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Pyelonephritis

Pyelonephritis

Pyelonephritis is a nonspecific infectious and inflammatory process that develops initially in the pyelocaliceal system and further spreads to the tubulointerstitium and the renal cortex.

The main route of infection of kidney tissue in pyelonephritis is ascending infection. With the blood flow, microbes enter the kidney exclusively against the background of sepsis or episodes of bacteremia and lead to the appearance of symptoms of pyelonephritis.

In girls and women, the anatomical features of the urogenital tract lead to urinary tract infection (due to this, women are 8 times more likely to suffer from urinary tract infection), intense sexual activity, which contributes to the penetration of microorganisms from the urethra into the bladder and the further onset of symptoms of pyelonephritis.

In men, the symptoms of pyelonephritis most often develop in old age with urinary disorders associated with prostate adenoma.

Urinary disorders caused by urolithiasis, tumors, abnormalities of the kidneys and urinary system, pregnancy, etc., are the main cause of secondary pyelonephritis.

 

Clinical manifestations and symptoms of pyelonephritis

Acute pyelonephritis and especially obstructive pyelonephritis have a vivid clinical picture - a symptom of fever, back pain, urinary disorder (dysuria), symptoms of intoxication, and the treatment of such patients often remain the prerogative of urologists.

Chronic pyelonephritis without exacerbation proceeds with very scanty symptoms and only a targeted questioning of the patient reveals episodes of symptoms of unmotivated subfebrile condition, chills, complaints of pain in the lumbar region, nighttime urination disorders (nocturia), decreased performance, fatigue, which are usually not associated with a specific ailment.

 

Diagnostics of the symptoms of pyelonephritis

Often, the only sign of chronic pyelonephritis is isolated urinary syndrome (leukocyturia, bacteriuria, proteinuria no more than 1 g / day) or a combination of the urinary syndrome with anemia in the absence of symptoms of renal failure and hypertension.

To confirm the diagnosis of pyelonephritis, anamnestic data on repeated episodes of urinary tract infection or past bacteriuria and leukocyturia with their quantitative assessment are important, but their presence, as mentioned, does not allow to reliably establish the place and level of the inflammatory process.

A special role in the diagnosis of chronic pyelonephritis is played by intravenous urography, which reveals a decrease in the tone of the upper urinary tract, calyx deformation, and pyelectasis. Pyelonephritis is characterized by a decrease in the thickness of the renal parenchyma at the poles of the kidneys (Hodson's symptom), an increase of more than 0.4 of the renal-cortical index (the ratio of the area of the pyelocaliceal system to the area of the parenchyma).

Computed tomography of the kidneys (CT) gives an idea of the mass and density of the renal parenchyma, the condition of the pelvis, vascular pedicle, and perirenal tissue. With the help of ultrasound of the kidneys, the size of the organ is specified, X-ray negative stones (cystine), intraparenchymal cysts are detected.

 

Treatment of pyelonephritis symptoms

Pyelonephritis is an infectious disease, and the main task of treatment is to stop the symptoms of the inflammatory process as quickly as possible, creating a high concentration of uroseptic drugs in the kidney tissue and urinary tract.

Since there is a high risk of bacteremia at the onset of pyelonephritis, nitrofurans are rarely used to treat the symptoms of acute pyelonephritis, which are eliminated exclusively by the kidneys and whose content in urine reaches high values, but the level in the blood is not able to prevent bacteremia. For the same reason, aminopenicillins (ampicillin, amoxicillin), 1st generation cephalosporins (cephalexin, cefradine, cefazolin), nitroxoline cannot be recommended for the treatment of pyelonephritis symptoms.

In acute non-obstructive pyelonephritis of severe course in situations that preclude the rapid obtaining of urine culture results, empiric antibiotic therapy begins with intravenous administration of antibiotics that are highly active against E. coli. The drugs of choice are II and III generation cephalosporins, aminoglycosides, fluoroquinolones, aminopenicillins with b-lactamase inhibitors.

Treatment of pyelonephritis continues for 2-3 days, during which symptoms of intoxication usually disappear, urine, as a rule, becomes sterile. Then they switch to oral administration of cephalosporins, fluoroquinolones, sulfa drugs - co-trimoxazole, consisting of 400 mg sulfamethoxazole and 80 mg trimethoprim.

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