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The symptoms and treatment of chronic pyelonephritis kidney

Chronic pyelonephritis is a disease with infectious-inflammatory nature, in which the pathological process involved the calyx, pelvis and the tubules of the kidneys with the subsequent defeat of their glomeruli and blood vessels.

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

Most often the development of chronic pyelonephritis-affected women and girls, due to the peculiarities of the structure of their urethra. In a result, pathogens easier to penetrate into the bladder and kidneys. Mainly in the pathological process of chronic involved two kidneys, which is a distinction of chronic from acute pyelonephritis. Marvel at the bodies in this case are not the same. Acute disease is characterized by a sharp increase of symptoms, rapid progression of the disease. While the chronic pyelonephritis can often occur latently, giving itself felt only during periods of exacerbation, which are replaced after remission.

If complete recovery from an acute pyelonephritis does not occur for three months, it makes sense to talk about chronic pyelonephritis. Therefore, the chronic form of the disease, according to some, occurs more frequently than acute.

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Symptoms of chronic pyelonephritis

The disease and symptoms of chronic pyelonephritis is largely dependent on the localization of inflammation, the degree of involvement in the pathological process of one or both kidneys, from obstruction of the urinary tract, the presence of opportunistic infections.

For many years the disease can occur slowly, involving inflammation of interstitial kidney tissue. The symptoms are most pronounced during exacerbation of the disease and can be virtually imperceptible to the human during remissionof pyelonephritis.

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

  • The body temperature increase to high values, sometimes up to 39 degrees.
  • The appearance of pain in the lumbar region both with one and with two sides.
  • The emergence of dysuric phenomena.
  • Deterioration of General health of the patient.
  • The lack of appetite.
  • The occurrence of headaches.
  • Abdominal pain, vomiting and nausea occurs more often in children than in adult patients.

  • Several changes of the patient. These changes he can notice yourself, or they will pay attention to the doctor during the examination. Face is somewhat puffy, you may experience swelling of the eyelids (see also: Why swollen eyelids?). The skin is pale, there are bags under the eyes, they are particularly noticeable after sleep.

In the period of remission to diagnose the disease much more difficult. This is especially true of primary chronic pyelonephritis, which is characterized by a latent period.

Possible symptoms of this disease are the following:

  • Pain in the lumbar region are rare. They are small, are not constant. The nature of pain, pulling or aching.
  • Dysuria often absent, and if they appear, then very weakly and are almost imperceptible to the patient.
  • Body temperature usually is normal, although in the evening, perhaps a slight increase to 37.1 degrees.

  • If the disease for a long time is not diagnosed and not treated, people start to notice fatigue, loss of appetite and consequent weight loss, drowsiness, lethargy, and occasional inexplicable headaches. (see also: Causes, signs and symptoms, consequences)

  • The disease progresses dysuria grow, the skin begins to peel, becomes dry, its color changes to grayish-yellow.
  • The language of patients with long-term chronic pyelonephritis is overlaid with dark patina, lips and oral mucosa dry.
  • These patients often joins hypertension with a pronounced increase in diastolic blood pressure. Possible nosebleeds.
  • Running stages of chronic pyelonephritis are characterized by painbones, polyuria with up to 3 liters of urine per day, severe thirst.

Causes of chronic pyelonephritis

The cause of chronic pyelonephritis etiology can be only one – the defeat of kidney microbial flora. However, in order to get in on and start to proliferate, you need a provocative factors. Most often, the inflammation causes infection precisional or Escherichia coli, enterococci, Proteus, Pseudomonas aeruginosa, streptococci, as well as associations of microbes. Of particular importance in the development of chronic forms of the disease have L-form bacteria, which reproduce and exhibit pathogenic activity due to inadequate antimicrobial therapy, or by changing the acidity of urine. Such microorganisms are particularly resistant to drugs, difficult identifitseerida can for a long period of time just to exist in the interstitial tissue of the kidneys and to be active under the influence of favorable factors.

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

An additional motivating reasons to chronicization process are:

  • Time is not identified and treated the causes leading to violation of the outflow of urine. It could be kidney stones, stricture of the urinary tract, prostate adenoma, nephroptosis, vesicoureteral reflux.
  • Violation of terms of treatment of acute pyelonephritis, or improper therapy. The lack of a systematic medical control for patients who suffered acute inflammation.
  • Education L-bacteria and of protoplasts, which can long exist in the kidney tissue.
  • Reduction of immune forces of an organism. Immunodeficiency States.
  • In children the disease often develops after acute respiratory illness, scarlet fever, tonsillitis, pneumonia, measles, etc.
  • The presence of chronic disease. Diabetes, obesity, tonsillitis, diseases of the gastrointestinal tract.
  • In women at a young age a stimulus to the development of chronic diseases may become a regular sex life, its origin, pregnancy and childbirth.
  • A possible cause of disease not revealed congenital anomalies: diverticula of the bladder, ureterocele that violate normal urodynamics.
  • Recent studies point to a significant role in the disease development of secondary sensitization and the development of autoimmune reactions.
  • Sometimes the impetus for the development of the chronic form of the disease is hypothermia of the body.

