“Is chronic pyelonephritis more dangerous than acute kidney inflammation? How to treat it? Pyelonephritis - symptoms and treatment Pyelonephritis remission what

Many people wonder whether it is possible to cure chronic pyelonephritis, and the answer is simple - it is possible, because this disease is of a bacteriological nature, and, therefore, by eliminating the pathogen, you can get rid of unpleasant symptoms. Of course, the chronic form presupposes an already advanced condition, so it is more difficult to treat, however, by paying attention to concomitant diseases and completing a course of rehabilitation, you can get rid of it.

How to treat chronic pyelonephritis?

Etiological treatment of chronic pyelonephritis is based on correct diagnosis, i.e. identifying the causative agent of the disease. Most often, this is E. coli, but an attack by other microorganisms is also possible, in particular enterobacteria and staphylococci. The main categories of drugs used are penicillins, tetracyclines, aminoglycosides, etc., again, depending on the pathogen detected. For example, almost all types of staphylococcus have long become resistant to penicillins. If the kidneys have been attacked by a combination of different microbes, then broad-spectrum antibiotics are used.

If the etiology of chronic pyelonephritis is not determined, extended-spectrum penicillins are prescribed. They turn out to be the most effective in combating a large number of bacteria, and have a low number of side effects.

In remission, chronic pyelonephritis does not symptomatically disturb a person, and the main task is to prevent the possibility of a relapse of an acute attack. A very important measure is to follow the rules of therapeutic nutrition:

the daily diet should be rich in vitamins, dairy products and vegetable dishes; the daily caloric content of food intake should be in the range of 2000-2500 kcal; the consumption of spicy, salty and fatty foods should be reduced to a minimum; Every day you need to drink 2-3 liters of liquid, including mineral water and fresh juices (cranberry juice is especially useful); Watermelons, melons and other products that have a diuretic effect are very useful.

However, during an exacerbation of pyelonephritis, it is necessary to limit the consumption of liquids, watermelons, etc., and during this period the patient switches to a low-protein diet with limited consumption of table salt and potassium-containing products.

The diet should be designed so that for two days a person eats predominantly acidic foods, two days on alkaline foods, then again on acidic foods for two days, etc. This causes a change in the pH of the urine, which, in turn, creates unfavorable conditions for the proliferation of harmful bacteria.

During remission, chronic pyelonephritis can be combated using gentle methods, such as herbal medicine and passive kidney exercises. If the first method is known to everyone and involves the use of various products based on natural ingredients, for example, chamomile, nettle, cranberry, etc., then the second involves stimulating the functioning of the kidneys. Intravenous administration of drugs such as Furosemide or Lazex causes polyuria, and the reserve capacity of the kidneys is activated. Then they are provided with maximum peace.

Such passive gymnastics helps to increase antibacterial substances in the blood serum, which effectively act in the area of inflammation, and contribute to the healing of scars in the kidneys and the speedy cure of chronic pyelonephritis. You can learn more about chronic pyelonephritis and the means to combat it in the video.

Chronic pyelonephritis occurs in waves: periods of exacerbation are followed by stages of almost complete health (remissions) without the absence of any symptoms of the disease. Treatment at each of these stages is different and is based on active antimicrobial and anti-inflammatory therapy during the height of the disease and maintaining the achieved effect to prevent the development of repeated episodes.

First of all, in the remission phase it is necessary to pay attention to the diet. The diet of patients diagnosed with chronic pyelonephritis without increased blood pressure and signs of renal failure is no different from the diet of an ordinary person and requires only balanced ingredients with a sufficient content of proteins, slow carbohydrates and limiting fatty foods.

These requirements are best met by a dairy-vegetable diet. Meat and boiled or stewed fish are allowed. The daily diet should include sufficient quantities of vegetables (carrots, cabbage, beets) and fruits that are rich in the trace element potassium and vitamins C, P and B (plums, apples, apricots, grapes and figs), as well as milk and fermented milk products (sour cream, kefir, yogurt, fermented baked milk, cream, butter, cottage cheese, yoghurts). It is also advisable to eat eggs, both boiled and as an omelet. The daily energy requirement is 2000 – 3000 kcal. Throughout the entire period of treatment, you should limit the addition of hot spices and herbs to dishes.

As for the water regime, in the absence of contraindications, the patient is allowed to drink up to two to three liters of liquid per day in the form of still mineral waters, juices, compotes, decoctions, fruit drinks, infusions, herbal teas, jelly. Cranberry is especially useful, as it has a mild but rather strong diuretic effect, and is also a natural antiseptic. It is also recommended to include fruits such as pumpkin, watermelon and melon in your daily diet, which effectively cleanse the urinary tract of infectious agents.

