Advanced, also known as chronic pyelonephritis: causes, symptoms, diagnosis and treatment. Pyelonephritis and urolithiasis, prevention and treatment How to distinguish pyelonephritis from urolithiasis

Why is it necessary to treat pyelonephritis first in case of kidney stones?

Often urolithiasis disease accompanied by chronic pyelonephritis with frequent exacerbations and transitions to subacute and acute pyelonephritis.

The question arises, what comes first: pyelonephritis or kidney stones? In this article we will tell you how pyelonephritis and urolithiasis are related, as well as how acute and chronic pyelonephritis for kidney stones.

The relationship between chronic pyelonephritis and urolithiasis kidney

Chronic pyelonephritis, accompanied by constant infectious inflammation in the kidney tissues, leads to the gradual death of nephrons and the appearance in the urine of clots from dead cells of the kidney tissue and desquamated epithelial cells. All this creates the so-called protein matrix of the stone - a frame on which bacteria attach and mineral salts precipitate, forming stones.

In addition, with chronic pyelonephritis, congestion in the kidneys increases, since the outflow of urine through the ureters is disrupted due to inflammation. The resulting stones in turn injure urinary tract and the process becomes endless. Any pyelonephritis that develops against the background of kidney stones is considered complicated.

Kidney and ureteral stones continually irritate the renal parenchyma and mucous membrane of the ureters, bladder and urethra, causing inflammation and pain. On the injured surface of the urinary tract, pathogenic bacteria settle by adhesion (sticking), entering the kidneys either ascendingly (through the urethra and bladder with inadequate personal hygiene), or hematogenously (with blood flow from focal infections in other organs, for example, in the presence of caries, stomatitis, sore throat, etc.).

Since kidney stones and chronic pyelonephritis are closely interrelated, these diseases must be treated comprehensively.

Causes of kidney stones

Currently, a number of studies have been conducted confirming the bacterial nature of urolithiasis. As is known, some kidney stones, for example phosphates, formed when the urine reacts alkaline pH>7, are of bacterial origin. There is even a term "infected kidney stones." However, until now it was believed that stone formation in general is associated with metabolic disorders and other factors. More recently, scientists were able to discover in the body of people suffering from urolithiasis, special ultra-small bacteria that cause stone formation in the kidneys.

Antibiotic treatment of pyelonephritis and cystitis in urolithiasis of the kidneys

At the first signs of cystitis or pyelonephritis, you should immediately consult a doctor, who will order a urine test and select the necessary antibiotics to treat the infection. Typically, for chronic pyelonephritis, long-term (from 2 weeks to 1-2 months) courses of antibiotics and antibacterial drugs are prescribed.

Antibiotics for pyelonephritis

Most often, the following antibiotics are used in the treatment of pyelonephritis:

• Agumetin, Ampiox, Amoxicillin, Amoxiclav (amoxicillin with clavulanic acid), and other betalactam antibiotics;
• Cifran, Ciprofloxacin;
• Biseptol, Co-trimoxazole;
• Palin, 5-nok (although these drugs often do not create the concentration in the kidneys necessary for complete cure).

Antibacterial and anti-inflammatory drugs for pyelonephritis

In case of complicated pyelonephritis and the presence of kidney stones, along with taking antibiotics, antibacterial drugs plant origin:

• Canephron-N (tablets or drops);
• Phytolysin paste;
• Urolesan (drops and capsules).

Herbal medicine for pyelonephritis in urolithiasis

To treat inflammation in the kidneys and ureters, herbs with antibacterial, astringent and anti-inflammatory properties are used.

Kidney infusions and teas include the following components:

• Antibacterial: St. John's wort, round-leaved wintergreen, chamomile, ortilia unilateral (hog queen), wintergreen umbrella, cinnamon rose hips, etc.
• Astringent and anti-inflammatory: stinging nettle, shepherd's purse, licorice root, meadowsweet herb, etc.
• Diuretic: lingonberry leaves, bearberry (bear's ears), silver birch leaf, orthosiphon (kidney tea), etc.

