Acute non-obstructive pyelonephritis. Acute pyelonephritis is an insidious disease that leads to the development of kidney failure

Pyelonephritis - nonspecific inflammatory disease kidneys. There are two main forms: obstructive and non-obstructive. An ailment occurs against the background of other violations, for example, when urolithiasis or a bacterial infection. Obstructive pyelonephritis is characterized by a deterioration in the outflow of urine through the urinary tract. In the chronic course of the pathology, the functioning of the kidney is severely impaired, the risk is high renal failure.

Obstructive pyelonephritis

Inflammation of the renal structures rarely develops on its own, more often it is a "background" condition that occurs with bacterial infections in the excretory system, urolithiasis, impaired protein metabolism and other pathologies. In non-obstructive pyelonephritis, the normal outflow of urine from the renal pelvis and ureters remains, and in the obstructive form, it is impaired.

Obstructive pyelonephritis develops slowly, affecting individual renal structures, so the disease is difficult to recognize immediately.

Impaired urine flow occurs when inflammation of the kidney tissue is so severe that it causes a narrowing or spasm of the ureters.

It is important to understand that inflammation of the renal structures is not always caused by infectious diseases. For example, non-obstructive chronic pyelonephritis associated with reflux is formed due to pathologies in the development of the excretory system, and the course of chronic obstructive pyelonephritis is one of the complications of urolithiasis.

Forms of obstructive pyelonephritis

There are two main forms of obstructive pyelonephritis: acute and chronic. The first is characterized by the rapid development of obstruction - obstruction of the urinary tract against the background of acute infectious inflammation or under the influence of other factors.

The chronic form differs from the acute one in that it combines periods of recurrence of the inflammatory process with remission, during which the patient's excretory system begins to function normally.

Causes of obstructive pyelonephritis

There are many reasons provoking the development of pyelonephritis with urinary tract obstruction:

• congenital or acquired as a result of trauma or previous diseases, anomalies of the urinary system;
• advanced urolithiasis, when large deposits are formed that can clog the renal tubules;
• exacerbation of pathologies of the excretory system during pregnancy, when the load on the kidneys and ureters increases;
• adenoma or prostate cancer in men;
• severe hypothermia of the kidneys, followed by the addition of a bacterial infection or the death of organ tissues;
• type 1 or type 2 diabetes mellitus;
• gout;
• long-term use of antibiotics;
• lingering infectious diseases of other organ systems.

The exact cause of this ailment should be established by a nephrologist after hardware diagnostics and laboratory tests. It is important to prescribe the correct therapy.

Obstructive pyelonephritis symptoms

Symptoms of obstruction during inflammation of the kidneys do not appear immediately, the disease betrays itself at a time when the tissues are already severely damaged. The patient is tormented by the following symptom complex:

• renal colic;
• pain in the lumbar region (sometimes the patient clearly feels discomfort on one side);
• persistent with chills;
• intoxication of the body, which is manifested by puffiness, dark circles localized under the eyes, yellowing or reddening of the sclera, unpleasant odor of sweat and from the mouth;
• frequent headaches, sleep disturbances (insomnia or persistent drowsiness);
• constant feeling of thirst;
• decreased appetite, nausea;
• disruptions in heart rate, decreased endurance with physical activity;
• weakness;
• losing weight without changing the diet;
• painful sensations when urinating in the lumbar region.

Individual symptoms associated with the initial physical health the patient before the development of obstructive pyelonephritis. The appearance of signs of the disease is influenced by concomitant pathologies of the kidneys and other organs.

Acute obstructive pyelonephritis manifests itself brighter than the chronic or non-acute form. The patient experiences severe back pain, the temperature rises to 40 degrees, due to severe intoxication, vomiting, upset stools and loss of consciousness, sweating are possible. Urination is very difficult. Most often, this type of inflammatory process is associated with kidney damage by a severe infection of a bacterial or viral nature.

Diagnosis of obstructive pyelonephritis

The diagnosis of obstructive pyelonephritis should be started at the appearance of its first signs in order to minimize the negative effects for the patient. This pathology is dangerous for its complications. The most important laboratory tests are:

• a detailed blood test (counting immune and other blood cells) to confirm the inflammatory process in the body;
• analysis of the composition of urine;
• blood biochemistry;
• bacterial culture of urine (allows you to detect the causative agent of the infection if it has become the cause of pyelonephritis, and also to track the presence of antibiotic resistance in this pathogen).

Instrumental methods will help to more accurately determine the location of the focus of obstructive pyelonephritis, the intensity of the lesion, the state of the ureters. These include the following procedures:

• Ultrasound of the pelvic organs;
• X-ray examination of the kidneys (without contrast or contrast urography);
• CT and MRI.

The complex of these procedures will help the doctor to accurately diagnose, determine the location of the inflammation focus, find the cause of the pathology and choose the treatment. It is important to remember that you cannot try to get rid of this disease on your own - this can only aggravate the situation. No herbs or products will help eliminate, for example, an infection, and a blurred clinical picture will prevent a correct diagnosis.

