- Risk factors for pyelonephritis
- Causes of pyelonephritis
- Ascending infection in the etiology of pyelonephritis
- Vesicular-urethral reflux as a cause of pyelonephritis
- Other ways of infection with pyelonephritis
- Infectious agents
- Symptoms of pyelonephritis
- Pyelonephritis in adults: signs and symptoms
- Symptoms of pyelonephritis in women
- Symptoms of pyelonephritis in men
- Pyelonephritis in childhood
- Pyelonephritis Forms
- Types of acute pyelonephritis
- Chronic inflammatory process
- Primary and secondary form of pyelonephritis
- Forms depending on the localization of the inflammatory process
- Diagnosis of the disease
- Pyelonephritis: Symptoms and Treatment
- Adult Treatment
- The choice of therapy in childhood
- Antibiotic groups used to treat patients with pyelonephritis
Pyelonephritis is a kidney disease of infectious etiology, accompanied by an inflammatory process. Causes of pyelonephritis in the penetration and reproduction in the kidney tissues of pathogenic bacteria in the lower urinary tract (bladder). Hematogenous, lymphogenous routes of infection and the introduction of an infectious agent for injuries or medical procedures are also distinguished. In 90% of cases, E. coli or E. coli becomes the cause of pyelonephritis. Pyelonephritis can affect people of different ages and sexes, although in girls and women it is found 3-4 times more often due to the structural features of the urogenital organs, which cause easy penetration of bacteria into the kidneys during an ascending pathway.
Risk factors for pyelonephritis
In addition to the features of the structure of the excretory system in women, there are non-sex factors that increase the risk of pyelonephritis. These include:
- congenital or acquired abnormalities, pathologies of the structure of the kidneys, bladder, urethra;
- immunodeficiency states of various etiologies;
- diabetes, high sugar content in the urine creates favorable conditions for the reproduction of pathogenic organisms;
- age factor: the older the person, the higher the risks;
- injuries to the organs of the peritoneum, spinal cord;
- surgery and medical manipulations in the urinary system;
- chronic diseases of bacterial etiology, foci of infection in the body.
In men, pyelonephritis can be triggered by prostate gland diseases, accompanied by an increase in body size.
Causes of pyelonephritis
Pyelonephritis is an infectious disease of the kidneys of bacterial pathogenesis. The cause of pyelonephritis is reproduction of pathogenic organisms due to stagnant urine or when they enter the kidney tissue in an excess amount for local immunity.
Ascending infection in the etiology of pyelonephritis
The penetration of the infection through the urethra into the bladder, its spread through the channels into the upper structures and, as a result, into the kidneys, is the most common cause of pyelonephritis.
The structure of the female body causes an increased incidence of infection of the organs of the urinary system: pyelonephritis in women is diagnosed 5 times more often than in men. The short and wide urethra, the proximity of the urethra to the genitals and anus facilitate the entry of pathogens into the bladder and kidneys.
In men, the main reason for the development of pyelonephritis becomes an obstacle in the urethra, in the tissues of organs, which impede the excretion of urine and contribute to its stagnation (stones in the kidneys, urinary tract, proliferation of prostate tissue of various etiologies). In the accumulated fluid, infectious agents multiply, spreading to the organs of its production and filtration.
Obstacles to the flow of urine in the form of cysts, stones, tumor formations, strictures, acquired and congenital, can become the cause of the development of pyelonephritis in female patients, however, the most common for them is an ascending route of infection after colonization of the urethra with E. coli.
Vesicular-urethral reflux as a cause of pyelonephritis
Vesicular-urethral reflux is characterized by a re-injection of a portion of the secreted urine into the renal pelvis due to obstructed outflow through the ureters. This pathology as the cause of the inflammatory process in the kidneys is most characteristic of children suffering from pyelonephritis: vesicourethral reflux is diagnosed in almost half of children aged 0 to 6 years suffering from pyelonephritis as the cause of the disease. When the effect of reflux, urine is thrown back from the bladder to the kidney or distributed from the renal pelvis to other parts of the organ. In older periods, this pathology accounts for only 4% of the causes of the disease.
