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Acute pyelonephritis

Acute pyelonephritis is an inflammatory process affecting the intermediate tissue and the Cup the renal pelvis system of kidneys with non-specific nature.

In urological practice acute pyelonephritis is the most common inflammatory process affecting the kidney. It can occur in childhood, a favorable condition for that is the incompleteness of the urinary system and the high load on it. Adults don't fall under an exception, most of the disease affects women under the age of 40 years.

Doctors divide the primary and secondary acute pyelonephritis. Primary is caused by disorders of urine outflow from the kidney, and the secondary caused by the breach of its passage due to obstruction of the urinary tract.

Pyelonephritis in the acute phase differs from that of chronic pyelonephritis:

  • The course of the inflammatory process in acute pyelonephritis fast, and in chronic slow.
  • Symptoms of acute disease is expressed clearly, and with chronic symptoms are often blurred or non-existent.
  • Acute pyelonephritis is completed with the recovery of the sick or transition into the chronic stage.
  • Chronic pyelonephritis is characterized by frequent relapses of the disease.
  • Chronic pyelonephritis harder responding to therapy.

Acute pyelonephritis is able to hit both one and two kidneys. On average, 1% of people of the total population of the globe each year is diagnosed with pyelonephritis. And acute pyelonephritis is 14% kidney diseases, and purulent complication occurs in 1/3 of patients.

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Symptoms of acute pyelonephritis

Symptoms of acute pyelonephritis depend on the form of the disease and the stage on which it is located.

The initial stage of serous inflammation. The kidney increases in size, becomes tense, swollen near the film fiber. If the disease is to start treatment at this stage, the acute pyelonephritis is successfully eliminated.

Stage of acute purulent pyelonephritis is divided in turn into three phases: aposematism pyelonephritis, carbuncle andabscess of the organ. Early in the cortical layer of the kidney the formation of small abscesses, which, if untreated, merged and formed a carbuncle. In the centers of merging carbuncles occur the melting of the parenchyma of the organ and develops an abscess of the tissues of the kidneys.

  1. The symptoms of non-obstructive pyelonephritis in the acute phase, the following:

    • The disease develops very quickly, almost immediately. Sometimes quite a few hours to the patient's condition became serious, sometimes it gets worse during the day.
    • The person feels malaise and weakness, body temperature rises rapidly, reaching the level of 40 degrees.
    • Increased sweating, a headache, quickens the heartbeat.
    • The disease is accompanied by the feeling of nausea and vomiting, arthralgia, diarrhea or constipation.
    • People experiencing pain in the lumbar area, it radiates to the thigh, back, stomach. The character of the pain or dull, or heavy.
    • Signs of disorders of urination, as a rule, is not observed.
    • Is not too marked reduction of daily diuresis as large amounts of water which the patient loses then.

    • The urine becomes cloudy, it emits an unpleasant odor.

  2. Symptoms of secondary pyelonephritis in the acute phase:

    • Onset of the disease occurs by type of renal colic, due to obstruction of the urinary tract.
    • At the peak of pain in the human body temperature rises, until the development of fever.

    • The patient's cold, he's thirsty and suffers from vomiting. (see also: Causes and symptoms of vomiting)

    • When sweating stops, the body temperature sometimes decreases to critically low levels, sometimes to normal values. Feeling somewhat normal.
    • The attack of colic comes back a few hours later, if urinary tract obstruction is not eliminated.

  3. The symptoms of purulent pyelonephritis in the acute stage:

    • In the lumbar region occur persistent pain.
    • People suffer from fever, occurring in hectic type (changes in body temperature is 3-4 degrees and happen 2-3 times a day).
    • The increase in temperature is accompanied by a fever.
    • The muscular wall of the abdomen tense, and the same applies to the lumbar muscles.
    • Whenintoxication reaches a peak, possibly clouding of consciousness and the development of delirium.

Causes of acute pyelonephritis

Causes of acute pyelonephritis are the penetration into the kidney of pathogenic microorganisms. In 50% of cases this agent is E. coli, in other cases the disease triggered by Proteus, Escherichia coli, streptococci, staphylococci, viruses and fungi. Modern urological practice points to the rare detection of only one pathogen of pyelonephritis. Most often the disease is caused by the Association of several microorganisms. Special risk are hospital strains of pathogenic agents in terms of the development of inflammation, as they are very difficult to eliminate.