Treatment of obstructive pyelonephritis

Obstructive pyelonephritis is a reason for hospitalization of the patient. Often, treatment requires a course of antibacterial drugs, medications that restore the outflow of urine. Sometimes it is necessary to install a drainage tube; in severe cases, you cannot do without an apparatus that maintains a normal blood composition if the functioning of the kidneys is severely impaired.

In addition to drugs that fight the cause of the disease, the therapeutic complex includes drugs that relieve symptoms - it gives the patient a lot of discomfort. These drugs include non-steroidal anti-inflammatory drugs, analgesics, antispasmodics, prebiotics in case of taking antibiotics, as well as vitamin and mineral complexes.

In addition to drug and apparatus therapy, it is important to give the patient complete rest. Mandatory bed rest and refusal of heavy physical activity... you also need to adjust, give preference to light food, completely eliminate any drinks containing sugar and caffeine, reduce the intake of salt, fat and protein.

The development of obstructive pyelonephritis may be asymptomatic. This disease slowly affects the kidneys, disrupting their function and the flow of urine through the ureters. The causes of pyelonephritis are varied, therefore, before the appointment of therapy, the patient should be examined. The earlier the therapy begins, the less the likelihood of complications, so you should not self-medicate, it is better to immediately consult a doctor.

Obstructive pyelonephritis is an extremely dangerous infectious kidney disease that develops against the background of an acute violation of the outflow of urine through the calyx-pelvic system and the rapid multiplication of bacterial microflora. This disease is quite common. Obstructive, like non-obstructive pyelonephritis can develop in both children and adults. People with a weakened immune system are most susceptible to this disease.

The peak incidence usually occurs in spring and autumn, when there is an increase in the number of cases of SARS and influenza. Against the background of these respiratory infections, human immunity is significantly reduced, therefore, the bacteria that are always present on the mucous membranes of the genitourinary system are able to multiply, becoming the cause of inflammatory kidney damage. There are many other factors that greatly contribute to the appearance of this pathological condition.

Many different factors contributing to the obstruction of the outflow of urine create the conditions for the development of this infectious disease... Stagnant processes lead to an increase in the number of bacteria that provoke inflammatory tissue damage. Often pyelonephritis occurs against the background of congenital malformations of the kidneys and urinary tract. Usually, such pathologies begin to manifest themselves as inflammation already in early childhood.

Urolithiasis also often predisposes to the development of pyelonephritis, and then obstruction. Kidney stones, under certain circumstances, can descend into the ureter, partially or completely blocking the flow of urine. In men, pyelonephritis often develops against the background of adenoma or prostate cancer. In women, pregnancy can act as a provoking factor for such kidney damage, since an increase in the uterus contributes to a change in the position of this paired organ, and sometimes becomes the cause of compression of the ureters. In addition, there are factors that contribute to the onset of chronic obstructive pyelonephritis, including:

• diabetes;
• diseases of the thyroid gland;
• long-term use of antibiotics;
• hypothermia.

Previous operations on the urinary tract can create conditions for the development of such damage to the kidney tissue. In addition, kidney injury can contribute to the appearance of obstructive pyelonephritis. A decrease in immunity of any etiology can provoke the development of this pathological condition.

Symptoms

In most cases, this disease is acute. There is a rapid rise in body temperature up to +40 ° C. The main symptom of this violation is considered renal colic - sharp pain in the lower back. Because of the inflammatory damage to the kidney tissue, urinary problems are usually observed. Patients complain of chills and increased sweating. As a rule, general weakness is growing rapidly. As the disease progresses, the following symptoms may appear:

• intense thirst;
• vomit;
• nausea;
• a feeling of dryness in the blood;
• headache.

The intensity of the signs of this pathological condition usually increases over 3-4 days. This is due to the fact that toxins accumulate in the body, which, due to impaired renal function, cannot be excreted in the urine. To avoid development severe complications, it is necessary to consult a doctor at the first symptoms. If treatment was not started in a timely manner, this disease becomes chronic, which is characterized by the alternation of periods of relapse and remission. This outcome is considered extremely unfavorable, as it further leads to renal failure.

Diagnostics

First of all, the patient is examined, anamnesis is taken and the existing symptoms are assessed. Even this is enough for a specialist to suspect the development of obstructive pyelonephritis. Usually, to confirm the diagnosis, studies such as:

• general and biochemical analysis blood and urine;
• bacterial urine culture;
• urography;
• angiography;
• nephroscintigraphy;
• radiography.

The nephrologist independently decides which studies are required to make a diagnosis. Self-medication can pose a serious health hazard. After conducting a comprehensive diagnosis, the doctor may prescribe necessary drugs to suppress the inflammatory process.

Treatment of obstructive pyelonephritis

In the acute period, complex therapy is required to avoid the transition of the disease into a chronic form. First of all, a diet is prescribed - table number 7a. Drink at least 2–2.5 liters of liquid a day. This will allow you to quickly eliminate pathogenic microflora and suppress the inflammatory process. Your doctor may recommend thermal treatments to relieve pain and improve local circulation.