Stage of chronic pyelonephritis

There are four stages of chronic pyelonephritis:

  • In the first stage of development of the disease the glomeruli of the kidney intact, i.e., not involved in the pathological process, atrophy of collective tubules uniform.
  • At the second stage of the disease some hyalinized and zapustevayut glomeruli, vessels are subjected to obliteration, is much narrowed. The growing scar-sclerotic changes of the tubules and interstitial tissue.
  • In the third stage of the disease there is a destruction of most of the glomeruli, tubules are greatly atrophied, interstitial and connective tissue continues to grow.
  • In the fourth stage of development of chronic pyelonephritis most of the glomerular dies, and kidney decreases in size, its tissue is replaced by scar. Body looks like a small wrinkled substrate with a rough surface.

Complications and consequences of chronic pyelonephritis

Possible consequences of chronic pyelonephritis may be secondary renal scarring, or Pioneros. Pioneros is a disease that develops at the final stage of purulent pyelonephritis. In children the outcome of the disease is observed rarely, it is more common for people aged 30 to 50 years.

Complications of chronic pyelonephritis can be the following:

  • Acute renal failure. This is the state that has the ability to draw, comes on suddenly, is characterized by marked disturbance, or the complete cessation of the health of kidneys.
  • Chronic renal failure. This condition is a gradual extinction of the authority's work against the background of pyelonephritis caused by loss of nephrons.
  • The paranephritis. This complication is a process of purulent inflammation of the perinephric tissue located.

  • Necrotizing papillitis. This is the complication that is most often found in hospitalized urological patients, predominantly in women. Accompanied by renal colic, hematuria, pyuria andother serious disorders of the body (fever, arterial hypertension). Can complete renal failure. (see also: Causes and symptoms of kidney failure)

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

Diagnosis of chronic pyelonephritis

Diagnosis of chronic pyelonephritis must be comprehensive. For diagnosis you will need the results of laboratory and instrumental studies.

Doctors refer patients to pass the following laboratory tests:

  • KLA. The chronic course of the disease will indicate anemia, increased number of white blood cells, shift of blood formula to the left, and an increased erythrocyte sedimentation rate.
  • OAM. According to the results of the analysis will be identified alkaline environment. Urine turbid, its density is reduced. Perhaps the presence of cylinders is sometimes determined bacteriuria, white blood cell count increased.
  • Sample Nechiporenko will reveal a predominance of leukocytes over erythrocytes, moreover, in the urine will be found active white blood cells.
  • Execution of the test and prednisolone pirogennogo when the subject is introduced prednisone and after a certain period of time, collected several portions of urine.
  • The sample in General reveal a decrease in density in different portions of urine collected during the day.
  • The TANK will reveal an increased number of sialic acids, seromucoid, fibrin, urea.

In addition, to confirm the diagnosis and examine the condition of the body should be performing some instrumental examinations, the choice of which remains with the doctor:

  • Implementation overview x-ray examination of the kidneys. With chronic kidney disease in the size will be reduced (or two or one).
  • Implementation of chromolithography. If you have chronic pyelonephritis, the doctor will note the violation excretory functions of the kidneys – one or two-way.
  • The implementation of the excretory or retrograde pyelography will detect an existing deformation and pathological changes in the cups and pelvis organs.
  • Renal ultrasound can detect the asymmetry of the bodies, their deformation, and heterogeneity.
  • Radioisotope scanning also detects the asymmetry of the kidneys and diffuse their changes.
  • Detailed structural changes in the organ is able to detect highly informative studies such as CT and MRI.
  • Renal biopsies and examination of biopsy material is performed by clinically unclear cases.

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


Treatment of chronic pyelonephritis

Treatment of chronic pyelonephritis can not be complete without individual approach to the patient and without taking comprehensive measures for its recovery. It includes adherence to diet and drinking, intake of drugs, as well as the elimination of the causes that may impede the normal flow of urine.

In the stage of exacerbation of chronic pyelonephritis should be placed the patient for treatment and observation in hospital. With primary pyelonephritis patients to determine therapeutic or specialized Nephrology unit, and secondary in urology.

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

Swelling, as a rule, these patients do not occur, so their drinking regime should not be curtailed. Priority drinks is normal water, vitamin-fortified beverages, cranberry juice, juices, compotes, jellies. The volume supplied to body fluid during the day may amount to 2000 ml. the Decrease in its amount is possible by the physician, in the presence of arterial hypertension, disorders of the passage of urine. In this case, limit the consumption of salt, until its complete elimination.

A decisive moment in the treatment of chronic pyelonephritis is antibiotics. They are administered as early as possible and for long term after having established the sensitivity of bacterial agents to specific drugs that were sown from the urine. The effect will not be achieved if antibiotics are administered too late in the short term, or if there are any obstacles to the normal passage of urine.

If the disease is diagnosed at a late stage, even high doses of antimicrobial agents are often not enougheffective. In addition, on the background of existing violations of the kidney function, the risk of developing severe side effects from even the most effective drugs. The probability of development of resistance increases many times over.

