK 40 cm/sec., V/Renalis LSK 13 cm/sec. Blood flow can be traced to the periphery
Parenchyma thickness: 8mm

Sinus: unexpanded
ChLS: pelvis dilated 6mm
Ureter: not dilated
Concretions: no
Right kidney:
Location: normal
Mobility: preserved
Shape: bean-shaped
Contours: smooth
Dimensions: 46*21 mm A/Renalis LSK 21 cm/sec., V/Renalis LSK 9 cm/sec. Blood flow can be traced to the periphery
Parenchyma thickness: 4mm
Parenchyma structure: homogeneous
Parenchyma echogenicity: average
Sinus: unexpanded
ChLS: dilated pelvis 5 mm, lower cup 4 mm, upper cup 4 mm
Ureter: not dilated
Concretions: no
Diagnosis: hypoplasia of the right kidney.
Urine tests are normal.

We were referred by a nephrologist to the regional pediatric urologist to clarify the diagnosis and determine treatment tactics. In the direction indicated next diagnosis: chronic pyelonephritis, period of remission, FPS Developmental anomaly urinary tract. Active vesicoureteral reflux of the 3rd degree on the right. Dysplasia of the ureter on the right. Hypoplasia, secondary wrinkled kidney on the right?
The urologist's recommendation is to check urine once a week and monitor it with ultrasound every other month.
What is your opinion based on the data provided?
Do we need surgical elimination of vesicoureteral reflux or can this deviation disappear on its own as the child ages?
What else additional examinations did you advise us to pass?

Answers Burlaka Evgenia Anatolevna:

Dear Anna,
The diagnosis made by your doctor is absolutely correct, it does not raise any doubts. Prompt elimination of the causes of reflux is necessary in cases where there are frequent exacerbations of chronic pyelonephritis. In general, the prescription of surgical treatment is individualized and is prescribed by a doctor who knows your child’s condition well. I advise you to contact the nephrology department of the Children's clinical hospital No. 7 in Kiev, where you can be constantly monitored and receive treatment if necessary.

2009-10-14 13:18:43

Kristina asks:

Hello. A month ago, I had acute attack pyelonephritis and cystitis (determined by the results of the analysis), to treat pyelonephritis and cystitis, I took antibiotics (amoxicillin), but sometimes symptoms still arose, so I took tests again. The result was much better than it was before treatment. Also, I decided to undergo an ultrasound. Put diagnosis - chronic pyelonephritis and cystitis, they said that pyelonephritis is in remission, but cystitis is still present. What can be taken to completely cure cystitis?

Answers Chernikov Alexey Vitalievich:

Hello. You also have pyelonephritis, although in remission. So don't forget about it and pay due attention. In your case, you must adhere to your doctor’s recommendations (if any). Semi-bed rest is advisable until disappearance acute symptoms, dairy-vegetable diet, exclude foods with spicy seasonings, preservatives, limit salt intake to 3-5 grams per day, the amount of fluid consumed can be slightly increased compared to your norm. You should give up caffeine, alcohol, and smoking. Remember that everything that enters your body is excreted primarily through the kidneys, and therefore will irritate the lining of the bladder. You also need to include herbal medicines that have mild diuretic, antispasmodic, and anti-inflammatory effects. In our pharmacies these are either all kinds of herbs and infusions, or the phytocomplex drug Canephron N. You can choose a sanatorium that specializes in the prevention and treatment of urological diseases.

2009-04-09 11:42:14

Lera asks:

Good afternoon, ladies and gentlemen! I have chronic pyelonephritis. In the stage of exacerbation and remission, 80-100 red blood cells are constantly present in the urine analysis in the field of view. Is this typical for pyenephritis? What does this indicate? Thank you.