For pyelonephritis accompanying urolithiasis, herbs that dissolve and crush kidney stones should be added to herbal mixtures:

• knotweed (knotweed),
• horsetail,
• Erva woolly grass (half-fallen),
• madder root.

Hygiene for frequent cystitis and pyelonephritis

Treatment of chronic pyelonephritis in urolithiasis should always begin with the sanitation of foci of infection in the body and careful adherence to personal hygiene. It is necessary to thoroughly brush your teeth in the morning and evening, to prevent the occurrence of pustular diseases, and to treat caries in a timely manner.

In addition, people suffering from frequent cystitis or chronic pyelonephritis, or having kidney stones, should never wash themselves with soap and antibacterial agents containing triclosan. When washing, you should use special hygiene products containing lactic acid to restore and preserve the natural protective microflora of the mucous membranes genitourinary system, which protects the urinary tract from the penetration of pathogenic bacteria from outside.

Urolithiasis pyelonephritis- that's pretty serious illness, which appears against the background of inflammatory processes in the kidneys and the entire urinary system as a whole.

Forms of pyelonephritis

According to the nature of the course of this disease, modern medicine distinguishes 3 forms of its development:

Acute pyelonephritis appears unexpectedly for the patient and, as a rule, has the ability to progress rapidly. In this case, with timely diagnosis and proper therapy, the disease is completely cured without leaving negative consequences in the human body.

Chronic pyelonephritis is more sluggish with periodic exacerbations after a prolonged remission. This disease destroys kidney tissue and can lead to kidney failure in the patient.

Complicated chronic pyelonephritis appears with the advanced development of the usual chronic form of this disease. In medical circles it is also called purulent pyelonephritis. This disease affects the fatty layer on the surface of the kidneys and can be largely asymptomatic, but with periodic relapses.

Causes and signs of pyelonephritis

The most common manifestation or exacerbation of pyelonephritis occurs in the autumn or spring seasons. Just when the human body is susceptible to unexpected hypothermia. The body of those people who are Everyday life often find themselves in various stressful situations or suffer from off-season vitamin deficiency. In addition, overwork and lack of sleep become fertile ground for the development of pyelonephritis. From all of the above, we can conclude that any disease that reduces work can provoke the appearance of pyelonephritis. immune system human body:

Hypothermia of the body.

High blood sugar (diabetes) and high blood pressure.

Pregnancy can also lead to decreased immunity. Especially during the period that falls on the 22-25th week of the baby’s intrauterine development.

Untreated diseases of the genitourinary system.

Prolonged abstinence from emptying the bladder can provoke the inflammatory process.

Pyelonephritis can reappear in the human body.

Risk group

At a younger age, pyelonephritis most often affects representatives fair half humanity. The reason for this pattern is in the anatomy of the female body, and specifically in the close location of the urinary canal near the rectum. Infection of the genitourinary system can easily occur during the process of defecation. Also, infection of the female body can occur during the first sexual intercourse, especially in cases where the woman suffers from cystitis or progresses in her body. urolithiasis disease. Pyelonephritis also worries men, but more often after the age of 60 and as a complication in the presence of various problems in the field of urology.

In general, pyelonephritis occurs at any age throughout the entire human life. So, children are not immune from this disease. An inflammatory process in the renal system can occur even in infants. The consequences of pyelonephritis can be very dangerous for the life and health of the patient. For example, blood poisoning or swelling of the kidney may occur. It is for this reason that you remember: no matter what age and under what circumstances you are diagnosed with pyelonephritis, it can and should be treated. This disease can be treated even during pregnancy, but by using some more gentle therapy.

We invite you to come for a consultation at our medical Center in Moscow, and entrust your health to our team of professionals. We have everything to guide you high-quality diagnostics and prescribe the correct therapeutic treatment. All the necessary, most modern medical equipment and the vast experience of each of our doctors completely eliminate the possibility of medical error, and significantly bring the moment of complete recovery of patients closer.

