Chronic pyelonephritis is a bacterial process of a nonspecific nature, which in most cases affects the renal tissues and pyelocaliceal structures. The disease manifests itself as pain in the renal-lumbar region and symptoms of urinary dysfunction.

Most often, pyelonephritis is diagnosed in women and girls, since the structural features of the urethra in the female half of the population are conducive to the development of this disease. As a rule, both organs are involved in the process at once, which is why the chronic form differs from the acute form.

The acute form of the disease is accompanied by a sharp and rapid development of pathology, while chronic pyelonephritis in many cases is asymptomatic - long-term remission is replaced by an acute process. According to statistics, pyelonephritis is diagnosed more often than its acute form.

We can talk about a chronic form of pyelonephritis when the disease is not completely cured within 3 months.

The acute form of the disease becomes chronic for a number of reasons:

• the presence of stones or narrowing of the urinary ducts, which leads to disruption of the outflow of urine;
• urine reflux - urine reflux;
• the process of inflammation in organs that are located in close proximity - prostatitis, enterocolitis, cystitis, urethritis and others;
• general diseases - diabetes, obesity, immunodeficiency;
• intoxication – work in hazardous work, alcohol abuse, smoking;
• poor quality treatment of acute pyelonephritis.

The cause of the disease is the following pathological microorganisms:

• Proteus;
• coli;
• cocci;
• Pseudomonas aeruginosa;
• associations of microorganisms.

L-forms of bacterial flora can long time be in the body, and sooner or later enter the paired organs through the bloodstream.

In the chronic form of pyelonephritis, organs decrease in size, and the upper layer of the kidneys becomes lumpy. In advanced stages, the kidney shrinks and interstitial necrosis develops.

Risk factors are:

• pregnancy - this is due to hormonal changes in the body, in addition, the uterus, increasing in size, can put pressure on the urinary organs and impede the outflow of urine;
• promiscuous sex life - increases the risk of infection with microorganisms that pose a danger to human health - gonococci, chlamydia;
• hereditary predisposition;
• disruptions in the innervation of the bladder.

The process of transition from acute to chronic

The infection can get to the kidneys in the following ways:

• through blood;
• urinogenic method;
• along the wall of the urinary ducts - the ascending path.

Normally, bacteria that penetrate the bladder quickly disappear - this is due to the fact that urine has an antimicrobial property, as well as due to the washing out of the bacterial flora by urine. When the outflow of urine is disrupted, bacteria are retained in the ducts and begin to actively multiply.

Hemogenic spread of bacteria is most often observed in people with immunodeficiency or in severely weakened patients.

Once in the kidney tissue, the pathogens begin to actively release toxins that negatively affect the functioning of the organs. An inflammatory process develops, which, with a long course of the disease, becomes the cause of the proliferation of connective tissue. This phenomenon leads to shrinkage of the organ.

Processes that lead to disturbances in the outflow of urine provoke urinary retention and increased pressure in the ducts, which contributes to the chronicity of the disease. Subsequently, reflux develops, which allows the infection to easily penetrate the kidney.

Classification and stages of development

In nephology, all forms of pyelonephritis are divided into primary and secondary. If the first form develops as an independent disease, then the second occurs in the presence of other ailments, which are aggravated by congestive processes and urodynamic disorders.

Pyelonephritis varies according to age:

• children's;
• during pregnancy;
• senile.

There is a Lopatkin scheme, which includes the following types of illness:

• primary and secondary;
• one-sided and two-sided;
• necrotic;
• purulent;
• serous;
• latent;
• active inflammation phase;
• abscess;
• carbuncle;
• pyonephrosis;
• nephrosclerosis.

According to the severity of the disease, pyelonephritis can be as follows:

• latent – ​​symptoms are either completely absent or slightly developed;
• recurrent - exacerbations are replaced by subsidence of the disease. The frequency of change depends on the influence of provoking factors;
• anemic – the hemoglobin level drops, anemic syndrome develops;
• azotemic – renal failure develops;
• hypotensive - accompanied by an increase in pressure in the arteries.

The stages of chronic pyelonephritis are as follows:

• Stage 1 – the inflammatory process is actively developing, symptoms are pronounced;
• Stage 2 – the clinical picture is blurred, so the disease can only be determined through laboratory tests;
• Stage 3 – remission – temporary attenuation of the disease and absence of symptoms; in the case of a 5-year relapse, the doctor can say about a complete cure for the disease.

Symptoms of the disease

Symptoms of chronic pyelonephritis are very diverse.

Pathological processes occurring in paired organs can be confused with other ailments of the urinary system, so differential diagnosis in this case is extremely important.

The symptoms of the disease directly depend on the form of the disease. With a latent course of the disease, there are practically no symptoms. The patient may only be concerned about weakness and, in rare cases, a slight increase in temperature. Swelling, pain, disturbance of the urinary process and other signs are absent. Polyuria appears; leukocytes and bacterial flora can be detected in a urine test.