Among other things, a directed drug therapy... In the early days of the current acute period obstructive pyelonephritis has an extremely strong pain syndrome. To eliminate it, the nephrologist may prescribe antispasmodics. Targeted antibiotic therapy is required to suppress infection.

Usually, for obstructive pyelonephritis, drugs are used such as:

• Benzylpenicillin;
• Oxacillin;
• Ampicillin;
• Ampicillin sodium salt;
• Streptomycin;
• Tetracycline;
• Metacyclin;
• Morphocyclin;
• Tetraolean;
• Oletetrin;
• Gentamicin;
• Cephaloridin.

The course of antibiotic therapy should be at least 4 weeks. It should not be interrupted, as this can contribute to the transition of the disease into a chronic form. Such medicines usually given intravenously or intramuscularly. In addition, drugs are prescribed to lower body temperature. Can also be assigned vitamin complexes that help to increase immunity. However, if conservative methods treatments do not allow to achieve a pronounced effect, it can be shown surgery... Usually, such therapy is required in the presence of stones and various abnormalities of the urinary tract.

Chronic pathological changes in the kidneys, accompanied by inflammatory processes, can be hidden for a long time. But during an exacerbation, they give acute symptoms, which can manifest itself in the form of painful urination, edema and high fever.

This clinical picture may signal the development of a disease such as obstructive pyelonephritis. Its diagnosis and treatment present some difficulties. The inflammation is mostly asymptomatic and can be detected on early stages development is problematic, and when the acute phase begins, changes have already occurred in the kidney tissues, which are difficult to get rid of.

Speaking about the mechanism of development of obstructive pyelonephritis and what it is, it should be mentioned that this disease is characterized by a violation of the outflow of urine. Due to inflammation, a spasm of the ureters occurs, as a result of which urine, getting into the renal pelvis and calyx, does not leave them for a long time.

Often, pyelonephritis is a secondary disease that occurs against the background of pathologies leading to compression or blockage of the ureters. If there are no violations of the outflow of urine, the type of disease is called "non-obstructive pyelonephritis".

The kidney is a paired organ consisting of:

• pyramids of the medulla;
• medulla;
• renal artery and vein;
• pelvis;
• large and small renal cups;
• ureter;
• cortical layer.

Above, the kidney is covered with a dense membrane that protects the organ from mechanical damage... Every day, complex processes of urine formation take place in it - this is a biological fluid of the body that accumulates in the bowls and pelvis, and then is filtered and sent to the ureter, from where it enters bladder.

Development of the pathological process

With the development of pathological processes, the outflow of urine is disturbed, stagnation occurs, leading to the expansion of the organ capsule. An increase in the volume of the kidney leads to an increase in the pressure it exerts on the nerve endings, which contributes to the emergence of a strong pain syndrome... In the place of stagnation, bacteria begin to actively multiply, which provoke the development of inflammation.

This is how obstructive pyelonephritis develops, which has 2 forms - acute and chronic. In the first case, there is a rapid progression of the disease with a pronounced symptomatic picture. As a rule, acute obstructive pyelonephritis develops against the background of infection in the renal structures, which provokes a reaction in the form of inflammation and overlapping of the ureters.

The chronic form of the disease differs only in that it has two stages of its development, which are replaced by each other under the influence of certain factors on the body. During periods of remission, the work of the kidneys is normalized, and at the time of exacerbation, it is disrupted, which also leads to the emergence of acute symptoms, the severity of which also directly depends on the degree of obstruction. And she happens:

• relative - characterized by a partial violation of the outflow of urine;
• absolute - the outflow of urine is completely stopped;
• increasing - a gradual violation of the outflow of urine.

Causes of obstructive pyelonephritis

Various factors contribute to the onset of pyelonephritis. Most often, pathology provocateurs are:

• congenital anomalies of the urinary tract (for this reason, chronic obstructive pyelonephritis in children is diagnosed in 80% of cases);
• urolithiasis disease;
• injuries sustained by falling, impact, or surgical interventions;
• prostatitis and the formation of prostate adenoma in men;
• period of pregnancy in women.

In addition, in 70% of cases, the cause of the development of chronic obstructive pyelonephritis is improper treatment or complete absence in the acute course of the disease, as well as:

• the development of infections of the respiratory or genitourinary system;
• long-term use of antibacterial drugs;

Features in children

It should be noted that chronic kidney inflammation and impaired urine outflow are most often observed in young children. The reason for this is viral infections, which the mother suffered during pregnancy, genetic and hereditary predisposition.

The penetration of infection into the kidneys in children can occur in different ways:

• hematogenous;
• urinogenic.

Hematogenous infection most often occurs in children under 1 year of age. In this case, the provocateurs of the disease may be:

• pneumonia;
• omphalitis;

In older children, infection most often occurs by the urinogenic route. Here, diseases such as intestinal infections, vulvitis (in girls), balanoposthitis (in boys), cystitis, etc. Disregard of the rules of hygiene is of no small importance.

