Chronic pyelonephritis is a pathology of the renal tissue (code N11 according to ICD-10), which is provoked by disease-causing agents, lasting for years, aggravated when the immune system is weakened.

Exacerbation of chronic pyelonephritis

Morbidity statistics show that the disease is common, and after death it is recorded in every tenth. Among women, the disease is more common, which is caused by a short urethra in comparison with men.

Chronic pyelonephritis (ICD 10 code - N11) is able not to manifest itself for a long time, to proceed hidden. In this form, the disease sometimes persists until death, which occurs from causes not related to kidney disease.

With stones, narrowing of the urinary canals, urinary retention, decreased immunity, the disease can become more active and progress.

Causes

The reason for the recurrence of chronic pyelonephritis is the weakening of the immune system, a long stay in the cold, infection. E. coli, enterococci, staphylococcus, streptococcus, fungi, viruses, Pseudomonas aeruginosa provoke a relapse.

During pregnancy, 85% of women develop chronic pyelonephritis from E. coli. In pregnant women, Klebsiella, Proteus, and Pseudomonas aeruginosa are also found.

Pathogenic microorganisms are activated:

• hypothermia;
• climate change;
• irrational nutrition;
• diabetes
• hepatitis.

Symptoms

Exacerbations of inflammation of the kidneys are accompanied by:

• pains;
• temperature;
• edema;
• intoxication;
• violation of urination;
• pressure increase;
• anemia.

The temperature may not rise above 37.2 0 C, but sometimes there is a fever of 39 0 C with chills. High temperature is observed infrequently, usually in patients there is an increase in temperature to subfebrile condition in the evening, signs of intoxication with a relapse of chronic pyelonephritis are erased.

Exacerbation of chronic pyelonephritis manifests as dull pain in the lower back, lateral parts of the abdomen, radiating to the groin, the front side of the thigh. Pain in chronic pyelonephritis is sometimes very similar to the sensations in sciatica, gastritis, cystitis, inflammation of the ovaries.

To confirm the renal origin of the pain, you can use the Tofilo symptom. For the test, the patient is asked to lie on his back, bend his leg at the knee, press it to his chest while inhaling. If the pain in this position increases, then this increases the likelihood of chronic pyelonephritis.

Indirect signs of exacerbation are swelling of the face after sleep, fever, pressing nature of pain in the lower back. An exacerbation of chronic pyelonephritis is accurately diagnosed using ultrasound, laboratory tests of urine and blood.

Hypertension is noted in 75% of those suffering from chronic pyelonephritis. At the beginning of the disease, pressure increases appear only during periods of exacerbations, but over time, hypertension becomes a frequent occurrence for patients, and in 10% of patients it takes a complicated course.

Violation of daily urination is manifested by:

• nocturia.

During periods of exacerbation, there is a decrease in the specific gravity of urine, the presence of protein, leukocytes in the urine. When urinating, pain may be felt.

Exacerbation of chronic pyelonephritis causes a decrease in the production of erythropoietin, which causes anemia. During pregnancy, chronic pyelonephritis often worsens in the 2nd trimester. There is a risk of exacerbation 3 weeks after birth.

First aid

With exacerbation of chronic pyelonephritis, it is necessary to limit the mode of physical activity. With high blood pressure, acute pain, bed rest is recommended, it is only allowed to get up to visit the toilet and the dining room.

With severe pain, you should immediately call a doctor at home. You can not put a heating pad on the patient, give painkillers or offer to drink plenty of fluids. You need to wait for the arrival of the doctor.

Treatment

They treat with exacerbation with antibiotics, sulfonamides, nitrofurans, supplementing drug therapy with phytotherapy. Antibiotics are prescribed according to the results of bacterial culture.

Antibiotics are prescribed for kidney infection:

• coli - ampicillin, cephalosporin, chloramphenicol;
• proteem - ampicillin, carbenicillin, gentamicin;
• Pseudomonas aeruginosa - gentamicin, carbenicillin;
• enterococcus - ampicillin, carbenicillin;
• Staphylococcus aureus - penicillins, ampicillin;
• streptococcus - penicillins, cephalosporins;
• mycoplasmas - erythromycin.

In addition to antibiotics, derivatives are used to treat relapses of chronic pyelonephritis:

• nitrofuran - furazolidone, furadonin, furagin;
• nalixic acid - navigramone, blacks;
• 8-hydroxyquinoline - nitorxoline, 5-NOC.

An operation is necessary if the exacerbation is caused by apostema,. The purpose of the operation is to drain the kidney, aimed at restoring the outflow of urine.

Treatment during pregnancy

The task of treating exacerbation of pyelonephritis during pregnancy is becoming more complicated, the requirements for the safety of the drug are increasing. How to treat depends on the pathogenic flora, while the treatment should be absolutely safe for the fetus.

Treatment is carried out in a hospital, the course lasts 2 weeks. Treatment begins with intravenous administration of drugs, later switching to oral tablets. Do not use furazolidone, biseptol, chloramphenicol, tetracycline, fluoroquinolone, streptomycin during pregnancy because of the risk to the fetus.

The drug of choice for solving this problem is the inhibitor-protected penicillin ampicillin + sulbactam, amoxicillin + clavunate. Macrolides, cephalosporins are used during pregnancy.

Cefazosporins during pregnancy are used:

• the first 2 trimesters - 2nd generation drugs Cefaclor, Cefuroxime;
• in the 3rd trimester - preparations of 3rd, 4th generations Cedex, Maxipin, Fortum.