In the anemic form, the clinical picture may be as follows:

• dyspnea;
• pallor of the skin;
• weakness;
• sometimes there are complaints of pain in the cardiac region.

As for changes in urine, they are minor and cannot always be detected.

The hypertensive form is accompanied by:

• dizziness;
• shortness of breath;
• insomnia;
• pain in the projection of the heart.

The azotemic form develops with renal failure and is characterized by:

• anemia;
• increase blood pressure;
• stool disorders;
• nausea;
• decreased appetite;
• muscle weakness;
• numbness of the limbs.

There is a decrease in calcium concentration in urine.

In severe renal failure, the following may occur:

• joint pain;
• secondary gout;
• changes in heart rhythm;
• development of atrial fibrillation;
• swelling of the salivary glands;
• swelling of the face;
• unpleasant taste in the mouth.

In the recurrent form, the patient complains of discomfort in the kidney area, increased temperature and fever, and dysuria.

With an exacerbation of the chronic process, other symptoms of the acute form of the disease are added:

• headache;
• anemia;
• increased blood pressure;
• visual impairment.

A blood test can detect increased ESR, anemia and leukocytosis.

Complications

Complications of a chronic illness can be very serious, so ignoring the disease is strictly not recommended.

As for the kidneys themselves, two types of complications can arise in them:

1. Nephrosclerosis. This phenomenon occurs most often against the background of a latent course of the disease, the primary form, in which obstruction of the urinary ducts is not observed. Nephrosclerosis itself can be complicated by an increase in blood pressure of the nephrogenic type, and if there is damage to two kidneys at once, then the development of renal failure is possible.
2. Pyonephrosis. This is the final stage of pyelonephritis, developing in a purulent-destructive form. Most often, the pathological process is observed on one side. The disease occurs with secondary pyelonephritis, in the presence of disruptions in the flow of urine or with kidney tuberculosis. The organ greatly increases in size, the parenchyma becomes thinner, and the cavities are filled with purulent exudate. Chronic inflammation, fatty degeneration and sclerosis are also observed. The fatty capsule grows to the kidney, and the fibrous capsule becomes very thick, the urine contains pus, and the kidney moves poorly when palpated.

With a prolonged course of the chronic process, inflammation can spread to the fiber that surrounds the renal pedicle.

Diagnostic methods

Pyelonephritis is diagnosed as follows:

• studying the patient's medical history;
• assessment of symptoms and complaints;
• urine examination using the Kakovsky-Addis method;
• determining the number of active leukocytes in urine;
• tank urine analysis;
• renal biopsy.

Very often, specialists fail to recognize the chronic form of the disease and determine the form of the disease, especially if the disease occurs in a latent form or the clinical symptoms are varied.

To determine pyelonephritis, the patient may be referred for a blood test to determine creatinine, urea and residual nitrogen.

X-ray examination makes it possible to assess the size of the kidneys, their deformation, decreased tone of the urinary ducts, and when using the radioisotope research method, each organ can be studied in detail separately.

Retrograde and intravenous pyelography, echography (echosigns of the inflammatory process), chromocystoscopy, scenography are additional studies of chronic pyelonephritis.

Pyelonephritis must be clearly distinguished from chronic glomerulonephritis and hypertension.

Glomerulonephritis, in contrast to pyelonephritis, is accompanied by a high content of red blood cells in urine, a lack of active leukocytes, and the presence of microbial flora in the urine. As for hypertension, it is more often observed in people of older age groups, and occurs with changes in the cerebral vessels of the coronary vessels, and is also accompanied by hypertensive crises.

Principles of treatment

Pyelonephritis includes several areas of therapy. The patient’s regimen is determined by the doctor based on the severity of the patient’s condition, the phase of the disease and clinical characteristics. Indications for hospitalization are:

• pronounced course of the disease;
• development of arterial hypertension;
• progression of chronic renal failure;
• significant disruptions in urodynamics that require restorative procedures,
• a sharp deterioration in the condition of the kidneys.

Patients in any phase of the disease should not allow hypothermia and avoid physical activity.

If the disease occurs in a latent form, with normal blood pressure and while maintaining kidney functionality, no special restrictions are required in the regimen. In the acute stages of the disease, the patient is prescribed bed rest.

It is recommended to increase the amount of fluid consumed to 2.5 liters per day. With high blood pressure, the amount of fluid per day should not exceed a liter. As for salt, its consumption should be reduced to 5 grams per day.

Naturally, the patient should be prescribed antibiotics. Modern antibacterial drugs make it possible to prescribe empirical therapy, since they have wide range actions.

Most doctors consider it inappropriate to use highly toxic drugs for treatment, however, it is possible to select an adequate drug only after the results of urine culture.

It is very important to choose the correct dosage of the drug so that in the future the pathogenic microflora does not develop resistance to the active substance of the drug.

If the patient has not received antibacterial therapy for several years, then the probability that the causative agent is E. coli is 90%.

