Treatment of chronic pyelonephritis should be directed to the pathogenetic mechanisms of the disease. In the general scheme of therapy, several directions should be provided:

• remove infectious agents;
• normalize the flow of urine;
• increase the patient's own immunity;
• exclude the danger of chronic foci of infection and the possibility of re-infection by the hematogenous and lymphogenous route.

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

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

Natural defense mechanisms can be supported by caring for your health, diet, folk remedies from medicinal plants. The kidneys have several options that greatly hinder the spread of infection. Each needs to be influenced to help deal with inflammation.

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

By means of activating the immune system in chronic pyelonephritis, we achieve local destruction of harmful pathogens

Treatment for chronic pyelonephritis necessarily includes an integrated approach with a phased use of the possibilities of stationary volume and therapy at home.

What is required for successful antibiotic therapy?

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

Therefore, in order to permanently get rid of pyelonephritis, you must follow the principles of the use of antibacterial agents.

Treatment standards require:

• prescribe drugs as early as possible;
• the duration of the course is selected individually depending on the activity of pathogenic microorganisms, the severity of inflammation;
• strictly take into account the revealed sensitivity of the microflora, according to the conclusion obtained by the tank method. urine culture;
• if necessary, combine antibacterial drugs using compatibility properties;
• change medications when low sensitivity is detected;
• to prevent a negative effect, the growth of fungi, use antifungal drugs in cases of a long course of treatment;
• at the same time prescribe vitamins and immunostimulants.

In the treatment of pyelonephritis, the drug is chosen, around which bacteria do not grow.

If these principles are not followed, antibiotic therapy cannot achieve the desired result, as well as with preserved obstructions to the outflow of urine.

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

If the treatment is late, then the microorganisms degenerate into drug-resistant strains, form microbial associations with different sensitivities.

Preparations for antibacterial treatment

To treat chronic pyelonephritis, according to the developed recommendations, it is necessary to simultaneously combine several groups of drugs:

• antibiotics;
• sulfonamides (Urosulfan, Sulfadimetoksin);
• nitrofurans (Furagin, Furazolidone);
• preparations from nalidixic acid (Nilidixan, Nevigramone);
• oxyquinoline derivatives (5-NOC, Nitroxoline);
• combined agents such as Biseptol, Bactrim (sulfamethoxazole + trimethoprim).

Each patient is selected a drug with the highest sensitivity of the flora and the least toxic effect on the renal tissue.

Drugs with minimal toxicity include:

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

Moderately toxic are:

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

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

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

When choosing the most effective antibiotic, it is necessary to take into account such a property as the dependence of activity on the reaction of urine:

• Gentamicin and Erythromycin - act most effectively in an environment with an alkaline reaction at pH 7.5 - 8. When using them, a dairy and predominantly vegetable diet is recommended, alkalizing mineral waters (Borjomi).
• Ampicillin and 5-NOC - are active in an acidic environment at pH 5–5.5.
• Cephalosporins, Levomycetin, tetracyclines are quite effective in both alkaline and acidic urine at pH 2–9.

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

• 5-NOC,
• Levomycetin,
• Gentamicin.

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

Gentamicin is used intramuscularly and intravenously

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

• antibiotic + sulfanilamide;
• antibiotic + nitrofuran (Furagin);
• all together + 5-NOC.

Drugs from nalidixic acid are not recommended to be combined with nitrofurans (weaken the effect, summarize the toxic effect), are contraindicated in pregnancy in the first trimester and in children under two years of age. These funds are characterized by the least ability to develop resistant microbial species. The group includes, besides Nevigramon:

• Nagram,
• Negro
• cystidix,
• Nilidixan,
• nalix,
• Notricel,
• Nalidin,
• Nalidixin,
• nalix,
• Naligram,
• Naksuril,
• Nogram.

Examples of effective combinations include:

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

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

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

How can one judge successful antibiotic therapy?

The criteria for obtaining a positive result are:

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

You can find out about the clinical signs of exacerbation of chronic pyelonephritis.

Outpatient treatment after disease recurrence

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

Preparations are selected and alternate courses. The doctor necessarily focuses on the level of leukocyturia, bacteriuria, protein indicators in the blood and urine. Different authors propose to keep the duration of outpatient treatment from six months to two years.

The monthly schedule looks like this:

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

Lingonberry leaf tea washes the urinary tract well

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

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

• leukopenia, agranulocytosis;
• aplastic and B 12 deficiency anemia;
• impaired excretory function of the kidneys.