Seven herbs for seven weeks

Not so often seen among representatives official medicine doctors who not only do not reject tried and tested folk remedies treatment of certain diseases, but also use them in their practice. This fully applies to the chief physician of the Moscow City clinical hospital No. 54, candidate of medical sciences Viktor Ivanovich Nakhaev. The conversation with him about kidneys and pyelonephritis began with a monologue from the doctor.

It's the end of July, the peak of summer. It's time to collect herbs, which give us an excellent opportunity to improve our health and prolong our lives. Without herbal medicine, it is impossible to talk about serious therapy for kidney diseases such as urolithiasis and accompanying pyelonephritis.

Are you saying that these two diseases are closely related?

They're just twin sisters! If there are kidney stones, there is also pyelonephritis and vice versa. According to autopsies (autopsies), pyelonephritis occurs in 93 - 97% of cases. For some, the disease proceeds covertly, worsening with colds; for others, it becomes an intensive course of the disease, which entails a chronic process.
And this, in turn, leads to the death of nephrons; ultimately, pyelonephritis can cause renal failure, anuria, when the flow of urine into the bladder stops. In such cases, the patient must be periodically connected to an “artificial kidney” machine, that is, undergo hemodialysis.
It is known that the kidneys are one of the most actively supplied organs. In one minute, about 1000 - 1200 ml of blood flows through them, which is approximately one-fourth of the minute volume of blood ejected by the heart. The blood is purified in the kidneys and returned to the general circulatory system. It is clear why such close attention is paid to this organ in our body.

A few words about the nature and manifestations of urolithiasis and pyelonephritis

Urolithiasis, or kidney stones, is one of the most common diseases of the kidneys and ureters. It occurs in all countries of the world and affects people of all ages, but most often - 20 - 40 years old. Moreover, the stronger sex is more susceptible to this disease. One of the reasons for the appearance of stones is the presence inflammatory process and disturbance of urine urodynamics.
Most often, stones form in one kidney, the right one. Approximately 10 - 15% of patients have stones in both kidneys. Stones, or concretions, can choose a home in the renal pelvis, calyces, or in the ureter, where they enter from the kidneys. The weight of these pebbles ranges from a few milligrams to 2 kg! And the size is from a grain of sand to a solid man’s fist.

Lord, how do these “jewels” fit into the kidneys? After all, each of them has the shape of a bean measuring 10 - 12 cm in length, 5 - 6 cm in width and 4 cm in thickness.

That's how they fit! And, of course, they cause a lot of suffering to humans. Stones consist of salts excreted in the urine, bacteria, fibrin and other protein substances. These are urates, phosphates, carbonates (not to be confused with the famous delicacy), oxalates, cystine stones and a number of others. The range of their action is quite wide; we can say that the stone, by disrupting the outflow of urine and increasing intrapelvic pressure, leads to disruption of the blood supply and innervation of the kidney. Kidney atrophy may occur; it will be unable to cleanse the body of toxins, become a source of infection, and lead to increased blood pressure.

You said that pyelonephritis is an indispensable companion to urolithiasis

This is true. Pyelonephritis- a disease associated with the presence of bacteria in the urinary tract, primarily in the renal pelvis. Nowadays there is a lot of talk about the possibility of developing viral, fungal pyelonephritis, but most often it is caused by bacteria, among which Escherichia coli takes the lead.
If pyelonephritis occurs for the first time, it is called acute. Chronic pyelonephritis is characterized by the fact that several acute attacks are observed over a certain period of time - 2 - 3 times a year, for example. Fighting the bacteria that causes this disease is quite difficult even with the most modern medicines. Yes, you can sterilize your urinary tract with antibiotics for a while. But the root cause of the disease must be eliminated, otherwise the bacteria will again cause an exacerbation of the disease.

What are the symptoms of these kidney diseases? Can a person make a diagnosis on his own?