The most commonly prescribed antibacterial agents are:

• Ceftoxime;
• Ceftriaxone;
• 5-Nok;
• Furomag.

If a patient has chronic renal failure, he is prescribed the following medications:

• Pefoloxacin;
• Cefaperazone.

Surgery. If conservative treatment of chronic pyelonephritis remains ineffective, surgical intervention is prescribed. Any disruption in the outflow of urine is an indication for surgical intervention.

If the chronic course of the disease is complicated by the appearance of a carbuncle, then surgical treatment and installation of nephrostomy drainage are prescribed.

In severe cases, nephrectomy is prescribed; indications for such an operation are:

• pyonephrosis;
• nephrosclerosis;
• loss of kidney function;
• persistent hypertension that does not respond to conservative therapy.

Also, during conservative and surgical treatment, nutritional therapy and folk remedies therapy have been used.

Traditional methods of therapy

When treating a disease at home, with the permission of a doctor, you can use folk therapy.

Using medicinal herbs it is necessary to make sure that the patient does not have allergies or individual intolerance to herbal components.

You can use lingonberry infusion. This water is a good diuretic, it is easy to prepare an infusion from it - you need to pour a tablespoon of leaves with a glass of boiling water and leave for half an hour. Then strain and take a third of a glass three times a day. This remedy is approved for the treatment of children.

Corn silk is another very common diuretic, which is prepared and consumed in the same way as lingonberry infusion.

Aspen is used very often to treat pyelonephritis, since this plant copes well with various kidney ailments. To prepare a decoction of aspen, you can use leaves, young twigs and tree bark. A tablespoon of plant material is poured into a glass of boiling water and boiled for several minutes. You need to drink half a glass of the decoction several times a day.

A decoction of flaxseed should be taken every 2 hours for 2 days. To prepare it, you will need a glass of boiling water and 30 seeds; the product must be boiled for 10 minutes over low heat.

The treatment of kidney problems with watermelon has been known to residents of the southern regions since ancient times. The healthy berry is not only eaten, but also cooked medicine from its crusts. Pour boiling water over the dried peel in a ratio of 1:10, leave for several hours, and then drink instead of tea.

Juniper berries are an ancient remedy against pyelonephritis. 10 berries are poured with boiling water, left for a couple of hours, and then taken before eating.

In addition to the above remedies, birch leaves, cloudberries, elderberry, St. John's wort, marsh calamus and other herbs are used.

It must be remembered that folk remedies may be effective in the initial stages of the disease, in the future they can only be additional methods, which should not exclude treatment with medications.

Diet

Nutritional therapy is an important component of the treatment of chronic pyelonephritis; it is very important to strictly follow the doctor’s recommendations, since this disease can be quite dangerous and can provoke irreversible pathological phenomena in the kidneys.

For pyelonephritis, the following foods should be present in the diet:

1. Fruits and vegetables that have a diuretic effect - pumpkin, watermelon, cucumbers, zucchini.
2. Juices and fruit drinks made from berries that have anti-inflammatory and antimicrobial effects - cranberries, lingonberries.
3. In case of exacerbation of the disease and intoxication processes in the body, it is recommended to exclude from the diet foods containing protein - milk, meat and others. At this time, it is better to switch to vegetarian cuisine and consume vegetable purees, juices from vegetables and fruits.
4. During the remission stage, protein foods can be consumed within normal limits.
5. Whole grain cereals and bran.
6. Olive oil.
7. Green unsweetened tea.
8. Water containing calcium and chlorides.

It is necessary to exclude from the diet:

• hot and spicy seasonings and sauces;
• products that contain essential oils– onions, garlic, radishes, basil, parsley and others,
• strong broths;
• sour fruits and vegetables;
• pickles and marinades;
• confectionery and sugar;
• products with artificial additives and dyes;
• products containing oxalic acid;
• coffee, strong tea, sweet soda, alcoholic drinks.

• It is not allowed to consume salty mineral waters;
• to avoid constipation, for this it is necessary to introduce cereals, coarse fiber, and whole grain bread into the diet;
• in the absence of edema, increase the drinking regime;
• reduce salt intake;
• periodically carry out prophylaxis with decoctions of diuretic herbs;
• avoid hypothermia;
• boost immunity;
• if there are phosphates or oxalates in the urine, adhere to diet No. 6;
• if alkalization of urine is observed, switch to diet No. 14.

Prognosis and prevention

If the disease is mild, the prognosis is favorable. But of course, the presence of concomitant pathologies is of great importance. With the timely elimination of all provoking factors, the pathological process subsides, and a complete cure for the disease is possible.

In some cases, pyelonephritis may have a poor prognosis. The fact is that advanced stages of the disease are difficult to treat, and very often cause complications that can lead to the development of irreversible pathological processes in paired organs.

The prognosis of chronic pyelonephritis largely depends on the occurrence of complications. If a secondary infection is added to the inflammatory process, the prognosis worsens significantly; a worsening prognosis is also observed in the presence of kidney stones.