Symptoms

The clinical picture of this disease in children and adults is the same, and it depends directly on the course of the disease. So, for example, if a person has acute obstructive pyelonephritis, then in this case the following symptoms begin to bother him:

• renal colic, which is characterized by severe pain in the lumbar region (if pathological processes occur in only one kidney, discomfort appears on the left or right side if in two - on both sides);
• cramps when urinating;
• weakness;
• body temperature up to 38 degrees, but it can be higher;
• nausea;
• lack of appetite;
• dry mouth, constant thirst;
• increased heart rate;
• a sharp decrease in weight.

Main symptoms

With the development of this disease, the outflow of urine from the kidneys is disrupted, which leads to stagnation and reproduction of pathogenic microorganisms that secrete harmful substances. Against this background, intoxication occurs, which is characterized by the following symptoms:

• bad breath;
• chills;
• diarrhea;
• dizziness;
• headache;
• drowsiness;
• pallor of the skin.

Symptoms of chronic obstructive pyelonephritis during an exacerbation are no different from clinical picture, characteristic of the acute course of the disease. In moments of remission, when the functionality of the urinary system is restored, the person's condition returns to normal. The duration of the remission stage directly depends on the treatment that the patient receives and his lifestyle.

Diagnostics

If you suspect kidney inflammation, the following tests are prescribed:

• clinical blood test;
• bacterial culture of urine;
• general urine analysis.

These studies make it possible to verify the presence of inflammatory reactions in the body and to identify the causative agent of the disease, if an infectious agent has become it, as well as to establish its resistance to antibacterial drugs.

A computerized study of the kidneys is used to determine the location of the focus of inflammation, the degree of obstruction and the state of the ureters. In this case, the most commonly used are:

• x-ray;
• CT, MRI.

Treatment

In order for the fight against pyelonephritis to be successful and without complications, the patient must receive appropriate treatment, which is carried out under medical supervision in a hospital setting. It is selected on an individual basis, but it is almost always required to take antibiotics and other drugs, the action of which is aimed at restoring the outflow of urine.

With strong inflammatory reactions and partial overlapping of the ureters, surgery is performed, during which a drainage tube is installed, which ensures urine excretion.
If, during the examination, the patient was found to have obstructive pyelonephritis against the background of absolute obstruction of the ureter, then in this case, different kinds surgical interventions aimed at restoring the outflow of urine. For this purpose, they are most often used:

• the installation of a ureteral stent, which has the form of a tube that promotes the expansion of the ureter;
• Percutaneous nephrostomy, in which a tube is inserted to drain urine through the urethra
• pyeloplasty, in which the damaged part of the ureter is resected, followed by the installation of a stent;
• transureteroureterostomy, during which the damaged ureter is connected to a healthy one;
• reimplantation, which removes the affected area of ​​the ureter and then connects healthy tissues;
• ureterolysis, during which fibrous or scar tissue is removed that obstructs the normal flow of urine through the ureter;
• nephrectomy, which removes an obstructed kidney.

Drug treatment

Since this disease is accompanied by acute symptoms, is mandatory drug therapy aimed at stopping them. It includes reception:

• non-steroidal anti-inflammatory drugs (NSAIDs) that reduce inflammation and have antipyretic effects;
• antispasmodics and analgesics, which ensure the elimination of spasms and pain syndrome;
• multivitamin complexes that help strengthen the immune system;
• prebiotics to restore intestinal microflora (they are used only with concurrent administration of antibiotics).

According to doctors, medication and surgical treatment pyelonephritis is not enough. The patient needs complete rest. He also needs to adhere to a special diet that will help reduce the burden on the kidneys. To do this, you should minimize the use of salt, give preference only to light meals (you cannot eat fatty, fried, smoked foods) and completely abandon:

• alcohol;
• drinks that contain sugar and caffeine.

Together, all these measures provide relief of inflammatory processes and restoration of kidney functionality. It is important to start taking them in a timely manner when the disease is still in the acute phase. This will avoid its transition to a chronic form and the development of complications against its background.

Prophylaxis

Preventing the development of chronic obstructive pyelonephritis is much easier than treating it. And for this it is important to follow some rules:

• carry out timely treatment of renal pathologies and infectious diseases;
• strengthen immunity;
• avoid hypothermia;
• give up alcohol;
• eat properly.

If a person has already been diagnosed with obstructive pyelonephritis, then he should regularly visit a doctor and take blood and urine tests to control the course of the disease, constantly follow a diet and avoid emotional stress.

Pyelonephritis is a nonspecific inflammatory process that affects the renal tubular system. And although a person of any gender and age can suffer from this disease, from tiny babies to deeply elderly people, nevertheless, this disease is most often diagnosed in women. According to statistics, out of 100 people who have been diagnosed with pyelonephritis, 75 are the fair sex. And there are reasons for this.

Why are women more likely to experience pyelonephritis?