It is not used:

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

Folk remedies in the treatment of pyelonephritis

At home, folk remedies include decoctions and infusions from plant materials, which have a diuretic effect, a slight bacteriostatic effect, and increase the tone of the bladder and tracts.

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

The most popular appointment of bearberry, it is also known as "bear ears". You can brew in a thermos (2 tablespoons of dry grass per liter of boiling water) for half an hour. After straining, you can drink an incomplete glass three times a day. To improve the taste, it is recommended to add honey. Do not use during pregnancy (uterine tone increases).

A decoction of corn stigmas is prepared at home with preliminary boiling for 5–7 minutes. Then they insist and take it like a bearberry.

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

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

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

What other drugs are prescribed for pyelonephritis?

To reduce allergic manifestations, patients are prescribed antihistamines:

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

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

When is surgery used?

Surgical treatment is used in advanced stages of chronic pyelonephritis, when the patient enters the urological department with the following complications:

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

Most often, nephrectomy is indicated (removal of a diseased organ) with its unilateral lesion.

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

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

Nephrectomy has long been considered contraindicated in a bilateral process, with severe comorbidities that increase the risk of intervention. Currently, it is being replaced by a donor kidney transplant after removing both of its own. Before surgery, the patient undergoes systematic hemodialysis.

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

• Hemodez,
• plasma,
• isotonic solutions,
• if necessary - erythrocyte mass.

Against the background of high blood pressure, antihypertensive drugs are needed.

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

In order not to form a fistula from the suction of urine into the wound, the operating surgeons carefully check the suturing of the walls of the cups and vessels, for this it is better to use a chrome-plated catgut.

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

Spa treatment

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

The use of natural mineral waters contributes to the leaching of toxins and bacteria from the kidneys, the restoration of local immunity

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

In the presence of hypertension, anemia, renal failure, spa treatment is not indicated, there is no effect from it.

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

Pyelonephritis is an acute or chronic kidney disease that develops as a result of exposure to the kidney of some causes (factors) that lead to inflammation of one of its structures, called the pyelocaliceal system (the structure of the kidney in which urine is accumulated and excreted) and adjacent to this structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.

The definition of "Pyelonephritis" comes from the Greek words ( pyelos- translates as, pelvis, and nephros-bud). Inflammation of the structures of the kidney occurs in turn or simultaneously, it depends on the cause of the developed pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 39 0 C, nausea, vomiting, impaired urination), with proper treatment after 10-20 days, the patient recovers completely.

Chronic pyelonephritis is characterized by exacerbations (most often in the cold season), and remissions (subsidence of symptoms). Its symptoms are mild, most often, it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, abnormalities of the urinary system, prostate adenoma, and others).

Women, especially young and middle-aged women, get sick more often than males, approximately in a ratio of 6: 1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men are more likely to develop pyelonephritis at an older age, this is most often associated with the presence of prostate adenoma. Children also get sick, more often at an early age (up to 5-7 years), compared with older children, this is due to the low resistance of the body to various infections.

Kidney Anatomy

The kidney is an organ of the urinary system that is involved in removing excess water from the blood and products secreted by body tissues that were formed as a result of metabolism (urea, creatinine, drugs, toxic substances, and others). The kidneys remove urine from the body, further along the urinary tract (ureters, bladder, urethra), it is excreted into the environment.

The kidney is a paired organ, in the form of beans, dark brown in color, located in the lumbar region, on the sides of the spine.

The mass of one kidney is 120 - 200 g. The tissue of each of the kidneys consists of a medulla (in the form of pyramids) located in the center, and a cortical located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyxes (average 2-4 in one kidney). In the future, the large renal calyces pass into one large renal pelvis (a cavity in the kidney, funnel-shaped), which, in turn, passes into the next organ of the urinary system, which is called the ureter. From the ureter, urine enters the bladder (a reservoir for collecting urine), and from it through the urethra out.

It is accessible and understandable about how the kidneys develop and work.
Inflammatory processes in the calyces and pelvis of the kidney are called pyelonephritis.