The most unfavorable outcome of the disease can be considered renal failure. This disease leads to kidney dysfunction, edema and problems with the cardiovascular system.

Drug therapy for the chronic form of the disease is usually long-term and requires careful and strict adherence to all medical recommendations. With improper therapy, life expectancy can be significantly reduced.

Concerning preventive measures, it is necessary to promptly treat the underlying disease, which can cause pathological processes in the kidneys. If not treated correctly, ordinary cystitis can lead to serious consequences.

To prevent pyelonephritis it is necessary:

• strengthen immunity;
• Healthy food;
• fight bacterial infections;
• to live an active lifestyle;

Chronic pyelonephritis arises from acute. In some cases, the first inflammation of the kidney remains undiagnosed, since it occurs under the guise of another disease, most often a protracted acute respiratory viral infection. If after the first attack of pyelonephritis the symptoms of the disease persist for more than six months or after recovery there are at least two exacerbations over the same period, then we can talk about a chronic form of the infection.

Why does chronic pyelonephritis develop?

Everything in the body is individual, severe acute pyelonephritis may never remind itself again, and an unnoticed and very easily passed infection will remain in the body forever.

Chronicity of kidney inflammation is promoted by:

• Inadequate treatment of acute infection, which implies incorrect choice medication, insufficient dose or irregular use, as well as refusal to continue taking medication with subjective improvement.
• An unrecognized violation of the outflow of urine, which contributes to stagnation and proliferation of microflora.
• Long-term residence of inactive forms of bacteria in the interstitial tissue of the kidney, their activation under favorable immune conditions.
• Concomitant diseases that weaken the defenses.
• Immune deficiency.

Symptoms of chronic kidney inflammation

Acute pyelonephritis has characteristic symptoms, chronic pyelonephritis has nothing typical, everything is determined by the amount of tissue involvement and the type of inflammation at the moment. However, the initially focal local process covers the entire kidney over the years, replacing normal tissue with connective tissue scar tissue, disabling the functions of the organ and developing renal failure.

Chronic infection can occur without any obvious manifestations - a latent phase, in waves with alternating activity and subsidence of the process. It is often difficult to understand that there is an exacerbation, but when the activation of the infection is quite clearly separated from remission by an increase in the intensity of symptoms, then a recurrent version of the infection is assumed. Symptoms during an exacerbation are the same as for any sluggish infection:

• temperature reaction of varying severity,
• painful discomfort in the lumbar region,
• weakness and fatigue.

If the temperature rises for no apparent reason and weakness and fatigue persist for a long time, then a serious problem should be suspected; the Medicine 24/7 clinic will conduct an examination as soon as possible and determine the root cause of the symptoms of malaise.

Signs of disease activity

The diversity of clinical symptoms and the frequent secretive course led to the determination of the activity of the process according to objective criteria of the state of urine and blood. The more pronounced the urinary findings, the more active the inflammation in the kidneys.

In the urinary sediment after centrifugation of urine, the number of “dead” leukocytes and the proportion of active forms - “live” and increased in size leukocytes - Sternheimer-Malbin cells, and the number of bacteria are determined. The titer of antibodies produced against bacteria, the erythrocyte sedimentation rate, and protein toxins are determined in the blood.

For each phase of the disease, certain quantitative criteria, during exacerbation their level is maximum, during remission it is close to normal. If it is impossible to determine the stage of the process, they resort to provocation when inflammation occurs in response to the use of a certain medicine.

Is it possible to cure chronic pyelonephritis?

Chronic pyelonephritis is a disease that begins and spreads unnoticed, without causing inconvenience to the person. Symptoms of the disease appear gradually.

Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

The disease is a consequence of the untreated acute phase of pyelonephritis and lasts up to 15 years or more. The inflammatory process, affecting one kidney, often affects the second. The buds decrease in volume, their outer layer becomes loose and uneven.

Subsequently, if there is no response to symptoms, the organs shrink and necrosis of their tissue occurs. Chronic pyelonephritis can exist as an independent disease or another. According to statistics, women get sick more often than men, which is explained by the short urinary canal.

Symptoms and forms

The mechanism of pyelonephritis is based on the reflux of urine infected with bacteria into the pelvis. Inflammation begins, moving from the walls of the pelvis to the medulla and cortex of the kidneys. The disease is characterized by sluggish symptoms or their complete absence.

The pattern of symptoms may vary significantly between patients. This is explained by the presence of one form or another of pyelonephritis.

With the latent form, there are no specific symptoms, but minor manifestations of the following signs are observed:

• Fatigue,
• Dull pain in the side and lower back (Pasternatsky's symptom),
• Slight increase in temperature
• Headache,
• General malaise.

Sometimes the clinic is characterized by a slight increase in blood pressure and mild anemia.

At this stage, the kidneys lose their ability to concentrate urine.

