Pyelonephritis: symptoms, treatment, causes

Update: October 2018

Pyelonephritis is an infectious inflammatory disease of the kidneys,
which occurs when pathogenic bacteria spread from the lower
departments of the urinary system. AT большинстве случаев
возбудителем pyelonephritis является кишечная палочка (E. Coli),
which is sown in large quantities in patients in the urine.

This is a very serious disease, accompanied by severe
pain and significantly worsening the patient’s health.
Pyelonephritis is easier to prevent than to cure.

Pyelonephritis is included in the group of diseases with the common name
�”Urinary tract infection”. With неправильно проводимом
antibacterial treatment of lower infectious diseases
urinary bacteria begin to multiply and
gradually move into higher divisions, as a result of reaching
почек и вызывая симптомы pyelonephritis.

Facts and statistics

  • Every year in the US, an average of 1 person suffers with pyelonephritis.
    every 7 thousand inhabitants. 192 thousand of them pass stationary
    treatment in specialized departments of hospitals and hospitals.
  • Женщины болеют пиелонефритом в 4 — 5 раз чаще men. Acute
    pyelonephritis occurs more often in women leading active sexual
    a life.
  • У 95% больных лечение pyelonephritis дает положительный результат
    already in the first 48 hours.
  • AT детстве пиелонефрит развивается приблизительно у 3% девочек и
    1% of boys. 17% of them develop cicatricial changes of the parenchyma
    kidney, 10-20% – hypertension.
  • Simple water can significantly improve the condition of the patient.
    pyelonephritis. Drink plenty of fluids to keep you in balance
    fluids, and also provides “dilution” of blood and helps
    remove more bacteria and their toxins. It happens
    due to frequent urination in response to increased intake
    fluid.
  • Although with pyelonephritis, even a small movement can cause
    severe pain, it is important to urinate as often as possible.
    Although the patient feels discomfort during urination, it is
    the only way to get rid of the causative agent of the disease –
    bacteria are excreted in the urine only. Uncontrollable
    the growth of microorganisms will lead to deterioration by causing sepsis
    (blood poisoning) and may even cause the death of the patient.
  • Cranberry juice is considered a good helper in the fight against
    pyelonephritis. Juice can be drunk neat or diluted with water.
    (see how to make cranberry juice). With этом следует полностью
    give up alcohol, sugary carbonated drinks
    and coffee.

Risk factors

К факторам риска развития pyelonephritis относятся:

  • ATрожденные аномалии развития почек, мочевого пузыря и
    urethra;
  • AIDS;
  • Diabetes;
  • ATозраст (риск повышается по мере взросления);
  • Prostate diseases associated with an increase
    its size;
  • Kidney disease;
  • Spinal cord injury;
  • Bladder catheterization;
  • Surgical interventions on urinary organs
    systems;
  • ATыпадение матки.

Withчины возникновения pyelonephritis

ATосходящий путь инфекции

Pyelonephritis is caused by bacteria. They penetrate
the urinary system through the urethra, then spread
into the bladder. Next, the pathogen goes to the parent
structures ultimately penetrating the kidneys. Over 90% of cases
pyelonephritis вызваны кишечной палочкой – бактерией, размножающейся
in the intestines and penetrating the urethra from the anus during bowel movements.
This explains the increased incidence of disease among women.
(due to the anatomical proximity of the anus, external genitalia and
urethra).

ATосходящий путь инфицирования – наиболее распространенная
причина развития острого pyelonephritis. This explains the high
incidence rate among women. Due to anatomically short
urethra and structural features of the external genital organs intestinal
women’s flora disseminates the groin and vagina, further
spreading rapidly in the bladder and upwards.
Пиелонефрит: симптомы, лечение

Кроме кишечной палочки среди возбудителей pyelonephritis
allocate:

  • Staphylococcus (Staphylococcus saprophyticus, Staphylococcus
    aureus);
  • Klebsiella (Klebsiella pneumoniae);
  • Proteus (Proteus mirabilis);
  • Enterococcus;
  • Pseudomonas (Pseudomonas aeruginosa);
  • Enterobacter (Enterobacter species);
  • Pathogenic fungi.

To more rare ways of migrating infectious agents to the kidneys
include hematogenous and lymphogenous. Also микробы могут быть
brought with instrumental manipulations, for example, with catheters.
With последнем варианте наиболее вероятными возбудителями
pyelonephritis становятся клебсиелла, протей и синегонойная
wand.