Causes and risk factors in the development of pyelonephritis

Features of the urinary tract
Congenital anomalies (improper development) of the urinary system	R develop as a result of exposure to the fetus during pregnancy of adverse factors (smoking, alcohol, drugs) or hereditary factors (hereditary nephropathy, resulting from a mutation of the gene responsible for the development of the urinary system). Congenital anomalies leading to the development of pyelonephritis include the following malformations: narrowing of the ureter, underdeveloped kidney (small size), lowered kidney (located in the pelvic region). The presence of at least one of the above defects leads to stagnation of urine in the renal pelvis, and a violation of its excretion into the ureter, this is a favorable environment for the development of infection and further inflammation of the structures where urine has accumulated.
Anatomical features of the structure of the genitourinary system in women	In women, compared to men, the urethra is shorter and larger in diameter, so sexually transmitted infections easily enter the urinary tract, rising to the level of the kidney, causing inflammation.
Hormonal changes in the body during pregnancy
The pregnancy hormone, progesterone, has the ability to reduce the tone of the muscles of the genitourinary system, this ability has a positive effect (prevention of miscarriages) and a negative effect (violation of urine outflow). The development of pyelonephritis during pregnancy is a disturbed outflow of urine (a favorable environment for the reproduction of infection), which develops as a result of hormonal changes, and compression of the enlarged (during pregnancy) uterus of the ureter.
reduced immunity
The task of the immune system is to eliminate all substances and microorganisms alien to our body, as a result of a decrease in the body's resistance to infections, pyelonephritis may develop. Young children under 5 get sick more often because their immune system is underdeveloped compared to older children. In pregnant women, immunity normally decreases, this mechanism is needed to maintain pregnancy, but it is also a favorable factor for the development of infection. Diseases that are accompanied by a decrease in immunity, for example: AIDS, causes the development of various infectious diseases, including pyelonephritis.
Chronic diseases of the genitourinary system
Stones or tumors in the urinary tract, chronic prostatitis	lead to a violation of the excretion of urine and its stagnation;
Chronic cystitis	(inflammation of the bladder), in case of ineffective treatment or its absence, the infection spreads along the urinary tract upwards (to the kidney), and its further inflammation.
Sexually transmitted infections of the genital organs	Infections such as chlamydia, trichomoniasis, when penetrating through the urethra, enter the urinary system, including the kidney.
Chronic foci of infection	Chronic amygdalitis, bronchitis, intestinal infections, furunculosis and other infectious diseases are a risk factor for the development of pyelonephritis . In the presence of a chronic focus of infection, its causative agent (staphylococcus, E. coli, Pseudomonas aeruginosa, Candida and others) can enter the kidneys with the blood stream.

Symptoms of pyelonephritis

• burning and pain during urination, due to inflammation in the urinary tract;
• the need to urinate more often than usual, in small portions;
• beer-colored urine (dark and cloudy), is the result of the presence of a large number of bacteria in the urine,
• foul-smelling urine
• often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).

1. Pasternatsky's symptom is positive - with a light blow with the edge of the palm on the lumbar region, pain appears.
2. Edema, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appear on the face (under the eyes), legs, or other parts of the body. Edema appears in the morning, soft pasty consistency, symmetrical (on the left and right sides of the body of the same size).

Diagnosis of pyelonephritis

General urine analysis - indicates abnormal urine composition, but does not confirm the diagnosis of pyelonephritis, since any of the abnormalities may be present in other kidney diseases.
Proper collection of urine: in the morning, the toilet of the external genitalia is performed, only after that the morning, first portion of urine is collected in a clean, dry dish (a special plastic cup with a lid). The collected urine can be stored for no more than 1.5-2 hours.

Indicators of a general urine test for pyelonephritis:

• High level of leukocytes (normal in men 0-3 leukocytes in the field of view, in women up to 0-6);
• Bacteria in urine >100,000 per ml; the excreted urine is normal, must be sterile, but when it is collected, hygienic conditions are often not observed, therefore, the presence of bacteria up to 100,000 is allowed;
• Urine density
• Ph urine - alkaline (normally acidic);
• The presence of protein, glucose (normally they are absent).

Urinalysis according to Nechiporenko:

• Leukocytes are increased (normal up to 2000/ml);
• Erythrocytes are increased (normal up to 1000/ml);
• The presence of cylinders (they are normally absent).

Bacteriological examination of urine: used in the absence of the effect of the accepted course of antibiotic treatment. Urine is cultured to identify the causative agent of pyelonephritis, and in order to select an antibiotic sensitive to this flora for effective treatment.

Ultrasound of the kidneys: is the most reliable method to determine the presence of pyelonephritis. Determines the different sizes of the kidneys, a decrease in the size of the affected kidney, deformation of the pelvicalyceal system, the detection of a stone or tumor, if any.

Excretory urography, is also a reliable method for detecting pyelonephritis, but compared to ultrasound, you can visualize the urinary tract (ureter, bladder), and if there is a blockage (stone, tumor), determine its level.