It is recommended to follow a urine-acidifying diet for two to three days, during which you should consume baked goods, meat and eggs. The following days, the diet should be changed radically, giving preference to alkalizing foods (vegetables, fruits and milk). Such “gymnastics” creates conditions unfavorable for the proliferation of microorganisms in the kidneys and promotes their rapid elimination (destruction).

A special role in the treatment of chronic pyelonephritis during the period of remission is given to medicinal herbs and herbal remedies based on them. A number of plants have antibiotic and antiseptic properties, that is, they help eliminate the pathogen from the urinary tract. Other herbs promote better urine flow (diuretic effect), which, together with sufficient drinking, leads to “washing out” the infection from the kidneys.

Most often, bearberry or bear's ears are used in urology and nephrology. It contains a special substance, arbutin, which, when broken down, leads to the release in the kidneys of a compound that actively fights pathogenic flora, and also has a pronounced diuretic effect. Bearberry should be used in the form of a decoction. To do this, 30 g of medicinal raw material should be poured into 500 ml of boiling water and boiled in a water bath for 15 minutes. Then let it brew and strain. Drink the resulting liquid two tablespoons 5 – 6 times a day. Bearberry exhibits its maximum effect in alkaline water, so it is advisable to combine it with the simultaneous use of mineral water, as well as with apples, pears and raspberries.

Another useful plant is lingonberry. Its leaves are used for medicinal purposes, since they contain hydroquinone, which inhibits the growth of pathogens of genitourinary tract infections. It is used, like bearberry, in the form of a decoction together with alkaline solutions. To prepare it, pour 2 tablespoons of the raw material into 300 ml of boiling water, boil in a water bath, strain and consume 2 tablespoons 4-6 times a day.

One of the areas of treatment for chronic pyelonephritis during remission is the creation of an immunomodulatory effect, in other words, strengthening the body's defenses and resistance. For this purpose, multivitamin complexes are used twice a year (in autumn and spring), herbal adaptogens (tincture of ginseng, Schisandra chinensis, 30 drops three times a day).

It is also very important to avoid hypothermia. It is advisable not to wear low-waisted trousers and jeans, short jackets in winter and limit long swims in cold water.

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Chronic pyelonephritis is a disease that begins and spreads unnoticed, without causing any inconvenience to the person. Symptoms of the disease appear gradually.

The disease is a consequence of the untreated acute phase of pyelonephritis and can last more than 15 years. The inflammatory process, affecting one kidney, often affects the second. At the same time, the buds decrease in volume, their outer layer becomes loose and uneven.

Subsequently, if there is no response to symptoms, the organs shrink and necrosis of their tissue occurs. Chronic pyelonephritis can exist as an independent disease and as a consequence of some other ailment. According to statistics, women get sick more often than men, which is explained by the short urinary canal.

The mechanism of pyelonephritis is based on the reflux of urine infected with bacteria into the pelvis. Inflammation begins, moving from the walls of the pelvis to the medulla and cortex of the kidneys. The disease is characterized by sluggish symptoms or their complete absence.

The pattern of symptoms may vary significantly between patients. This is explained by the presence of one form or another of pyelonephritis.

In the latent form, there are no specific symptoms, but minor manifestations of the following signs are observed:

Fatigue, Dull pain in the side and lower back (Pasternatsky's symptom), slight increase in temperature, Headache, General malaise.

Sometimes the clinic is characterized by a slight increase in blood pressure and mild anemia.

At this stage, the kidneys lose their ability to concentrate urine.

Urinalysis shows periodic sedimentation of leukocytes and bacteria.

The anemic form has already pronounced symptoms:

tingling sensation in the heart area, shortness of breath, pale skin, severe weakness.

The hypertensive form is characterized by arterial hypertension.
In addition to the previous ailments:

dizziness, insomnia, hypertensive crises, stabbing pain in the heart.

The azothermic form of pyelonephritis is a disease that manifests itself already with the onset of chronic renal failure. In fact, this is an untreated latent form.

Recurrent form – phases of relapse and remission, which replace each other depending on the conditions of the person’s stay.
Symptoms of this form:

Increased temperature, chills, discomfort in the lower back, frequent urge to go to the toilet, pain when urinating.

The period of exacerbation is nothing more than acute pyelonephritis. With the development of a recurrent form, hypertensive or anemic syndrome often occurs.

According to the nature of inflammation, the disease is divided into the following phases:

Active inflammation, Latent inflammation, Remission.

Inflammation in the active phase, in the absence of proper treatment or with improper therapy, is replaced by a latent state, which flows either into remission or back into the inflammatory process.

Remission is a clinical recovery when the patient is not tormented by signs of pyelonephritis, and urine tests do not show any changes.
The duration of the remission period depends on the therapy and lifestyle of the patient.