ATезикулоуретральный рефлюкс

ATезикулоуретральный рефлюкс характеризуется нарушением оттока
urine through the ureters to the bladder and its partial discharge
back to the renal pelvis. If the disease is not diagnosed on
early stages, urine stasis leads to the growth of pathogenic
microorganisms that are thrown into the kidney and cause it
inflammation.

Частые повторные приступы острого pyelonephritis у детей вызывают
severe kidney damage resulting which could be their
scarring. This is a rare complication that occurs mainly in
children under 5 years old. However, cases of scar development are described.
changes after suffering pyelonephritis in children in pubertal
age

Increased tendency to cicatricial changes in the kidneys in children
due to the following factors:

  • Reflux in children occurs at a much lower pressure than in
    adults;
  • Decreased resistance of the body’s immune system
    against bacterial infections during the first year of life;
  • The complexity of early diagnosis of pyelonephritis in the infant
    age

In 20 – 50% of children younger than 6 years old, patients with pyelonephritis,
vesicourethral reflux diagnosed. Among adults this
the rate is 4%.

In 12% of patients on hemodialysis, irreversible
renal damage developed against the background of pyelonephritis in the early
childhood.

Other causes of pyelonephritis are rare. AT
In some cases, inflammation does not develop in an ascending way.
bladder, and immediately upon entry of the pathogen into
kidneys from other organs in the blood vessels.

ATероятность инфицирования повышается при закупорке мочеточников
stone or obstruction of urine excretion by an enlarged prostate.
The impossibility of removing urine leads to its stagnation and reproduction in
her bacteria.

Symptoms of pyelonephritis

The most common symptoms of acute pyelonephritis
include:

  • Fever, chills
  • Nausea, vomiting
  • General weakness, fatigue
  • Dull aching pain in the side on the side of the lesion or lower back
    shingles
  • Frequent urination in women and frequent urination in
    men
  • Slight swelling

Additional non-specific symptoms of pyelonephritis,
characterizing the course of inflammatory disease:

  • Fever;
  • Dehydration;
  • Cardiopalmus.

In chronic pyelonephritis disease manifestations
may occur in a milder form, but persist for
a long time. At the same time the blood test is calm, in the urine
leukocytes, but bacteriuria may not be. No remission
Symptoms, blood and urine tests are normal.

Every third patient with pyelonephritis has associated symptoms.
infections of the lower urinary system (cystitis in women,
уретрит у men):

  • Stitching or burning pain during urination;
  • The appearance of blood in the urine;
  • Strong, increased urge to urinate, even when empty
    bladder;
  • Discoloration of urine (dark, turbid). Sometimes – with a characteristic
    unpleasant “fish” smell.
Pyelonephritis tests
  • A blood test shows signs of inflammation (an increase in
    leukocytes, accelerated ESR).
  • AT анализах мочи выявляется значительное количество бактерий
    (more than 10 to 5 degrees CFU), more than 4000 leukocytes in the sample
    Nechiporenko, hematuria of varying degrees, protein up to 1 g per liter,
    reduced urine specific gravity.
  • AT биохимическом анализе крови может быть увеличение креатинина,
    urea, potassium. The growth of the latter indicates the formation
    renal failure.
  • When visualizing the kidneys on ultrasound, the affected organ is enlarged in
    volume, its parenchyma thickens and compacted, observed
    expansion of the chastechno-pelvic system.

Complications

The risk of developing complications increases in pregnant women, and
in patients with diabetes. Complicationsми острого pyelonephritis
I can be:

  • Kidney abscess (formation of a cavity filled with pus);
  • Renal failure;
  • Sepsis (blood poisoning) in contact with pathogenic bacteria
    into the bloodstream.

Pyelonephritis and sepsis

Unfortunately, pyelonephritis is not always easy to treat, more often
due to errors during diagnostics. AT некоторых случаях заболевание
goes into severe form before going to the doctor. Risk groups in
in this case are people with spinal injuries
(paralyzed, not feeling back pain), as well as dumb,
who can not independently complain when deterioration
states.

Late treatment or lack of it leads to
progression of the disease, the growth of bacteria and their penetration into
bloodstream with the development of sepsis. This condition is also called
blood poisoning. This is a serious complication, often ending
death of the patient.