If the exacerbation is caused by Pseudomonas aeruginosa, cefaperazone + sulbactam, ceftazidime is used. In case of allergy to penicillins, cephalosporins, aztreon is the reserve drug. The drug is prescribed strictly according to indications, with caution.

With a particularly difficult course of exacerbation, thienams (carbapenems) are used. A feature of the treatment of chronic pyelonephritis is the abolition of sulfonamides and nitrofurans 20 days before delivery due to the possibility of complications in the fetus. Do not prescribe ototoxic antibiotics (gentamicin) that cause hearing damage to the fetus.

With lactation

Aztreonam, gentamicin, furadonin, furagin, cephalosporins cefaclor, ceftributen practically do not penetrate into breast milk. This allows medication to be used without interrupting breastfeeding.

Temporarily stop breastfeeding during treatment with antibiotics from the group of fluoroquinolones - ofloxacin, ciprofloxacin, perfloxacin.

Herbal preparations

You can use for treatment both herbal preparations Fitonefrol, Kanefron N, and medicinal herbs, fees for preparing decoctions.

The preparation contains lovage, rosemary, centaury. They take the medicine in a course, it enhances the effect of antibiotics that are used in the main therapy, is an aseptic, diuretic, and has an anti-inflammatory effect.

The use of Kanefron can reduce proteinuria, reduce protein loss in the urine due to a decrease in the permeability of blood capillaries.

Medicinal plants that are used to prepare decoctions at home for chronic pyelonephritis should have the following properties:

• anti-inflammatory - bearberry, lingonberry, chamomile, St. John's wort, marshmallow, nettle;
• - birch leaves, juniper, parsley, kidney tea, cornflower flowers, corn silk, elecampane, bearberry.

Diet Features

In chronic pyelonephritis in the acute stage, diet No. 7 is recommended, in which:

• sharply reduce the amount of salt (or exclude on the recommendation of a doctor);
• protein products are slightly limited;
• increases plant foods containing vitamin C, thiamine, riboflavin, iron, nicotinic acid, potassium, magnesium;
• seasonings, smoked meats are excluded;
• food is prescribed up to 6 times a day;
• drinking regime during exacerbation - up to 1.5 l / day.

Prevention of exacerbations lies in the fact that the diet includes foods high in iron (raspberries, pomegranates, apples), potassium (dried apricots, raisins, figs). It is recommended for the period of illness a dairy-vegetarian diet with a small amount of additions in the form of boiled meat, fish.

On the video about the symptoms and treatment of exacerbation of chronic pyelonephritis:

Pyelonephritis is an inflammation of the kidneys that occurs in acute or chronic form. The disease is quite widespread and very dangerous to health. Symptoms of pyelonephritis include pain in the lumbar region, fever, severe general condition and chills. Occurs most often after hypothermia.

It can be primary, that is, it develops in healthy kidneys, or secondary, when the disease occurs against the background of already existing kidney diseases (glomerulonephritis, etc.). There are also acute and chronic pyelonephritis. Symptoms and treatment will directly depend on the form of the disease.

It is the most common kidney disease in all age groups. More often they suffer from young and middle-aged women - 6 times more often than men. In children, after diseases of the respiratory system (,) takes second place.

Causes of pyelonephritis

Why does pyelonephritis develop, and what is it? The main cause of pyelonephritis is infection. Infection refers to bacteria such as E. coli, Proteus, Klebsiella, Staphylococcus and others. However, when these microbes enter the urinary system, the disease does not always develop.

In order for pyelonephritis to appear, contributing factors are also needed. These include:

1. Violation of the normal flow of urine (urine reflux from the bladder to the kidney, "neurogenic bladder", prostate adenoma);
2. Violation of the blood supply to the kidney (deposition of plaques in the vessels, vasospasm with, diabetic angiopathy, local cooling);
3. Immune suppression (treatment with steroid hormones (prednisolone), cytostatics, immunodeficiency as a result);
4. Pollution of the urethra (non-compliance with personal hygiene, with incontinence of feces, urine, during sexual intercourse);
5. Other factors (decrease in secretion of mucus in the urinary system, weakening of local immunity, impaired blood supply to the mucous membranes, urolithiasis, oncology, other diseases of this system and, in general, any chronic diseases, reduced fluid intake, abnormal anatomical structure of the kidneys).

Once in the kidney, microbes colonize the pelvicalyceal system, then the tubules, and from them - the interstitial tissue, causing inflammation in all these structures. Therefore, you should not put off the question of how to treat pyelonephritis, otherwise severe complications are possible.

Symptoms of pyelonephritis

In acute pyelonephritis, the symptoms are pronounced - it starts with chills, when measuring body temperature, the thermometer shows over 38 degrees. After a while, aching pain in the lower back appears, the lower back "pulls", and the pain is quite intense.

The patient is disturbed by the frequent urge to urinate, very painful and indicating accession and. Symptoms of pyelonephritis may have general or local manifestations. General signs are:

• High intermittent fever;
• Severe chills;
• Sweating, dehydration and thirst;
• Intoxication of the body occurs, as a result of which the head hurts, fatigue increases;
• Dyspeptic symptoms (nausea, no appetite, stomach ache, diarrhea appears).

Local signs of pyelonephritis:

1. Pain in the lumbar region, on the affected side. The nature of the pain is dull, but constant, aggravated by palpation or movement;
2. The muscles of the abdominal wall may be tense, especially on the affected side.

Sometimes the disease begins with acute cystitis - rapid and, pain in the bladder area, terminal hematuria (appearance of blood at the end of urination). In addition, general weakness, weakness, muscle and headache, lack of appetite, nausea, and vomiting are possible.