2009-01-05 16:42:48

Olga asks:

Good afternoon I am 25 years old, there have been no pregnancies, no abortions.
2 months ago I was diagnosed with chronic pyelonephritis. I visited a gynecologist with complaints of a constant urge (often false) to urinate during sexual activity. I start running to the toilet and, as you understand, there is no desire to continue anything. During the day at work, at home I somehow didn’t attach any importance to this, but I also ran often. Then I started going to the toilet more and more often, It's a dull pain in the area of the ovaries (the doctor says that the ureters are located there), a dull pain appeared in the lower back (I have had problems with the sacrum for a long time, so it is difficult to understand what exactly is bothering me).
The gynecologist sent me to take a general urine and blood test, and with them to a therapist, who sent me for an ultrasound. The diagnosis is chronic pyelonephritis. We treated Solidago compositum (injections), Traumeel and Renel sublingual tablets, sumamed.
I went to see my endocrinologist today and told him about my new sores. After looking at the tests and ultrasound, he says that this is not pyelonephritis at all, but cystitis. She recommended drinking Canephron and not worrying about the fact that there is pyelonephritis, and even a chronic one.
Tell me what to do and how to be?
Here are urine tests before treatment and 2 weeks after treatment
Before treatment:
15.10.2008:
Quantity 250g,
Transparency: transparent,
Specific gravity: 1.011 (normal: 1.001-1.040),
Reaction: slightly sour. (norm: 5.0-7.0),
Protein: mucus,
Glucose: negative.
Microscopic examination:
Red blood cells: little change. 2-3 in W.
Leukocytes: 6-7 per...(inaudible) ,
Epithelium: flat 2-3 in...(inaudible),
transitional: unit. in......(inaudible),
Homogeneous mucus +,
Salts: -,
Bacteria: +
After Solidago injections, Renel, Traumeel
28.10.2008
Quantity 80g
Transparency: transparent
Color: light yellow
Specific Gravity: 1003
Reaction: neutral
Protein: negative
Sugar: negative
Sediment microscopy: Leukocytes 2-3 in p/zr
Red blood cells: units.
Hyaline cylinders: -
Granular cylinders: 1 in p/zr.
Waxy cylinders: -
Flat epithelium: 2-3 in p/zr
Renal epithelium: negative.
Salts: urates in small quantities.
Ultrasound 05.11.2008 kidneys and bladder
Kidneys:
Contour: smooth, clear (for both kidneys)
Location: right - excellent, left - lowered;
Breathing excursion: right and left. saved
Linear dimensions:
Right: length 107mm, width 53mm, thickness 44mm
Left: length 103mm, width 57mm, thickness 43mm
Parenchyma: altered heterogeneous structure, decreased echogenicity
Thickness:
at the poles 21mm, middle segment 18mm (right);
at the poles 20mm, middle segment 17mm (left)
Cortico-medullary differentiation: preserved (right and left)
Education: not identified
Education: not identified
Hyperechoic inclusions in the parenchyma: single qi…. (inaudible) 1-2mm
CHLS: The pelvis is not dilated (right and left)
Anterior-posterior size: 18mm (right)
anterior-posterior size: 19mm (left)
Cups: not widened
ChLS walls: 3.2mm (right), 3.3mm (left)
Ureter:
right: not expanded 4mm wide, visualized over 18mm from the LMS
left: not expanded 5mm wide, visualized over 19mm from the LMS
Stones: (hyperechoic inclusions in the maxillary sinus/sinus): not detected
Urine sand, salt crystals: moderate amount
Perinephric fiber: not changed
Bladder: 104x65mm
Contour: smooth, clear
Shape: homogeneous, with finely dispersed... (possibly “mucus”, illegible)
Walls: 5.4mm
Space-occupying formations, Stones: not identified
Ureters: not dilated
Walls, mouths, Concretions: -
Ultrasound signs at the time of examination: Chr. pyelonephritis in the stage of incomplete remission.
I kindly ask you to comment on my analyzes and results.
Thank you in advance,
Olga

They can be acute or chronic. Acute pyelonephritis is a disease that suddenly arose against the background healthy condition kidneys

Read about treatments for pyelonephritis, including antibiotics, physical therapy, and other ways to improve kidney function.

Primary, bilateral, segmental and other pyelonephritis

Pyelonephritis that is not associated with a previous disease of the urinary system is called primary. Accordingly, secondary pyelonephritis occurs against the background of damage to the urinary tract, for example, cystitis or urethritis.

If the disease occurs in both kidneys at once, then pyelonephritis is called bilateral. If in one kidney, then the disease is one-sided; Right- or left-sided pyelonephritis is usually indicated.

Pyelonephritis is considered segmental if an area or segment of an organ is affected, and if the kidney is completely damaged, pyelonephritis is called total.

