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Pyelonephritis is based on an infectious lesion of the pelvis and calyces of the kidney, as well as its parenchyma. Most often it is caused by pathogenic bacteria that enter the body from the outside. It is one of the most common inflammatory diseases and the most common among various pathologies kidney Moreover, very often pyelonephritis disguises its symptoms as other diseases, which significantly complicates treatment, which is already quite difficult.

But each of us in our lives may encounter. And in order to suspect the onset of the disease in time and begin effective treatment, you need to know what it is and how it usually manifests itself. We will talk about this and much more in this article.

Classification and causes of pyelonephritis

There are chronic and acute, unilateral and bilateral, primary and secondary form pyelonephritis. Moreover, secondary pyelonephritis is noticeably more common (in 80% of cases), which develops as a result of functional and organic changes in the urinary tract and the kidneys themselves, leading to problems with the outflow of urine, lymph and venous blood from the kidney.

In children, the disease is most often associated with congenital dysplastic lesions in renal tissues and microobstruction (obstructed urine outflow) at the nephron level. The disease is often observed in pregnant women (gestational pyelonephritis). This is explained by the fact that in most expectant mothers the tone of the upper urinary tract decreases. Such processes are caused by both endocrine (hormonal changes) and enlargement of the uterus during pregnancy.

Typical causative agents of pyelonephritis are white and aureus staphylococci. They are the ones who can provoke the onset of the disease in quite healthy person for no reason. Other microorganisms cause pyelonephritis only in the presence of certain local factors.

Clinical picture of pyelonephritis

This is one of the most important points regarding this disease, since diagnosing pyelonephritis can be quite difficult even for experienced doctors. Therefore, it is imperative to familiarize yourself with the signs of this pathology, and best of all, learn it.

The clinical picture of acute and chronic pyelonephritis is markedly different, therefore, it is best to consider these diseases separately from each other.

Chronic pyelonephritis

Complaints

All complaints of patients with pyelonephritis can be divided into two main groups: specific and general.

So, common complaints include:

• Headaches;
• Decreased appetite;
• Poor sleep;
• Decreased performance;
• Weakness.

Specific complaints:

• Aching pain in the lower back (usually one-sided). In the painful form of pyelonephritis, they can be quite intense. In addition, pain often radiates to bottom part abdomen, thigh or genitals;
• Dysuric phenomena (for example, frequent urination associated with cystitis);
• Discharge of rather cloudy urine, which often has an unpleasant odor;
• Chilling (during an exacerbation) with periodic rises in temperature up to 39 degrees. As a rule, it returns to normal by morning.

Remember! Never hide your complaints from your doctor. After all, every little detail can be important when making a final diagnosis and prescribing subsequent effective treatment.

Inspection

The next point that the doctor also focuses his attention on is examining the patient. So, signs of pyelonephritis that appear during examination:

• Paleness of visible mucous membranes and skin;
• Reduced body weight (not always);
• Facial pastiness. Severe swelling is extremely rare;
• Pain when tapping and palpating the lumbar region (can be both unilateral and bilateral);
• Tofilo's symptom - lying on his back, the patient bends his legs and presses them to his stomach.

Examination of internal organs

Chronic pyelonephritis is characterized by the following:

• Arterial hypertension;
• Expansion of the left borders of the heart;
• Muffled heart sounds;
• Functional liver disorders;
• Reduced secretion of gastric juice.

Doctors often note pronounced psychasthenic and neurasthenic personalities of the patient. In addition, if the disease is left without proper treatment, it gradually develops into chronic renal failure.

Affected kidney

The first signs of problems with functional state kidneys are considered:

• Polyuria (daily urine volume more than 2 liters);
• Nocturia (night diuresis prevails over daytime diuresis);
• Dry mouth;
• Thirst;
• Decreased urine density.

It should be noted that chronic renal failure, which occurs against the background of pyelonephritis, often has a recurrent nature. This is largely due to inflammatory processes in the interstitium of the kidney.