The acute and chronic course of the disease in women occurs five times more often than in men. This is due to the anatomical structure of the genitourinary system. The urethra is shaped differently in women than in men. In the female bladder, it is much easier and more likely to penetrate a different plan of infection, which is why such a large percentage of pyelonephritis in women and girls. In most cases, pyelonephritis is characterized by the so-called "ascending" infection, in which pathogenic bacteria from the urinary tract, moving upward, penetrate the kidneys and already begin their "work" there. Sometimes the development of pyelonephritis does not make itself felt, and the patient does not have any uncomfortable sensations, the general state of health does not deteriorate. It often happens that a woman learns about the pathological process in her body several years after the onset of the development of the disease. That is why it is very important to know the symptoms of pyelonephritis in order to undergo an examination as early as possible and, if fears are confirmed, to begin a comprehensive and effective treatment.

Symptoms of the development of pyelonephritis in women

There are many types and subspecies of this kidney disease, but if briefly and generally, we can say that pyelonephritis is divided into two main types: acute and chronic. Each of these two types of disease has its own causes and, of course, symptoms.

Acute pyelonephritis and its symptoms

The acute course of pyelonephritis is divided, in turn, into obstructive and non-obstructive pyelonephritis. Non-obstructive pyelonephritis is characterized by a predominance common symptoms getting the infection into the body. Obstructive pyelonephritis has more pronounced local symptoms.

Acute non-obstructive pyelonephritis

Able to develop at lightning speed (3-24 hours). The patient is overcome by general malaise, severe weakness, chills of the body. Body temperature rises sharply to critical levels of 40 degrees. Headaches torment. Malfunctions are not uncommon of cardio-vascular system, tachycardia (palpitations) appears. Possible malfunctions gastrointestinal tract in the form of constipation, diarrhea and increased gas production. Local symptoms of non-obstructive pyelonephritis are characterized by pain in lumbar the spine, which spreads, depending on the course of the ureter, to the thigh area, less often to the abdomen and back. The pain can be either constant, dull, or sharp and intense. The process of urination in most cases is not disturbed, however, the total daily amount of urine can be significantly reduced. This is due to intense sweating, which is unavoidable with a significant increase in body temperature.

Acute obstructive pyelonephritis

Always begins with renal colic. Along with this, a fever begins with severe chills, pains in the head, which are of a sharp shooting character. Vomiting and diarrhea are common. The sick woman is constantly thirsty. The body temperature rises rapidly and critically. However, heavy sweating quickly lowers the temperature to normal or near-normal levels. At this stage, the general well-being improves somewhat. This is the insidiousness of the disease: the patient decides that everything has returned to normal and does not rush for the help of a specialist. And at the same time, if you do not receive qualified assistance, such attacks can be repeated repeatedly.

Chronic pyelonephritis and its symptoms

Diagnostics chronic pyelonephritis in women it is complicated by the fact that in the overwhelming majority of cases the disease does not manifest itself in any way. However, this is only at first glance. Nevertheless, if you listen more carefully to your body, then it is quite possible to suspect a problem in time. There are some indirect symptoms that indicate a sluggish development of chronic pyelonephritis. Symptoms of chronic pyelonephritis include:

discomfort in the lumbar spine general malaise of the body; episodic nausea; small changes in the mode of emptying the bladder; abrupt changes in the temperature regime of the body

These are indirect symptoms. chronic course pyelonephritis. However, in rare cases, there is pain and a burning sensation directly in the kidney itself. Periodic increases in body temperature indicate that a serious, often irreversible inflammatory process has begun in the kidneys. The symptoms of chronic pyelonephritis are wide enough and at the same time blurred. In individual cases, the patient may show symptoms that are characteristic of diseases such as peritonitis and cholecystitis.

Acute pyelonephritis is an acute nonspecific infectious inflammation of the pyelocaliceal system and tubulo-interstitial zone of the kidneys. Distinguish between unilateral and bilateral, non-obstructive (primary) and obstructive (secondary), serous and purulent acute pyelonephritis (OP).

In the development of OP, the leading role is played by the gram-negative intestinal microflora (E. coli, enterococci, Proteus). Senile (senile) OP is often caused by Pseudomonas aeruginosa. A rarer and most pathogenic causative agent of OP is plasmacoagulant staphylococcus aureus.

The nephropathogenicity of these bacteria is associated with the phenomenon of adhesion, which prevents the washing out of microbes from the calyx-pelvic system, as well as with the phenomenon of physiological obstruction caused by the release of endotoxin by these pathogens, which reduces the normal tone and peristalsis of the urinary tract.

Urinogenic drift of infection is also facilitated by disturbances in urodynamics in vesicoureteral reflux (VUR), lesions spinal cord, prostate adenoma, a number gynecological diseases, nephrolithiasis, abnormalities of the kidney, pregnancy. Hematogenous and lymphogenous pathways of infection with OP are also possible.