For the treatment of chronic pyelonephritis the following drugs:

  • Semisynthetic penicillins – Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.
  • Cephalosporins – Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.
  • Nalidixic acid – Blacks, Nevigramon.
  • The aminoglycosides used in severe disease – Kanamycin, Gentamicin, Colimycin, Tobramycin, Amikacin.
  • Fluoroquinolones: Levofloxacin, Ofloxacin, Ciprinol, Moxifloxacin, etc.
  • Nitrofurans Furazolidone, Furadonin.
  • Sulfonamides – Ursulan, Etazol etc.
  • Antioxidant therapy reduced the intake of Tocopherol, Ascorbic acid, Retinol, Selenium, etc.

Before you opt for a particular antibacterial drug, the doctor needs to see the pH of urine of patients, since it has an impact on the effectiveness of medicines.

Antibiotics in the period of exacerbation of the disease is prescribed for up to 8 weeks. The specific treatment duration will depend on the results of performed laboratory tests. If the patient's condition is severe then he prescribed a combination of antibiotics, they are administered parenterally, or intravenously and in high doses. One of the most effective modern uroseptics is the drug 5-NOK.

To self-medicate is strictly prohibited, although drugs for the treatment of pyelonephritis there are many. The disease is exclusively in the competence of specialists.

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

  • The lack of dysuric phenomena;
  • Normalization of blood counts and urine tests;
  • Normalization of body temperature;
  • The disappearance of leukocyturia, bacteriuria, proteinuria.

However, in spite of successful therapy of chronic pyelonephritis, a relapse is possible, which occurs with a probability of 60% to 80%. Therefore, doctors perform months-long anti-relapse therapy, which is justified in chronic inflammation of the kidneys.

If the treatment experience an allergic reaction, it is necessary to carry antihistamine therapy, which boils down to the use of such drugs as: Tavegil, pipolfen,Suprastin, Diazolin, etc.

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

Patients with arterial hypertension recommend receiving Reserpine, Clonidine, Gemiton and other hypotensive means in combination with Hydrochlorothiazide, Triampur and other saluretikami.

In terminal stages of the disease recommended surgical intervention and organ preservation, or nephrectomy. Often with the scope of surgical intervention could be determined during surgery.

In addition, the patients shown Spa treatment in sanatoriums balneoesthetic.

Topic: Effective treatment of pyelonephritis folk remedies


Nutrition in chronic pyelonephritis

Proper nutrition in chronic pyelonephritis is a prerequisite of proper treatment. It provides for the exclusion from the diet of spicy food, all nourishing broths, a variety of seasonings to enhance the taste and also strong coffee and alcohol.

Calorie foods to understate should not be, per day an adult should consume up to 2500 calories. The diet should be balanced in protein, fats and carbohydrates and have a maximum range of vitamins.

Optimal chronic pyelonephritis is considered a vegetable and milk diet with the addition of meat and fish dishes.

You need to include in your daily diet a variety of vegetables: potatoes, zucchini, beets, cabbage, and various fruits. Necessarily on the table must be present eggs, dairy products and milk itself.

In iron deficiency you must eat more apples, strawberries, pomegranates. At any stage of chronic pyelonephritis diet should be enriched with watermelon, cantaloupe, cucumbers, pumpkin. These products have a diuretic effect and allow you to quickly deal with the disease.

Read more: which foods are allowed and prohibited in chronic pyelonephritis


Prevention of chronic pyelonephritis

  • Prevention of patients with pyelonephritis is reduced to a timely and thorough treatment of patients at the stage of acute pyelonephritis. Such patients should be at the dispensary.
  • Are the recommendations for placement of patients with chronic pyelonephritis: patients are advised not to arrange for enterprisesrequiring heavy physical labor, contributing to being in a constant nervous tension. It is important to avoid hypothermia in the workplace and outside of it, you should avoid working on the legs and in the night, excluded work in hot shops.
  • You should follow a diet with restriction of salt on the recommendations of doctors.
  • The success of preventive measures at the secondary pyelonephritis depends on the full elimination of the causes that led to the development of the disease. Important it is mandatory to remove any obstacles to the normal outflow of urine.
  • It is important to the detection and treatment of latent foci of infection and intercurrent illnesses.
  • After discharge from hospital, patients should be put on dispensary registration for a period of not less than one year. If after this time is not detected bacteriuria, leukocyturia and proteinuria, patient-registration is removed. If the symptoms persist, it is necessary to extend the observation period for such patients up to three years.
  • If identified in patients with primary pyelonephritis, the treatment of long-term, with periodic putting them in the hospital.
  • Not less important, correction of immunity and the maintenance of its normal. This requires the observance of a healthy lifestyle, prolonged stay in the fresh air, exercise dosed by the physician.
  • Stay in sanatorium establishments of the specialized profile allows to reduce the number of exacerbations of the disease.
  • Special attention is given to the prevention of disease in pregnant women and children, and patients with weakened immune systems.

When latent course of the disease patients for a long time do not lose the ability to work. Other forms of pyelonephritis can have a significant impact on human performance, as there is a threat of a rapid accession of complications.