Chronic pyelonephritis

The diagnosis of chronic pyelonephritis is established after three months of acute pyelonephritis without recovery or after several acute pyelonephritis that ended in recovery.

Dr. Lerner offers personalized. In St. Petersburg, it is possible to call a doctor at home. We send herbal medicines to other cities by mail.

Remission and exacerbation of chronic pyelonephritis

Chronic pyelonephritis can be in the acute phase or in the remission phase. An exacerbation is a period of activation of the inflammatory process, when there are any manifestations of the disease (pain, fever, changes in urine tests, etc.). Remission is a period of subsidence of the disease, during which there are no clinical manifestations and normal urine test results.

In the acute phase, the activity of the inflammatory process may vary. An active inflammatory process is indicated if urine tests show a large number of leukocytes, bacteria, active leukocytes, Sternheimer-Malbin cells are found; V general analysis blood ESR (erythrocyte sedimentation rate) is increased. The phase of the latent (hidden) inflammatory process is indicated by slight increase leukocyte count in urine analysis, absence of Sternheimer-Malbin cells; in analysis blood ESR- on upper limit norms.

Clinical forms of chronic pyelonephritis

There are several clinical forms chronic pyelonephritis: latent, recurrent, hypertensive, anemic, septic, hematuric and nephrotic. The division into forms is due to the fact that the symptoms of the disease are often varying degrees severity, and sometimes the forms of pyelonephritis are very similar to other diseases.

The latent form is characterized by a small number of symptoms or their weak severity. Weakness, fatigue, slight chills - these are the signs of the disease that the patient complains about. Sometimes nocturia (urination) is a concern more at night than during the day), unexpressed pain in the lower back, which can be mistaken for osteochondrosis. This often makes it difficult to make a correct diagnosis.

The relapsing form is an alternation of periods of exacerbations and remissions. In the exacerbation phase, the classic clinical picture of chronic pyelonephritis is usually present. Sometimes the symptoms are so pronounced that they can be mistaken for acute pyelonephritis; progression of chronic renal failure (CRF) is possible. After a course of treatment, the manifestations of the disease gradually subside, tests become normal - the remission phase begins.

In the hypertensive form of chronic pyelonephritis, the symptom of arterial hypertension (high blood pressure) comes to the fore. Changes in urine may be slight and inconsistent.

The anemic form of the disease is diagnosed if the patient's symptoms are dominated by anemia, caused by intoxication and impaired synthesis of erythropoietin, which controls the maturation of red blood cells. Severe anemia often occurs with the development of chronic renal failure. Deviations in urine tests are small, sometimes they may be normal.

With severe exacerbation of chronic pyelonephritis, a septic form of the disease may develop. It is accompanied by high body temperature, tremendous chills, serious condition sick. There are a very large number of leukocytes in the urine, and bacteria are often found in the blood.

The hematuric form of chronic pyelonephritis is quite rare. Here the content of a large number of red blood cells in the urine (macrohematuria) comes to the fore. There can be many causes of hematuria, so a thorough examination of the patient is necessary to exclude others. possible diseases(for example, tuberculosis or malignant tumor kidneys). Only after other diseases are not confirmed can a diagnosis of the hematuric form of chronic pyelonephritis be made.

The nephrotic form of the disease is also rare. A urine test reveals a large amount of protein, a blood test shows a decreased level of albumin (a type of protein) and an increased level of lipids (fats), and the patient may also experience swelling.

Chronic pyelonephritis is an inflammatory disease that primarily affects the renal collecting system. It can develop at any age, in men and women, and can be an independent disease or a complication of other diseases or developmental anomalies.

According to statistics, up to 20% of the population suffers from this disease, but experts believe that in fact its prevalence is even higher.

What clinical symptoms are typical for chronic pyelonephritis?

In chronic pyelonephritis, the inflammatory process is localized in the area of the calyces and pelvis of the kidneys.

Lower back pain is often mild, aching, and usually asymmetrical. It has been noticed that pain often appears not on the affected side, but on the opposite side. There may be a feeling of discomfort and heaviness in the lower back, especially when walking or standing for long periods of time. Patients complain that their lower back is cold and try to dress warmer. Strong or cramping pain rather typical for urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.
Temperature rise, not higher than 38 C, usually in the evening, without visible reasons.
, especially at night.
Increased blood pressure. During remission, this may be the only symptom.
Deterioration of health, fatigue and weakness, more pronounced in the morning, decreased mood, headaches.
Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.