If these symptoms of pyelonephritis appear, you should consult a doctor as soon as possible. In the absence of competent therapy, the disease can turn into a chronic form, which is much more difficult to cure.

Complications

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

Treatment of pyelonephritis

In primary acute pyelonephritis, in most cases, the treatment is conservative, the patient must be hospitalized in a hospital.

The main therapeutic measure is the impact on the causative agent of the disease with antibiotics and chemical antibacterial drugs in accordance with the data of the antibiogram, detoxification and immunity-enhancing therapy in the presence of immunodeficiency.

In acute pyelonephritis, treatment should begin with the most effective antibiotics and chemical antibacterial drugs, to which the microflora of the urine is sensitive, in order to eliminate the inflammatory process in the kidney as quickly as possible, preventing it from turning into a purulent-destructive form. In secondary acute pyelonephritis, treatment should begin with the restoration of urine massage from the kidney, which is fundamental.

Treatment of the chronic form is fundamentally the same as the acute form, but longer and more laborious. In chronic pyelonephritis, treatment should include the following main measures:

1. Elimination of the causes that caused the violation of the passage of urine or renal circulation, especially venous;
2. The appointment of antibacterial agents or chemotherapy drugs, taking into account the data of the antibiogram;
3. Increasing the immune reactivity of the body.

Restoration of urine outflow is achieved primarily by the use of one or another type of surgical intervention (removal of prostate adenoma, stones from the kidneys and urinary tract, nephropexy with, plastic of the urethra or ureteropelvic segment, etc.). Often, after these surgical interventions, it is relatively easy to obtain a stable remission of the disease without long-term antibacterial treatment. Without a sufficiently restored urine massage, the use of antibacterial drugs usually does not give a long-term remission of the disease.

Antibiotics and chemical antibacterial drugs should be prescribed taking into account the sensitivity of the patient's urine microflora to antibacterial drugs. To obtain antibiogram data, antibacterial drugs with a wide spectrum of action are prescribed. Treatment for chronic pyelonephritis is systematic and long-term (at least 1 year). The initial continuous course of antibiotic treatment is 6–8 weeks, since during this time it is necessary to suppress the infectious agent in the kidney and resolve the purulent inflammatory process in it without complications in order to prevent the formation of scar connective tissue. In the presence of chronic renal failure, the appointment of nephrotoxic antibacterial drugs should be carried out under constant monitoring of their pharmacokinetics (concentration in the blood of urine). With a decrease in the indicators of humoral and cellular immunity, various drugs are used to increase immunity.

After the patient reaches the stage of remission of the disease, antibiotic treatment should be continued in intermittent courses. The timing of interruptions in antibacterial treatment is set depending on the degree of kidney damage and the time of onset of the first signs of an exacerbation of the disease, i.e., the onset of symptoms of the latent phase of the inflammatory process.

Antibiotics

Medicines are selected individually, taking into account the sensitivity of the microflora to them. The most commonly prescribed antibiotics for pyelonephritis are:

• penicillins with clavulanic acid;
• 2nd and 3rd generation cephalosporins;
• fluoroquinolones.

Aminoglycosides are undesirable because of their nephrotoxic effects.

How to treat pyelonephritis with folk remedies

Home treatment of pyelonephritis with folk remedies must necessarily be accompanied by bed rest and a healthy diet, consisting mainly of plant foods in raw, boiled or steam form.

1. During the period of exacerbation, such a collection helps. Mix equally taken white birch leaves, St. John's wort and knotweed grass, calendula flowers, fennel fruits (dill). Pour in a thermos 300 ml of boiling water 1 tbsp. l. collection, insist 1-1.5 hours, strain. Drink warm infusion in 3-4 doses 20 minutes before meals. The course is 3-5 weeks.
2. Outside of an exacerbation of the disease, use a different collection: knotweed herb - 3 parts; herb yasnotki (deaf nettle) and grass (straw) oats, leaves of sage officinalis and round-leaved wintergreen, rose hips and licorice roots - 2 parts each. Take 2 tbsp. l. collection, pour 0.5 l of boiling water in a thermos, leave for 2 hours and strain. Drink a third cup 4 times a day 15-20 minutes before meals. The course is 4-5 weeks, then a break for 7-10 days and repeat. In total - up to 5 courses (until stable results are obtained).

Diet

With inflammation of the kidneys, it is important to observe bed rest and a strict diet. Drink enough fluids to stop dehydration, which is especially important for pregnant women and people over 65.

With inflammatory processes in the kidneys, it is allowed: lean meat and fish, stale bread, vegetarian soups, vegetables, cereals, soft-boiled eggs, dairy products, sunflower oil. In small quantities, you can use onions, garlic, dill and parsley (dried), horseradish, fruits and berries, fruit and vegetable juices. Forbidden: meat and fish broths, smoked meats. You also need to reduce the consumption of spices and sweets.

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How to treat chronic pyelonephritis in women and men at home?

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. According to medical statistics, about 20% of the population suffer from pyelonephritis.

In childhood, from 2 to 15 years, girls are more likely to suffer from it; in old age, the disease affects more men. Despite this, pyelonephritis is considered a predominantly female disease due to the anatomical location of the genitourinary organs and other functional features of the female body.

What it is?