Under no circumstances should you engage in self-diagnosis! And the symptoms of urolithiasis and pyelonephritis are as follows: renal colic occurs - aching pain in the lower back, which radiate along the ureter into the bladder, groin, and scrotum. That is, urolithiasis is recognized when the stone begins to move, when it clogs the urinary tract. The kidney is functioning, but there is no urine output. Hence the bursting pain in the lower back.
TO general symptoms include poor health, weakness, weakness. Sometimes there is pain in the joints and muscles, dry mouth, decreased appetite, and increased temperature.

And what should a person do when his eyes darken from pain?

As an “ambulance”, take an antispasmodic tablet (drotaverine) or baralgin, increase fluid intake by an average of 1 liter per day. If the patient has previously had renal colic, and the doctor recommended that he take a warm bath or put a heating pad on his lower back - follow these instructions.
But, as they say, disease is easier to prevent. And summer, in this sense, generously shares its gifts with us.

What do you have in mind?

Chief physician of the Moscow City Clinical Hospital No. 54, Candidate of Medical Sciences, Viktor Ivanovich Nakhaev.

Based on materials from the magazine “Bulletin of Healthy Lifestyle” No. 14 for 2004

These 2 diseases are like best friends - always together. Urolithiasis and chronic pyelonephritis appear at the same time, occur without bright clinical coloring, but lead to severe complications. It is worth noting that more often it suffers right kidney in people aged 20-40 years. Diseases bring great discomfort to a person, so they need to be treated immediately.

What is the connection between stones and inflammation?

To begin with, kidney stones are salt deposits that range in size from a small grain of sand to a cobblestone the size of a man's fist. The composition of stones includes salts excreted in the urine, bacteria, and protein substances. The stones take on the shape of a bean, and, despite their size, are placed in the renal pelvis, calyces or ureters, where they block the passage of fluid, causing stagnation. An infection begins to accumulate in the cavity of the organ, which destroys the walls of the kidney, causing inflammation - pyelonephritis.

When the stones are smaller, along with the outflow of urine, they move through the ureters into the bladder, thereby injuring their walls and again causing infection. The infection moves upward and, reaching the kidneys, causes inflammation. Pyelonephritis against the background of urolithiasis is considered complicated, and if attacks are repeated 2-3 times a year, then this form becomes.

The opposite often happens: the inflammatory process provokes the development of a microbial environment in which tissue cells die and its clots settle in the urine. As a result, these clots enlarge, becoming covered with salts and microbes, which turns them into stones.

Reasons that will cause kidney problems

Recent studies have shown that kidney stones are bacterial in nature. It turned out that the human body contains bacteria that cause stone formation. These are phosphates formed during the alkaline reaction of urine. This reaction can be caused by a number of internal and external factors, among which are the following:

Signs of kidney stones and inflammation

With pyelonephritis and urolithiasis, a whole “bouquet” of symptoms arises that will allow an accurate diagnosis. Among clear signs the following are distinguished:

• frequent urge to go to the toilet, most of which are false;
• urine becomes darker;
• urine becomes cloudy, blood and pus are observed in it;
• the person feels unwell;
• temperature rises;
• there is nausea, vomiting;
• loss of appetite;
• severe pain in the lower back that radiates down the abdomen;
• renal colic.

Diagnostic methods

Despite the characteristic symptoms, self-diagnosis is not worthwhile. When a person has at least 3 signs, you need to take an antispasmodic and seek help from a urologist. Experienced doctor immediately recognizes stones or pyelonephritis: collects anamnesis, palpates the organ and prescribes a series of studies. To confirm the diagnosis, the patient needs to undergo the following tests:

Complex treatment of pyelonephritis and urolithiasis

Treatment of pyelonephritis in urolithiasis is carried out comprehensively, using medication and folk therapy. This treatment is aimed at stabilizing mineral metabolism, improving urine flow, fighting infection and eliminating stones. The treatment is intensive, so you shouldn’t expect it to go away quickly. The full course is 2 months, and involves use to eliminate the causes of the disease. For pyelonephritis complicated by stones, it is customary to prescribe antibiotics and herbal preparations, including:

• "Amoxicillin", "Amoxiclav";
• "Biseptol";
• "Ciprofloxacin";
• "Canephron" in tablets or drops;
• "Phytolysin";
• Urolesan capsules.

