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Clinical forms of acute pyelonephritis. Pyelonephritis: causes, symptoms, diagnosis and treatment

Pyelonephritis is the most common kidney disease. It is characterized by an inflammatory process due to infection. The most common causes of pyelonephritis are Escherichia coli and Pseudomonas aeruginosa, Proteus bacteria, enterococci and staphylococci. But kidney infection can also occur due to other bacteria penetrating from the urethra. Moreover, every fifth disease develops against the background of a mixed infection.

Symptoms of pyelonephritis can be detected within a few hours after kidney infection. True, in some cases, the development of the disease and the manifestation of vivid symptoms can continue for several days.

A particular difficulty in correctly diagnosing pyelonephritis is the similarity of manifestations with many infectious and inflammatory processes.

Main symptoms of the disease:

  • elevated temperature, up to 39 degrees;
  • general malaise, fatigue, lack of appetite, nausea, pale skin;
  • frequent urination with severe cloudiness of the urine, often mixed with blood;
  • pain in the lower back and in the area where the kidneys are located.

In this case, the symptoms of pyelonephritis may not be clearly expressed, which poses a particular danger when prescribing a course of treatment. After all, untimely assistance very quickly leads to a chronic form of pathology.

In medical practice, symptoms of pyelonephritis are more often observed in women. The disease in this case is a complication of cystitis and develops during pregnancy or after the onset of sexual activity. The physiological characteristics of the urethra, which is somewhat shorter in women, also explain the high prevalence of pyelonephritis at an early age in girls.

Diagnosing the disease in men has its own characteristics. Older patients are prone to pyelonephritis. Symptoms usually appear against the background of prostatitis, urolithiasis or prostate adenoma.

The main causative agents of pyelonephritis

The essence of this pathology is the penetration of infection into the urinary tract and kidney tissue. In this case, the causative agent of pyelonephritis is bacteria that can provoke inflammatory processes in any organs. Their presence causes symptoms of the disease and leads to frequent urination as one of the main signs of kidney damage.

The main causative agents of pyelonephritis include:

  • any infectious infections of the urinary tract;
  • coli;
  • pathogenic bacteria Klebsiella and Proteus;
  • Staphylococcus aureus;
  • various types of fungi, especially Candida;
  • chlamydia, salmonella, mycoplasma.

To determine the causative bacteria of the disease, it is necessary to conduct a series of laboratory tests of the patient’s blood and urine. This will make it possible not only to correctly diagnose the disease, but also to determine the susceptibility of the infection to the antibiotic. Only in this case can you prescribe treatment that will quickly provide the necessary healing effect.

Depending on the type of bacteria and the method of infection, the course of therapy will be carried out. Very often, for a complete picture of pyelonephritis, it is necessary to conduct an ultrasound of the kidneys, which will help to study their condition in more detail.

Main threats

Symptoms that indicate the presence of the disease indicate kidney damage. Moreover, each exacerbation spreads to new areas of the organ. This ultimately leads to scar formation.
The long course of the disease causes a decrease in healthy kidney tissue, which leads to compression, atrophy of the kidneys and the inability to fully function in the body.

Symptoms of bilateral pyelonephritis threaten to cause. In this case, the only way to preserve the patient’s health and life is a donor organ transplant, or constant hemodialysis - a procedure for artificial filtration of the kidneys.

Methods of infection

The causative agent of infection can enter the kidneys in the following ways:

  • ascending urinogenic – with reverse flow of urine;
  • hematogenous (through infected blood);
  • through lymph from foci of inflammation in the intestines or other neighboring organs.

If the last two methods do not require explanation - blood and lymph carry an infection that is present in the body during inflammatory processes in various organs, then it is worth dwelling on the reverse flow of urine in more detail.

The infection very often enters the kidneys through infected urine. This pathological process indicates the presence of reflux disease. It is characterized by reflux of urine in the opposite direction.

According to the characteristics of the opposite outflow of urine, refluxes are:

  • vesicoureteral;
  • pelvic-renal.

Reflux usually develops due to:

  • anatomical defects in the structure of the urinary system (narrowing of the urethra, insufficiency of the valve mechanism, hypertrophy of the bladder neck, etc.);
  • cystitis;
  • functional disorders (neurogenic bladder).

Along with reflux, disturbances in its outflow can also have a negative impact on the passage of urine. This is also one of the most common factors in exacerbation of the disease.

Any violation of the correct flow of urine leads to stagnation. Urodynamics may suffer due to kinks and narrowing of the ureter, doubling of the pelvis, prolapse of the kidneys and other congenital or acquired defects. As a result, the patient experiences stagnation of urine, which first leads to reflux, then progresses to pyelonephritis.

Provoking factors

Among the causes of pyelonephritis, it should be noted:

  • re-diagnosis of the disease;
  • congestion in the urinary tract;
  • consequences of improper treatment of cystitis;
  • the presence of various inflammatory processes in the body;
  • diabetes mellitus;
  • pathologies that reduce immune protective functions - infectious diseases, HIV, hypovitaminosis, etc.;
  • kidney and bladder injuries;
  • presence of postoperative urinals or catheters;
  • congenital anomalies of the urinary system;
  • polycystic disease;
  • pregnancy;
  • hormonal imbalances;
  • receiving chemotherapy and radiation therapy.

Very often, the development of acute pyelonephritis is caused by hypothermia and excessive fatigue over a long period.

The disease can also be triggered by:

  • kidney stones;
  • helminthic infestation;
  • colitis, constipation;
  • inflammation of the genital organs;
  • failure to comply with personal hygiene rules.

The source of microbes that can cause disease are various chronic infections in the body:

  • sinusitis;
  • caries;
  • adenoids;
  • tonsillitis;
  • pneumonia, etc.

In the presence of such inflammatory foci, the immune system suffers, which can lead to exacerbation of pyelonephritis. Therefore, it is so important to monitor your health and eliminate any infectious processes in their initial stages.

To summarize the information, we can identify several main factors, the combination of which causes symptoms of pyelonephritis:

  • entry of microbial organisms into the kidneys;
  • decreased general immunity;
  • disruption of proper urine flow.

Features of therapy and prevention

Treatment of pyelonephritis will depend on the form of the disease - acute or chronic - and the severity of its course. But also when prescribing medications, the results of laboratory tests will be taken into account, which will indicate the correct effect of the drugs on certain types of bacteria.

Mild forms of pyelonephritis require treatment with antimicrobial drugs that act exclusively on the genitourinary system - uroseptics. It is very important to include antibiotics and antispasmodics in therapy. A mandatory component of the treatment course should be medications that strengthen the immune system, anti-inflammatory and diuretics.