Urinalysis shows periodic sedimentation of leukocytes and bacteria.
The anemic form has already pronounced symptoms:

• Tingling sensation in the heart area,
• Dyspnea,
• Pale skin
• Marked weakness.

The hypertensive form is distinguished by arterial hypertension.
In addition to the previous ailments:

• Dizziness,
• Insomnia,
• Hypertensive crises,
• Stitching pains in the heart.

The azothermal form of pyelonephritis is a disease that manifests itself already with the onset of chronic renal failure. In fact, this is an untreated latent form.

Recurrent form – phases of relapse and remission, which replace each other depending on the conditions of the person’s stay.
Symptoms of this form:

• Temperature increase,
• Chills,
• Discomfort in the lower back,
• Frequent urge to go to the toilet,
• Pain when urinating.

The period of exacerbation is acute pyelonephritis. With the development of a recurrent form, hypertensive or anemic syndrome often occurs.

According to the nature of inflammation, the disease is divided into phases:

• Active inflammation
• Latent inflammation
• Remission.

Inflammation in the active phase, in the absence of proper treatment or with improper therapy, is replaced by a latent state, which flows either into remission or back into the inflammatory process.

Remission is a clinical recovery when the patient is not tormented by signs of pyelonephritis, and urine tests do not show any changes.
The duration of the remission period depends on the therapy and lifestyle of the patient.

Causes

The first cause of pyelonephritis is microorganisms that enter the active stage due to improper hygiene, incorrect use of antibacterial agents, and changes in the pH environment.
The disease is caused by common types of bacteria:

• Proteus,
• Escherichia coli,
• Staphylococci and streptococci,
• Enterococci,
• Pseudomonas aeruginosa and others.

L-types of microorganisms influence the occurrence of the disease because they can persist in human tissues for a long time and enter the kidneys with the blood.

Microbes are resistant to antibiotics, and when favorable conditions begin to actively lead their life activities.

Chronic pyelonephritis can be a consequence of existing diseases:

• Urolithiasis disease,
• BPH,
• Cystitis,
• Diabetes,
• Gout,
• Obesity,
• Cholecystitis,
• Appendicitis and others.

The onset of the disease in women is caused by pregnancy, childbirth, and sexual activity.
Medical procedures - cystoscopy, catheterization, anesthesia and others - also provoke the onset of the disease.
Children suffer from this disease due to congenital pathologies - ureterocele, bladder diverticula.

Diagnosis of primary and secondary pyelonephritis

Diagnosis is somewhat difficult, and the course of the disease is mild. Only detailed questioning about symptoms and laboratory tests help establish the correct diagnosis.
To make a diagnosis, diagnostic methods are used:

• General analysis of urine and blood,
• Bacteriological culture,
• Blood chemistry,
• Kidney biopsy.

For diagnostic purposes, pyelography and renography are performed. The patient is prescribed a catheterization to determine the amount of protein and blood enzymes that are precipitated.

These methods make it possible to establish the primary or secondary nature of pyelonephritis.
Primary develops in people who complain of kidney problems for the first time.

Secondary chronic pyelonephritis is diagnosed if a person has already suffered from diseases that are associated with the kidneys, or has congenital renal pathologies.

The causes of the secondary manifestation of the disease are the same factors as in primary pyelonephritis.

Video

Treatment

Treatment requires a long time, compliance with all the specialist’s instructions, and proper nutrition.
The best results will come from comprehensive treatment, including eliminating the causes of the disease and changing lifestyle.
The complex of treatment measures includes:

• Compliance with the regime
• Diet,
• Taking antibacterial agents,
• Phytotherapy,
• Immunomodulatory therapy,
• Physiotherapy,
• Symptomatic treatment
• Visit to the sanatorium,
• Planned treatment to avoid relapses.

The disease is bacterial, taking antibiotics becomes mandatory. The doctor prescribes antibiotics based on the tests obtained, which reveal the sensitivity of microbes to certain drugs.

Antibacterial therapy includes taking penicillins:

• Amoxicillin,
• Methicillin,
• Oxacillin,

Depending on the sensitivity of bacteria to antibiotics, cephalosporin drugs may be prescribed:

• Cefazolin,
• Ceftriaxone,
• Cephalexin.

Sulfonamides are prescribed as additional antimicrobial agents:

• Urolesan,
• Groseptol,
• Lidaprim.

Along with antibiotics, vitamin complexes and antiallergic drugs - diazolin, suprastin - are prescribed.

For the anemic type of pyelonephritis, iron intake is indicated, and the hypertensive type of the disease requires the use of antihypertensive drugs and antispasmodics.

After the main antimicrobial therapy, long-term treatment against relapses is carried out with the alternating use of different antibiotics.

Surgical treatment of the disease is carried out in the following cases:

• Disturbance of urine outflow,
• Reflux into the ureter from the bladder,
• Presence of kidney stones,
• Prostate adenomas.

