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Acute pyelonephritis: symptoms, treatment, diet, complications

What it is?

Acute and chronic pyelonephritis is an inflammatory lesion of the kidneys caused by pathogenic microorganisms. In the inflammatory process involved cups, pelvis and kidney parenchyma.

This disease can develop at any age. In terms of prevalence, it ranks second, second only to acute respiratory tract infections.

About the causes of acute pyelonephritis

Acute pyelonephritis

Acute renal pyelonephritis is always associated with infectious agents, which are its direct cause. The most common pathogens are bacteria that normally live in the colon. It:

  • E. coli (found in 90% of cases);
  • Klebsiella;
  • Enterobacteria;
  • Staphylococcus;
  • Enterococci;
  • Pseudomonas aeruginosa;
  • Proteus.

Other possible pathogens are: Mycobacterium tuberculosis, candida, viruses.

Microorganisms can enter the kidney in various ways:

  • Ascending - the most common path. It implies the initial multiplication of microorganisms at the external opening of the urethra and their subsequent penetration into the bladder.
  • Hematogenous, realized in bacteremia, when bacteria are present in the blood, with which they penetrate the kidney.
  • Contact - microbes spread to the kidney from adjacent organs in which the inflammatory process has already developed.

An increased risk of pyelonephritis exists in people with predisposing factors:

  • Retention of urine due to obstruction of the urinary tract;
  • Diabetes (significantly increases the risk of purulent forms of the disease);
  • Polycystic Kidney Disease;
  • Abnormal development of the urinary and genital organs;
  • Urolithiasis disease;
  • Catheterization of the bladder.

According to epidemiological studies, there are three periods of increased incidence of pyelonephritis, depending on age:

  1. The period of early childhood, when the incidence of girls is 8 times higher than that of boys.
  2. Reproductive age up to 35 years - the incidence of women prevails over the incidence of men (7 times).
  3. The age is over 60 when men are more vulnerable than women (this is due to the frequent development of prostate tumors in older men).


Signs of acute pyelonephritis

Signs of acute pyelonephritis

Forms of acute pyelonephritis determine the nature of clinical symptoms. The higher the activity of the inflammatory process, the more severe the disease flows and the more diverse the clinical picture.

The main forms of acute pyelonephritis are:

  • Serous, representing the initial stage of inflammation, in which purulent infiltrate in the kidneys yet;
  • Purulent - the next stage of serous inflammation;
  • Apostematozny - multiple small foci of purulent exudate are formed in the kidneys;
  • Carbuncle - merging several purulent foci into one;
  • An abscess is the formation of a purulent cavity in the renal parenchyma, preceded by ischemia and necrosis, followed by the addition of pyogenic bacteria.

Symptoms of acute pyelonephritis

Symptoms of acute pyelonephritis

Uncomplicated acute pyelonephritis has vivid clinical symptoms. It consists of general intoxication syndrome and local inflammatory:

  1. The patient's condition is moderate or severe.
  2. Weakness, excessive sweating.
  3. Fever up to 40 ° C with chills.
  4. Nausea with vomiting.
  5. Headache.
  6. Increased urination (as opposed to cystitis, it is painless).
  7. Pain in the lumbar region aching or cramping.

Against the background of the depressed state of the immune system, acute pyelonephritis can occur in an atypical form, simulating the defeat of the gastrointestinal tract.

Diagnosis of acute pyelonephritis

The diagnosis of acute pyelonephritis is set based on the results of 2 main tests:

  • General clinical examination of urine (sometimes requires analysis Nechiporenko with a targeted count of white blood cells).
  • Bacteriological examination of urine with the determination of the sensitivity to antibiotics of the isolated microorganisms.

Urinalysis in acute pyelonephritis will be reliable and informative only if the rules for its collection are observed. These include:

  • Collecting a medium stream of urine (the first 10 ml is urine from the urethra, and the rest is urine from the bladder filtered in the kidneys).
  • A man should take the foreskin and thoroughly wash the glans penis.
  • A woman should thoroughly rinse the genitals, after which the vagina should be closed with a cotton ball to prevent microorganisms from getting into her urine.

Laboratory signs of acute pyelonephritis are:

  • Increased white blood cell count in the urinary sediment.
  • Detection of bacteria.
  • A small number of red blood cells, indicating necrosis and stones in the urinary tract.