CT scan, is the method of choice, using this method it is possible to assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)

Treatment of pyelonephritis

Medical treatment of pyelonephritis

1. antibiotics, are prescribed for pyelonephritis, according to the results of bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.

Therefore, self-medication is not recommended, since only the attending physician can select the optimal drugs, and the duration of their use, taking into account the severity of the disease and individual characteristics.
Antibiotics and antiseptics in the treatment of pyelonephritis:

• Penicillins(Amoxicillin, Augmentin). Amoxicillin inside, 0.5 g 3 times a day;
• Cephalosporins(Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
• Aminoglycosides(Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg / kg 2 times a day;
• Tetracyclines (Doxycycline, orally 0.1 g 2 times a day);
• Levomycetin group(Chloramphenicol, orally 0.5 g 4 times a day).

• Sulfonamides(Urosulfan, inside 1 g 4 times a day);
• Nitrofurans(Furagin, inside 0.2 g 3 times a day);
• Quinolones(Nitroxoline, inside 0.1 g 4 times a day).

1. Diuretic drugs: are prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and are not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
2. Immunomodulators: increase the reactivity of the body during the disease, and to prevent exacerbation of chronic pyelonephritis.

• Timalin, intramuscularly 10-20 mg 1 time per day, 5 days;
• T-activin, intramuscularly, 100 mcg once a day, 5 days;

1. Multivitamins , (Duovit, 1 tablet 1 time per day) Ginseng tincture - 30 drops 3 times a day are also used to improve immunity.
2. Non-steroidal anti-inflammatory drugs (Voltaren), have an anti-inflammatory effect. Voltaren inside, 0.25 g 3 times a day, after meals.
3. To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantyl, 0.025 g 3 times a day.

Phytotherapy for pyelonephritis

Herbal medicine for pyelonephritis is used as an adjunct to medical treatment, or to prevent exacerbation in chronic pyelonephritis, and is best used under medical supervision.

Cranberry juice, has an antimicrobial effect, drink 1 glass 3 times a day.

A decoction of Bearberry, has an antimicrobial effect, take 2 tablespoons 5 times a day.

Boil 200 g of oats in one liter of milk, drink ¼ cup 3 times a day.
Kidney collection No. 1: A decoction of the mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.

Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, cowberry. Finely chop all these herbs, pour 2 tablespoons of water and boil for 20 minutes, take half a cup 4 times a day.

Almost every third elderly person has changes characteristic of chronic pyelonephritis. At the same time, the disease is diagnosed much more often in women, starting from childhood and adolescence, and ending with the menopause period.

It should be understood that chronic pyelonephritis rarely gives severe symptoms characteristic of kidney disease. Therefore, the diagnosis is difficult, but the consequences are quite serious.

Chronic pyelonephritis: what is it?

Pyelonephritis means inflammation of the renal pelvis. And, if acute inflammation cannot be overlooked - a high temperature rises, severe back pain occurs, pronounced changes in the urine are recorded - then chronic pyelonephritis most often develops gradually.

In this case, structural changes occur in the renal tubules and pelvis, which are aggravated over time. Only in a third of cases, chronic pyelonephritis is due to improperly treated acute inflammation. The diagnosis of chronic pyelonephritis is made when there are characteristic changes in the urine and symptoms for more than 3 months.

The cause of inflammation is a nonspecific pathogenic microflora: proteus, staphylococci and streptococci, E. coli, etc. Often several types of microbes are sown at once. Pathogenic microflora has a unique chance of survival: it has developed resistance to antibiotics, is difficult to identify under microscopic examination, can go unnoticed for a long time and is activated only after a provoking effect.

The factors that activate the inflammatory process in the kidneys in women include:

• Congenital pathology - bladder diverticula, vesicoureteral reflux, urethrocele;
• Acquired diseases of the urinary system - cystitis / urethritis, nephrolithiasis, nephroptosis and, in fact, untreated acute pyelonephritis;
• Gynecological pathology - non-specific vulvovaginitis (thrush, bacterial vaginosis, reproduction in the vagina of Escherichia coli, etc.), sexual infections (gonorrhea, trichomoniasis);
• Intimate sphere of a woman - the beginning of sexual contacts, active sex life, pregnancy and childbirth;
• Concomitant diseases - diabetes mellitus, chronic pathology of the gastrointestinal tract, obesity;
• Immunodeficiency - frequent diseases of angina, influenza, bronchitis, otitis media, sinusitis, not excluding HIV;
• Elementary hypothermia - habit of washing feet in cold water, inappropriate clothing in cold weather, etc.