Among antibiotics, treatment with cephalosporin (Cefrtiaxone) and fluoroquinolone (Ofloxin, Ozerlik) drugs is considered the most effective. Among uroseptics, Furadonin, Palin and Nitroxoline are usually used.

Treatment of pyelonephritis cannot be carried out independently. Diagnosis and prescription of drugs should be carried out exclusively by a qualified doctor who, based on the research and analysis of the disease picture, will select the correct course, controlling the dosage of drugs and the duration of treatment.

The most common preventive measures for pyelonephritis include timely emptying of the bladder, effective treatment of all infectious inflammatory processes in the body, ensuring genital hygiene, special attention to the immune system and the prevention of urological diseases.
Eliminating factors and causes that can provoke pyelonephritis will help keep the kidneys healthy for a long time, ensuring that they perform important functions in the body.

Among infectious diseases of the kidneys and excretory system, pyelonephritis occupies a special place. This is an extremely common disease associated with infectious agents that have penetrated the kidney tissue. Like many other similar pathologies, it can be caused by opportunistic microflora, which “normally” does not cause harm, as well as by specific pathogens. Treatment of pyelonephritis is always a rather long and complex process, since there is a risk of constant re-infection and the persistence of a focus of inflammation in the body.

What is pyelonephritis

The name of the disease comes from the Greek words for “pelvis”, “kidney” and a characteristic suffix denoting an inflammatory process. Kidney pyelonephritis occurs very often, and in almost 80% the acute stage then develops into a chronic form, causing a person to suffer from manifestations of the pathological process from time to time.

The disease is nonspecific, that is, there is no specific pathogen that would provoke pathogenesis. There are many bacteria that cause inflammation, among them the following types:

  • proteas;
  • enterococci - these microorganisms can even be part of opportunistic microflora; they do not cause harm while they are in the intestines, but do not penetrate other organs;
  • Escherichia coli is another type of bacteria that lives in the intestines;
  • Pseudomonas aeruginosa is a pathogenic microorganism whose reproduction is normally suppressed by the immune system;
  • staphylococci - these bacteria cause the most severe and difficult to treat forms of pyelonephritis.

Up to two thirds of all people with urological problems suffer from pyelonephritis, even if they do not complain to doctors about kidney disease. The source of infection can persist throughout life, remaining not completely cured and causing exacerbations, which are removed by emergency measures without completely eliminating the pathological agents. Chronic pyelonephritis in 70% of cases is asymptomatic or with mild symptoms that a person does not pay attention to.

However, the presence of a focus of infection in the kidneys and renal pelvis cannot be ignored. The disease, triggered and suppressed by the immune system of a healthy person, can cause severe complications, even life-threatening, at the slightest weakening of the body’s defenses.

The acute form rarely goes unnoticed, as it causes a characteristic clinical picture. This disease poses a serious danger to young children, the elderly and weakened people, since nephronecrosis or renal failure may develop against the background of acute pyelonephritis and insufficiently effective therapy. Pyelonephritis is extremely prone to chronicity due to a very favorable environment for bacteria and an abundance of nutrients, so it is necessary to carry out diagnosis not only at the initial stage of diagnosis, but also after visible recovery.

Causes of pyelonephritis

There is no single causative agent of the disease. A common cause may be the penetration of infectious agents into the renal pelvis. This process rarely occurs independently, developing, as a rule, against the background of primary infections. There are features of age, anatomical structure and other factors that contribute to the occurrence of kidney pyelonephritis. Among them are:

  1. Age - children under 7 years of age are especially susceptible to the disease due to an insufficient immune system response and anatomical features.
  2. Belonging to the female gender. According to statistics, boys and men get sick 3-5 times less often. It must be borne in mind that pyelonephritis in women is more severe, especially if they are little girls or older people in the postmenopausal period.
  3. Urogenital infections - as the most common direct cause, are also associated with a person’s gender. Since women more often suffer from cystitis and other diseases of the genitourinary system, complications develop more often.
  4. Among males, the disease occurs in middle and older age and occurs as a complication of prostatitis.
  5. Pyelonephritis in women can occur at a young age during the onset of sexual activity, if intimate and personal hygiene is not observed. Genial infections easily penetrate the bladder and ureters, from where they rise to the kidneys.
  6. Pregnant women are at particular risk. Their disease is fraught with fetal death, risk for the expectant mother and other serious complications, even life-threatening for the child or the woman herself.
  7. In general, pyelonephritis can be provoked by any factors that interfere with the normal outflow of urine from the kidneys. Stagnation provokes the proliferation of bacteria and inflammation of varying severity.

The immediate cause may be hypothermia, which causes a failure in the body's protective reactions. This process is especially dangerous for children, especially girls. The primary attack of acute pyelonephritis occurs in them, as a rule, after swimming in cold water or getting wet feet. In a child, the disease can immediately occur in an acute form, affecting one or both kidneys.

There are also chronic diseases that contribute to the development of infection in the kidneys and pelvis. Among them are:

  • chronic renal failure;
  • injuries of the peritoneal organs;
  • any immunodeficiencies.

It must be remembered that the disease can be provoked by any chronic infectious disease, even if the source of infection is in a completely different organ. For example, pyelonephritis develops in some cases as a complication of chronic sinusitis and tonsillitis. This is due to the fact that the method of transmission is hematogenous, through the blood, which means that any bacteria has a chance to get into the kidneys, where conditions are always extremely favorable for them.

Types of pyelonephritis

Doctors divide the disease into different forms and modes of progression, depending on how the infection develops and where it came from. The following types of pyelonephritis are diagnosed:

  1. Primary - this type means that the kidney, in general, is in normal condition and nothing interferes with its work in the form of urine outflow. This disease occurs in previously healthy people, including children.
  2. Secondary - it is provoked by pathologies present in the body, in particular in the kidneys. Appears against the background of congenital anomalies, nephroptosis - prolapse of excretory organs, urolithiasis. In this condition, the outflow of urine is always disrupted, which is why the patient’s condition is more severe than in the primary form of the disease.
  3. Acute - as a rule, combined with primary. The clinical picture is clearly expressed and the symptoms are characteristic. This condition develops quickly and occurs with varying severity depending on the person's age, immunity and other factors.
  4. Chronic - a permanent focus of infection localized in the renal pelvis. It may not manifest itself symptomatically, but remains a background condition, which is aggravated as a result of hypothermia, violation of the drinking regime and other sudden changes in a person’s lifestyle. It is dangerous because it changes the structure of the kidneys and leads to a general deterioration in human health.
  5. Unilateral - one kidney is affected, this type is more common.
  6. Bilateral - both organs were affected by infection. The clinical picture is more severe and the prognosis is worse than with a unilateral form of the disease.