Laboratory signs of chronic pyelonephritis

Decreased hemoglobin in a general blood test.
Triple urine tests reveal increased amount leukocytes (normally no more than 4-6 per field of view); bacteriuria more than 50-100 thousand microbial bodies in 1 ml; red blood cells (especially with urolithiasis); sometimes - protein, but not more than 1 g/l, and there are no cylinders at all.
In Zimnitsky's sample, the specific gravity often decreases (in no single portion does it exceed 1018).
IN biochemical analysis blood total protein within normal limits, albumin may decrease slightly, and when signs of renal failure appear, creatinine and urea increase.

Treatment of pyelonephritis

Elimination of the pathogen. For this purpose, antibiotics and uroseptics are used. The main requirements for the drugs: minimal nephrotoxicity and maximum effectiveness against the most common infectious agents: E. coli, Proteus, Klebsiella, staphylococcus, Pseudomonas aeruginosa, etc.

It is optimal to conduct a urine culture before starting treatment to determine sensitivity to antibiotics - then the choice will become more accurate. Most often prescribed

penicillins (amoxicillin, carbenicillin, azlocillin) – with minimal nephrotoxicity, they have a wide spectrum of action;
2nd and 3rd generation cephalosporins are not inferior to the first in effectiveness, however, the bulk of the drugs are intended for injection, therefore they are used more often in hospitals, and in outpatient practice Suprax and Cedex are most often used;
fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin) are effective against most pathogens of urinary tract infections, non-toxic, but they are prohibited for use in children, pregnant and lactating women. One of the side effects is photosensitivity, so during use it is recommended to avoid visiting the solarium or going to the beach;
sulfonamide drugs (in particular Biseptol) were used so often in our country at the end of the 20th century to treat literally any infections that now most bacteria are insensitive to them, so it should be used if culture has confirmed the sensitivity of the microorganism;
nitrofurans (furadonin, furamag) are still very effective for pyelonephritis. However sometimes side effects- nausea, bitterness in the mouth, even vomiting - force patients to refuse treatment with them;
hydroxyquinolines (5-Nok, nitroxoline) are usually well tolerated, but sensitivity to these drugs, unfortunately, has also decreased recently.

The duration of treatment for chronic pyelonephritis is at least 14 days, and if complaints and changes in urine tests persist, it can last up to a month. It is advisable to change medications once every 10 days, repeating urine cultures and taking their results into account when choosing the next medication.

Detoxification

If there is no high blood pressure and severe swelling, it is recommended to increase the amount of fluid you drink to 3 liters per day. You can drink water, juices, fruit drinks, and when high temperature and symptoms of intoxication - rehydron or citroglucosolan.

Phytotherapy

Most effective means herbal medicine for chronic pyelonephritis is bearberry leaf.

These folk remedies treatments for pyelonephritis are effective as an addition to antibacterial therapy, but will not replace it, and should not be used during an exacerbation period. Herbal infusions should be taken for a long time, in monthly courses after completion antibacterial treatment or during remission, for prevention. It is optimal to do this 2-3 times a year, in the autumn-spring period. Undoubtedly, herbal medicine should be abandoned if there is a tendency to allergic reactions, especially hay fever.
Examples of fees:

Bearberry (leaf) – 3 parts, cornflower (flowers), licorice (root) – 1 part each. Brew in a ratio of 1 tablespoon per glass of boiling water, leave for 30 minutes, drink a tablespoon 3 times a day.
Birch leaf, corn silk, horsetail 1 part each, rose hips 2 parts. Pour a tablespoon of the mixture into 2 cups of boiling water, leave for half an hour, drink half a glass 3-4 times a day.

Drugs that improve renal blood flow:

antiplatelet agents (trental, chimes);
drugs that improve venous drainage(escusan, troxevasin) are prescribed in courses of 10 to 20 days.

Spa treatment

It makes sense because healing effect mineral water is quickly lost during bottling. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

Chronic pyelonephritis is a disease characterized by periodic exacerbations. This disease is understood as a nonspecific inflammatory process in which the kidneys are affected, followed by sclerosis of the parenchyma. By medical statistics, pyelonephritis affects about 20% of the population.