Important! Recent studies have shown the dependence of the development of chronic pyelonephritis with an inadequate immune response. Sensitization to one's own tissues activates an autoimmune attack on one's own kidney cells.

Stages of chronic pyelonephritis

With chronic inflammation, a gradual degeneration of the renal tissues occurs. Depending on the nature of structural changes, four stages of chronic pyelonephritis are distinguished:

1. I - atrophy of the tubular mucosa and the formation of infiltrates in the interstitial tissue of the kidneys;
2. II - sclerotic foci form in the tubules and interstitial tissue, and the renal glomeruli become empty;
3. III - large-scale atrophic and sclerotic changes, large foci of connective tissue are formed, renal glomeruli practically do not function;
4. IV - the death of most of the glomeruli, almost all of the renal tissue is replaced by connective tissue.

The larger the irreversible changes, the more severe the symptoms of kidney failure.

Chronic pyelonephritis is characterized by an undulating course. Periods of deterioration are replaced by remission and give the patient a false sense of complete recovery. However, most often chronic inflammation proceeds erased, without bright exacerbations.

Symptoms of chronic pyelonephritis in women with a latent course of the disease are lethargy, headache, fatigue, loss of appetite, periodic temperature rises to 37.2-37.5ºС. In comparison with acute inflammation, in chronic pyelonephritis the pain is not very pronounced - a weak symptom of Pasternatsky (pain when tapping in the lumbar region).

Changes in the urine are also not informative: a small amount of protein and leukocytes is often associated with cystitis or eating salty foods. The same explains the periodic increase in the number of urination, a slight increase in pressure and anemia. The appearance of the patient also changes: dark circles under the eyes clearly appear on the pale skin of the face (especially in the morning), the face is puffy, hands and feet often swell.

Exacerbation of the chronic form

With recurrent pyelonephritis against the background of poor symptoms - malaise, slight hyperthermia, mild back pain, increased urination (especially at night) - suddenly, after a provoking effect, a picture of acute pyelonephritis develops. High temperature up to 40.0-42ºС, severe intoxication, severe lumbar pain of a pulling or pulsating nature are accompanied by vivid changes in the urine - proteinuria (protein in the urine), leukocyturia, bacteriuria and rarely hematuria.

Progressive replacement of the renal tissue with connective tissue leads to a decrease in kidney function, up to the development of renal failure. Toxins and decay products enter the bloodstream and poison the entire body.

In this case, the further development of chronic pyelonephritis can proceed according to the following scenarios:

• Urinary syndrome - signs of urination disorders come to the fore in the symptomatic picture. Frequent nightly trips to the toilet are associated with the inability of the kidneys to concentrate urine. Sometimes when emptying the bladder, pain occurs. The patient complains of heaviness and frequent pain in the lower back, swelling.
• The hypertensive form of the disease - severe arterial hypertension is difficult to respond to traditional therapy with antihypertensive drugs. Often patients complain of shortness of breath, heart pain, dizziness and insomnia, hypertensive crises are not uncommon.
• Anemic syndrome - a violation of the functionality of the kidneys leads to the rapid destruction of red blood cells in the blood. With hypochromic anemia due to kidney damage, blood pressure does not reach high levels, urination is scanty or periodically increases.
• Azotemic variant of the course - the absence of painful symptoms leads to the fact that the disease is diagnosed only with the development of chronic renal failure. Laboratory tests that detect signs of uremia help confirm the diagnosis.

Differences between chronic pyelonephritis and acute inflammation

Acute and chronic pyelonephritis differ at all levels, from the nature of structural changes to the symptoms and treatment of women. In order to accurately diagnose the disease, it is necessary to know the signs characteristic of chronic pyelonephritis:

1. Both kidneys are more often affected;
2. Chronic inflammation leads to irreversible changes in the kidney tissue;
3. The beginning is gradual, extended in time;
4. The asymptomatic course can last for years;
5. The absence of pronounced symptoms, in the foreground - intoxication of the body (headache, weakness, etc.);
6. In the period of remission or in the latent course, the urinalysis changed slightly: the protein in the general analysis is not more than 1 g / l, the Zimnitsky test reveals a decrease in beats. Weights less than 1018;
7. Hypotensive and antianemic drugs are not very effective;
8. Taking traditional antibiotics only reduces inflammation;
9. The gradual decline in renal function leads to renal failure.

Often, chronic pyelonephritis is diagnosed only with instrumental examination. When visualizing (ultrasound, pyelography, CT) of the kidney, the doctor discovers a diverse picture: active and fading foci of inflammation, connective tissue inclusions, deformity of the renal pelvis. In the initial stages, the kidney is enlarged and looks lumpy due to infiltration.