In addition to nonspecific infectious types, which are common in 90% of patients with pyelonephritis, there are also rare types. They are caused by a nonspecific reaction of the body to a bacterial irritant. Among such pathologies is xanthogranulomatous pyelonephritis, a special condition when the kidneys significantly increase in size against the background of abundant proliferation of macrophages and cholesterol cells. The process is dangerous due to the appearance of adhesions and fibrosis; it is diagnosed using ultrasound, which shows the characteristic yellowish color of the affected tissue.

Apostematous nephritis is the most dangerous form of the disease, characterized by the appearance of carbuncles at the site of inflammation. Small abscesses also appear. Even with a favorable course, replacement tissue appears in place of the affected tissue, that is, the kidney cannot perform its functions 100%. The so-called wrinkling of the kidney often occurs due to atrophy of its parenchyma. This malignant type of pyelonephritis is typical for young children and the elderly, and can lead to the complete inability of the organ to perform its functions.

Symptoms of pyelonephritis


Symptoms of pyelonephritis appear very clearly in the acute form and rather vaguely in the chronic form. However, the latter does not occur without a preliminary phase, so it is important not to miss the following signs of the disease:

  1. Painful sensations in the lumbar region. They can be of varying intensity depending on the severity of the disease. If there is no obstruction of the urinary tract, then the pain is dull, aching, within the limits of tolerance. Obstructive types are sharply painful.
  2. High temperature - in children it rises to 40 degrees, in adults - up to 38-39.
  3. Chills, decreased appetite, general weakness and poor health.
  4. Urination can be painful, but not always: more often pain when trying to go to the toilet as a symptom of pyelonephritis occurs if the disease has become a complication of cystitis or prostatitis.
  5. Nausea, in severe cases - vomiting.
  6. Children complain of abdominal pain, which makes diagnosis difficult due to the similarity with gastrointestinal diseases.
  7. Difficulty urinating may indicate severe obstruction of the excretory tract. Urine is cloudy, sometimes whitish due to impurities of pus. Hematuria - urination with blood indicates extensive kidney damage.

In children and the elderly, acute pyelonephritis can lead to kidney failure and death. However, partial cure occurs much more often.

Chronic pyelonephritis is characterized by:

  1. Frequent urination, this symptom increases with hypothermia.
  2. Frequent, although mild, pain in the lower back.
  3. High blood pressure.

Relapses can occur up to several times a year, which can lead to the degeneration of kidney tissue into connective tissue with further loss of normal functions. That is why the chronic form of the disease cannot be ignored.

Treatment of pyelonephritis

Therapy depends on the severity of the pathology. From a medical point of view, uncomplicated acute pyelonephritis is considered the simplest - being a purely bacterial disease, it responds well to antibiotic therapy, especially if the microorganisms have not yet developed resistance to drugs. Treatment should be carried out inpatiently, it includes the following measures:

  1. Urinalysis to identify a specific pathogen.
  2. Antibiotics for pyelonephritis are prescribed by infusion - intramuscularly and intravenously. Among the most common drugs: Ceftriaxone, Ceftazidime. These drugs belong to modern third-generation cephalosporins and are designed specifically to combat urogenital infections.
  3. Sulfonamides - most often, Metrogyl is prescribed intravenously.
  4. Diuretics may be prescribed in combination with plenty of fluids to flush the kidneys.
  5. Antispasmodics for pain and to relieve obstruction. No-Shpa is most often used.

Treatment for chronic pyelonephritis is more difficult, since bacteria are likely to develop resistance to antibiotics. The strategy includes:

  1. Gentle regimen for the patient.
  2. Careful selection of antibiotic - it is important to do a preliminary culture to determine the sensitivity of the strain. Antibiotic therapy takes longer, so tablets may be prescribed.
  3. Nitrofurans - Furazolidone, Nitrofurantoin - also in a long course.
  4. Physiotherapy is generally recommended.
  5. Vitamin complexes with a high content of microelements of group B, as well as A and C are needed for a general improvement of immunity.

It is quite difficult to cure chronic kidney disease, so you need to find a competent nephrologist, and the patient, in turn, must carefully follow all instructions.

Diet for pyelonephritis

During treatment, it is recommended to put as little stress on the kidneys as possible. In this regard, the diet for pyelonephritis will require the following restrictions:

  1. Avoid salt as much as possible, it is advisable to remove it from the diet altogether.
  2. Spicy foods and spices are prohibited.
  3. You cannot drink caffeine-containing drinks - coffee, strong tea, energy drinks, alcohol is strictly prohibited.
  4. Natural diuretics are recommended - watermelons, pumpkins.
  5. Excessive consumption of protein is undesirable; it is recommended to reduce meat in the diet as much as possible.

The diet should continue throughout the treatment period plus another three to four weeks after recovery. The general principle is a minimum of salt and toxins, a maximum of fluid to prevent stagnation of urine.

Prevention of pyelonephritis

The best way to treat pyelonephritis is prevention, since it is easier to prevent any pathology than to then restore the body. You can avoid infection in the kidneys if you carefully monitor sexual and personal hygiene, especially for women, treat cystitis and prostatitis in a timely manner, and prevent areas of bacterial proliferation. Warm clothing that covers the lower back during the cold season also prevents the disease.

Pyelonephritis is a kidney disease of infectious etiology, accompanied by an inflammatory process. The causes of pyelonephritis are the penetration and reproduction in the kidney tissues of pathogenic bacteria located in the lower parts of the urinary system (bladder).

There are also hematogenous, lymphogenous routes of infection and the introduction of an infectious agent during injuries or medical procedures. In 90% of cases, the cause of pyelonephritis is the bacterium E. Coli or Escherichia coli. Pyelonephritis can affect people of different ages and genders, although it occurs 3-4 times more often in girls and women due to the structural features of the genitourinary organs, which cause easy penetration of bacteria into the kidneys through an ascending route of infection.

Risk factors for developing pyelonephritis

In addition to the structural features of the excretory system in women, there are non-sexual factors that increase the risk of pyelonephritis. These include:

  • congenital or acquired anomalies, pathologies of the structure of the kidneys, bladder, urethra;
  • states of immunodeficiency of various etiologies;
  • urolithiasis;
  • diabetes mellitus, increased sugar content in the urine creates favorable conditions for the proliferation of pathogenic organisms;
  • age factor: the older the person, the higher the risks;
  • injuries of the peritoneal organs, spinal cord;
  • surgical operations and medical manipulations in the organs of the urinary system;
  • chronic diseases of bacterial etiology, foci of infection in the body.

In men, pyelonephritis can be triggered by diseases of the prostate gland, accompanied by an increase in the size of the organ.

Causes of pyelonephritis

Pyelonephritis is an infectious kidney disease of bacterial pathogenesis. The cause of pyelonephritis is the proliferation of pathogenic organisms due to stagnation of urine or when they penetrate into the kidney tissue in quantities excessive for local immunity.