Important! Chronic pyelonephritis in diabetes mellitus and in pregnant women can be extremely severe, often with the presence of papillary necrosis. In such cases, there is severe chills, a rise in temperature up to 40 degrees, a sharp deterioration in the general condition, leukocytosis, pyuria, as well as cutting pain in the lower abdomen and lower back.

Clinical forms of chronic pyelonephritis

Today, all practicing doctors prefer to distinguish several clinical forms of CP. Their presence greatly facilitates the diagnosis of this disease.

Latent form

Characterized by mild symptoms. Often patients are bothered by unmotivated weakness, nocturia, chills, and mild pain in the lumbar region (it is often described as a manifestation of spinal osteochondrosis). Such vague and vague symptoms create many problems for diagnosing the disease. In such cases, the doctor needs to carry out OAM, the Nechiporenko test and bacterial urine culture as often as possible. This form is detected mainly by ultrasound.

Recurrent form

It represents alternating periods of remissions and exacerbations of pyelonephritis. So, in the second case, the clinical picture is quite clearly visible and almost always specific symptoms and changes in laboratory data are detected. Sometimes this form confused with acute pyelonephritis, however, a thorough study of the medical history helps to establish the correct diagnosis. During exacerbations, rapid development of chronic renal failure is possible. With timely relief of relapse, clinical and laboratory parameters gradually return to normal.

Hypertensive form

With this course, arterial hypertension syndrome comes to the fore. In this case, urinary syndrome is observed quite rarely or is mildly expressed.

Important! If a person has hypertension, it is always necessary to exclude CP as its main cause.

Anemic form

In this situation, the clinical picture will be dominated by anemia, which is usually caused by impaired production of erythropoietin (the hormone responsible for the formation of red blood cells) and severe intoxication. As a rule, severe anemia appears with pyelonephritis only in combination with chronic renal failure. In this case, minor and inconsistent changes in the urine are observed.

Septic form

This form develops with severe exacerbation of CP. It is accompanied by high body temperature levels, severe chills, hyperleukocytosis, severe intoxication and bacteremia. Recognize septic form pyelonephritis is quite easy, since in such cases there are clear clinical and laboratory symptoms.

Hematuric form

It is extremely rare. It is characterized by gross hematuria. When diagnosing “hematuric form of chronic pyelonephritis”, the doctor must carry out differential diagnosis with the following diseases: malignant tumors or tuberculosis bladder, kidneys, hemorrhagic diathesis, urolithiasis, nephroptosis.

Acute pyelonephritis

The onset of AP is similar to interstitial serous inflammation. Thus, pyelitis, which is an inflammation of the renal pelvis, is considered one of several phases of acute pyelonephritis. In this case, a significant change in the functioning of the collecting system is observed. The disease is often complicated purulent inflammation associated with the destruction of kidney tissue.

It is quite varied and depends on how impaired the passage of urine is.

In primary AP, local signs are practically not observed or are completely absent. The patient's condition is extremely serious, chills, general weakness is noted, temperature with pyelonephritis reaches 40 degrees, pain throughout the body, profuse sweating, nausea with bouts of vomiting, tachycardia, dry tongue.

With secondary pyelonephritis, which is usually caused by a violation of the outflow of urine, there is a frequent change in symptoms. Often the deterioration of the condition occurs simultaneously with a significant increase in pain in the lower back or renal colic. Often, at the height of pain, chills appear, gradually giving way to fever. Sometimes the temperature drops critically, which is expressed in profuse sweating. The intensity of pain in the kidneys decreases throughout the course of the disease and gradually disappears. However, in cases where the main cause of the disturbance in the outflow of urine is not eliminated, the improvement in the condition is only temporary - after a few hours the pain intensifies again and a new attack of OP begins.

Practitioners note that the course of acute pyelonephritis depends on the person’s age, gender, body condition, and the presence of previous pathologies of the kidneys and urinary tract. Today it is customary to distinguish acute, acute, latent and subacute forms of AP.