In the future, the affected organ shrinks, large inclusions of connective tissue protrude above its surface. In acute pyelonephritis, instrumental diagnostics will show the same type of inflammation.

Possible complications: what is the danger of chronic pyelonephritis?

The absence of pronounced symptoms in chronic pyelonephritis is the reason for the late visit of women to the doctor. Antibiotics that are effective in the treatment of acute pyelonephritis will only slightly reduce inflammation in the chronic form of the disease. This is due to the high resistance of microflora to conventional antibacterial agents. Without adequate therapy, the chronic form of pyelonephritis leads to the development of chronic renal failure: a little slower with a latent course and faster with frequent exacerbations.

Possible consequences:

• pyonephrosis - purulent fusion of renal tissue;
• paranephritis - a purulent process extends to the perirenal tissue;
• necrotic papillitis - necrosis of the renal papillae - a severe condition accompanied by renal colic;
• wrinkling of the kidney, "wandering" kidney;
• acute renal failure;
• stroke by hemorrhagic or ischemic type;
• progressive heart failure;
• urosepsis.

All these conditions pose a serious threat to a woman's life. It is possible to prevent their development only with complex therapy.

Illness during pregnancy

The double load on the kidneys of a pregnant woman leads to inflammation. At the same time, the impact of impaired renal function in a future mother can lead to miscarriage, fading of pregnancy, the formation of developmental anomalies in the fetus, premature birth and stillbirth. Doctors distinguish three degrees of risk associated with pyelonephritis:

• I - pyelonephritis first appeared during pregnancy, the course of the disease without complications;
• II - chronic pyelonephritis was diagnosed before pregnancy;
• III - chronic pyelonephritis, occurring with anemia, hypertension.

An exacerbation of the disease can occur 2-3 times during the gestation period. At the same time, every time a woman is hospitalized without fail. I-II degree of risk allows you to carry a pregnancy. A pregnant woman’s card is labeled “chronic pyelonephritis”, a woman more often than the usual schedule (depending on the duration of pregnancy) takes tests and undergoes ultrasound. Even with the slightest deviation, the expectant mother is registered for inpatient treatment.

III degree of risk - a direct indication for termination of pregnancy.

Struck photo, photo

Only an integrated approach to the treatment of chronic pyelonephritis will prevent the progression of the pathological process and avoid renal failure. How to treat chronic pyelonephritis:

• Gentle regimen and diet

First of all, provoking moments (colds, hypothermia) should be avoided. Food must be complete. Coffee, alcohol, carbonated drinks, spicy and salty dishes, fish / meat broths, marinades (contain vinegar) are excluded. The diet is based on vegetables, dairy products and boiled meat / fish dishes.

Not recommended citrus fruits: Vit. C irritates the kidneys. During exacerbations and pronounced changes in the analyzes, salt is completely excluded. In the absence of hypertension and edema, it is recommended to drink up to 3 liters of water in order to reduce intoxication.

• Antibiotic therapy

To select an effective drug, it is necessary to do a urine culture (it is better during an exacerbation, the pathogen may not be detected during remission) and conduct tests for sensitivity to antibiotics. Taking into account the results of the analysis, the most effective drugs are prescribed: Ciprofloxacin, Levofloxacin, Cefepime, Cefotaxime, Amoxicillin, Nefigramon, Urosulfan. Nitroxoline (5-NOC) is well tolerated, but not very effective, often prescribed for pregnant women.

Furadonin, furazolidone, Furamag have a pronounced toxic effect and are poorly tolerated. Palin, effective in renal inflammation, is contraindicated in pregnancy. Treatment of chronic pyelonephritis lasts at least 1 year. Antibacterial courses continue for 6-8 weeks. and are periodically repeated.

• Symptomatic therapy

In hypertensive syndrome, antihypertensive drugs are prescribed (enalapril and other ACE inhibitors, as well as combined drugs with hypothiazide), and antispasmodics that enhance their effect (No-shpa). If anemia is detected, Ferroplex, Ferrovit forte and other iron-containing tablets are prescribed.

It is also necessary to compensate for the lack of folic acid, vit. A and E, B12. Vit. C is allowed to be taken outside the exacerbation period.

To improve blood circulation in the kidneys, the nephrologist prescribes antiplatelet agents (Kurantil, Parsadil, Trental). With severe symptoms of intoxication, intravenous infusions of Regidron, Glucosolan are prescribed. In the presence of edema, diuretics are prescribed at the same time (Lasix, Veroshpiron). Uremia and severe renal failure require hemodialysis. With complete kidney failure, a nephrectomy is performed.