Ascending path of infection in the etiology of pyelonephritis

Penetration of infection through the urethra into the bladder, its spread through the canals to the upper structures and, as a result, to the kidneys, is the most common cause of pyelonephritis.
The structure of the female body causes an increased incidence of infection of the urinary system: pyelonephritis in women is diagnosed 5 times more often than in men. The short and wide urethra and the proximity of the urethra to the genitals and anus facilitate the penetration of pathogens into the bladder and kidneys.
In men, the main reason for the development of pyelonephritis is an obstruction in the urethra, in organ tissues, which impedes the excretion of urine and contributes to its stagnation (kidney stones, urinary tract, proliferation of prostate tissue of various etiologies). Infectious agents multiply in the accumulated fluid, spreading to the organs of its production and filtration.
Obstacles to the outflow of urine in the form of cysts, stones, tumor formations, strictures, acquired and congenital, can cause the development of pyelonephritis in female patients, but the most typical for them is an ascending route of infection after contamination of the urethral area with E. coli.

Vesiculourethral reflux as a cause of pyelonephritis

Vesiculourethral reflux is characterized by the backflow of part of the excreted 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 typical for children with pyelonephritis: vesiculourethral reflux is diagnosed in almost half of children from 0 to 6 years old suffering from pyelonephritis as the cause of the disease. With the reflux effect, urine is thrown back from the bladder into 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 have dangerous consequences for the kidneys in the form of scarring of organ tissue. Before puberty, attacks of acute pyelonephritis in children and the formation of scars are caused by the physiological characteristics of children:

  • lower fluid pressure, compared to adults, required for the effect of reverse reflux of urine;
  • inability to completely empty the bladder until an average of five years of age;
  • reduced resistance of the child’s immune system 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;
  • difficulties in early diagnosis of the disease;
  • more frequent, compared to adults, downward migration of pathogenic organisms: with scarlet fever, sore throat, caries, etc.

Scarring of tissue is a serious pathology that significantly reduces the functioning of the kidneys as an organ. In 12% of patients requiring hemodialysis due to irreversible changes in kidney tissue, the cause of tissue scarring is complications of pyelonephritis suffered in childhood.

Other routes of infection for pyelonephritis

Other variants of migration of bacteria and microorganisms into kidney tissue are much less common. There is a hematogenous route of infection along with the blood flow, lymphogenous, as well as direct introduction of the pathogen during instrumental manipulations, for example, catheterization of the bladder.

Infectious agents

The most common pathogenic microorganism in the pathogenesis of pyelonephritis is Escherichia coli, the bacterium E. Coli. Other causative agents of pyelonephritis include:

  • staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
  • Klebsiella pneumoniae;
  • proteus (Proteus mirabilis);
  • enterococci;
  • pseudomonas (Pseudomonas aeruginosa);
  • enterobacter species;
  • Pseudomonas aeruginosa;
  • pathogenic fungal microorganisms.

The ascending migration of infection is most characterized by the presence of E. coli in the urine, which is determined by laboratory analysis. When the pathogen is directly introduced during instrumental manipulations, the most common causes of pyelonephritis are Klebsiella, Proteus, and Pseudomonas aeruginosa.

Symptoms of pyelonephritis

Symptoms of pyelonephritis vary depending on the form of the disease, its stage and the age of the patient.

Pyelonephritis in adults: signs and symptoms

Physiological differences in the structure of the male and female body affect not only the incidence rate, 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. The acute form of pyelonephritis in women is often accompanied by such symptoms as:

  • a sharp increase in body temperature to febrile levels (over 38°C);
  • symptoms of body intoxication: nausea, chills, fever, headaches;
  • possible change in the characteristics of urine, especially with the simultaneous presence of cystitis: loss of transparency, presence of inclusions of blood, pus, etc.

An important test for primary diagnosis is a positive response to the Pasternatsky test: when tapping in the kidney area, pain intensifies, hematuria is noted, and blood appears in the urine.

The chronic form of pyelonephritis in women outside 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 with difficulty passing urine.

Pyelonephritis and cystitis in women are often combined in one time period, and 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 treatment for pyelonephritis.
Symptoms of cystitis in women include:

  • discomfort, pain, burning sensation accompanying urination;
  • frequent urge to go to the toilet, feeling of incomplete emptying of the bladder;
  • pain in the lower abdomen, etc.
Pyelonephritis in pregnant women

Up to 4% of pregnant women, or almost every 20th woman during pregnancy, encounters manifestations of pyelonephritis in acute or chronic form. Most often, the disease develops in the middle of the second to early third trimester of pregnancy due to the growing pressure of the expanding uterus on the kidneys and ureters.

Under pressure, the outflow of urine slows down, stagnation occurs in the kidneys: the body is not able to promptly remove fluid with a growing concentration of pathogenic bacteria. Especially often, pyelonephritis in pregnant women develops against the background of acute or indolent cystitis.
The kidneys are one of the most important organs during gestation; they experience increased load, filtering increased volumes of fluid. For any symptoms indicating diseases or dysfunctions of the urinary tract, you should immediately consult a doctor.
Complications of pyelonephritis in pregnant women include anemia, sepsis, renal failure, and the likelihood of premature birth due to intoxication of the body.

Pyelonephritis during pregnancy is dangerous not only due to the usual complications, but also the development of gestosis, eclampsia, which is life-threatening for the mother and child. Self-treatment of exacerbations of chronic pyelonephritis during pregnancy is also unacceptable due to possible side effects for the fetus: previously effective drugs may be prohibited for use during pregnancy.
With timely initiation of therapy, pyelonephritis is cured without affecting the child’s health.

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 often than in women. Most often, the disease occurs in an erased, chronic form, developing against the background of obstructed urine outflow due to the formation of stones in the kidneys, ureters, and prostate tumors.
With this form of the disease, the symptoms are similar to those of chronic pyelonephritis in women: symptoms of general minor intoxication (general malaise, weakness, decreased appetite, etc.), disturbances in the urination process, mild pain in the lumbar region, thirst, dry mouth, profuse urination, morning swelling.
When kidney stones move, the symptoms of pyelonephritis are complemented by manifestations of renal colic: severe pain, hematuria.
The acute form of pyelonephritis in men is most often provoked by the downward spread of infection from the source of the inflammatory process (with sore throat, caries, etc.). Pyelonephritis in the acute stage in men manifests itself in the same way as in women, regardless of the route of migration of the pathogen: body hyperthermia, lower back pain, positive Pasternatsky’s symptom, possible changes in the composition of urine.