Herbal preparations are used as alternative therapy for inflammation of the kidneys and ureters. All herbs from medicinal preparations have a diuretic effect, promote the dissolution of stones and their gentle exit from the body. Therefore, kidney herbs often include the following herbs:

• lingonberries, birch leaves, bearberry, as diuretics;
• chamomile, St. John's wort, rosehip, as antibacterial;
• nettle, shepherd's purse, meadowsweet as anti-inflammatory.

The chronic form of pyelonephritis is an inflammatory process that spreads in the kidneys. The disease manifests itself in the form of malaise, pain in the lumbar region and other symptoms.

Pyelonephritis with chronic form has several stages, each of which manifests itself with certain symptoms. carried out using antimicrobial drugs.

General information about the disease

Chronic pyelonephritis is a nonspecific inflammation of kidney tissue. As a result of the spread pathological process destruction of the organ's blood vessels is noted.

The chronic form develops against the background of previously suffered acute pyelonephritis, in which treatment was carried out incorrectly or was completely absent. In some cases, the pathology may be asymptomatic and many patients do not even notice the presence of the disease. Pyelonephritis can acquire chronic course for several reasons:

• urine reflux;
• inadequate treatment of the acute form;
• impaired excretion of urine as a result of narrowing of the urinary tract;
• chronic intoxication.

Chronic pyelonephritis according to ICD-10 has code N11 and is divided into several forms depending on various symptoms.

Statistical data

According to statistics, chronic pyelonephritis occurs in 60% of cases of genitourinary system disease with the development of an inflammatory process. In 20%, the pathology develops against the background of an acute course.

The disease is diagnosed most often in women and girls. This is due anatomical structure urethra. It is easier for viruses and bacteria to penetrate female body through the vagina, from where they penetrate the kidneys and bladder.

The chronic course differs from the acute one in that the pathological process affects both kidneys, while the organs are not affected equally. This form most often occurs latently, and remissions are replaced by exacerbations.

Etiology of the disease

Pyelonephritis develops as a result of the activation and spread of pathogenic microbes under the influence of various factors. Most often this is infection with E. coli, streptococci, enterococci and other microorganisms.

Additional causes of inflammation in the kidneys are:

• incorrect treatment;
• , prostate adenoma, urine reflux and other diseases of the genitourinary system that were not promptly diagnosed and treated;
• proliferation of bacteria that for a long time are located in the tissues of the kidneys;
• decreased immunity as a result of prolonged infectious diseases or immunodeficiency conditions;
• chronic pyelonephritis can be a complication after ARVI, tonsillitis, measles, pneumonia or scarlet fever (children are most susceptible);
• chronic pathologies such as diabetes, tonsillitis, obesity or bowel dysfunction;
• in women, or during the onset of sexual activity;
• unidentified congenital diseases of the genitourinary system.

Hypothermia and the presence of autoimmune reactions can trigger the development of the pathological process.

Clinical picture

The chronic form of pyelonephritis can be asymptomatic. Signs do not appear during remission. They become pronounced during the acute stage. To the main clinical manifestations pyelonephritis include:

1. Intoxication of the body. It is characterized by the presence of general weakness, nausea, vomiting, malaise, decreased appetite, and headaches and chills. When diagnosed, pallor is noted skin and tachycardia.
2. Painful sensations . Localized mainly in the lumbar region.
3. Unpleasant smell of urine, can especially occur early in the morning, after sleep.
4. Pain when urinating, .

Against the background of chronic pyelonephritis, water and electrolyte disturbances occur, which manifest themselves in the form of dry mouth, the appearance of cracks on the lips, peeling of the horse's coat and constant thirst.

The disease has several stages, each of which is manifested by special symptoms, in the presence of which the doctor can determine the degree of development of the pathology and prescribe the necessary treatment.