• Physiotherapy

Drug treatment of a sluggish current chronic process in the kidneys is enhanced by physiotherapeutic procedures. Electrophoresis, UHF, modulated (SMT-therapy) and galvanic currents are especially effective. Outside the period of exacerbation, sanatorium treatment is recommended. Sodium chloride baths, mineral water and other physiotherapy significantly improve the condition of patients.

With a latent course of chronic pyelonephritis and complex treatment of the disease, women do not lose their quality of life. Frequent exacerbations leading to kidney failure lead to disability and pose a serious threat to life.

Chronic pyelonephritis can proceed secretly, as if there was no acute infection, but in fact, acute pyelonephritis disappeared under the guise of another inflammatory process and was not noticed. On average, by the end of the first decade of the disease of both kidneys, there are already signs of chronic renal failure, and after another five years, you need to prepare for dialysis and kidney transplantation.

Where should chronic pyelonephritis be treated?

The disease proceeds in waves, when it is difficult, according to clinical signs, to separate the period of exacerbation of the process from remission, and the manifestations are very atypical and sluggish.

The goal of therapy is to reduce the activity of inflammation, ideally - to rid the urinary tract of pathological microflora.

• With an exacerbation of the disease occurring against the background of normal urine output, treatment can be carried out on an outpatient basis.
• Inpatient treatment is indicated for patients with complications - a violation of the excretion or passage of urine, which creates favorable conditions for the growth and reproduction of the bacterial flora.
• In all cases of a purulent process or a septic condition, symptoms of renal failure, microflora resistance to antibiotics, hospitalization is necessary.

What can a patient do for himself with pyelonephritis?

Regardless of the activity of the process, to remove microbes and their toxins, you need to drink plenty of water, so a person suffering from chronic pyelonephritis should drink a lot, at least 2.5 liters. Restrictions on fluid volumes are imposed with the development of "renal" hypertension, in this case, consultation with a cardiologist is necessary.

• Drinking is “soft”, plain water is better, a good therapeutic effect of cranberry and lingonberry fruit drinks has been proven.
• You can use diuretic herbal teas, hypertensive patients need to coordinate their actions with a doctor, since diuretics are prescribed to reduce pressure, harmless herbal tea can become a “fly in the ointment”.
• You can take herbal preparations cystone and kanefron, "cleansing" urine.
• Salty and spicy food is limited, the diet is sparing, that is, nothing irritating and spices.

How is chronic pyelonephritis treated?

In the latent phase, in the absence of clinical symptoms, antibiotic therapy, as a rule, is not carried out. The need for antibiotics occurs with an exacerbation of the process. With mild or moderate severity, antibiotics are prescribed in tablets for two weeks, with severe form, injectable drugs in high doses.

Before prescribing antibiotics, the type of infectious agent and its sensitivity to the drug must be determined, and in this case it is important how quickly this analysis can be performed in the laboratory of a medical institution.

In some severe and rapidly progressive cases, antibiotics are given empirically, but after the result of the analysis is received, the treatment is adjusted.

Surgery for pyelonephritis

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

Description of the disease

It is an infectious process of an inflammatory nature that forms in the kidney tissues. This disease develops due to the active life of various types of bacteria. It is predominantly common among the fair sex. This is due to the morpho-functional features of the urethra. Due to its special structure, the penetration of microorganisms into the internal organs is greatly facilitated. Pathology can develop during certain periods of the female cycle (defloration, pregnancy, menopause).

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

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

Main reasons

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

Very often, chronic pyelonephritis precedes the stage of exacerbation of the pathology. Chronization of inflammation contributes to unresolved in a timely manner violations of the outflow of urine due to stones in prostate adenomas. Such a pathological process in the body can be supported by other diseases of a bacterial nature (otitis, prostatitis, urethritis, cholecystitis, appendicitis, etc.), general somatic ailments (diabetes mellitus, obesity), as well as immunodeficiency.

In young women, the onset of sexual activity, childbirth and pregnancy can become the impetus for the development of this disease. Quite often, doctors diagnose and among young patients chronic can be caused by disorders in the body at the congenital level, which change the usual urodynamics (ureterocele, bladder diverticula).