Pyelonephritis in childhood

The main symptom that occurs with acute pyelonephritis in childhood is a sudden increase in temperature to febrile levels. If, against the background of general health, the child’s temperature rises and for several days there are no symptoms characteristic of acute respiratory viral diseases, infectious diseases, or signs of a “cold,” it is necessary to immediately submit blood and urine samples to exclude or confirm the diagnosis of pyelonephritis.
Due to a sharp rise in temperature and general intoxication of the body, the child’s condition is unsatisfactory; hyperthermia is accompanied by chills, nausea, possible vomiting, drowsiness, and lack of appetite. Children may complain of headaches, 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 of the chronic form may vary depending on the stage of the disease; the latent form may be asymptomatic, while negatively affecting the kidneys and contributing to the development of irreversible changes in their tissues.

Forms of pyelonephritis

Depending on the nature and course of the disease, the localization of the inflammatory process, several forms of the disease are distinguished.

Types of acute forms of pyelonephritis

The acute serous form is characterized by the formation of multiple foci of inflammation in the kidney tissues, an increase in the size of the organ, and swelling of the surrounding tissues. In the absence of therapy, serous inflammation progresses and turns into a purulent-destructive form of the disease.
The development of acute purulent inflammation of the kidneys has a high percentage of deaths, 1 out of 5 patients die. There are several stages in the development of this form of the disease:

  • the stage of formation of apostemes, small abscess formations, in the tissues of the kidney;
  • stage of carbuncle, the fusion of several apostemes into a single focus up to 2 cm in size. There may be several carbuncles;
  • stage of purulent abscess that occurs when apostema and carbuncles merge. It is characterized by extensive damage, melting, and destruction of tissue at the site of infiltration.

The abscess is accompanied by extreme body temperature (40-41°C), acute pain, and a pronounced picture of intoxication. Breakthrough of the infiltrate into the retroperitoneal space most often leads to sepsis and death.

Chronic inflammatory process

To diagnose the chronic form of pyelonephritis, a long period of illness is required - from 6 months, or the detection of the acute stage at least twice during a given period of time. The acute form is considered a separate manifestation if the patient achieves complete clinical recovery within a two-month period after the start of therapy.

The cause of the development of the chronic form is most often incomplete cure during an acute inflammatory process. Less common is a self-emerging chronic process, provoked by the presence of foci of infection in the body or difficulties in the outflow of urine due to various reasons.

Primary and secondary forms of pyelonephritis

With primary pyelonephritis, against the background of a decrease in local or general immunity, the development of an acute inflammatory process in the kidneys is observed due to the proliferation of pathogenic flora.
The secondary form is more often expressed as a chronic disease, occurring against the background of anatomical and/or functional disorders in the process of urine outflow.

Forms of pyelonephritis depending on the location of the inflammatory process

If one kidney is affected, unilateral 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 well-being and deviations of indicators from the norm:

  • collecting anamnesis from the patient’s words and information from medical documents: the presence of current or past 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, the appearance and smell of urine, frequency of urination, hyperthermia, signs of general malaise;
  • examination of the patient;
  • laboratory tests, instrumental diagnostics.

The list of laboratory tests includes the following studies:

  • general and biochemical analysis of blood and urine;
  • samples according to Zimnitsky and Nechiporenko;
  • culture of urine microflora to determine sensitivity to antibiotics of different groups.

Blood tests for pyelonephritis indicate the presence of bacterial inflammation: an increase in the concentration of leukocytes, the SOE indicator, characteristic changes in the biochemical composition.
A general urine test reveals changes in the specific gravity and number of leukocytes; inclusions of blood, pus, and protein may be present.
Biochemical analysis of urine shows an increased level of salt content.
Urine culture allows you to identify the causative agent of the disease and select the most effective drug for treatment.

For instrumental diagnostics, an ultrasound examination of the peritoneal organs is performed, concentrating on the kidneys and bladder. The method of excretory urography with the introduction of a contrast agent intravenously and computed tomography are also used.

Pyelonephritis: symptoms and treatment

In the case of pyelonephritis, symptoms and treatment vary depending on the pathogenesis, form, stage of the disease, the age of the patient and his individual characteristics. Although there are general recommendations for patients with pyelonephritis: warmth, rest, bed rest, drinking plenty of fluids (diuretic, anti-inflammatory herbal teas, lingonberry, cranberry juices, oatmeal broth, clean water, etc.) and taking antimicrobial drugs.

Treatment of pyelonephritis in adults

When suffering from pyelonephritis, women are strongly recommended to undergo examination by a gynecologist to identify a concomitant source of infection. In the presence of cystitis or inflammatory diseases of the genital area, treatment of pyelonephritis is complicated and can provoke the disease to become chronic.
Long-term therapy with antibiotics aimed at curing inflammatory processes in the kidneys, without attention to foci of infection, leads to 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 older male patients occurs in a chronic form and is associated with stagnation of urine, difficulty in 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 complete outflow of urine, inflammatory processes will continue to occur in the bladder and kidneys.

Choice of therapy in childhood

In childhood, the most common cause of the disease is congenital reflux, in which some of the urine is refluxed from the ureters and bladder into the kidneys. With this etiology of the disease, conservative therapy is carried out with antibiotics, uroseptics, NSAIDs, measures are taken to increase the general immunity of the body, and surgical techniques are used for surgical treatment.

Groups of antibiotics used to treat patients with pyelonephritis

Antibiotics are 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 resistant to the effects of antimicrobial drugs.
Most often, pyelonephritis occurs when E. coli multiplies, a pathogen that responds well to semisynthetic penicillin in combination with clavunic acid (Augmentin), 1-3 generation cephalosporins.
The most common antimicrobial agents are the fluoroquinalone group (Nolicin) and ciprofloxacins (Ciprofloxacin, Cifran).
To prevent relapses in the chronic form, patients with pyelonephritis use derivatives of nalidixic acid (Nevigramon) and hydroxyquinoline (5-NOK).

Pyelonephritis is a nonspecific inflammatory disease of the kidneys of bacterial etiology, characterized by damage to the renal pelvis (pyelitis), calyces and kidney parenchyma. Due to the structural characteristics of the female body, pyelonephritis is 6 times more common in women than in men.

The most common causative agents of the inflammatory process in the kidney are Escherichia coli (E.coli), Proteus (Proteus), Enterococcus (Enterococcus), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and staphylococcus (Staphylococcus).

Penetration of the pathogen into the kidney is most often associated with the reflux of urine into the kidneys (vesicoureteral reflux - VUR) due to obstructed urine outflow, bladder overflow, increased intravesical pressure due to hypertonicity, structural abnormalities, stones or enlarged prostate gland.

Why is pyelonephritis dangerous?