Chronic pyelonephritis is a disease of an infectious-inflammatory nature in which the calyces, pelvises and tubules of the kidneys are involved in the pathological process, followed by damage to their glomeruli and blood 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 - E. coli, staphylococcus aureus, enterococci, proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis, forms of microbes that are resistant to negative factors and antibiotics are especially relevant. They can persist for a long time in the region 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 of an acute form of pyelonephritis, non-compliance by the patient with the clinical recommendations of a doctor, disruption of dispensary observation of a child or adult;
• untimely diagnosis and treatment of diseases that violate the outflow of urine (, nephroptosis, vesicoureteral reflux, congenital anomalies of 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 be inactive for a long time in the renal tissue, but cause an exacerbation with a decrease in protective forces or 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, predominantly bottle-fed;
• girls during the onset of sexual activity;
• people in old age.

These patients are most indicated for the prevention of chronic pyelonephritis.

Classification

Forms of chronic pyelonephritis:

1. latent form. It is characterized by minor clinical manifestations. The patient may be disturbed by general weakness, fatigue, headache, sometimes the temperature may rise slightly. As a rule, lower back pain, edema and dysuria are absent, although some have a positive Pasternatsky symptom (pain when tapping in the lumbar region). In the general analysis of urine, a slight proteinuria is detected, leukocytes and bacteria can be excreted in the urine periodically. With a latent course, the concentration ability of the kidneys is usually impaired, therefore, a decrease in urine density and polyuria are characteristic. Sometimes you can find moderate anemia and a slight increase in blood pressure.
2. relapsing form. The change of periods of exacerbation and remission is characteristic. The patient may be disturbed by discomfort in the lower back, chills, fever. Dysuric phenomena appear (frequent urination, sometimes painful).
3. Azotemic form. There are those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of the already existing, but not timely detected latent course of the disease. It is the azotemicheskaya form that is characteristic of chronic renal failure.
4. hypertonic form. Arterial hypertension predominates. There are headache, dizziness, sleep disturbance, stabbing pains in the projection of the heart, frequent hypertensive crises, shortness of breath. Changes in the urine are not very pronounced and are not permanent. Hypertension in pyelonephritis is often malignant.
5. anemic form. It is characterized by the fact that among the signs of the disease, 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. Violations in urination are mild.

Exacerbation of chronic pyelonephritis clinically resembles a picture of acute inflammation. As the process progresses, the leading syndrome becomes hypertensive, which is manifested by headache, dizziness, visual impairment, pain in the heart. Sometimes, as a result of long-term pyelonephritis, an 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 the process of inflammation, swelling of the connective tissues of the inner layer of the urinary organ, as a result of which the vessels are compressed, atrophy of the tubules appears, renal bleeding decreases;
• the second degree is detected by means of a nephrogram, where diffuse narrowing of the arterial renal bed is noted, the size of the cortical substance becomes smaller, there are no interlobar arteries;
• the third degree in pyelonephritis is expressed by narrowing and changing the shape of all vessels of the urinary organ, the renal tissue is replaced by scar tissue, the kidney becomes wrinkled.

Symptoms

The degree of manifestation of symptoms of pyelonephritis depends on the localization of inflammation (on one side or both kidneys), on the degree of inflammation activity, on the accompanying obstructions to the outflow of urine and previous treatment. In 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:

1. Deterioration of health, weakness and weakness, more pronounced in the morning, decreased mood, headaches.
2. Temperature rise, not higher than 38 C, usually in the evening, for no apparent reason.
3. Frequent urination, especially at night.
4. Increase in blood pressure. During remission, this may be the only symptom.
5. Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.
6. Lower back pain is often non-intense, aching, usually asymmetrical. It is noticed that often the pain does not appear on the affected side, but on the opposite side. There may be a feeling of discomfort, heaviness in the lower back, especially when walking or standing for a long time. Patients complain that the lower back is cold, tend to dress warmer. Severe or cramping pains are rather typical of 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 remission, all symptoms of pyelonephritis are minimal, but the longer there is pyelonephritis, 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, hemorrhage, polyuria with the release of up to 3 or more liters of urine with thirst and dry mouth, anemia may occur.

Complications

With the progression of chronic pyelonephritis develops. It is manifested by an increase in the amount of daily urine and especially the night portion, a decrease in the density of urine, thirst, 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 on the basis of patient complaints and the clinical picture of the disease. The doctor finds out whether attacks of acute pyelonephritis, cystitis, inflammation of the urinary tract and kidneys were tolerated in childhood or during pregnancy in women.

When interviewing men, special attention is paid to past injuries of the spine, bladder and inflammation of the urogenital organs. The doctor detects the presence of factors that predispose to the occurrence of pyelonephritis - the presence of chronic diseases (prostate adenoma, diabetes mellitus, etc.).

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

1. Hypertension. The disease affects the elderly, there are no changes in the blood and urine.
2. Chronic glomerulonephritis. In pathology, there are no active leukocytes and pathogens, but erythrocytes are present.
3. Amyloidosis of the kidneys. Bacteria and signs of inflammation are absent. The disease is characterized by the presence of foci of infection and poor urine sediment.
4. Diabetic glomerulosclerosis. Accompanying diabetes mellitus, manifested by signs of angiopathy.

Examination of 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 such problems:

• elimination of the causes that caused a violation of the normal functioning of the kidneys;
• the use of antibacterial medicines and other medicines;
• boosting immunity.

The most effective drugs are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.

Medical treatment

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

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

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

1. Nitrofurans - Furazolidone, Furadonin.
2. Sulfonamides - Urosulfan, Etazol, etc.
3. Nalidixic acid - Negram, Nevigramone.
4. Cephalosporins - Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.
5. Semi-synthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.
6. Fluoroquinolones: Levofloxacin, Ofloxacin, Ciprinol, Moxifloxacin, etc.
7. Antioxidant therapy comes down to taking Tocopherol, Ascorbic acid, Retinol, Selenium, etc.
8. Aminoglycosides are used in severe cases of the disease - Kanamycin, Gentamicin, Colimycin, Tobramycin, Amikacin.