To speed up recovery and prevent relapses, patients are advised to use physiotherapeutic methods of treatment:

• Electrophoresis,
• Galvanization,
• Sodium baths.

Nutrition

Diet plays a big role in maintaining kidney function.
Medical nutrition includes following the rules.

How to treat chronic pyelonephritis in women and men at home?

Chronic pyelonephritis is a disease characterized by periodic exacerbations. This disease is understood as a nonspecific inflammatory process in which the kidneys are affected, followed by sclerosis of the parenchyma. According to medical statistics, about 20% of the population suffers from pyelonephritis.

In childhood, from 2 to 15 years old, it affects girls more often; in old age, the disease affects men more often. Despite this, pyelonephritis is considered predominantly a female disease due to the anatomical location of the genitourinary organs and other functional characteristics of the female body.

What it is?

Chronic pyelonephritis is a disease of an infectious-inflammatory nature in which the calyces, pelvis and tubules of the kidneys are involved in the pathological process with subsequent damage to their glomeruli and vessels.

According to statistics, chronic pyelonephritis among all diseases of the genitourinary organs with an inflammatory nonspecific nature is diagnosed in 60-65% of cases. Moreover, in 20-30% of cases it is.

Causes

The main causes of pyelonephritis are microbes - Escherichia coli, staphylococcus, enterococci, Proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis, resistant to negative factors and antibiotics forms of microbes. They can persist for a long time in the area of ​​the calyxes and pelvis, with a decrease in immune defense, causing activation of inflammation.

Why does an acute process become chronic?

The causes of chronic pyelonephritis can be considered:

• poor-quality treatment of acute pyelonephritis, failure of the patient to comply with the doctor’s clinical recommendations, failure to monitor a child or adult;
• untimely diagnosis and treatment of diseases that impair the outflow of urine (nephroptosis, vesicoureteral reflux, congenital anomalies of narrowing of the urinary tract);
• the presence of concomitant chronic diseases that undermine the body’s immunity or are constant foci of infection (obesity, diabetes, diseases of the gallbladder, intestines, pancreas);
• the ability of some pathogens to form L-forms, which can remain in the kidney tissue for a long time in an inactive state, but cause exacerbation when they decrease protective forces or immunodeficiency states.

There is no standard risk group for chronic pyelonephritis, but practitioners believe that the infection is most dangerous for:

• pregnant women;
• children up to three years, predominantly bottle-fed;
• girls during the onset of sexual activity;
• elderly people.

Prevention of chronic pyelonephritis is most indicated for these patients.

Classification

Forms of chronic pyelonephritis:

1. Latent form. Characterized by minor clinical manifestations. The patient may experience general weakness, fatigue, headache, and sometimes the temperature may rise slightly. As a rule, there is no lower back pain, swelling or dysuria, although some experience a positive Pasternatsky symptom (pain when tapping the lumbar region). A general urine test reveals slight proteinuria; leukocytes and bacteria may be excreted in the urine periodically. With a latent course, the concentrating ability of the kidneys is usually impaired, so a decrease in urine density and polyuria are characteristic. Mild anemia and a slight increase in blood pressure can sometimes be detected.
2. Recurrent form. Characterized by alternating periods of exacerbation and remission. The patient may experience discomfort in the lower back, chills, and fever. Dysuric phenomena appear (frequent urination, sometimes painful).
3. Azotemic form. These include those cases when the disease manifests itself in the form of chronic renal failure. They should be qualified as a continuation of an already existing, but not timely identified latent course of the disease. It is the azotemic form that is characteristic of chronic renal failure.
4. Hypertonic form. Arterial hypertension predominates. Headache, dizziness, sleep disturbance, stabbing pain in the projection of the heart, frequent hypertensive crises, and shortness of breath occur. Changes in urine are subtle and not constant. Hypertension with pyelonephritis is often malignant.
5. Anemic form. It is characterized by the fact that among the signs of the disease, the symptoms of anemia predominate - a decrease in the number of full-fledged red blood cells in the blood. This form of the disease in patients with chronic pyelonephritis is more common, more pronounced than in other kidney diseases, and is usually hypochromic in nature. Disturbances in urination are mild.

Exacerbation of chronic pyelonephritis clinically resembles the picture of acute inflammation. As the process progresses, the leading syndrome becomes hypertensive, which is manifested by headache, dizziness, visual impairment, and pain in the heart. Sometimes, as a result of long-term pyelonephritis, anemic syndrome develops. The outcome of the disease is chronic renal failure.

Stages

In chronic pyelonephritis, there are three stages of disease progression:

• the initial degree is characterized by the development of inflammation, swelling of the connective tissues of the inner layer of the urinary organ, as a result of which the vessels are compressed, tubular atrophy appears, and renal bleeding decreases;
• the second degree is detected through a nephrogram, where diffuse narrowing of the arterial renal bed is noted, the size of the cortex becomes smaller, interlobar arteries are absent;
• the third degree of pyelonephritis is expressed by a narrowing and change in the shape of all vessels of the urinary organ, the kidney tissue is replaced by scar tissue, the kidney becomes wrinkled.