There are two ways in which the causative agents can penetrate into the kidney:

  • Hematogenous route in which infection occurs by the bloodstream. This is the most rare cause of inflammation of kidneys, hematogenous route causes disease only in 5% of cases. The primary foci of infection can be urogenital organs, the presence of inflammation (cystitis, adnexitis, prostatitis, etc.), distant organs in case of sinusitis, bronchitis, dental caries, tonsillitis, cholecystitis, furunculosis, etc.
  • Urinogenous way route of infection is the most common way of infection in the kidneys. Microorganisms enter them from the lower urinary tract. Even this method of infection called ascending.

It is worth considering that in normal, infection can be exposed to only the distal urethra.

In order to further the spread of the infection, additional precipitating causes or factors, among which are:

  • The prevalence of periurethral area and in the area of the perineum of Escherichia coli. This can happen because of intestinal dysbiosis, with dysbiosis of the vagina in women.
  • Hormonal imbalance.
  • The increase in the acid environment of the vagina in women during menopause, due to lack of estrogen.
  • Sexually active women, and frequent change of sexual partners facilitates the penetration of infection into the bladder.

  • Vesicoureteral reflux can be a cause of the disease. While retrograde dregs of urine facilitates the movement of microorganisms of up, the mucosa of the urinary tract. This also contributes to the increased intrarenal pressure.(see also: Causes and symptoms of intracranial pressure)

  • Stricture of the ureter.
  • Kidney stones and blockage of the stone of the lumen of the urethral valve urethral.
  • Prostate adenoma and prostate cancer.
  • Neurogenic bladder.
  • Hypothermia.
  • Pregnancy.
  • Diabetes.
  • SARS.
  • Vitamin deficiencies and exhaustion.

The probability of occurrence of acute pyelonephritis is increased through the combination of several causes that occurs most often.


Complications and consequences of acute pyelonephritis

Complications and consequences of acute pyelonephritis can be severe and threaten life and health of the patient.

Danger:

  1. Sepsis.

  2. Bacterial shock.

  3. The paranephritis.

  4. Postisometric pyelonephritis.

  5. Carbuncle of the kidney.

  6. Abscess of the kidney.

  7. Necrosis of renal papillae.

  8. Pioneros renal tissues with their purulent fusion.

  9. Acute renal failure.

Diagnosis of acute pyelonephritis

Diagnosis of acute pyelonephritis often causes difficulties for individuals. Primarily this is due to the presence of bright symptoms of the disease.

Often in the anamnesis of such patients have chronic disease, or acute purulent inflammation. The clinical picture of acute pyelonephritis is always accompanied by a rise in body temperature to higher values and the concurrent pain in the lower back, mostly one-sided. Patients complain of difficulty urinating and changes in odor and color of urine. It acquires a reddish tint, it shows a haze.

Laboratory tests reveal the presence of urine protein and bacteria. To determine the type of pathogen, will be required to perform bacterial seedingurine.

Also needed blood for General analysis. Acute pyelonephritis will indicate increased ESR and leukocytosis. Identification of the pathogen is possible by performing specialized tests.

Review urography indicates that one kidney increases in volume compared to the other.

Excretory urography indicates marked limitation of mobility of the affected organ, which is noticeable when holding AutoProbe. If the patient aposematism pyelonephritis, the inflammation is markedly reduced excretory function, as seen in the diagnostic study. In carbuncle or abscess will indicate the bulging of the contour of the kidney, deformation of the pelvis and cups as a result of compression.

To assess structural changes of the kidneys, which is called pyelonephritis, it is appropriate to perform an ultrasound. To estimate the concentration capabilities of the authorities used a sample of General which will require the collection of urine.

CT is a method to exclude or confirm the presence of kidney stones, as well as to identify potential anatomical abnormalities in the structure of organs.


Treatment of acute pyelonephritis

Non-drug treatment is a prerequisite for the recovery of the patient. It boils down to maintaining sufficient daily diuresis. For this purpose the patient must drink the liquid in the amount from 2 to 2.5 litres.