Clinical signs

The symptoms of the disease are non-specific in nature, and recently asymptomatic course has become more and more common. A patient who has previously dealt with acute pyelonephritis or other urological pathologies should be responsible for their own health and listen to the body. Often, the onset of the disease is a consequence of a violation of the immune response from the body, which accompanies diabetes mellitus and tuberculosis. The weakening of the protective forces is also observed due to insufficient intake of vitamins and minerals. Despite all the specificity of clinical manifestations, a number of signs of this disease can be distinguished, which should be paid special attention to:

• An increase in temperature in the evening for no apparent reason.
• Headache.
• Increased fatigue, weakness.
• Frequent urge to urinate.
• Pain discomfort in the lumbar region, which manifests itself when walking.
• Change in color and smell of urine, its turbidity.

All of the above signs point to chronic pyelonephritis. Symptoms and treatment of the disease are of a general nature, this has already been discussed in the article. Often, patients perceive such clinical manifestations as the most common cold and begin treatment with appropriate drugs. Such therapy can really relieve symptoms and improve the patient's condition at first. And the inflammatory process will continue its development. That is why in this case it is recommended to seek the advice of a specialist, and not try to overcome the disease on your own.

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

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

Classification

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

In addition, pyelonephritis is unilateral and bilateral, depending on the number of affected organs.

According to the severity of the course of the disease, the following forms are distinguished:

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

Pyelonephritis and pregnancy

Many women in a position who had to deal with such a disease are worried about how it can affect the health of the baby. All those who let this pathology take its course and do not seek qualified help may face very serious problems. Why is chronic pyelonephritis dangerous during pregnancy?

The consequences of the disease primarily affect the fetus. A child can be seriously affected by a developed intrauterine infection. As a rule, such pathology of the kidneys causes spontaneous abortion or premature birth. The consequences of infection for babies manifest themselves in different ways. Some are diagnosed with the most common conjunctivitis, which does not pose a threat to life, while others have severe infectious lesions of the internal organs.

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

Symptoms and treatment of the disease should be determined exclusively by a specialist. If an inflammatory process is detected, the doctor prescribes antibiotics to the future woman in labor. Of course, such drugs are undesirable to take during the bearing of the baby. However, a specialist can choose such means that will not cause serious harm to the fetus and will help the mother cope with the disease. Also in this kind of situation, painkillers, antispasmodics, vitamins, sedatives are prescribed, physiotherapy procedures are carried out.

Establishing diagnosis

Quite often it is difficult to confirm chronic pyelonephritis. Symptoms in women can vary, moreover, cases of a latent course of the disease are not uncommon. Diagnosis is usually based on history, laboratory findings, and the presence of a characteristic clinical picture. Additionally, the following diagnostic methods may be required:

• General analysis of urine / blood.
• Quantification of cells (Stenheimer-Malbin method).
• Examination of the urinary sediment.
• Determination of the content of electrolytes in urine and blood.
• Kidney radiograph.
• Radioisotope renography.
• Kidney biopsy.

Chronic and treatment

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

• Penicillins with a wide spectrum of action ("Amoxicillin", "Azlocillin").
• Second and third generation cephalosporins.
• Fluoroquinolones ("Levofloxacin", "Ofloxacin", "Ciprofloxacin"). Preparations of this group are prohibited for pregnant and lactating women.
• Nitrofurans ("Furadonin", "Furamag"). Sometimes patients experience side effects in the form of nausea, a bitter taste in the mouth, and vomiting.
• Sulfanilamide preparations ("Biseptol").

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

Chronic pyelonephritis: diet

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

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

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

Help of traditional medicine

Phytotherapy can be used as an additional treatment to the main one. You should not try to overcome chronic pyelonephritis on your own with the help of traditional medicine. Antibiotic treatment is generally more effective and safer for human health.

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

Herbal treatment involves taking them orally and using baths. For example, taking a bath with parsley has not only an anti-inflammatory, but also a cleansing effect. It enhances blood flow and promotes the elimination of existing toxins. Chamomile has an antibacterial and at the same time soothing effect on all systems of internal organs. St. John's wort is an excellent assistant in the fight against various kinds of infections.

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

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

Once again, it should be noted that one should not try to overcome chronic pyelonephritis on their own. Symptoms and herbal treatment are two interdependent factors that the physician must pay attention to. In each patient, the clinical manifestations of the disease, the degree of their severity may vary. Moreover, not in every case herbal medicine has a positive effect, sometimes it significantly aggravates the state of health.

Prevention

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

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

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

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

As for the question of life expectancy with this disease, there is no definite answer. If the patient clearly follows all the recommendations from the doctor, eats right and monitors his condition, you can live a long and happy life. If the disease is aggravated by constant alcohol intoxication, the lack of competent therapy, then the probability of death increases several times.

Conclusion

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