Symptoms

The degree of manifestation of symptoms of pyelonephritis depends on the location of inflammation (one side or both kidneys), the degree of activity of inflammation, concomitant obstacles to the outflow of urine and previous treatment. During the remission stage, there may be no manifestations at all, or they may be minimal - minor changes in urine tests.

The main symptoms of pyelonephritis in women and men:

1. Deterioration of health, fatigue and weakness, more pronounced in the morning, decreased mood, headaches.
2. Temperature rise, not higher than 38 C, usually in the evening, for no apparent reason.
3. Frequent urination, especially at night.
4. Increased blood pressure. During remission, this may be the only symptom.
5. Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.
6. Lower back pain is often mild, aching, and usually asymmetrical. It has been noticed that pain often appears not on the affected side, but on the opposite side. There may be a feeling of discomfort and heaviness in the lower back, especially when walking or standing for long periods of time. Patients complain that their lower back is cold and try to dress warmer. Severe or cramping pain is more typical for urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.

In the remission stage, all symptoms of pyelonephritis are minimal, but the longer pyelonephritis is present, the higher the likelihood of arterial hypertension, cardiac hypertrophy, the development of chronic renal failure and secondary degenerative changes in the kidneys. In the later stages, polyneuritis, bone pain, hemorrhages, polyuria with the release of up to 3 or more liters of urine with thirst and dry mouth, and anemia may occur.

Complications

As chronic pyelonephritis progresses, it develops. It manifests itself as an increase in the amount of daily urine and especially the nightly portion, a decrease in the density of urine, thirst, and dry mouth.

A sharp exacerbation of chronic pyelonephritis may be accompanied by the development of acute renal failure.

Diagnostics

Acute and chronic pyelonephritis is diagnosed based on patient complaints and the clinical picture of the disease. The doctor finds out whether attacks of acute pyelonephritis, cystitis, inflammation of the urinary tract and kidneys were suffered in childhood or during pregnancy in women.

When interviewing men Special attention focuses on injuries to the spine, bladder and inflammation of the genitourinary organs. The doctor identifies the presence of factors that predispose to the occurrence of pyelonephritis - the presence of chronic diseases (prostate adenoma, diabetes mellitus, etc.).

Differential diagnosis is carried out with a number of such diseases:

1. Hypertension. Elderly people are susceptible to the disease; there are no changes in blood and urine.
2. Chronic glomerulonephritis. In pathology, there are no active leukocytes and pathogens, but red blood cells are present.
3. Amyloidosis of the kidneys. There are no bacteria or signs of inflammation. The disease is characterized by the presence of foci of infection and scanty urine sediment.
4. Diabetic glomerulosclerosis. Accompanying diabetes mellitus, manifested by signs of angiopathy.

Examining a patient with chronic pyelonephritis in this way will help to avoid medical errors and prescribe effective treatment.

How to treat chronic pyelonephritis?

Therapy should be aimed at eliminating the following problems:

• elimination of the causes that cause disruption of the normal functioning of the kidneys;
• use of antibacterial medications and other drugs;
• increasing immunity.

The most effective medications are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.

Drug treatment

Antibiotics during exacerbation of the disease are prescribed for up to 8 weeks. The specific duration of therapy will be determined based on the results of laboratory tests performed. If the patient’s condition is severe, then he is prescribed combinations of antibacterial agents, they are administered parenterally or intravenously and in large doses. One of the most effective modern uroseptics is the drug 5-NOK.

Self-medication is strictly prohibited, although there are many drugs for the treatment of pyelonephritis. This disease is solely within the competence of specialists.

Typically, the following drugs are used to treat chronic pyelonephritis:

1. Nitrofurans – Furazolidone, Furadonin.
2. Sulfonamides - Urosulfan, Etazol, etc.
3. Nalidixic acid – Negram, Nevigramon.
4. Cephalosporins - Kefzol, Ceporin, Ceftriaxone, Cefepime, Cefixime, Cefotaxime, etc.
5. Semi-synthetic penicillins - Oxacillin, Ampicillin, Amoxiclav, Sultamicillin.
6. Fluoroquinolones: Levofloxacin, Ofloxacin, Tsiprinol, Moxifloxacin, etc.
7. Antioxidant therapy comes down to taking Tocopherol, Ascorbic acid, Retinol, Selenium, etc.
8. Aminoglycosides are used in severe cases of the disease - Kanamycin, Gentamicin, Kolimycin, Tobramycin, Amikacin.

Before choosing one or another antibacterial drug, the doctor should familiarize himself with the acidity of the patients’ urine, as it affects the effectiveness of the drugs.

Physiotherapeutic treatment

Physiotherapeutic techniques have the following effects:

• increase blood supply to the kidney, increase renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
• relieve spasm of the smooth muscles of the renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

Physiotherapeutic treatment is used in the complex therapy of chronic pyelonephritis.