IN childhood From 2 to 15 years old, it affects girls more often; in old age, the disease affects more men. Despite this, pyelonephritis is considered predominantly female disease thanks to anatomical location genitourinary organs and others functional features female body.

What it is?

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

According to 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.

Causes

The main causes of pyelonephritis are microbes - coli, staphylococcus, enterococci, Proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis, resistant to negative factors and antibiotics forms of microbes. They can persist for a long time in the area of the calyces and pelvis, with a decrease in immune defense causing activation of inflammation.

Why does an acute process become chronic?

The causes of chronic pyelonephritis can be considered:

poor quality treatment acute form pyelonephritis, failure of the patient to comply clinical recommendations doctor, breakdown dispensary observation for a child or adult;
untimely diagnosis and treatment of diseases that impair the outflow of urine (nephroptosis, vesicoureteral reflux, congenital anomalies narrowing of the urinary tract);
the presence of concomitant chronic diseases that undermine the body’s immunity or are constant foci of infection (obesity, diabetes, diseases of the gallbladder, intestines, pancreas);
the ability of some pathogens to form L-forms, which can remain in the kidney tissue for a long time in an inactive state, but cause an exacerbation when the defenses are reduced or in immunodeficiency states.

There is no standard risk group for chronic pyelonephritis, but practitioners believe that the infection is most dangerous for:

pregnant women;
children under three years of age, mostly bottle-fed;
girls during the onset of sexual activity;
elderly people.

Prevention of chronic pyelonephritis is most indicated for these patients.

Classification

Forms of chronic pyelonephritis:

Latent form. Characterized by minor clinical manifestations. The patient may experience general weakness, fatigue, headache, sometimes the temperature may rise slightly. As a rule, there is no lower back pain, swelling or dysuria, although some experience positive symptom Pasternatsky (pain when tapping on lumbar region). A general urine test reveals slight proteinuria; leukocytes and bacteria may be excreted in the urine periodically. With a latent course, the concentrating ability of the kidneys is usually impaired, so a decrease in urine density and polyuria are characteristic. Mild anemia and a slight increase in blood pressure can sometimes be detected.
Recurrent form. Characterized by alternating periods of exacerbation and remission. The patient may be bothered discomfort in the lower back, chills, fever. Dysuric phenomena appear (frequent urination, sometimes painful).
Azotemic form. These include those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of an already existing, but not timely identified latent course of the disease. It is the azotemic form that is characteristic of chronic renal failure.
Hypertonic form. Arterial hypertension predominates. Headache, dizziness, sleep disturbances occur, stabbing pains in the projection of the heart, frequent hypertensive crises, shortness of breath. Changes in urine are subtle and not constant. Hypertension with pyelonephritis is often malignant.
Anemic form. It is characterized by the fact that among the signs of the disease, the symptoms of anemia predominate - a decrease in the number of full-fledged red blood cells in the blood. This form of the disease in patients with chronic pyelonephritis is more common, more pronounced than in other kidney diseases, and is usually hypochromic in nature. Disturbances in urination are mild.

Exacerbation of chronic pyelonephritis clinically resembles the picture acute inflammation. As the process progresses, the leading syndrome becomes hypertensive, which is manifested by headache, dizziness, visual impairment, and pain in the heart. Sometimes, as a result of long-term pyelonephritis, anemic syndrome develops. The outcome of the disease is chronic renal failure.

Stages

In chronic pyelonephritis, there are three stages of disease progression:

the initial degree is characterized by the development of inflammation, swelling of the connective tissues of the inner layer of the urinary organ, as a result of which the vessels are compressed, tubular atrophy appears, and renal bleeding decreases;
the second degree is detected through a nephrogram, where diffuse narrowing of the arterial renal bed is noted, the size of the cortex becomes smaller, interlobar arteries are absent;
third degree with pyelonephritis is expressed by narrowing and changing the shape of all vessels of the urinary organ, kidney tissue is replaced by scar tissue, the kidney becomes wrinkled.

Symptoms

The degree of manifestation of symptoms of pyelonephritis depends on the location of inflammation (one side or both kidneys), the degree of activity of inflammation, concomitant obstacles to the outflow of urine and previous treatment. During the remission stage, there may be no manifestations at all, or they may be minimal - minor changes in urine tests.

