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Pyelonephritis is a nonspecific inflammatory disease of the kidneys of bacterial etiology, characterized by a lesion of the renal pelvis (pyelitis), calyx and kidney parenchyma. In view of the structural features of the female body, pyelonephritis is 6 times more common in women than in men. The most frequent pathogens of the inflammatory process in the kidney are Escherichia coli (E. coli), Proteus (Proteus), Enterococcus (Enterococcus), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and Staphylococcus (Staphylococcus).
The penetration of the causative agent into the kidney is most often associated with urine incubation in the kidneys (bladder-ureter reflux-PMR) due to difficulty in urinary outflow, bladder overflow, increased intravesical pressure due to hypertonia, structural abnormality, stones, or enlargement of the prostate gland. What is dangerous pyelonephritis? Each new exacerbation of pyelonephritis involves all the new areas of kidney tissue in the inflammatory process. With the passage of time at this place, the normal tissue of the kidney dies and a scar is formed. As a result of a prolonged course of chronic pyelonephritis, the functional tissue (parenchyma) of the kidney gradually decreases. In the end, the kidney wrinkles and stops functioning.
With bilateral renal damage, this leads to chronic renal failure. In this case, in order to maintain the vital functions of the kidney function, it is necessary to replace the "artificial kidney" with the device, that is, regularly perform hemodialysis - artificial blood purification by passing through the filter. Pyelonephritis forms Acute pyelonephritis Chronic pyelonephritis Diagnosis of pyelonephritis Pyelonephritis is manifested by dull pain in the lower back, low-intensity or medium-intensity aching, an increase in body temperature to 38-40 ° C, chills, general weakness, decreased appetite and nausea (all symptoms may occur, And only a part of them).
Usually, during reflux, there is an expansion of the cup-and-pelvic system (CLS), which is observed on ultrasound. Pyelonephritis is characterized by an increase in leukocytes, the presence of bacteria, protein, erythrocytes, salts and epithelium in the urine, its opacity, turbidity and sediment. The presence of protein indicates an inflammatory process in the kidneys and a violation of the blood filtration mechanism. The same can be said about the presence of salts: the blood is salty, is not it? Consumption of salty foods increases the burden on the kidneys, but is not the cause of 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 (do not think that good) are recommended to reduce the amount of salt consumed from the food - normal?
Even huroologists like to say that with pyelonephritis you need to consume as much liquid as possible, 2-3 liters per day, uroseptics, cranberries, cranberries, etc. So it is so, but not quite. If the cause of pyelonephritis is not eliminated, with increasing the amount of fluid consumed, the reflux becomes even more intense, hence, the kidneys become inflamed even more. First, you need to provide a normal passage of urine, exclude the possibility of overflow (no more than 250-350 ml depending on the size of the bladder), and then consume a lot of fluid, only in this case, the fluid intake will be beneficial, but for some reason very often This is forgotten.
Treatment of pyelonephritis should be comprehensive, and should include not only antibiotic therapy, but, and more importantly, activities aimed at eliminating the very cause of pyelonephritis. With the help of antibiotics, the inflammation is removed in the shortest possible time, but if the cause itself is not eliminated, after a while, after the antibiotic cancellation, the pyelonephritis will become aggravated again and after a certain number of such relapses the bacteria will acquire resistance to this antibacterial drug. In connection with which the subsequent suppression of bacterial growth by this drug will be difficult or even impossible.
It is desirable that the antibiotic be selected on the basis of the results of bacteriological culture of urine with the determination of the sensitivity of the pathogen to various drugs. In the case of acute pyelonephritis, immediately after the sowing, a broad-spectrum antibiotic from the group of fluoroquinols, for example, Ciprolet, can be prescribed and adjusted according to the results of the sowing. Antibiotic therapy should last at least 2-3 weeks.
The most probable causes of pyelonephritis include reflux caused by difficulty with urination, bladder overflow, increased intravesical pressure, complication of cystitis, as well as anatomical abnormalities in the structure of the ureters, disruption of the sphincter function. Violations of urination can be caused by hypertension of the sphincter of the bladder and the bladder itself, complicated by the outflow of urine due to inflammatory disease of the prostate (prostatitis), spasms caused by cystitis, structural changes in the sphincter of the ureters and anomalies, a violation of neuromuscular conduction and in the least Degree - the weakness of the smooth muscles of the bladder.
Despite this, most urologists start treatment with the stimulation of detrusor cuts, which further aggravate the situation, although in combination with antibiotic therapy, in most cases, this gives visible but short-term improvements. If urine passage is difficult (outflow), in order to prevent reflexes, it is necessary to resort to periodic catheterization of the bladder, or to install a Foley catheter with a change every 4-5 days. In the case of hypertension of the sphincter of the bladder or himself, one must search for the cause of the appearance of hypertonia or spasms and eliminate it, thereby restoring the normal outflow of urine. If you put cystitis, then you need to treat it, since pyelonephritis can be a complication of cystitis. In inflammatory diseases of the prostate, you need to undergo treatment for prostatitis (read the article on prostatitis). If there are structural abnormalities of the bladder, urethra, ureters, one should consult with doctors and take measures to eliminate defects, possibly surgically.
For the treatment of disorders of neuromuscular conduction there are many drugs and techniques, tacticians should be selected by qualified doctors. Before "stupidly" to stimulate the strength of contractions of the muscles of the bladder, you must exclude the presence of all the above-described disorders, be vigilant and control the treatment you are prescribed. Exacerbations of pyelonephritis inevitably lead to a thinning of the functional part of the kidney and the death of nephrons, therefore, in order to preserve as much of the kidney as possible, it is extremely important to eliminate the cause of pyelonephritis in the shortest possible time. Ask to measure the thickness of the kidney parenchyma during the passage of ultrasound. The thickness of the parenchyma of healthy kidneys is on average 18 mm.