Each new exacerbation of pyelonephritis involves more and more new areas of kidney tissue in the inflammatory process. Over time, normal kidney tissue dies at this site and a scar forms. As a result of a long course of chronic pyelonephritis, a gradual decrease in the functional tissue (parenchyma) of the kidney occurs. Eventually, the kidney shrinks and stops functioning. With bilateral kidney damage, this leads to chronic renal failure. In this case, in order to maintain the vital functions of the body, kidney function must be replaced with an “artificial kidney” device, that is, hemodialysis is regularly performed - artificial blood purification by passing it through a filter.

Forms of pyelonephritis

Diagnosis of pyelonephritis

Pyelonephritis is manifested by dull pain in the lower back, aching in nature, of low or medium intensity, an increase in body temperature to 38-40°C, chills, general weakness, loss of appetite and nausea (all symptoms may occur at once, or only some of them). Typically, with reflux, there is an expansion of the collecting-pelvic system (PSS), which is observed on ultrasound.

Pyelonephritis is characterized by an increase in leukocytes, the presence of bacteria, protein, red blood cells, salts and epithelium in the urine, its opacity, turbidity and sediment. The presence of protein indicates an inflammatory process in the kidneys and a disruption of the blood filtration mechanism. The same can be said about the presence of salts: blood is salty, isn’t it? Consumption of salty foods increases the load on the kidneys, but does not cause the presence of salts in the urine. When the kidneys do not filter well enough, salts appear in the urine, but instead of looking for the cause of pyelonephritis, our favorite urologists with the letter X (don’t think that they are good) recommend reducing the amount of salt consumed in food - is this normal?

Urologists also like to say that with pyelonephritis you need to consume as much fluid as possible, 2-3 liters per day, uroseptics, cranberries, lingonberries, etc. That’s how it is, but not quite. If the cause of pyelonephritis is not eliminated, then with an increase in the amount of fluid consumed, reflux becomes even more intense, therefore, the kidneys become even more inflamed. First you need to ensure normal passage of urine, exclude the possibility of overflow (no more than 250-350 ml depending on the size of the bladder), and only then consume a lot of fluid, only in this case will fluid consumption be beneficial, but for some reason very often this is forgotten.

Treatment of pyelonephritis

Treatment of pyelonephritis should be comprehensive, and should include not just antibacterial therapy, but also, more importantly, measures aimed at eliminating the very cause of pyelonephritis.

With the help of antibiotics, inflammation is relieved in the shortest possible time, but if the cause itself is not eliminated, then after some time, after stopping the antibiotics, pyelonephritis will worsen again and after a certain number of such relapses, the bacteria will acquire resistance (resistance) to this antibacterial drug. Therefore, subsequent suppression of bacterial growth with this drug will be difficult or even impossible.

Antibacterial therapy

It is desirable that the antibiotic be selected based on the results of bacteriological urine culture with determination of the sensitivity of the pathogen to various drugs. In the case of acute pyelonephritis, immediately after taking a culture, a broad-spectrum antibiotic from the fluoroquinol group, for example, Tsiprolet, can be prescribed and adjusted based on the culture results. Antibacterial therapy should continue for at least 2-3 weeks.

Causes of pyelonephritis

The most likely causes of the development of pyelonephritis include reflux caused by difficulty urinating, bladder overflow, increased intravesical pressure, complications of cystitis, as well as anatomical abnormalities in the structure of the ureters, disruption of the sphincters.

Disturbances in urination can be caused by hypertonicity of the sphincter of the bladder and the bladder itself, obstructed outflow of urine due to spasms, which may be caused by structural changes in the ureteral sphincters and anomalies, impaired neuromuscular conduction and, to a lesser extent, weakness of the smooth muscles of the bladder. Despite this, most urologists begin treatment by stimulating the force of detrusor contractions, which further aggravates the situation, although in combination with antibacterial therapy, in most cases, this gives visible but short-term improvements. If the passage (outflow) of urine is difficult, in order to prevent reflexes, it is necessary to resort to periodic catheterization of the bladder, or installation of a Foley catheter with a change every 4-5 days.

In the case of hypertonicity of the bladder sphincter or itself, it is necessary to look for the cause of hypertonicity or spasms and eliminate it, thereby restoring the normal outflow of urine. If you are diagnosed with cystitis, you need to treat it, since pyelonephritis can be a complication of cystitis.

In case of inflammatory diseases of the prostate gland, you need to undergo treatment (read the article on prostatitis).

If there are structural abnormalities of the bladder, urethra, or ureters, you need to consult with doctors and take measures to eliminate the defects, possibly surgically.

There are many drugs and techniques for the treatment of neuromuscular conduction disorders; qualified doctors must select tactics.

Before “stupidly” stimulating the force of contractions of the bladder muscles, you need to exclude the presence of all the disorders described above, be vigilant and control the treatment prescribed to you yourself.

Exacerbations of pyelonephritis inevitably lead to thinning of the functional part of the kidney and death of nephrons, therefore, in order to preserve as much of the kidney as possible in working condition, it is extremely important to eliminate the cause of pyelonephritis in the shortest possible time. Ask to measure the thickness of the renal parenchyma during an ultrasound scan. The thickness of the parenchyma of healthy kidneys is on average 18 mm.

Diseases associated with pyelonephritis

Elena Malysheva talks about the disease pyelonephritis


Pyelonephritis is an infectious inflammatory disease of the kidneys that occurs when pathogenic bacteria spread from the lower parts of the urinary system. In most cases, the causative agent of pyelonephritis is Escherichia coli (E. Coli), which is sown in large quantities in patients' urine.

This is a very serious disease, accompanied by severe pain and significantly worsens the patient’s well-being. Pyelonephritis is easier to prevent than to cure.

Pyelonephritis is part of a group of diseases collectively called “urinary tract infection.” With improper antibacterial treatment of infectious diseases of the lower parts of the urinary system, bacteria begin to multiply and gradually move to higher parts, eventually reaching the kidneys and causing symptoms of pyelonephritis.

Facts and statistics

  • Every year in the United States, an average of 1 person out of every 7 thousand people falls ill with pyelonephritis. 192 thousand of them are undergoing inpatient treatment in specialized departments of hospitals and clinics.
  • Women suffer from pyelonephritis 4-5 times more often than men. Acute pyelonephritis occurs more often in women who are sexually active.
  • In 95% of patients, treatment of pyelonephritis gives a positive result within the first 48 hours.
  • In childhood, pyelonephritis develops in approximately 3% of girls and 1% of boys. 17% of them develop cicatricial changes in the renal parenchyma, and 10-20% develop hypertension.
  • Plain water can significantly improve the condition of a patient with pyelonephritis. Drinking plenty of fluids maintains normal fluid balance and also dilutes the blood and helps eliminate more bacteria and their toxins. This occurs due to frequent urination in response to increased fluid intake.
  • Although even slight movement can cause severe pain with pyelonephritis, it is important to urinate as often as possible. Although the patient feels discomfort during urination, this is the only way to get rid of the causative agent of the disease - bacteria are removed from the body only with urine. Uncontrolled growth of microorganisms will worsen the condition, causing sepsis (blood poisoning) and can even cause the death of the patient.
  • Cranberry juice is considered a good helper in the fight against pyelonephritis. The juice can be drunk pure or diluted with water (see). In this case, you should completely avoid drinking alcohol, sweet carbonated drinks and coffee.