Patients with pyelonephritis should not die, as it is not heavy
a disease that can be cured quickly and effectively
antibacterial drugs. But if the disease is complicated
sepsis or, in the terminal stage, septic shock, the risk
death rises sharply. According to world statistics, in the world
every third patient with sepsis dies. Among those who succeeded
to cope with this condition many remain disabled as in
during the course of treatment, the affected organ is removed.

loading...
Famous people with pyelonephritis, complicated
sepsis:
  • Marianne Bridi Costa – Brazilian model

Born on June 18, 1988. Died January 24, 2009 from sepsis,
developed against the background of pyelonephritis. AT ходе лечения были произведены
amputation of both hands in an attempt to stop the progression
diseases. Death occurred 4 days after surgery.

  • Etta James – singer, four-time Grammy winner

AT январе 2010 года 72-year-old Etta James went to the reception
the hospital department for pyelonephritis complicated by sepsis. AT
During the survey, it was found out that the woman also suffers
Alzheimer’s disease.

  • Jean-Paul II – Pope

Born on May 18, 1920. He died on April 2, 2005 from sepsis,
the cause of which was pyelonephritis.

Emphysematous pyelonephritis

Emphysematous pyelonephritis – это тяжелое осложнение острого
pyelonephritis with a high incidence of deaths (43%).
The risk factors for the development of this complication are sugar
diabetes or obstruction of the upper urinary tract.
The main symptom is the accumulation of gas in the tissues of the kidney, which
приводит к их некрозу и развитию renal failure.

Pyelonephritis in pregnant women

The incidence of bacteriuria during pregnancy
is 4-7%. Pyelonephritis develops in approximately 30%
pregnant women from this group (1-4% of the total number of pregnant women).
The most common symptoms of pyelonephritis occur in the second
trimester. Among the complications of pyelonephritis in pregnant women are:

  • Anemia (23% of cases);
  • Sepsis (17%);
  • Renal failure (2%);
  • Premature birth (rare).

Increased incidence of asymptomatic bacteriuria in
pregnant women among the representatives of low
socioeconomic class, as well as in multi-view women.

Pyelonephritis treatment

AT случае, когда возникает острый пиелонефрит или обостряется
chronic with high fever, lowering blood pressure (arterial
pressure), a strong process can develop
or violation of urine outflow – treatment may require surgical
intervention. Also in the case when taking tablets
antibiotics are accompanied by vomiting, nausea, or increasing
intoxication – hospitalization of the patient is shown. AT остальных
In cases, the doctor may prescribe treatment at home.

For diseases like pyelonephritis, symptoms and treatment like
symptomatic and antibacterial are closely related.
Symptomatic treatment includes:

  • Bed rest for the first few days (blanket mode),
    i.e. horizontal position and warm.
  • Nonsteroidal anti-inflammatory drugs to achieve
    analgesic effect and reduce body temperature (Metamizole,
    diclofenac, paracetamol – for children);
  • Drink plenty of water.

In chronic pyelonephritis, both in remission and
exacerbations should be avoided wet cold – this is the worst
the enemy is a weak kidney. It is also advisable to take in the middle of the day.
supine position for at least 30 minutes and prevent rare
emptying the bladder.

Antibacterial treatment of pyelonephritis in adults

Typically, an antibiotic is first assigned empirically for 5-7 days, and
then it may be replaced taking into account the results of bacterial
sowing.

Pyelonephritis treatment антибиотиками проводится препаратами группы
fluoroquinolones, ampicillin in combination with inhibitors
beta-lactamase, as well as cephalosporins (drugs of choice in children).
Convenience of cephalosporins 3 – 4 generations (ceftriaxone, cefotaxime)
consists in the fact that the introduction of therapeutic doses is not more than 2
once a day. Due to its high resistance (40%) ampicillin
use less and less. Course duration 7 – 14 days in
depending on the severity of the disease and the effect of the
treatment.

By maintaining a high concentration after absorption from
intestinal ciprofolxacin can be used as
preformed forms. ATнутривенное введение антибиотика показано
only with nausea and vomiting.

If the patient’s condition does not improve after 48-72 hours
start of treatment, it is necessary to conduct a CT scan of the abdominal
cavity to exclude abscess and hydronephrosis of the kidney. Also
need to re-bacteriological analysis of urine with
determining the sensitivity of the pathogen to antibiotics.

AT некоторых случаях после проведения курса антибактериальной
therapy may need re-treatment with another antibiotic
groups. Treatment of chronic pyelonephritis involves the appointment
long courses of taking antibacterial drugs.
The main problem of treating diseases caused by bacteria is
development of antibiotic resistance.