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

Physiotherapy treatment

Physiotherapy techniques have the following effects:

• increase the blood filling of the kidney, increase the renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
• relieve spasm of smooth muscles of the renal pelvis and ureters, which contributes to the discharge of mucus, urinary crystals, bacteria.

Physiotherapy treatment is used in the complex therapy of chronic pyelonephritis.

Spa treatment

It makes sense, as 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.

Raw 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 a serious attitude to the diet. Recommended:

• cereals, dairy products and vegetarian dishes;
• watermelons, melons and pumpkin dishes;
• increase fluid intake to 2.5 liters;
• include in the diet a small amount of meat or fish broths;
• boil fish and meat of non-fatty varieties, or cook only for a couple;
• 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 a quick recovery. With an exacerbation of the disease, fresh fruits and vegetables, as well as at least 2 liters of liquid, should be included in the diet. Unacceptable in the diet - fried, spicy, fatty and salty foods.

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 in women, long-term use of antibacterial agents in low doses (biseptol or furadonin) is recommended.

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

As a preventive measure for exacerbations, it is also recommended to conduct 10-day antibacterial courses, and then for 20 days a course of herbal medicine is carried out (a decoction of bear's eye grass, birch leaves, horsetail, juniper fruits, cornflower flowers). It is necessary to conduct several such courses, every month it is recommended to change the antibacterial agent.

Pyelonephritis is a disease in which an inflammatory process of the renal system occurs. It can be chronic as a result of repeated exacerbations. ICD 10 disease code - N11. This disease affects both men and women at any age. Therefore, what is chronic pyelonephritis, its symptoms and treatment should be considered in detail.

Causes of pyelonephritis

This disease develops as a result of such ailments:

• hormonal imbalance;
• promiscuity;
• infectious diseases of the genitourinary system;
• immune system disorders;
• nervous strain and regular stressful situations;
• hypothermia of the body, especially in the lumbar region;
• diabetes.

Chronic pyelonephritis in women also occurs due to gynecological diseases, so they are more susceptible to kidney damage than men.

Important to remember! Chronic pyelonephritis of the kidneys is a consequence of an untreated acute disease! Therefore, timely therapy is required.

Symptoms of the disease

Pyelonephritis of a chronic nature quite often proceeds without tangible signs. Only during periods of exacerbation are more pronounced ailments observed. The following signs will help identify the disease:

• dull pain in the lumbar region, especially during moments of physical activity;
• violations of the process of urination;
• rapid overwork of the body;
• intermittent loss of appetite;
• increased blood pressure;
• slight increase in body temperature.

The late stage of pyelonephritis is characterized by the following symptoms:

• constant thirst;
• pain in the lumbar region begins to manifest itself more pronounced;
• heartburn;
• swelling of the face;
• the skin turns pale;
• frequent urination.

The disease in children is difficult to identify. After all, its signs have a latent course. Diagnosis is carried out with the help of laboratory tests and a detailed survey of parents for uncharacteristic behavior for the child.

Important to remember! At the first symptoms of the disease, you need to consult a specialist!

This disease is classified according to several aspects. According to the number of exacerbations, the following types are distinguished:

1. Primary pyelonephritis. Occurs as an exacerbation of the disease. It is the cause of the appearance of the disease in a chronic form, if it is not completely cured or therapy is ignored. Therefore, acute and chronic pyelonephritis are interrelated.
2. Secondary chronic pyelonephritis. It is formed against the background of previous infectious diseases of the genitourinary system. Initially, only one kidney is affected, but after a few years, with insufficient treatment, the second kidney also ceases to function normally.

According to the degree of complexity of the disease, the following types are distinguished:

1. Chronic calculous pyelonephritis. This is one of the most difficult diseases. It is characterized by the occurrence of kidney stones. There are sharp pains in the kidney area. If treatment is not started on time, then this type of ailment can lead to fatal consequences.
2. Non-obstructive chronic pyelonephritis associated with reflux. It is a chronic inflammatory process of the kidney membrane with its damage. It occurs quite rarely.
3. Chronic obstructive pyelonephritis. It is a consequence of congenital pathologies of the kidneys.

Important to remember! Timely treatment of the disease at an early stage will help to avoid complications in the future!

Treatment of the disease

How to treat chronic pyelonephritis? Therapy should be aimed at eliminating such problems:

• elimination of the causes that caused a violation of the normal functioning of the kidneys;
• the use of antibacterial medicines and other medicines;
• boosting immunity.

The most effective drugs are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.

Important to remember! Only a specialist can prescribe drug therapy! You should not choose medicines for treatment on your own.

Treatment of chronic pyelonephritis in the acute stage

During the period of exacerbation of the disease, it is very important to choose such drugs that are quickly excreted from the body. Since during this period there may be problems with urine excretion, it is necessary to include in drug therapy the intake of antibacterial drugs that affect not only the kidneys, but also the genitourinary system.

The treatment does not end there: in parallel, it is required to take antibiotics that have an anti-inflammatory effect. You can also include the use of alternative medicine to avoid re-exacerbation.

The entire period of treatment and rehabilitation is required to observe a special diet. The diet includes the use of low-fat vegetable soups, black bread, various cereals, dairy products, juices. Smoked dishes, meat soups, sugar, honey, jam should be excluded from the diet.

Disease during pregnancy

How to cure pyelonephritis during pregnancy? Most often, chronic pyelonephritis develops in a woman long before pregnancy. This condition is not the cause of its occurrence, but contributes to active development. What to do if exacerbations are observed during pregnancy? Expectant mothers are more prone to pyelonephritis than others due to a weakened immune system.