Risk factors

Risk factors for developing pyelonephritis include:

  • Congenital anomalies of the kidneys, bladder and urethra;
  • AIDS;
  • Diabetes mellitus;
  • Age (risk increases as you get older);
  • Diseases of the prostate gland, accompanied by an increase in its size;
  • Kidney stone disease;
  • Spinal cord injury;
  • Bladder catheterization;
  • Surgical interventions on the urinary system;
  • Uterine prolapse.

Causes of pyelonephritis

Ascending route of infection

Pyelonephritis is caused by bacteria. They enter the urinary system through the urethra and then spread to the bladder. The pathogen then moves to higher structures, ultimately penetrating the kidneys. More than 90% of cases of pyelonephritis are caused by Escherichia coli, a bacterium that multiplies in the intestines and enters the urethra from the anus during bowel movements. This explains the increased incidence among women (due to the anatomical proximity of the anus, external genitalia and urethra).

Ascending infection is the most common cause of acute pyelonephritis. This explains the high incidence among women. Due to the anatomically short urethra and the structural features of the external genitalia, the intestinal flora in women infests the groin area and vagina, then quickly spreading upward to the bladder and higher.

In addition to E. coli, among the causative agents of pyelonephritis there are:

  • Staphylococcus (Staphylococcus saprophyticus, Staphylococcus aureus);
  • Klebsiella pneumoniae;
  • Proteus (Proteus mirabilis);
  • Enterococcus;
  • Pseudomonas aeruginosa;
  • Enterobacter species;
  • Pathogenic fungi.

Less common routes of migration of infectious agents into the kidneys include hematogenous and lymphogenous. Microbes can also be introduced during instrumental manipulations, for example, with catheters. With the latter option, the most likely causative agents of pyelonephritis are Klebsiella, Proteus and Pseudomonas aeruginosa.

Vesiculourethral reflux

Vesiculourethral reflux is characterized by a violation of the outflow of urine through the ureters to the bladder and partial reflux of it back into the renal pelvis. If the disease is not diagnosed in the early stages, stagnation of urine leads to the growth of pathogenic microorganisms that are thrown into the kidney and cause its inflammation.

Frequent repeated attacks of acute pyelonephritis in children cause severe damage to the kidneys, which can result in scarring. This is a rare complication, occurring mainly in children under 5 years of age. However, cases of the development of cicatricial changes after pyelonephritis in children at puberty have been described.

The increased tendency to cicatricial changes in the kidneys in children is explained by the following factors:

  • Reflux in children occurs at much lower pressure than in adults;
  • Reduced resistance of the body's immune system to bacterial infections during the first year of life;
  • The difficulty of early diagnosis of pyelonephritis in infancy.

In 20 - 50% of children under 6 years of age with pyelonephritis, vesiculourethral reflux is diagnosed. Among adults, this figure is 4%.

In 12% of patients on hemodialysis, irreversible kidney damage developed due to pyelonephritis in early childhood.

Other causes of pyelonephritis are rare. In some cases, inflammation does not develop upward from the bladder, but directly when the pathogen enters the kidneys from other organs through the blood vessels.

The likelihood of infection increases if the ureter is blocked by a stone or an enlarged prostate obstructs urine output. The inability to remove urine leads to stagnation and the proliferation of bacteria in it.

Symptoms of pyelonephritis

The most common symptoms of acute pyelonephritis include:

  • Fever, chills
  • Nausea, vomiting
  • General weakness, fatigue
  • Dull aching pain in the side on the affected side or in the lower back of a girdling nature
  • Minor swelling

Additional nonspecific symptoms of pyelonephritis, characterizing the course of the inflammatory disease:

  • Fever;
  • Increased heart rate.

In the chronic course of pyelonephritis, manifestations of the disease may occur in a milder form, but persist for a long time. In this case, the blood test is calm, there are leukocytes in the urine, but there may be no bacteriuria. During remission, there are no symptoms, blood and urine tests are normal.

Every third patient with pyelonephritis has concomitant symptoms of infection of the lower urinary system (,):

  • Stitching or burning;
  • The appearance of blood in the urine;
  • Strong, frequent urge to urinate, even with an empty bladder;
  • Change in urine color (dark, cloudy). Sometimes - with a characteristic unpleasant “fishy” smell.
Tests for pyelonephritis
  • A blood test shows signs of inflammation (increased leukocytes, accelerated ESR).
  • Urine tests reveal a significant number of bacteria (more than 10 to 5 CFU), more than 4000 leukocytes in the Nechiporenko test, hematuria of varying degrees, protein up to 1 g per liter, and the specific gravity of urine decreases.
  • A biochemical blood test may show an increase in creatinine, urea, and potassium. The growth of the latter indicates the formation of renal failure.
  • When visualizing the kidneys on ultrasound, the affected organ is enlarged in volume, its parenchyma thickens and becomes denser, and an expansion of the renal pelvis system is observed.

Complications

The risk of complications increases in pregnant women, as well as in patients with diabetes. Complications of acute pyelonephritis can include:

  • Kidney abscess (formation of a cavity filled with pus);
  • Kidney failure;
  • Sepsis (blood poisoning) when pathogenic bacteria enter the bloodstream.

Pyelonephritis and sepsis

Unfortunately, pyelonephritis is not always easy to treat, often due to errors during diagnosis. In some cases, the disease becomes severe even before seeing a doctor. The risk groups in this case are people with spinal injuries (paralyzed, who do not feel pain in the lower back), as well as mutes who cannot independently complain if their condition worsens.

Untimely treatment or its absence leads to the progression of the disease, the growth of bacteria and their penetration into the bloodstream with the development of sepsis. This condition is also called blood poisoning. This is a serious complication, often resulting in the death of the patient.

Patients with pyelonephritis should not die, since this is not a serious disease that can be quickly and effectively treated with antibacterial drugs. But if the disease is complicated by sepsis or, in the terminal stage, septic shock, then the risk of death increases sharply. According to world statistics, every third patient with sepsis dies in the world. Among those who managed to cope with this condition, many remain disabled, since during treatment the affected organ is removed.

Famous people with pyelonephritis complicated by sepsis:
  • Marianna Bridie Costa - Brazilian model

Born June 18, 1988. She died on January 24, 2009 from sepsis that developed against the background of pyelonephritis. Treatment included amputations of both arms in an attempt to stop the progression of the disease. Death occurred 4 days after the operation.