It was found that favorable conditions for the development of infection in the interstitium create renal tissue hypoxia, which occurs during nephroptosis, hypertension, atherosclerosis and nephrosclerosis, electrolyte disturbances (hypokalemia), abuse of non-narcotic analgesics, disorders of carbohydrate metabolism (diabetes mellitus).

Morphologically, with serous OP, focal neutrophilic infiltration of the medulla of the kidney and pyramids, pronounced interstitial edema of the stroma, and perivascular infiltration are found.

With the hematogenous spread of infection in the kidney in the form of infected emboli located in its vessels, pustules form in the cortical layer (apostematous nephritis, kidney carbuncle), purulent paranephritis and necrosis of the renal papillae may develop. Due to acute occlusion of the urinary tract, renal-pelvic reflux is formed, as a result of which urine saturated with endotoxins enters the bloodstream, which leads to bacteremic shock with disseminated intravascular coagulation syndrome, urosepsis. Bacteremic shock, mortality in which reaches 20%, develops in every tenth patient with obstructive OP, especially often with senile and gestational pyelonephritis.

The clinical picture of acute pyelonephritis

At different forms OP has characteristic symptoms.

Non-obstructive form of acute pyelonephritis

manifests itself as an acute increase in body temperature (up to 38-39 ° C) with chills, dull pains in the lower back, headache, nausea, myalgia. Dysuria and the discharge of cloudy urine with an unpleasant odor are characteristic. On examination: blood pressure is normal, neutrophilic leukocytosis, pyuria, bacteriuria, moderate (less than 1 g / l) proteinuria.

Obstructive form of acute pyelonephritis

usually debuts at the height of renal colic. The pains become intense, bursting, there is a tremendous chill with a fever of 39-40 ° C (a sign of renal renal reflux), intoxication increases. A sharply positive symptom of Pasternatsky, an increasing neutrophilic leukocytosis, is found. Urinalysis may be normal if there is complete obstruction, which is confirmed by chromocystoscopy.

Purulent acute pyelonephritis

characterized by repeated (3-4 times a day) chills with pouring sweat, severe intoxication and leukocytosis (up to leukemoid numbers), local soreness and muscle tension during bimanual palpation of the lumbar region. However, it should be emphasized that senile purulent OP often proceeds areactively, without high fever and severe pain, but at the same time, general intoxication and severe complications join especially quickly.

Dangerous complications of purulent OP are considered the appearance of massive macrohematuria with secondary renal colic and the presence of necrotic tissues in the urine (necrotizing papillitis), the sudden development of deep collapse with signs of disseminated intravascular coagulation, an increase in azotemia and jaundice (bacteremic shock).

Diagnostics of the acute pyelonephritis

non-obstructive OP usually does not cause difficulties (lumbodynia, dysuria, pyuria). With obstructive purulent OP, when changes in urine may be absent, differential diagnosis performed with acute surgical (appendicitis, acute cholecystitis, pancreatic necrosis), infectious (typhus, brucellosis, croupous pneumonia, subacute infective endocarditis) and oncological (hemoblastosis, lymphogranulomatosis) diseases. Especially great difficulties are caused by the diagnosis of apostematous nephritis, in which renal failure appears late (at 2-3 weeks of high fever). The resulting metastatic abscesses and associated liver damage (jaundice, hyperfermentemia) mask the primary focus in the kidney and often lead to death (from purulent meningitis, abscess pneumonia) even before the onset of uremia.

Endoscopic (chromocystoscopy) and instrumental (intravenous urography, echography, computed radiography) methods are important in diagnostics. A purulent focus in the kidney can be detected by static nephroscintigraphy with gallium or labeled autoleukocytes. If a lesion suspicious for an abscess is detected in cases difficult for diagnosis, an aspiration biopsy of this kidney zone is performed under the control of a sectoral ultrasound scan.

Treatment of acute pyelonephritis

The decisive factor for successful treatment is the elimination of obstructions with the restoration of the normal passage of urine. Only after that, antibiotic therapy is started. In case of OP, antibiotics are prescribed as early as possible - before the results of urine culture are obtained. If it is not possible to determine the pH of urine, choose a drug (or a combination of drugs) that is effective in any urine reaction. With mild (serous) OP, oral therapy is possible: chloramphenicol in combination with furagin, monotherapy with ampicillin or cephalosporins. Correction of therapy is carried out after receiving the results of urine culture. Parenteral administration of antibiotics is started if there is no effect (and in the case of a severe course of the disease, on the first day). A pronounced bactericidal effect is obtained by the combination of ampicillin with furagin, carbenicillin with nalidixic acid, gentamicin with cephalosporins, especially with claforan.

In case of development of bacteremic shock, it is necessary intravenous administration polyglucin, hemodez, sodium bicarbonate, pressor amines (dopamine, mezatone), prednisolone (300-1000 mg / day). If there are signs of disseminated intravascular coagulation (DIC), heparin and rheopolyglucin infusion are prescribed.

Surgical treatment is carried out with apostematous nephritis, purulent paranephritis.