Since many drugs are contraindicated during pregnancy, the doctor should prescribe the safest possible means. The most suitable in this situation are Monural and Amoxiclav.

Symptoms in pregnant women can be relieved with medication. That is, at elevated body temperature, you should drink an antipyretic, after consulting with a specialist.

Army and chronic pyelonephritis

Many young people are interested in the question: do they take to the army with such a diagnosis? In order to answer this question, a number of tests are required. Based on their results, the doctor makes a diagnosis. After that, the draft board considers the advisability of serving in the army. It all depends on the severity of the disease. With an easy stage, the likelihood that a young man will go to the army is very high.

It's important to know! If a young man has not experienced an exacerbation for 6 months, then he is fit for military service!

How to treat the disease at home? To do this, you can use traditional medicine recipes that are based on natural ingredients. Most often, medicinal herbs are used for the preparation of medicines.

oats

It will take 2 tbsp. l. dried oat grass and 0.5 liters of water. Put the ingredients on a slow fire and boil for 30 minutes. Then strain the prepared broth and take 1 glass 2 times a day.

Corn silk

You should take 1 tbsp. l. corn stigmas, pour 1 cup of boiling water, put on fire to boil for about 5 minutes. After the time has elapsed, insist 30 minutes, then strain the broth and consume 2 tbsp. l. 5 times a day.

yarrow

Requires 2 tbsp. l. yarrow herb, which should be crushed. Pour 1 cup boiling water over and steep for 1 hour. Take 50 ml of the resulting decoction 3 times a day.

Linen

To prepare the medicine, you will need flax seeds in the amount of 1 tsp. Pour in 1 cup hot water. Put on fire and boil for 5 minutes. Then insist 1 hour. After the time has elapsed, strain the broth and take 50 ml 4 times a day.

Important to remember! Before using a certain alternative medicine, you should consult a specialist!

Disease prevention

In order to avoid the appearance of chronic pyelonephritis, you should follow these rules:

• timely detection and treatment of diseases of the genitourinary system;
• elimination of chronic infections;
• elimination of stones in the kidneys or bladder;
• boosting immunity.

You should also not forget about observing the daily routine and proper nutrition, devote time to physical activity and walks in the fresh air.

Chronic pyelonephritis develops against the background of a long-term untreated acute form of the disease and can cause the development of renal failure and disability of the patient.

Chronic pyelonephritis is an infectious-inflammatory disease characterized by involvement in the pathological process of the tubules of the kidney and damage to the glomeruli and blood vessels in the future. According to medical statistics, kidney pyelonephritis in a chronic form is diagnosed in 60% of cases among possible infectious diseases of the genitourinary system and occupies a leading position as one of the causes of patient disability.

What is this disease and who is at risk?

Representatives of the weaker sex are more likely to develop chronic pyelonephritis, which is due to the peculiarities of the structure of their urethra - it is short and wide in women. Pathogenic microorganisms easily penetrate through the urethra into the bladder, and then into the kidneys, causing an inflammatory process in them.

The main difference between acute pyelonephritis and the chronic form is that in the second case, the pathological process extends to both kidneys, while acute inflammation is observed mainly on one side only (often in the right kidney). The chronic form of the disease is characterized by periods of remission and exacerbation, during which the symptoms are pronounced, as with.

If acute pyelonephritis does not recover within 3 months, then the disease gradually subsides and becomes chronic. Further, any predisposing factor will cause an exacerbation, and each exacerbation, in turn, will cause parenchymal changes in the structure of the kidneys. Gradually, changes in the structure of the organ completely disrupt its work, which is a direct path to kidney failure and disability.

Symptoms of chronic pyelonephritis

Symptoms of chronic pyelonephritis directly depend on the localization of the inflammatory process in the kidneys, on the degree of spread of inflammation to the organ (one and both kidneys at once), on the presence of concomitant complications in the form of a narrowing of the lumen of the ureters or the urethra. Signs of chronic pyelonephritis may not make themselves felt at all for many years, but meanwhile the inflammation will sluggishly spread to all tissues and parts of the kidney.

Symptoms appear brightly during the period of exacerbation of the disease and are characterized by the following:

• high body temperature (up to 38.5-39.0 degrees);
• dull pain in the lumbar region on one side or both sides;
• various dysuric phenomena - a violation of the outflow of urine, a feeling of incomplete emptying of the bladder, pain and cramps at the time of urination, a decrease in daily diuresis;
• severe headaches and increased blood pressure;
• nausea, general weakness;
• swelling of the limbs and face;
• vomiting and symptoms of general intoxication of the body;
• pale skin and rapid pulse.

Important! During the period of subsiding of severe clinical symptoms, it is very difficult to diagnose the disease, since pyelonephritis passes into a latent (hidden) form of the course.

During the period of remission, intermittent symptoms may appear, to which the patient does not pay attention:

• rare pains in the lumbar region of a dull pulling nature - they intensify after exertion, the use of salty, spicy, alcohol;
• minor dysuric phenomena - oliguria, frequent urge, discomfort during urination;
• body temperature rises to subfebrile levels (37.0-37.4), but the general condition of the patient is not disturbed;
• frequent headaches and swelling of the face and limbs in the morning, especially after eating pickles, large amounts of liquid, alcohol.

If the disease is not diagnosed for a long time and is not treated in any way, then the symptoms progress.

The patient has the following symptoms:

• itching and peeling of the skin (the skin becomes yellowish or earthy);
• secondary arterial hypertension appears;
• frequent nosebleeds.