Attacks of acute pyelonephritis in childhood are dangerous consequences for the kidneys in the form of scarring of the tissues of the organ. Before puberty, attacks of acute pyelonephritis in children and the formation of scars are due to the physiological characteristics of children:
- lower fluid pressure, compared with adults, required for the effect of urine rejection;
- inability to fully empty the bladder on average until the age of five;
- low resistance of the immune system of the child’s body during the first years of life, including to bacterial infections, against the background of insufficient personal hygiene and the absence of bactericidal components in the urine;
- the difficulties of early diagnosis of the disease;
- more frequent, in comparison with adults, the downward path of migration of pathogenic organisms: for scarlet fever, sore throat, caries, etc.
Tissue scarring is a severe pathology that significantly reduces the functioning of the kidneys as an organ. In 12% of patients in need of hemodialysis due to irreversible changes in the tissues of the kidneys, complications of pyelonephritis, suffered in childhood, cause scarring of the tissues.
Other ways of infection with pyelonephritis
Other options for the migration of bacteria and microorganisms into the kidney tissue are much less common. Allocate a hematogenous route of infection along with blood, lymphogenous, as well as direct introduction of the pathogen during instrumental manipulations, for example, catheterization of the bladder.
The most common pathogen in the pathogenesis of pyelonephritis is E. coli, E. coli. Among other causative agents of pyelonephritis, there are also:
- Staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
- Klebsiella (Klebsiella pneumoniae);
- Proteus (Proteus mirabilis);
- Pseudomonas aeruginosa;
- Enterobacter species;
- pus day pusher;
- pathogenic fungal pathogens.
For ascending migration of an infection, the presence of Escherichia coli in the dischargeable urine is most characteristic, as determined by laboratory analysis. With the direct introduction of the pathogen during instrumental manipulations, most often the cause of pyelonephritis is Klebsiella, Proteus, Pseudomonas aeruginosa.
Symptoms of pyelonephritis
Symptoms of pyelonephritis vary depending on the form of the disease, its stage and the patient’s age.
Pyelonephritis in adults: signs and symptoms
Physiological differences in the structure of the male and female body affect not only the incidence of disease, but also the course of the disease.
Symptoms of pyelonephritis in women
The disease manifests itself with different symptoms depending on the form of the disease. Acute pyelonephritis in women is often accompanied by symptoms such as:
- a sharp rise in body temperature to febrile (above 38 ° C);
- symptoms of intoxication: nausea, chills, fever, headaches;
- Possible changes in urine characteristics, especially with simultaneous presence of cystitis: loss of transparency, presence of blood inclusions, pus, etc.
An important test during the initial diagnosis is a positive response to the Pasternatsky test: when tapping in the area of the kidneys, pain increases, hematuria, blood in the urine is noted.
The chronic form of pyelonephritis in women beyond periods of exacerbations has mild symptoms, manifested by the following symptoms:
- moderate pain in the lumbar region;
- minor symptoms of intoxication: weakness, headaches, loss of appetite;
- swelling after a night’s sleep if there is difficulty in excreting urine.
Pyelonephritis and cystitis in women are often combined in the same time period, while the symptoms of cystitis in their severity can significantly prevail over the clinical picture of the secondary disease, which can lead to insufficient diagnosis and lack of pyelonephritis therapy.
Among the symptoms of cystitis in women are:
- discomfort, pain, burning, accompanying urination;
- frequent urging to the toilet, feeling of incomplete emptying of the bladder;
- lower abdominal pain, etc.
Up to 4% of pregnant women, or almost every 20th woman in the period of gestation, is experiencing acute or chronic pyelonephritis. Most often the disease develops in the middle of the second and the beginning of the third trimester of pregnancy due to the increasing pressure of the uterus increasing in volume on the kidneys and ureters.
Under pressure, urine outflow slows down, stagnation occurs in the kidneys: the body is not able to discharge fluid in time with increasing concentrations of pathogenic bacteria. Especially often pregnant pyelonephritis develops on the background of acute or sluggish cystitis.
The kidneys are one of the most important organs during the gestation period, they experience an increased load, filtering out increased volumes of fluid. In case of any symptoms indicating diseases or dysfunctions of the urinary tract, it is necessary to consult a doctor immediately.
As complications of pyelonephritis in pregnant women, anemia, sepsis, renal failure, the likelihood of premature birth due to intoxication of the body are noted.