Depending on the severity of the pathology, pyelonephritis can be obstructive and non-obstructive. Each of them has its own ways of manifestation in the body, treatment method and classification. The disease can be chronic, acute, as well as bilateral and unilateral.

Obstructive or non-obstructive pyelonephritis gets its name from the presence or absence of obstruction. They can be different, for example, a tumor, prostate adenoma or abnormal structures of the genitourinary system.

Obstructive pyelonephritis is an inflammatory process in the kidneys that affects their individual areas. These are, most often, the renal pelvis and calyces. If they are under the influence of pathology, this will lead to difficulty in the outflow of urine through the urethra.

The disease, in general, does not arise on its own and is a complication of any infectious disease of the kidneys or ureters. Because of this, obstructive pyelonephritis is also called secondary. Infection is always caused by organisms of pathogenic microflora, they enter the organs through the urethra, and then - the bladder or blood.

Types of obstructions

An obstruction is any situation that means that the natural flow of urine is obstructed. The most common is urolithiasis, individual anatomical features organism and tumor.

Adenoma of the prostate is also one of the obstructions. In male patients, this is the most common problem. The urethra, that is, the urethra, passes through the tissues of the prostate, if it enlarges as a result of inflammation, the duct is compressed. Over time, this will lead to difficulty urinating, but if fluid constantly accumulates in the bladder, there is a high likelihood of occurrence.

Note! After a while, the infection will pass through the ureter into the kidney and provoke pyelonephritis. Therefore, it is very important to diagnose the problem in a timely manner.

Neoplasms can create problems, not only being directly in the kidneys or ureter. If a tumor is found in the intestine, it can at least affect the obstruction of the channels. They will be compressed from the outside, which will also lead to inflammation.

With urolithiasis, calculi can form either in the calyx of the kidney or in the bladder. When they begin to move, they block the channels, which affects the normal flow of urine. The most common problem is always with a too large stone blocking the ureter. As a result, urine will accumulate in organ tissue and pelvis.

Obstruction degree

If the patient is infected with chronic or acute obstructive pyelonephritis, the degree of obstruction will play a fundamental role:

• an obstruction that develops on an increase will mean a gradual overlap of the channels. This is typical for malignant tumors or prostate adenoma;
• acute obstructive pyelonephritis often develops due to absolute obstruction. In this case, the patient feels renal colic and pronounced fever, which threatens the development of hydronephrosis;
• relative obstruction will mean that the outflow is partially impaired.

This happens when the stone at the exit of the ureter does not completely block it. But if the calculus changes its position and blocks the channel, pyelonephritis can sharply worsen and go from chronic, with mild symptoms, to acute.

Causes of infection

Always associated with urinary outflow problems. This can be triggered by the following number of reasons:

1. ICD (urolithiasis). The resulting stones will eventually begin to come out of the kidney and block the canal. This will lead to complete obstruction followed by renal colic.
2. Lesions - inflammation of the kidneys, bladder and ureter.
3. Congenital pathologies of the genitourinary system.

With the development of the kidneys even at the embryonic level, there is a possibility of the manifestation of defects. These can be problems with the muscular layer of the walls of the organs or the absence of a lumen of the urethra. All this will provoke a violation of the natural excretion of urine.

Signs of obstructive pyelonephritis

The obstructive form of the disease has a similar picture of symptoms with non-obstructive pyelonephritis. The difference will depend on the sequence of manifestations and the course of the disease.

Obstructive pyelonephritis symptoms:

1. Renal colic.
2. Elevated temperature up to 40 degrees.
3. Severe migraine.
4. Vomiting and nausea.
5. Body aches and weakness.
6. Dry mouth.
7. Heart rhythm problems.
8. Intense thirst.

The most obvious sign of the disease is renal colic, which is accompanied in the lumbar region. Most patients position these pains as the most severe in their life. But they are of an increasing nature, it is very important here to call an ambulance in a timely manner to give an anesthetic injection.

Renal colic is distinguished by its intensity due to a violation of the outflow of urine. Stagnation expands the pelvis and "cups", then the organ tissue itself lends itself to changes. This edema will immediately provoke the expansion of the capsule. It is on it that the nerve cells are located, which are responsible for the intensity of pain.

Advice! Sometimes the pain is so strong that even powerful pain relievers cannot help the patient. In such a situation, you should not give a large number of injections. If the stone is stuck, the only recourse is to remove it.

If a person suffers from acute chronic pyelonephritis, these symptoms are almost 100% likely to occur. But if the pathology proceeds in chronic form, its signs will be very vague, so people are often unaware that they are already sick. In this case, it is recommended to pay attention to the following minor deviations:

• increased sleepiness;
• decreased performance;
• weakness;
• mild pain in the lumbar region;
• loss of body weight.

Very often, such signs are attributed to a decrease in immunity. To avoid an exacerbation of the disease, it is advisable, as a preventive measure, to undergo an examination.