You can learn more about how chronic pyelonephritis manifests itself in more detail on the video in this article - the information is for informational purposes and cannot replace the advice of a urologist.

Why chronic pyelonephritis develops: the main reasons

The causes of chronic pyelonephritis are directly related to kidney damage by pathogenic microorganisms. In order for the infection to enter directly into the structure of the kidneys and inflammation develops, favorable conditions are necessary for this.

Most often, the development of acute pyelonephritis, and then the chronic form, is promoted by Escherichia coli, Pseudomonas aeruginosa, amoeba proteus, streptococci and staphylococci. The development of a chronic pathological process in the kidneys is facilitated by microorganisms that are resistant to antibiotics and other drugs, and this happens in situations where the patient self-medicates or arbitrarily stops the course of therapy prescribed by the doctor, believing that he has already recovered.

Chronic pyelonephritis is always preceded by an acute inflammatory process, and the predisposing factors for the transition of the disease to chronicity are:

1. Diseases of the urinary system, which are accompanied by a violation of the outflow of urine. Such pathologies include kidney prolapse, prostate adenoma in men, urolithiasis, narrowing of the sphincter of the bladder, oncological formations in the ureters and bladder.
2. Untreated acute inflammatory process in the kidneys or self-medication. It is strictly forbidden to arbitrarily start a course of therapy or stop taking antibiotics prescribed by a doctor. Persons who have had acute pyelonephritis should be under dispensary supervision of a urologist for 3 months, as this is a critical period when the disease can secretly become chronic.
3. Immunodeficiency states - weakened individuals with weak immunity are more prone to chronic inflammation than people with a good immune response.
4. Chronic pyelonephritis often develops as a complication of tonsillitis, SARS, influenza, measles pneumonia, scarlet fever.
5. The presence of chronic inflammatory processes in the body - tonsillitis, sinusitis, sinusitis, gastritis and colitis. Carious neglected teeth can also be a source of spread of bacterial flora that causes inflammation in the kidneys.
6. In women, a predisposing factor to the development of acute and then chronic pyelonephritis is pregnancy. In the later stages, as the fetus grows in the uterus, all internal organs are compressed, including the bladder. Stagnation of urine and a violation of its outflow contributes to the multiplication of bacteria in the bladder, and with a weakened immune system, the expectant mother increases the risk of infection spreading to the kidneys.
7. Anomalies in the development of the organs of the urinary system - hydronephrosis of the kidney, diverticula of the bladder, narrowing of the lumen of the ureters. All these conditions prevent the full outflow of urine and create prerequisites for the active reproduction of microbes.
8. Severe hypothermia of the body, especially the lumbar region.

How chronic pyelonephritis manifests itself: stages of the disease

The chronic inflammatory process of the kidneys develops in stages, each of which has its own clinical symptoms:

Stage of the disease	What is manifested?
First	At this stage of the development of the disease, the glomeruli of the kidneys are not involved in the pathological process. The collecting ducts of the organ are slightly atrophied
Second	Some glomeruli stop working, the vessels of the organ narrow significantly, which makes it difficult to filter urine. Destructive-sclerotic changes in the renal tubules occur and rapidly progress.
Third	Most of the glomeruli die, the tubules atrophy, most of the organ is replaced by connective tissue
Fourth	Most of the glomeruli of the kidney die, the organ is significantly reduced in size and shrinks. Most of the interstitium is replaced by connective tissue

Possible Complications

Is it possible to cure chronic pyelonephritis without complications? In the absence of timely diagnosis and therapy, this is almost impossible. A common consequence of a long-term untreated chronic inflammatory process in the kidneys is pyonephrosis.

What is pyonephrosis? This is a purulent lesion of the kidney, which is more typical for patients older than 40 years; in children, such a complication practically does not occur.

Other common complications of untreated chronic pyelonephritis are:

• acute renal failure- a reversible condition characterized by a sudden disruption of the kidneys or a complete shutdown of the functions of the organ;
• chronic renal failure- a condition caused by the death of kidney cells and the complete cessation of the work of the organ (such patients are tied to renal dialysis and can live only thanks to this procedure or a donor kidney transplant);
• urosepsis- a complication, often fatal and characterized by the spread of infection from the affected kidneys through the bloodstream throughout the body;
• purulent inflammation of the perirenal tissue.

Methods for diagnosing the disease

In order to make an accurate diagnosis for the patient and differentiate chronic pyelonephritis from other diseases of the urinary tract, it is necessary to conduct a comprehensive examination. It includes laboratory and instrumental diagnostic methods.

Laboratory examination of the patient

A patient with suspected chronic inflammatory process of the kidneys is prescribed:

• complete blood count - xp pyelonephritis, which has not yet been treated, is characterized by anemia, increased ESR, a shift of the leukocyte formula to the left, severe leukocytosis;
• general urinalysis - if the treatment of xp pyelonephritis has not yet been carried out, then an alkaline environment, low density and turbidity are detected in the urine analysis, which is due to the high content of bacteria and leukocytes in the material;
• - pronounced leukocytosis, active leukocytes;
• urine sample according to Zimnitsky - this study reveals a decrease in the density of urine in various daily portions;
• biochemical blood test - reveals an increase in urea, sialic acids and seromucoid.

Instrumental diagnostic methods

The presented diagnostic methods are chosen by the attending physician to choose from and allow you to clarify the diagnosis and the severity of the pathological process:

• chromocyotoscopy - a study that allows you to determine a unilateral or bilateral inflammatory process;
• Ultrasound of the kidneys - with the help of ultrasound, the doctor evaluates the size of the kidneys, the wrinkling of the organ, the presence of gross structural changes;
• retrograde pyelography - a study that allows you to diagnose existing deformities of the pelvis and calyces of the kidney;
• CT and MRI.