  • Etta James - singer, four-time Grammy winner
  • Jean-Paul II - Pope

Born May 18, 1920. He died on April 2, 2005 from sepsis, the cause of which was pyelonephritis.

Emphysematous pyelonephritis

Emphysematous pyelonephritis is a severe complication of acute pyelonephritis with a high mortality rate (43%). Risk factors for the development of this complication include diabetes mellitus or blockage of the upper urinary system. The main symptom is the accumulation of gas in the kidney tissues, which leads to their necrosis and the development of renal failure.

Pyelonephritis in pregnant women

The incidence of bacteriuria during pregnancy is 4-7%. Pyelonephritis develops in approximately 30% of pregnant women from this group (1-4% of the total number of pregnant women). Most often, symptoms of pyelonephritis appear in the second trimester. Among the complications of pyelonephritis in pregnant women are:

  • Anemia (23% of cases);
  • Sepsis (17%);
  • Renal failure (2%);
  • Premature birth (rare).

An increased incidence of asymptomatic bacteriuria in pregnant women is observed among representatives of a low socioeconomic class, as well as in multiparous women.

Treatment of pyelonephritis

In cases where acute pyelonephritis occurs or chronic pyelonephritis worsens with high fever, decreased blood pressure (blood pressure), severe pain, a suppurative process or a violation of the outflow of urine may develop - treatment may require surgical intervention. Also, in cases where taking tablet forms of antibiotics is accompanied by vomiting, nausea, or increasing intoxication, hospitalization of the patient is indicated. In other cases, the doctor may prescribe treatment at home.

For a disease such as pyelonephritis, symptoms and treatment, both symptomatic and antibacterial, are closely related. Symptomatic treatment includes:

  • Bed rest for the first few days (duvet rest), that is, horizontal position and warmth.
  • Non-steroidal anti-inflammatory drugs to achieve an analgesic effect and reduce body temperature (metamizole,);
  • Drink plenty of fluids.

In case of chronic pyelonephritis, both during remission and during exacerbation, wet cold should be avoided - this is the worst enemy of weak kidneys. It is also advisable to lie down in the middle of the day for at least 30 minutes and avoid infrequent emptying of the bladder.

Antibacterial treatment of pyelonephritis in adults

Typically, the antibiotic is first prescribed empirically for 5-7 days, and then it can be changed based on the results of bacterial culture.

Treatment of pyelonephritis with antibiotics is carried out with drugs from the fluoroquinolone group, ampicillin in combination with beta-lactamase inhibitors, as well as cephalosporins (drugs of choice in children). The convenience of cephalosporins of 3–4 generations (ceftriaxone, cefotaxime) is that therapeutic doses are administered no more than 2 times a day. Due to high resistance (40%), ampicillin is used less and less. The duration of the course is 7–14 days, depending on the severity of the disease and the effect of the treatment.

Due to the retention of high concentration after absorption from the intestine, ciprofoloxacin can be used in tablet form. Intravenous antibiotic administration is indicated only for nausea and vomiting.

If the patient's condition does not improve 48-72 hours after the start of treatment, it is necessary to perform a computed tomography scan of the abdominal cavity to exclude an abscess and. You will also need to conduct a repeated bacteriological analysis of urine to determine the sensitivity of the pathogen to antibiotics.

In some cases, after a course of antibiotic therapy, repeated treatment with an antibiotic of a different group may be necessary. Treatment of chronic pyelonephritis involves prescribing long courses of antibacterial drugs. The main problem in treating diseases caused by bacteria is the development of antibiotic resistance.

In the case where the symptoms characterizing pyelonephritis were quickly identified and treatment was started in a timely manner, for most patients the prognosis remains positive. The patient is considered healthy if the pathogen is not detected in the urine within a year after discharge.

A weekly course of ciprofloxacin is an effective treatment for pyelonephritis

Studies have shown that a seven-day course of the antibacterial drug ciprofloxacin is as effective as a 14-day course of drugs from the fluoroquinolone group. One study involved two subgroups of 73 and 83 women with acute pyelonephritis treated with ciprofloxacion (7 days) and fluoroquinolone (14 days). The results showed that in both groups the effectiveness of treatment was 96-97%. Moreover, in the group treated with fluoroquinolone, 5 patients developed symptoms of candidiasis, while in the other group no such symptoms were detected.

Antibacterial therapy of pyelonephritis in children

Treatment begins with intravenous administration of antibacterial drugs. After achieving a positive effect and reducing the temperature, it is possible to switch to tablet forms of cephalosporin drugs:

  • Ceftriaxone;
  • Cefepin;
  • Cefixime.

Treatment of mild forms can initially be carried out with tablet preparations.

Treatment of pyelonephritis of fungal etiology

Antifungal treatment is carried out with Fluconazole or Amphotericin (see). In this case, it is mandatory to control the removal of fungal compounds using radiopaque urography, computed tomography or retrograde pyelography. Pyelonephritis, caused by pathogenic fungi and accompanied by blockage of the urinary tract, is treated surgically with the application of a nephrostomy. This method ensures the normalization of urine outflow and allows the administration of antifungal drugs directly to the site of infection.

Nephrectomy

The issue of nephrectomy (kidney removal) is considered if developed sepsis does not respond to conservative treatment. This operation is especially indicated for patients with increasing renal failure.

Herbal medicine for pyelonephritis

If present, naturally, medicinal herbs will cause an allergic reaction, so herbal preparations can be used if there is no tendency to allergies. Many plants, in addition to the antiseptic effect, have a number of positive effects, have diuretic and anti-inflammatory properties:

  • reduce swelling - bearberry, horsetail, see.
  • urinary tract spasms - orthosiphon, oats
  • reduce bleeding -
  • Ciprofloxacin 0.5-0.75 twice daily and Norfloxacin 400 mg twice daily remain relevant only for previously untreated patients.
  • 2nd line antibiotics (alternative) – Amoxicillin with clavulanic acid (625 mg) 3 times a day. If sensitivity is culture-proven, Ceftibuten 400 mg once daily can be used.
  • In case of severe pyelonephritis requiring hospitalization, therapy in a hospital is carried out with carbopenems (Ertapenem, Miranem) intramuscularly or intravenously. After the patient has a normal temperature for three days, therapy can be continued with oral medications. Levofloxacin and Amikacin are becoming alternatives to carbopenems.
  • Pyelonephritis in pregnant women is no longer treated with amoxicillin, but, regardless of gestational age, the following drugs are prescribed:
    • Cefibutene 400 mg once daily or
    • Cefixime 400 mg once daily or
    • Cefatoxime 3-8 g per day in 3-4 injections intramuscularly or intravenously or
    • Ceftriaxone 1-2 g per day once intramuscularly or intravenously.