1. Exacerbation. At this stage, the signs are clearly expressed. There are strong painful sensations and intoxication of the body. A laboratory blood test reveals an acceleration of ESR. Anemia is also observed. Lack of treatment at this stage leads to the development of renal failure, the diagnosis and treatment of which is difficult.
2. Latent. The symptoms are not pronounced. Patients more often complain about increased fatigue and constant weakness. In exceptional cases, hyperthermia is noted. There is practically no pain in the lumbar region and when urinating. Against the background of a pathological process, the ability of the kidneys to concentrate urine decreases, which affects its density. Laboratory testing of urine reveals the presence of bacteria and leukocytes.
3. Remission. At this stage there are no symptoms. The disease does not manifest itself with any signs, which complicates diagnosis. During the laboratory research urine may show a slight deviation from normal indicators. When exposed to negative factors, the remission stage goes into the exacerbation stage, the symptoms become aggressive, and the patient requires medical attention.

Classification of the disease

Based on ICD-10, the types and forms of chronic pyelonephritis are determined by various factors. Highlight:

1. Primary chronic form. Pathology develops on a healthy organ, the pathological process affects both kidneys.
2. Secondary chronic form. It is a complication of another pathology. At first it is unilateral in nature, then the inflammation affects the second kidney.

A certain group of scientists prefers to divide pyelonephritis into a community-acquired form and a hospital-acquired form, when the patient requires hospitalization. Depending on the location of the pathological process, the following are distinguished:

• One-sided.
• Double-sided.

According to the severity of the disease, the disease can be divided into:

• Complicated when other pathologies are associated.
• Uncomplicated, occurring without concomitant diseases.

A separate group includes pyelonephritis, which occurs with renal failure. Most often complicated forms.

Treatment options

Diagnosis and therapy are complicated by the fact that in the remission stage the disease does not show symptoms. Each patient with chronic pyelonephritis requires an individual approach and complex treatment. First of all, to relieve symptoms during the exacerbation stage, they are prescribed medications to relieve symptoms and destroy pathological microorganisms.

When a chronic form of pyelonephritis is established, the following groups are assigned:

• Cephalosporins. "Kefzol", "Cefepime" or "Tseporin";
• Semi-synthetic penicillins. "Amoxiclav", "Ampicillin" or "Oxacillin", these are antibiotics wide range actions that help destroy microorganisms that cause the development of the disease;
• “Negram”, the drug belongs to the group of nilidixic acids;
• in severe cases, Tobramycin, Gentamicin or Kanamycin are prescribed.

Used as antioxidants ascorbic acid, "Selenium", "Tocopherol". for chronic forms of pyelonephritis, they are prescribed for up to eight weeks. In cases of severe exacerbation, antibacterial drugs are administered intravenously, which helps to achieve greater effectiveness and faster results. One of the most modern means for pyelonephritis it is considered “5-NOK”. It helps relieve symptoms and relieve inflammation in a short time.

The patient should limit the consumption of fatty foods, salty and spicy foods, and also follow the drinking regime prescribed by the doctor.

Traditional methods

Treatment of the pathology can occur after stopping the exacerbation stage and only after consultation with the attending physician. The most effective are the following recipes:

1. White acacia tea. Brew like regular tea. Drink half a glass for 10 days.
2. Bean broth. Chop a glass of beans, pour a liter of boiling water, put on fire and bring to a boil. Take daily for 7 days in a row.
3. Heather infusion. Pour two tablespoons of dried herbs into two glasses of boiling water and leave for an hour. Then strain and drink in large sips.

For pyelonephritis, baths with the addition of tincture of pine branches are also useful. The water temperature should not be less than 35 degrees. The duration of the bath is no more than 15 minutes. The course of treatment is 15 procedures.

Disease Prevention

To avoid the development of inflammation in the kidney tissues, you should follow. Experts recommend:

• avoid hypothermia;
• Healthy food;
• strengthen immunity;
• promptly treat infectious diseases.

The chronic form is dangerous because it may not manifest itself for a long time. The disease is diagnosed through the diagnosis of other pathologies. If symptoms occur, you should consult a doctor, as acute form always develops into a chronic condition that is difficult to treat.