AT том случае, когда были быстро выявлены характеризующие
pyelonephritis symptoms, and treatment is started in a timely manner, for
for most patients, the prognosis remains positive. A patient
considered healthy if the pathogen is not detected in the urine in
one year after discharge.

One week course of ciprofloxacin – effective therapy
pyelonephritis

AT ходе проведенных исследований доказано, что семидневный курс
antibacterial drug ciprofloxacin has the same
effectiveness, as well as the 14-day course of drugs from the group
fluoroquinolones. AT одном из исследований участвовали две подгруппы из
73 and 83 women with acute pyelonephritis treated
ciprofloxation (7 days) and fluoroquinolone (14 days). As shown
results, in both groups, the effectiveness of treatment was 96-97%.
Moreover, in the group treated with fluoroquinolone, in 5 patients
developed symptoms of candidiasis while in the other group
no such symptoms have been identified.

Антибактериальная терапия pyelonephritis у детей

Treatment begins with the intravenous administration of antibacterial
drugs. After achieving a positive effect and reducing
temperatures possible transition to tablet form preparations
cephalosporin series:

  • Ceftriaxone;
  • Cefepine;
  • Cefixime.

Treatment of milder forms may initially be made.
preformed tablets.

Pyelonephritis treatment грибковой этиологии

Antifungal treatment is carried out by fluconazole or
Amphotericin (see antifungal drugs in pills). With
this is mandatory to control the removal of fungal compounds
using x-ray urography, computed tomography
or retrograde pyelography. Pyelonephritis caused by pathogens
mushrooms and accompanied by blockage of the urinary tract, is treated
surgically with the imposition of nephrostomy. This method provides
normalization of urine flow and allows for the introduction
antifungal drugs directly to the site of infection.

Nephrectomy

ATопрос о нефрэктомии (удаление почки) рассматривается в том
if the developed sepsis does not give in to conservative
treatment. This operation is especially indicated for patients with increasing
renal failure.

Фитотерапия pyelonephritis

With наличии поллиноза, естественно, лекарственные травы вызовут
allergic reaction, so herbal can be used
in the absence of a tendency to allergies. Many plants except
antiseptic effect, have a number of positive actions,
possess diuretic, anti-inflammatory properties:

  • reduce swelling – bearberry, horsetail, see diuretics
    folk remedies
  • urinary tract spasms – ortosiphon, oats
  • reduce bleeding – dogrose, nettle
  • reduce dyspepsia (from taking antibiotics) – strawberry leaf,
    chamomile, plantain
  • herbal medicines – Fitolizin, Monurel (extract
    cranberries, see cranberries for cystitis), Canephron, and Cystone may
    used for prophylaxis or in complex treatment
    pyelonephritis (см. Цистон при цистите)
  • help extend remission various ready-made fees – renal
    teas

See also complete list of kidney medications.

New European treatment guidelines for acute
неосложненного pyelonephritis

  • The group of first-line antibiotics – fluoroquinolones.
    • Selection drugs – Cefixime (400 mg per day) and Levofloxacin
      (0,5-0,75 1 time per day) in tablets.
    • Ciprofloxacin 0.5-0.75 twice a day and Norfloxacin 400 mg
      Twice a day, they remain relevant only for previously untreated
      patients.
  • Antibiotics 2 rows (alternative) – Amoxicicillin with
    clavulanic acid (625 mg) 3 times a day. With доказанной
    susceptibility of ceftibuten 400 mg 1
    once a day.
  • With тяжелом пиелонефрите, требующем госпитализации терапия в
    Inpatient, held by carbopenems (Ertapenem, Miranem)
    intramuscularly or intravenously. After three days
    the patient has a normal temperature, therapy may be
    continued oral preparations. Alternative to carbopenems
    become Levofloxacin and Amikacin.
  • Pyelonephritis in pregnant women больше не лечат амоксициллином, а, не
    Depending on the period of gestation, the following drugs are prescribed:

    • Zefibuten 400 mg 1 time per day or
    • Cefixime 400 mg 1 time per day or
    • Cefoatoxime 3-8 g per day in 3-4 injections intramuscularly or
      intravenously or
    • Ceftriaxone 1-2 g per day once intramuscularly or
      intravenously.

Автор: Коробов Никита Александрович врач-анестезиолог

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