For the replenishment of water can be used as fortified decoctions in the form of fruit drinks, which have antiseptic effects. It's cranberries, lingonberries and rosehips. In addition, shows the use of diuretics fees.

However, recommend drinking plenty of fluids can only a doctor because it is contraindicated in cardiac and pulmonary insufficiency, hypertension. If the patient is suffering from disorders of carbohydrate metabolism, consumption of liquid should not contain sugar.

Drug treatment of acute pyelonephritis

If the patient has no signs pointing to the urinary tract obstruction, he urgently appointed antibacterial therapy. Its duration can be from 5 days to two weeks. It is preferable to begin treatment with parenteral administration of antibiotics. When the symptoms of the acute phase of the disease will be cropped, antibiotics taken orally.

To modern antibacterial agents include:

  • Fluoroquinolones, which have antibacterial properties. Such drugs include:Levofloxacin, Sparfloxacin, Moxifloxacin, Ciprofloxacin, Ciprinol, Ofloxacin, Pefloxacin, Lomefloxacin. These medications not used to treat pregnant women, during breast feeding, it is not recommended to assign them to children and adolescents the period of active growth.
  • Drugs from the group of beta-lactams is common aminopenicillin, such as Amoxicillin and Ampicillin. Therapeutic effect was observed against Escherichia coli, Proteus, enterococci. However, often the drugs in this group of bacteria become resistant and therefore recommended to prescribe for the treatment of pyelonephritis in pregnant women. For all other patients use protected penicillins: Amoxiclav, Flemoklav Solutab and Sultamicillin. If pyelonephritis occurs in a complicated form, then apply carboxypenicillins: Tikarcillina, Carbenicillin, and ureidopenicillin: Piperacillin, Azlocillin.
  • Cephalosporins, which are often other drugs are used by professionals for getting rid of pyelonephritis. It can be: Cefazolin, Cefuroxime, Cephalexin, Cefradine, Cefixime, Ceftibuten, Ceftriaxone, Cefotaxime, Cefoperazone, Cefepime.
  • For the treatment of serious hospital-acquired forms of pyelonephritis, as well as serious complications of the disease is prescribed aminoglycosides: Netilmicin, Gentamicin, Tobramycin, Amikacin.

In addition to antibiotics, doctors used and other antimicrobials that continue to take even after the abolition of antibacterial drugs. It nitrofurans: Furazidin, Nitrofurantoin, combined anti-microbial agents: Co-trikomsel, 8-okshihinolina: Nitroxoline. They influence microbial activity, the impact on the acidity of the urine.

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Surgical treatment of acute pyelonephritis

When the use of antibiotics and other drugs is ineffective and also unable to restore the patency of the upper urinary tract with the installation of the catheter, necessary surgery. It is shown in the deterioration of the patient. Operate most often purulent forms of the disease: apostasy and carbuncles kidney.

The nature of the operation often remains open until it is run, the question is resolved when rendering the scale of involvement of the kidney in the pathological process. Its main objective is to prevent further development of purulent-inflammatory progress of the disease in the kidney, to prevent transfer of disease to healthy body to restore the normal flow of urine.

Physiotherapy for the treatment of acutepyelonephritis

As a use physiotherapy techniques such as: SMV-therapy, UHF and electrophoresis.

It is important to pay attention to the dietary habits of the patient with a predominance of easily digestible protein.


Diet in acute pyelonephritis

Diet in acute pyelonephritis implies conformity to rigid rules. Thanks to her, manages to arrest pain syndrome, to adjust the acidity of the urine. The drink should be plentiful and at the peak of the disease be not less than 2 liters.

When the acute symptoms subside, you should go to the vegetable-dairy diet. Salt in the diet of the patient is limited. In the day it can consume no more than 6 g. and in complicated forms of the disease, it does exclude from the diet.

Necessarily on the table the patient should be vegetables and fruits with a diuretic effect: squashes, melons, watermelons, cucumbers.

Under the absolute prohibition fall: soups - meat and fish, legumes, meats, marinades, pickles, mushrooms, canned foods, beverages, gases, alcohol, flavourings (read more: which foods are allowed and prohibited in pyelonephritis).

Under recovery menu, the patient is gradually returned meat products and fish. The first dish must be vegetarian. Food must be fractional, and food processing methods – sparing.