Pyelonephritis during pregnancy is dangerous not only the usual complications, but also the development of preeclampsia, eclampsia, dangerous to the life of the mother and child. Self-treatment of exacerbations of chronic pyelonephritis during pregnancy is also unacceptable because of possible side effects for the fetus: previously effective drugs may be prohibited for use during gestation.
With the timely start of therapy, pyelonephritis is cured without affecting the health of the child.
Symptoms of pyelonephritis in men
Due to the peculiarities of the anatomical structure of the urinary system, pyelonephritis in men is diagnosed several times less than in women. Most often, the disease occurs in erased, chronic form, developing on the background of difficult urine outflow due to the formation of kidney stones, ureters, prostate tumors.
In this form of the disease, symptoms are similar to the manifestations of chronic pyelonephritis in women: symptoms of general minor intoxication (general malaise, weakness, loss of appetite, etc.), disturbed urination, mild pain in the lumbar region, thirst, dry mouth, profuse urination, presence of morning edema.
When moving kidney stones, the symptoms of pyelonephritis are complemented by manifestations of renal colic: severe pain, hematuria.
The acute form of pyelonephritis in men is most often triggered by a downward spread of infection from the source of the inflammatory process (with angina, caries, etc.). Pyelonephritis in the acute stage in men is manifested in the same way as in women, regardless of the pathogen migration pathways: body hyperthermia, low back pain, positive Pasternack symptom, possible changes in urine composition.
Pyelonephritis in childhood
The main symptom that occurs in acute pyelonephritis in childhood is a sudden rise in temperature to febrile indices. If, against the background of general health, the child has a fever and for several days there are no symptoms characteristic of acute respiratory viral diseases, infectious diseases, signs of a “cold”, it is urgent to donate blood and urine for tests to exclude or confirm the diagnosis of pyelonephritis.
Due to a sharp rise in temperature and general intoxication of the body, the child’s state is unsatisfactory, hyperthermia is accompanied by chills, nausea, vomiting, drowsiness, and lack of appetite is possible. Children may complain of headache, pain in the lower back, in the iliac region.
The chronic form in children is diagnosed when an inflammatory process is detected for at least 6 months or in the presence of two or more episodes of acute pyelonephritis within six months.
Symptoms in the chronic form may vary depending on the stage of the disease, the latent form may be asymptomatic, with a negative effect on the kidneys and contributing to the development of irreversible changes in their tissues.
Depending on the nature and course of the disease, the localization of the inflammatory process, there are several forms of the disease.
Types of acute pyelonephritis
The acute serous form is characterized by the formation of multiple foci of inflammation in kidney tissues, an increase in body size, and swelling of surrounding tissues. In the absence of therapy, serous inflammation progresses and turns into a purulent-destructive form of the disease.
The development of acute suppurative inflammation of the kidneys has a high percentage of deaths, kills 1 out of 5 cases. There are several stages in the development of this form of the disease:
- stage of formation of apostema, small abscesses, in kidney tissues;
- carbuncle stage, merging several apostems into a single center of up to 2 cm. There can be several carbuncles;
- Stage of purulent abscess that occurs when the apostle and carbuncles merge. It is characterized by extensive damage, melting, destruction of tissues in the place of infiltration.
An abscess is accompanied by an exorbitant body temperature (40-41 ° C), acute pain, a pronounced pattern of intoxication. Breakthrough infiltration into the retroperitoneal space most often leads to sepsis and death.
Chronic inflammatory process
To diagnose the chronic form of pyelonephritis requires a long period of the disease – from 6 months, or the detection of the acute stage at least two times during a given period of time. The acute form is considered a separate manifestation if the patient achieves a complete clinical recovery in a two-month period after the start of therapy.
The cause of the development of the chronic form most often becomes an incomplete cure in the acute inflammatory process. Less common is a self-sustained chronic process, triggered by the presence of foci of infection in the body or difficulties in the outflow of urine due to various reasons.
Primary and secondary form of pyelonephritis
In case of pyelonephritis of the primary form, with a decrease in local or general immunity, the development of an acute inflammatory process in the kidneys due to the reproduction of pathogenic flora is observed.
The secondary form is more often expressed as a chronic disease, arising against the background of anatomical and / or functional disorders in the process of urine outflow.