Symptoms of non-obstructive pyelonephritis

Symptoms of the development of non-obstructive pyelonephritis appear within 1 day. The first signs will resemble the manifestations of an infectious disease. Following them, the patient will feel the following:

1. Nausea and vomiting.
2. Tachycardia.
3. Headaches (most often in the forehead).
4. If, a person feels pain on both sides in the lumbar region.
5. Violation of natural urination. Desires can be frequent and painful.
6. Chills, eventually flowing into increased sweating and a temporary decrease in body temperature.
7. General weakness.

The first thing that a sick person will feel is intoxication and heat... These manifestations of non-obstructive pyelonephritis are often confused with ARVI. Further, a weak It's a dull pain in the lower back.

Diagnostics of pathologies

Diagnosis of obstructive and non-obstructive pyelonephritis is carried out only by a urologist. The first stage is to interview the patient and determine the complete picture of the development of pathology. These data will be enough to draw conclusions regarding the preliminary diagnosis.

1. Donating blood for biochemistry. If inflammatory processes occur in the body, an increase in the level will be noticed here.
2. Urine culture is necessary to draw up an overall picture of the bacterial environment and susceptibility to antibacterial components of drugs.
3. Ultrasound examination - will allow you to see the changes that have occurred in the kidney, ureters and pelvis.
4. General urine analysis. With all pyelonephritis, multiple leukocytes will be seen. Sometimes it will be necessary to conduct a study of the liquid according to Zimnitsky, to determine the total number of cells. This type of disease always involves an increased amount harmful organisms in the urine.
5. X-ray examination with the introduction of contrast. It is used before each type of treatment for non-obstructive pyelonephritis. The data obtained will make it possible to assess the degree of permeability of urine from the calyx-pelvic area.
6. Magnetic resonance imaging and computed tomography. These types of studies are used when there is a suspicion of the formation of tumors and the likelihood that it is they who are compressing the ureter. It will also allow an assessment of the organ structure.

Treatments for obstructive pyelonephritis

For the treatment to be as effective as possible, it must be carried out only in a specialized department of surgery or urology. Therapy is always carried out according to the following principles:

• emptying the urethra and restoring the normal outflow of urine;
• reception;
• ridding the patient of the symptoms of the disease;
• in especially difficult cases, surgical intervention is used.

The first thing to do when a patient is admitted to the hospital is to restore the natural outflow of urine. Sometimes this cannot be done to the fullest. But if doctors can partially free or widen the canal, this will already affect the improvement of the patient's well-being. The temperature will drop almost immediately, and the intensity of the pain will be controlled. It is highly discouraged to take antibiotics without eliminating drainage problems.

If the problem areas are in the organ itself or the ureter, doctors prescribe intravenous antispasmodics, for example, Baralgin. This will help partially widen the canal and restore urine flow.

All types and forms of pyelonephritis must be accompanied by antibiotic therapy... Doctors use drugs to begin with. wide range actions or use combination therapy, that is, 2-3 antibacterial agents simultaneously. In order for the effect to manifest itself as quickly as possible, they are injected into a vein or intramuscularly.

If previously used medications do not help within the first 2 days, the funds must be replaced, as this will mean that bacteria can resist the active components of the drug. In order not to face such problems, patients, immediately after arriving at the hospital, are tested to determine the pathogen and its susceptibility to the drug. The course of therapy is 7-11 days.

Surgical intervention

The operation to eliminate the problem is always carried out only in the very last resort... The reason for its appointment may be the inability to eliminate problems with urine outflow in the first 2 days, as well as the prevention of a recurrence of such episodes.

At the moment, technical progress makes it possible to carry out operations without using a scalpel. For example, for urolithiasis, endoscopic method... This means that a special device will be introduced to the patient through the canal and the operation will be performed from the inside. If the obstruction is anatomical, laparoscopic surgery is performed, which does not leave scars.

Disease prevention

Exactly how a person will be infected is almost impossible to predict. But everyone can help to minimize these risks. To do this, it is recommended to adhere to the following rules:

1. Timely treatment of diseases that can be provocateurs of obstructive and non-obstructive pyelonephritis. Also included are diseases such as all forms of cystitis and prostatitis. These pathologies increase the risk of infection entering the kidneys through the ureter ascending by several times.
2. Quite often, the causative agents are harmful bacteria that have entered the organ from foci such as teeth with caries, nasopharynx or tonsils. This means that initially it is necessary to pay attention to the health of all ENT organs. Pregnant women need to be especially careful. If at the moment in the body there are any chronic diseases infectious, the probability of infection is almost 100%.
3. Genital hygiene. Girls school age and women suffer from pyelonephritis more often than men 4 times. This is due to the fact that they have a short and wide urethra. This allows infections to travel easily to the bladder and then to the kidneys. To avoid infection, adult women need to follow the rules of hygiene after each intercourse.

Conclusion

Like all other types of pyelonephritis, obstructive and non-obstructive forms of the disease require timely detection and subsequent treatment. If you ignore the pathology, over time it will move to a more complex stage, which may involve surgical intervention.