It should be remembered that the severity of purulent-inflammatory processes in the kidney does not always correspond general condition sick. For example, in elderly people, weakened people, and also if a person has a severe infection, the clinical picture will be less pronounced, the symptoms may be blurred or not detected at all. In such situations, the disease becomes very similar to sepsis, " acute stomach", paratyphoid fever, meningitis and others.

Unfortunately, when examining patients with AP, already at early stages diseases, doctors discover complications that may well even lead to fatal outcome. To such pathological conditions include:

• Necrosis of the renal papillae;
• Endotoxic (bacteremic) shock;
• Urosepsis;
• Parnephritis;
• Acute renal failure (ARF);
• Septicopyemia (one of the forms of sepsis in which purulent processes are observed).

During palpation in acute pyelonephritis, the doctor often detects pain in the area of ​​the affected kidney, as well as pathological tension in the muscles of the abdominal wall. At laboratory research leukocytosis with a sharp shift is detected leukocyte formula to the left. In addition, leukocyturia and bacteriuria are diagnosed.

Something to remember! In acute obstructive pyelonephritis, changes in urine analysis may be absent for 2-3 days.

Examination program

In order to present a complete clinical picture, doctors adhere to the following examination program for patients with suspected pyelonephritis:

1. OA of urine, blood and feces. Urinalysis for pyelonephritis is considered the most important indicator.
2. Analysis according to Nechiporenko, Zimnitsky;
3. Definition of bacteriuria;
4. Determination of sensitivity to antibiotics;
5. Analysis for BC;
6. Biochemical urine analysis;
7. X-ray of the kidneys;
8. Chromocystoscopy;
9. Retrograde pyelography;
10. Ultrasound of the kidneys;
11. Fundus examination.

Kidney diseases. Pyelonephritis Pavel Aleksandrovich Fadeev

Clinical picture of chronic pyelonephritis

The clinical picture of chronic pyelonephritis depends on phases of the disease, i.e., on the state of the inflammatory process - its active form (exacerbation) and inactive form (remission).

There are two forms of exacerbation - rapidly progressive and recurrent. They are manifested by the signs indicated in the table. 2 on p. 62.

At rapidly progressive form chronic pyelonephritis rapidly, within a short time chronic renal failure develops. This form is characterized by frequently recurring relapses with rare and short-lived remissions. This is the most unfavorable course of the disease. The recurrent form of chronic pyelonephritis is characterized by alternating periods exacerbations and remissions. At the same time, the progression of the disease is not so rapid and the exacerbation phase is replaced by a more or less long-term remission, in which clinical signs there are no diseases.

Table 2

Complaints of patients with chronic pyelonephritis (frequency, %)

In the acute stage, the clinical picture of chronic pyelonephritis, as well as objective examination data, are identical to those that occur with acute pyelonephritis.

In remission (out of exacerbation) The patient’s illness usually does not bother him. There may be complaints of fatigue, general weakness, headaches, loss of appetite, nausea, weight loss, dry skin, periodic “unreasonable” rises in temperature, swelling, pasty eyelids in the morning, mild pain or discomfort in the lumbar region (especially in wet, cold weather). Possible frequent, painful urination, a predominance of nighttime diuresis over daytime. The urine is cloudy and may contain flakes.

All of these signs may be either absent or barely noticeable, especially in patients who suffer diabetes mellitus, with fungal pyelonephritis, as well as in elderly and old people.

The next four collections are for the treatment of chronic pyelonephritis and chronic cystitis, diseases that, unfortunately, are quite common. Collection No. 5 Calamus root - 2 Black elderberry flowers - 4 St. John's wort herb - 5 Flax seed - 3 Melissa herb

For the treatment of chronic pyelonephritis, I alternate two collections. I am 41 years old, I have chronic pyelonephritis. To treat it, I use two herbal mixtures. I alternate the collections - I drink one for a month and a half, then a break for two weeks, then the next one: 1) white birch buds - 2 parts, grass