Forms depending on the localization of the inflammatory process
With the defeat of one kidney, one-sided pyelonephritis is diagnosed, which is much more common than bilateral. With bilateral pyelonephritis, the inflammatory process affects both kidneys, which often leads to the development of both acute and chronic renal failure.
Diagnosis of the disease
Data collection and diagnostics are carried out in accordance with the scheme for collecting information about the patient’s state of health and deviation from the norm:
- collection of anamnesis from the patient’s words and information from medical documents: the presence of current or existing acute and chronic infectious diseases, structural pathologies, diseases of the genitourinary system;
- collecting information to compile a clinical picture of the disease: complaints of pain in the lumbar region, type, smell of urine, frequency of urination, hyperthermia, signs of general malaise;
- patient examination;
- laboratory tests, instrumental diagnostics.
The following tests are included in the list of laboratory tests:
- general and biochemical analysis of blood, urine;
- samples of Zimnitsky and Nechiporenko;
- seeding microflora of urine to determine sensitivity to antibiotics of different groups.
Blood tests for pyelonephritis indicate the presence of bacterial inflammation: an excess of leukocyte concentration, an indicator of CO2, characteristic changes in the biochemical composition.
Urinalysis reveals changes in specific weight and white blood cell count, there may be blood inclusions, pus, protein.
Biochemical analysis of urine shows elevated levels of salt.
Sowing urine allows you to identify the causative agent of the disease and choose the most effective drug for treatment.
For instrumental diagnostics, an ultrasound of the organs of the peritoneum is carried out with concentration on the kidneys and bladder. The method of excretory urography with intravenous injection of contrast material and computed tomography are also used.
Pyelonephritis: Symptoms and Treatment
With pyelonephritis, the symptoms and treatment vary depending on the pathogenesis, form, stage of the disease, age of the patient and his individual characteristics. Although there are general recommendations for patients with pyelonephritis: warmth, rest, bed rest, abundant drinking (diuretic, anti-inflammatory herbal teas, lingonberry, cranberry, oatmeal, clean water, etc.) and taking antimicrobial drugs.
In cases of pyelonephritis, women are strongly advised to be examined by a gynecologist to identify a concomitant focus of infection. In the presence of cystitis or inflammatory diseases of the sexual sphere, the treatment of pyelonephritis is complicated and can provoke the transition of the disease to the chronic form.
Long-term therapy with antibiotics aimed at curing the inflammatory processes in the kidneys, without attention to the foci of infection, leads to a loss of sensitivity of pathogenic bacteria and lack of effect from taking the drugs.
Treatment of pyelonephritis in men requires diagnosis by a urologist. Most often, pyelonephritis in age-related male patients occurs in a chronic form and is associated with stagnation of urine, obstruction of its outflow due to diseases of the genitourinary system: urolithiasis, prostatitis, prostate adenoma, etc. In such cases, treatment of the cause of stagnation is primary, since without ensuring the complete outflow of urine in the bladder and kidneys will continue to cause inflammatory processes.
The choice of therapy in childhood
In childhood, the most common cause of the disease is congenital reflux, in which part of the urine is thrown from the ureters and bladder into the kidneys. With this etiology, the disease is carried out as a conservative therapy with antibiotics, uroseptics, medicines of the NSAID group, they take measures to increase the overall immunity of the body, and they use surgical techniques of surgical treatment.
Antibiotic groups used to treat patients with pyelonephritis
Antibiotics – the basic group of drugs in the treatment of patients with pyelonephritis. Independent choice of medication or attempts at home treatment without the use of modern antimicrobial agents most often lead to the development of a chronic form of the disease and the development of pathogenic flora that are resistant to antimicrobial drugs.
Most often, pyelonephritis occurs during the reproduction of Escherichia coli, the pathogen that is well exposed to semi-synthetic penicillin in combination with clavic acid (Augmentin), cephalosporins 1-3 generations.
The most common antimicrobial agents are the fluoroquinalone group (Nolitsin), ciprofloxacins (Ciprofloxacin, Cyfran).
For the prevention of relapse in chronic patients with pyelonephritis, they use derivatives of nalidixic acid (Nevigramon) and oxyquinoline (5-LCM).