If modified parts of the kidney are found, in some cases a biopsy is prescribed to the patient to clarify the diagnosis. A tissue sample is taken from a suspicious area, which is sent for further detailed study in a histological laboratory. This method is highly informative for detecting kidney cancer at an early stage.

Important! When examining a patient, chronic pyelonephritis should be differentiated from amyloidosis of the kidney, hypertension, diabetes mellitus, since these pathologies may have similar clinical symptoms.

Treatment of chronic pyelonephritis

Treatment for chronic pyelonephritis is complex and includes:

• regimen and strict diet;
• antibacterial therapy;
• implementation of measures aimed at normalizing the outflow of urine.

How to cure chronic pyelonephritis? First of all, you need to be prepared for the fact that the therapy will be long, and during periods of exacerbations, the patient must be hospitalized in a hospital.

Mode and diet

During the period of exacerbation of the disease, the patient must comply with strict bed rest - failure to comply with this condition increases the risk of complications and renal failure. Dietary nutrition and drinking regimen are integral aspects of effective treatment.

Important! The main mistake of patients with a chronic form of pyelonephritis is a sharp restriction of water in the diet, but meanwhile, it is necessary to limit not water, but the amount of salt, since it is salt that provokes edema and disrupts the outflow of urine.

Ordinary clean water is suitable for drinking, including weakly alkaline mineral water without gas, kissels, fruit drinks, compotes, juices, rosehip broth. During the period of exacerbation of the disease, the patient can drink up to 2 liters of liquid, not counting the first courses. Reducing water in the diet is advisable only with a pronounced increase in blood pressure and complications from the cardiovascular system.

To prevent edema and fluid retention in the body, the amount of table salt should be reduced, and sometimes completely eliminated for a certain period. The patient is shown diet No. 7 with the exception of spicy dishes, pork, animal fats, spices, spices, vinegar, smoked meats and preservation.

Proteins are limited, as they increase the load on the kidneys. The diet is dominated by dishes of plant origin, stewed vegetables, fresh fruits, vegetable soups, cereals (buckwheat, oatmeal, rice).

Medical treatment

If symptoms characteristic of chronic pyelonephritis are diagnosed, treatment is not complete without antibiotics, which, unfortunately, are not always effective, especially if the pathological process is detected at an advanced complicated stage. How to treat each individual patient decides the urologist, depending on the severity of the disease.

For the treatment of chronic inflammatory process in the kidneys, the following groups of antibiotics are used:

1. Penicillins with clavulanic acid- Amoxicillin, Amoxiclav, Flemoxin solutab. A distinctive feature of these drugs from conventional penicillins is their ability to dissolve the protective capsule of pathogens resistant to penicillins. These drugs may be given in the form of injections or tablets, depending on the severity of the disease.
2. Cephalosporins- Ceftriaxone, Loraxone, Cefixime, Tseporin. Preparations of this group can sometimes be combined with antibiotics of the aminopenicillin series in severe inflammatory processes.
3. Aminoglycosides- Gentamicin, Amikacin. Assign injection in combination with cephalosporins or penicillins in complicated pyelonephritis.
4. Preparations of the nitrofuran series- Furadonin, Furazolidone. They are uroseptics and enhance the effect of antibiotics.
5. Sulfonamides- Biseptol. These drugs are combined with antibiotics, they have a bacteriostatic effect, that is, they slow down the growth and reproduction of pathogens.

To maintain the patient's immune system, it is imperative to prescribe Ascorbic acid by injection and vitamins A and E, which are powerful antioxidants and fight free radicals.

Important! In chronic pyelonephritis, a course of antibiotic therapy is prescribed up to 21 days - in the first 7 days, drugs are injected, and when the patient's test results improve, they are transferred to tablet intake.

The success of drug therapy can be judged by the following signs:

• the outflow of urine is established and dysuric phenomena disappear;
• urine and blood tests are normalized;
• body temperature is within normal limits;
• edema disappears and blood pressure normalizes.

Auxiliary drugs

• to prevent allergic reactions to numerous drugs, the patient must be prescribed antihistamines - Suprastin, Loratadin, Diazolin;
• for the treatment of anemia, which is a frequent companion of chronic kidney damage, iron preparations and vitamins B12 are prescribed in the form of injections;
• to normalize blood pressure indicators, drugs from the group of antihypertensive drugs are prescribed - Clonidine, Reserpine, Co-prenessa.

During the period of remission, the patient is shown sanatorium treatment.

Disease prevention

The following is an instruction for actions aimed at preventing the transition of acute pyelonephritis to a chronic form of the course:

• after suffering acute pyelonephritis, one should be registered with a urologist for at least 3 months, and in case of a complicated course - 1 year;
• after the infection, avoid physical overload and hard work for six months;
• do not overcool;
• in the first six months after pyelonephritis, be sure to follow a diet number 7, give up alcohol, coffee and spices;
• every 4 weeks during the first year after pyelonephritis, urine and blood tests should be taken - if all indicators are within the normal range, then the patient can be removed from the dispensary.

Important! If within a year after pyelonephritis there was at least once a relapse of the disease, then the dispensary registration is extended for 3 years with regular monitoring of tests and the patient's condition.

To strengthen the body's immune forces, it is necessary to sanitize all foci of chronic infection, including carious teeth, eat well, have more rest, and engage in moderate physical activity.