The main symptoms of pyelonephritis in women and men:

Deterioration of health, fatigue and weakness, more pronounced in the morning, decreased mood, headaches.
Temperature rise, not higher than 38 C, usually in the evening, for no apparent reason.
Frequent urination, especially at night.
Increased blood pressure. During remission, this may be the only symptom.
Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.
Lower back pain is often mild, aching, and usually asymmetrical. It has been noticed that pain often appears not on the affected side, but on the opposite side. There may be a feeling of discomfort and heaviness in the lower back, especially when walking or standing for long periods of time. Patients complain that their lower back is cold and try to dress warmer. Severe or cramping pain is more typical for urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.

In the remission stage, all symptoms of pyelonephritis are minimal, but the longer pyelonephritis is present, the higher the likelihood of arterial hypertension, cardiac hypertrophy, the development of chronic renal failure and secondary dystrophic changes in the kidneys. In the later stages, polyneuritis, bone pain, hemorrhages, polyuria with the release of up to 3 or more liters of urine with thirst and dry mouth, and anemia may occur.

Complications

As chronic pyelonephritis progresses, it develops. It manifests itself as an increase in the amount of daily urine and especially the nightly portion, a decrease in the density of urine, thirst, and dry mouth.

A sharp exacerbation of chronic pyelonephritis may be accompanied by the development of acute renal failure.

Diagnostics

Acute and chronic pyelonephritis is diagnosed based on patient complaints and clinical picture diseases. The doctor finds out whether attacks of acute pyelonephritis, cystitis, inflammation of the urinary tract and kidneys were suffered in childhood or during pregnancy in women.

When interviewing men Special attention focuses on injuries to the spine, bladder and inflammation of the genitourinary organs. The doctor identifies the presence of factors that predispose to the occurrence of pyelonephritis - the presence chronic diseases(prostate adenoma, diabetes mellitus, etc.).

Differential diagnosis is carried out with a number of such diseases:

Hypertension. Elderly people are susceptible to the disease; there are no changes in blood and urine.
Chronic glomerulonephritis. In pathology there are no active leukocytes and pathogens, but red blood cells are present.
Amyloidosis of the kidneys. There are no bacteria or signs of inflammation. The disease is characterized by the presence of foci of infection and scanty urine sediment.
Diabetic glomerulosclerosis. Accompanying diabetes mellitus, manifested by signs of angiopathy.

Examining a patient with chronic pyelonephritis in this way will help to avoid medical errors and prescribe effective treatment.

How to treat chronic pyelonephritis?

Therapy should be aimed at eliminating the following problems:

elimination of the reasons that caused the violation normal functioning kidney;
use of antibacterial medications and other drugs;
increasing immunity.

Most effective medicines are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.

Drug treatment

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 the performed laboratory tests. If the patient’s condition is severe, he is prescribed combinations antibacterial agents, they are administered parenterally or intravenously and 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.

Typically, the following drugs are used to treat chronic pyelonephritis:

Nitrofurans – Furazolidone, Furadonin.
Sulfonamides - Urosulfan, Etazol, etc.
Nalidixic acid – Negram, Nevigramon.
Cephalosporins - Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.
Semi-synthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.
Fluoroquinolones: Levofloxacin, Ofloxacin, Tsiprinol, Moxifloxacin, etc.
Antioxidant therapy is reduced to taking Tocopherol, Ascorbic acid, Retinol, Selena, etc.
Aminoglycosides are used in severe cases of the disease - Kanamycin, Gentamicin, Kolimycin, Tobramycin, Amikacin.

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.

Physiotherapeutic treatment

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 smooth muscles renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

Physiotherapeutic treatment is used in complex therapy chronic pyelonephritis.

Spa treatment

It makes sense, since the healing effect of mineral water is quickly lost when bottled. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

Damp cold, smoking and alcohol adversely affect the course of pyelonephritis. And regular examinations with monitoring of urine tests, and preventive courses of treatment contribute to long-term remission and prevent the development of renal failure.