Spa treatment

It makes sense, since the healing effect mineral water quickly lost during bottling. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

Damp cold, smoking and alcohol adversely affect the course of pyelonephritis. And regular examinations with monitoring of urine tests, and preventive courses of treatment contribute to long-term remission and prevent the development of renal failure.

Diet and nutrition rules

The chronic course of the disease requires serious attention to diet. Recommended:

• cereals, dairy products and vegetarian dishes;
• watermelons, melons and pumpkin dishes;
• increase fluid intake to 2.5 liters;
• include a small amount of meat or fish broth in the diet;
• Boil fish and meat of non-fatty varieties, or cook only by steaming;
• fresh and boiled vegetables and fruits;
• Horseradish, garlic and radish should be excluded from the diet;
• Limit salt intake per day to 8 grams.

A balanced diet promotes rapid recovery. When the disease worsens, the diet should include fresh fruits and vegetables, as well as at least 2 liters of liquid. Fried, spicy, fatty and salty foods are not allowed in the diet.

Prevention

Even in the absence of signs of active infection, it is necessary to periodically (once a year or every six months) examine the function of a previously affected kidney. In the presence of frequent exacerbations in women, long-term use of antibacterial agents in low doses (biseptol or furadonin) is recommended.

All pregnant women require a bacteriological examination of urine in the first trimester. If bacteriuria is detected, treatment is carried out with penicillins or nitrofurans.

To prevent exacerbations, it is also recommended to carry out 10-day antibacterial courses, and then for 20 days a course of herbal medicine (decoction of bear's ear grass, birch leaves, horsetail, juniper fruits, cornflower flowers) is carried out. It is necessary to carry out several such courses; it is recommended to change the antibacterial agent every month.

The diagnosis of “Chronic pyelonephritis” is made when 90 days have passed since the onset of the disease or there have been repeated exacerbations. The pathological process is characterized by a permanent form with manifestations, as well as the disappearance of signs. This article examines the features of the treatment of chronic pyelonephritis with the weakening of clinical symptoms - remission.

A distinction is made between complete and incomplete disappearance of signs of the disease. In the latter case, some of the symptoms of renal inflammation do not go away due to an unsuccessfully chosen treatment strategy or the presence of concomitant diseases. In such a situation we are talking about chronic secondary pyelonephritis.

Inflammation changes the kidney. Therefore, once remission occurs, treatment cannot be stopped.

Causes of secondary pyelonephritis

Secondary kidney inflammation is prone to recurrence and occurs under the influence of the following harmful factors:

• Inaccurate diagnosis.
• Incomplete destruction of pathogens. Premature discontinuation of antimicrobial agents by the patient. The emergence of races of bacteria resistant to antibiotics.
• The presence of chronic forms of concomitant diseases.

Treatment

The treatment strategy for the disappearance of clinical symptoms or partial weakening is different.

Remission stage

Chronic pyelonephritis in remission does not bother a person. Clinical symptoms disappeared. The indicators of blood components, as well as urine, do not exceed normal limits. However, the occurrence of an infectious disease, a cold, or a violation of nutritional parameters can resume the pathological process. Therefore, treatment is not stopped, but is limited to diet therapy and the use of herbal remedies.

Melons and watermelons are useful for pyelonephritis.

No special nutrition is required during this period, but the restriction of salty, smoked, spicy, fatty, and canned foods remains in effect. It is not recommended to abuse tobacco, drinks containing caffeine and ethanol. Drinking plenty of water is encouraged, as well as eating watery pumpkins - melons and watermelons.

Decoctions of medicinal plants, their preparations in the form of pastes, extracts or pills sanitize the urinary tract and prevent the proliferation of secondary microflora.

A method of passive renal gymnastics has been developed. It involves the infusion of a diuretic, for example, Furosemide, which causes cleansing polyuria, followed by a gentle regime, which helps accelerate the scarring of defects and restore the filtering function of the kidneys.

Stage of incomplete remission

Chronic pyelonephritis with incomplete remission is a consequence of delayed treatment of manifest inflammation, the presence of concomitant ailments or congenital pathologies. In this case, it is necessary to prevent exacerbation.

Diet therapy is represented by a ban on the consumption of foods that are limited during complete remission. Alternative diets are used to prevent the formation of kidney stones. Initially, products are used that acidify urine for 2...3 days, containing bakery, egg and meat foods. Then an alkalizing diet is used, in which milk, fruits, and vegetables occupy the leading position.

The use of herbal uroseptics is not enough. Courses of treatment are carried out with nitrofurans, antibiotics, sulfonamides, changing medications.

Nitrofuran antimicrobial drugs are in demand in the treatment of pyelonephritis

Conclusion

In chronic pyelonephritis, it is important to keep pathological processes in the phase of weakening clinical symptoms - remission, without allowing exacerbations. The main techniques are diet therapy and elimination of secondary microflora.