NB Leucocyturia and bacteriuria are not always detected in patients with pyelonephritis. Therefore, the absence of these signs does not exclude this diagnosis. Most often, a similar situation is observed in apostematic pyelonephritis and abscess, when the purulent foci are located in the upper layers of the kidney cortex.

The diagnostic criterion for pyelonephritis during bacteriological examination is the microbial titer of more than 104 CFU / ml. If the figures are below this value, then infection in the urinary tract is absent.

Ultrasound is additional to the above. It is carried out to study the structure of the kidneys and the exclusion of local pathological processes (purulent foci and cysts) and anomalies in them. It can be used to determine the presence of urinary obstruction.

In difficult diagnostic cases, radiography and computed tomography are required.

Treatment of acute pyelonephritis, antibiotics

Treatment of acute pyelonephritis is carried out with mandatory patient compliance with bed rest. The first line of treatment is the mandatory prescription of antibiotics for a period of 1 to 2 weeks.

Fluoroquinolones are the group of choice, since E. coli (as the most frequent causative agent) is sensitive to them. In some cases, protected penicillins may also be administered.

In the case of a serious condition of a patient, antibiotic treatment begins with an injection. After clinical and laboratory improvement, they switch to tablet forms.

The second direction in the treatment is the use of antispasmodic and anti-inflammatory drugs. The latter not only suppress the inflammatory reaction in the kidneys, but also reduce the increased body temperature, normalizing the well-being.

In some cases, patients may require surgical treatment. The indications for him are:

  • Destruction of the kidney parenchyma (purulent inflammation).
  • Violation of urine outflow.

For purulent foci, depending on their size, complete kidney removal (nephrectomy) or drainage of the abscess through the skin under ultrasound control can be performed. Disturbed urodynamics (urine outflow) involves ureteral catheterization.

Diet for illness

Diet for acute pyelonephritis (diet number 7) is important in the early and most complete restoration of kidney function. It implies a restriction of protein products and the complete elimination of salt, while the amount of fat and carbohydrates remains within the normal range.

The daily volume of liquid should not exceed 800 ml. Extractive substances are prohibited.

Patients with pyelonephritis are allowed to:

  • Protein-free and bran bread;
  • Soups, but on the second broth;
  • Low-fat meat (the first 14 days of the disease its amount in the diet should be reduced, and then you can increase the daily portion);
  • Lean fish;
  • Eggs (no more than 2 per week);
  • Dairy products and milk (in moderation);
  • Vegetables and fruits;
  • Low-fat and unsalted cheese;
  • Poor coffee and tea.

From the diet should be excluded:

  • Black and wheat bread;
  • Pickles;
  • Broths based on meat, fish and mushrooms;
  • Fatty meat, incl. and sausages;
  • Legumes and mushrooms;
  • Onion and garlic;
  • Strong coffee and chocolate;
  • Any type of alcohol;
  • Mineral water enriched with sodium.

As part of the diet number 7 culinary processing can be different - boiling, baking and steaming. Frying is also allowed. The temperature of the food does not matter.

Pyelonephritis complications

Acute pyelonephritis, occurring without complications, very quickly "responds" to the ongoing antibiotic therapy. Residual damage to the renal parenchyma is minimal or absent, especially in case of illness in childhood (all changes are reversible).

Repeated episodes of the disease are rare.

However, after acute pyelonephritis, adverse outcomes may rarely develop:

  • Nephrosclerosis - the formation of scars on the kidney, leading to a decrease in their function.
  • Acute renal failure (timely start of treatment contributes to the successful resolution).
  • Septic syndrome (the patient’s diabetes mellitus predisposes to its development)

A very rare complication with an aggressive course is xanthogranulomatous pyelonephritis. It is characterized by the presence of a large number of lymphocytes and macrophages in the renal parenchyma, which stimulate the formation of lipid inclusions and uncontrolled reproduction of cells.

These signs bring together xanthogranulomatous pyelonephritis with a malignant tumor. Therefore, in establishing the diagnosis a large role is given to competent histological research.

Prevention of acute pyelonephritis

Preventive measures will help prevent the development of acute pyelonephritis in patients at risk. They are recommended:

  • Timely treatment of carious teeth and other diseases of the oral cavity, pathology of upper respiratory tract.
  • Regular urination, excluding stagnant urine.
  • Hardening and strengthening of immunity.
  • Hygiene of the genitals.

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