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Pyelonephritis

 

Pyelonephritis

Pyelonephritis is a non-specific infectious inflammation which develops initially in pyelocaliceal system and spreads over the tubulointerstitium and renal cortex.

The main way of infection kidney tissue during pyelonephritis - a rising infection. With blood microbes penetrate into the kidney exclusively with sepsis or bacteremia episodes.

In girls and women to the infection of the urinary tract cause anatomical features of urogenital (thanks to this woman is 8 times more likely to suffer urinary tract infection), intense sexual life, the penetration of microorganisms from the urethra into the bladder and further occurrence of pyelonephritis.

Men pyelonephritis most often develops in older age in impairment of urination associated with BPH.

Urination disorders caused by urolithiasis, tumors, abnormalities of kidney and urinary system, pregnancy, etc., are a major cause of secondary pyelonephritis.

 

Clinical manifestations of pyelonephritis

Acute pyelonephritis, especially obstructive pyelonephritis have a bright clinical picture - fever, pain, dysuria (dysuria), symptoms of intoxication, and treatment of such patients often remains the prerogative of urologists.

Chronic pyelonephritis without exacerbation occurs with very little symptoms, and only a focused question the patient reveals episodes of unmotivated subfebrile, chilling, complaints of pain in the lumbar region, disorders of nocturnal urination (nocturia), decreased performance, fatigue, not normally associated with a particular ailment.

 

Diagnosis of pyelonephritis

Often the only sign of chronic pyelonephritis is an isolated urinary syndrome (leucocyturia, bacteriuria, proteinuria less than 1 g / day) or a combination of bladder syndrome with anemia in the absence of renal failure and hypertension.

To confirm the diagnosis of pyelonephritis important medical history of repeated episodes of urinary tract infection or bacteriuria and transferred leukocyturia to quantify, but their presence, as mentioned, will not reliably establish the location and the level of the inflammatory process.

Special role in the diagnosis of chronic pyelonephritis is an intravenous urography, revealed decreased tone of the upper urinary tract, the deformation of the cups, pyeloectasia. When pyelonephritis characterized by thinning of renal parenchyma in the renal poles (symptom Hodson), increased more than 0,4-renal cortical index (the ratio of the area pyelocaliceal system to the area of the parenchyma).

Computed tomography of kidneys gives an idea of the mass and density of the renal parenchyma, pelvis condition, pedicle, perirenal fat. With the help of ultrasound kidney specify the size of the body reveal rentgennegativnye stones (cystine), vnutriparenhimatoznye cyst.

 

Treatment of pyelonephritis

Pyelonephritis - an infection, and the challenge of treatment - as quickly as possible to arrest the inflammatory process, creating a high concentration of drugs uroseptics in renal tissue and urinary tract.

Since the debut of pyelonephritis is a high risk of bacteremia, for the treatment of acute pyelonephritis is rarely used nitrofurans, which are eliminated exclusively by the kidneys and content in the urine reaches high values, but the level in the blood can not prevent bacteremia. For the same reason, can not be recommended for the treatment of pyelonephritis aminopenicillins (ampicillin, amoxicillin), cephalosporins I generation (cephalexin, tsefradin, cefazolin), nitroksolin.

In acute nonobstructive pyelonephritis severe in situations precluding fastest results urine culture, empiric antibiotic therapy initiated with intravenous antibiotics, high level for E. coli. Cephalosporins are the drugs of choice II and III generation, aminoglycosides, fluoroquinolones, aminopenicillins with b-lactamase inhibitors.

Treatment of pyelonephritis lasts 2-3 days, during which the symptoms usually disappear after intoxication, the urine usually becomes sterile. Then move on to oral cephalosporins, fluoroquinolones, sulfonamides - co-trimoxazole, consisting of 400 mg of sulfamethoxazole and trimethoprim 80 mg.

The duration of therapy of pyelonephritis should not be less than 2 weeks. If symptoms persist, pyelonephritis, treatment can be continued up to 6 weeks.

 

If you have any questions about the diagnosis or treatment of acute or chronic pyelonephritis, you can specify them with our urologist or a nephrologist on the phone: (499) 130-08-09

 

 
 

 

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