Diet and nutrition rules

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

cereals, dairy products and vegetarian dishes;
watermelons, melons and pumpkin dishes;
increase fluid intake to 2.5 liters;
include a small amount of meat or fish broth in the diet;
fish and meat not fatty varieties boil or steam only;
fresh and boiled vegetables and fruits;
Horseradish, garlic and radish should be excluded from the diet;
Limit salt intake per day to 8 grams.

A balanced diet promotes rapid recovery. When the disease worsens, 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.

Prevention

Even in the absence of signs of active infection, it is necessary to periodically (once a year or every six months) examine the function of a previously affected kidney. In the presence of frequent exacerbations recommended for women long-term use antibacterial agents in low doses (biseptol or furadonin).

All pregnant women require a bacteriological examination of urine in the first trimester. If bacteriuria is detected, treatment is carried out with penicillins or nitrofurans.

To prevent exacerbations, it is also recommended to carry out 10-day antibacterial courses, and then a course of herbal medicine is carried out for 20 days (a decoction of bear’s ear grass, birch leaves, horsetail, juniper fruits, cornflower flowers). It is necessary to carry out several such courses; it is recommended to change the antibacterial agent every month.

Chronic pyelonephritis is a disease that begins and spreads unnoticed, without causing any inconvenience to the person. Symptoms of the disease appear gradually.

The disease is a consequence of untreated acute phase pyelonephritis and lasts up to 15 years or more. Inflammatory process, affecting one kidney, often affects the second. The kidneys decrease in volume, they outer layer becomes loose and uneven.

Subsequently, if there is no response to symptoms, the organs shrink and necrosis of their tissue occurs. Chronic pyelonephritis can exist as an independent disease and as a consequence of another. According to statistics, women get sick more often than men, which is explained by the short urinary canal.

Symptoms and forms

The mechanism of pyelonephritis is based on the reflux of urine infected with bacteria into the pelvis. Inflammation begins, moving from the walls of the pelvis to the medulla and cortex of the kidneys. The disease is characterized by sluggish symptoms or their complete absence.

The pattern of symptoms may vary significantly between patients. This is explained by the presence of one or another form of pyelonephritis.

With the latent form, there are no specific symptoms, but minor manifestations of the following signs are observed:

Fatigue,
Dull pain in the side and lower back (Pasternatsky's symptom),
Slight increase in temperature
Headache,
General malaise.

Sometimes the clinic is characterized by a slight increase in blood pressure and mild anemia.

At this stage, the kidneys lose their ability to concentrate urine.

Urinalysis shows periodic sedimentation of leukocytes and bacteria.
The anemic form has already pronounced symptoms:

tingling sensation in the heart area,
dyspnea,
pale skin,
pronounced weakness.

The hypertensive form is characterized by arterial hypertension.
In addition to the previous ailments:

dizziness,
insomnia,
hypertensive crises,
stabbing pain in the heart.

The azothermic form of pyelonephritis is a disease that manifests itself already with the onset of chronic renal failure. In fact, this is an untreated latent form.

Recurrent form – phases of relapse and remission, which replace each other depending on the conditions of the person’s stay.
Symptoms of this form:

Temperature increase,
Chills,
Discomfort in the lower back,
Frequent urge to go to the toilet,
Pain when urinating.

The period of exacerbation is nothing more than acute pyelonephritis. With the development of a recurrent form, hypertensive or anemic syndrome often occurs.

Based on the nature of inflammation, the disease is divided into the following phases:

Active inflammation
Latent inflammation
Remission.

Inflammation in the active phase, in the absence of proper treatment or with improper therapy, is replaced by a latent state, which flows either into remission or back into the inflammatory process.

Remission is a clinical recovery when the patient is not tormented by signs of pyelonephritis, and urine tests do not show any changes.
The duration of the remission period depends on the therapy and lifestyle of the patient.

Causes

The first cause of pyelonephritis is microorganisms that enter the active stage due to improper hygiene, incorrect use of antibacterial agents, and changes in the pH environment.
The disease is caused by the most common types of bacteria:

Proteus,
Escherichia coli,
Staphylococci and streptococci,
Enterococci,
Pseudomonas aeruginosa and others.

L-types of microorganisms influence the occurrence of the disease because they can persist in human tissues for a long time and enter the kidneys with the blood.

Such microbes are resistant to antibiotics, and when favorable conditions begin to actively lead their life activities.

Chronic pyelonephritis can be a consequence of existing diseases:

The onset of the disease in women can be caused by pregnancy, childbirth, and sexual activity.
Medical procedures - cystoscopy, catheterization, anesthesia and others - also often provoke the onset of the disease.
Children suffer from this disease due to congenital pathologies– ureterocele, bladder diverticula.

Diagnosis of primary and secondary pyelonephritis

Diagnosis is somewhat difficult, and the course of the disease is very mild. Only detailed questioning about symptoms and laboratory research help establish the correct diagnosis.
To make a diagnosis, the following diagnostic methods are used:

General analysis of urine and blood,
Bacteriological culture,
Blood chemistry,
Kidney biopsy.

For diagnostic purposes, pyelography and renography are performed. The patient is prescribed a catheterization to determine the amount of protein and blood enzymes that are precipitated.

These methods make it possible to establish the primary or secondary nature of pyelonephritis.
Primary develops in people who complain of kidney problems for the first time.

Secondary chronic pyelonephritis is diagnosed if a person has already suffered kidney-related diseases or has congenital renal pathologies.

The causes of the secondary manifestation of the disease are the same factors as in primary pyelonephritis.

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Treatment

Treatment requires a long time, compliance with all the specialist’s instructions, and proper nutrition.
The best results will come from comprehensive treatment, including eliminating the causes, causing disease, and lifestyle changes.
To the complex therapeutic measures includes:

The disease is bacterial, taking antibiotics becomes mandatory. The doctor prescribes antibiotics based on the tests obtained, which reveal the sensitivity of microbes to certain drugs.

Antibacterial therapy involves taking penicillins:

amoxicillin,
methicillin,
oxacillin,

Depending on the sensitivity of bacteria to antibiotics, cephalosporin drugs may be prescribed:

cefazolin,
ceftriaxone,
cephalexin.

As additional antimicrobial agents sulfonamides are prescribed:

urolesan,
groseptol,
lidaprim.

Along with antibiotics, they are prescribed vitamin complexes, antiallergic drugs – diazolin, suprastin.

For anemic pyelonephritis, iron intake is indicated, and hypertensive type illness requires treatment antihypertensive drugs and antispasmodics.

After the main antimicrobial therapy, long-term treatment against relapses with alternating use of different antibiotics.

Surgical treatment of the disease is carried out in the following cases:

disturbance of urine outflow,
reflux into the ureter from the bladder,
the presence of kidney stones,
prostate adenomas.

To speed up recovery and prevent relapses, patients are advised to use physiotherapeutic methods of treatment:

electrophoresis,
galvanization,
sodium baths.

Nutrition

Diet plays a big role in maintaining kidney function.
Medical nutrition implies adherence to the following rules:

Refusal of spicy, fried, pickled foods, coffee, broths, alcohol;
It is allowed to eat dairy products, cereals, stewed vegetables, fruits, lean meat, fish;
During the day you should drink 2 liters of water and other liquids (tea, compote, mineral water). During a relapse, fluid intake should be reduced;
At hypertensive form you should reduce the use of salt in food, or avoid salt altogether;
Diuretic products are shown - melon, pumpkin.

Sometimes alternate adherence to different specific diets is prescribed. For example, for several days the patient eats acidifying foods - meat, bread products. Uses the next few days alkaline foods– vegetables, fruits, milk.

Such a change in food changes acid-base balance urine, which negatively affects bacteria.

Medical nutrition should be coordinated with the attending physician, who, if necessary, adjusts the diet.

Complications

Negligent attitude towards oneself during pyelonephritis is fraught with complications.
Lack of treatment causes replacement of healthy kidney tissue with coarse connective tissue, as a result of which the organs cannot function fully.

It is important to prevent chronic bilateral pyelonephritis, as it leads to renal failure.
Very dangerous complication Pyonephrosis is considered when the kidney is filled with thick pus.
Secondary hypertension is another complication that is quite difficult to treat. If the body is severely weakened, sepsis is possible.

Preventing chronic pyelonephritis is always easier than treating it. After all preventive measures quite simple - regular medical checkup and control, avoiding contact with cold surfaces, being sensitive to yourself.

If the diagnosis is made, the prognosis is favorable - every fifth patient, with proper comprehensive treatment, gets rid of the disease completely.