The first cause of chronic pyelonephritis is microorganisms that enter the active stage due to improper hygiene, improper use of antibacterial agents, and changes in the pH environment.
The disease is caused by the most common types of bacteria:

Proteus, Escherichia coli, Staphylococci and streptococci, Enterococci, Pseudomonas aeruginosa and others.

L-types of microorganisms also affect the occurrence of the disease because they can persist in human tissues for a long time and enter the kidneys with the blood.

Such microbes are resistant to antibiotics, and when favorable conditions occur, they begin to actively conduct their life activities.

Chronic pyelonephritis can be a consequence of existing diseases:

Urolithiasis, Prostate Adenoma, Cystitis, Diabetes, Gout, Obesity, Cholecystitis, Appendicitis and others.

The onset of the disease in women can be caused by pregnancy, childbirth, and sexual activity.
Medical procedures - cystoscopy, catheterization, anesthesia and others - also often provoke the onset of the disease.
Children suffer from chronic pyelonephritis due to congenital pathologies - ureterocele, bladder diverticula.

Diagnosis of primary and secondary pyelonephritis

Diagnosis is somewhat difficult, since the course of the disease is very mild. Only detailed questioning about symptoms and laboratory tests help establish the correct diagnosis.
To make a diagnosis, the following diagnostic methods are used:

General analysis of urine and blood, ultrasound, bacteriological culture, biochemical blood test, kidney biopsy.

For diagnostic purposes, pyelography and renography are performed. The patient is also given a catheterization to determine the amount of blood protein and enzymes that are precipitating.

These methods make it possible to establish the primary or secondary nature of pyelonephritis.
Primary develops in people who complain of kidney problems for the first time.

Secondary chronic pyelonephritis is diagnosed if a person has already suffered any kidney-related diseases or has congenital renal pathologies.

The causes of the secondary manifestation of the disease are the same factors as in primary pyelonephritis.

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Treatment requires a long time, compliance with all the specialist’s instructions, and proper nutrition.
The best results will come from comprehensive treatment, ranging from eliminating the causes of the disease to changing lifestyle.
The complex of treatment measures includes:

Compliance with the regimen, Diet, Taking antibacterial drugs, Herbal medicine, Immunomodulating therapy, Physiotherapy, Symptomatic treatment, Visiting a sanatorium, Planned treatment to avoid relapses.

Since the disease is bacterial, taking antibiotics becomes mandatory and vital. The doctor prescribes antibiotics based on the tests obtained, which reveal the sensitivity of microbes to certain drugs.

Antibacterial therapy involves taking penicillins:

amoxicillin, methicillin, oxacillin,

Depending on the sensitivity of bacteria to antibiotics, cephalosporin drugs may be prescribed:

cefazolin, ceftriaxone, cephalexin.

Sulfonamides are prescribed as additional antimicrobial agents:

urolesan, groseptol, lidaprim.

Along with antibiotics, vitamin complexes and antiallergic drugs - diazolin, suprastin - are prescribed.

For the anemic type of pyelonephritis, iron intake is indicated, and the hypertensive type of the disease requires the use of antihypertensive drugs and antispasmodics.

After the main antimicrobial therapy, long-term treatment against relapses is carried out with the alternating use of different antibiotics.

Surgical treatment of the disease is carried out in the following cases:

disturbance of the outflow of urine, reflux into the ureter from the bladder, the presence of kidney stones, prostate adenoma.

To speed up recovery and prevent relapses, patients are advised to use physiotherapeutic methods of treatment:

electrophoresis, galvanization, sodium baths.

Diet plays a big role in maintaining kidney function.
Medical nutrition implies adherence to the following rules:

Refusal of spicy, fried, pickled foods, coffee, broths, alcohol; It is allowed to eat dairy products, cereals, stewed vegetables, fruits, lean meat, fish; During the day you should drink 2 liters of water and other liquids (tea, compote, mineral water). During a relapse, fluid intake should be reduced; In case of hypertensive form, you should reduce the use of salt in food, or avoid salt altogether; Diuretic products are shown - melon, pumpkin.

Sometimes alternate adherence to different specific diets is prescribed. For example, for several days the patient eats acidifying foods - meat, bread products. Over the next few days he uses alkaline foods - vegetables, fruits, milk.

Such a change in food changes the acid-base balance of the urine, which negatively affects bacteria.

Medical nutrition should be coordinated with the attending physician, who, if necessary, makes adjustments to the diet.

– infectious and inflammatory disease of the kidneys, with predominant localization in the tubulointerstitial zone.

Urologists often encounter this pathology, since the incidence is 19 cases per 1000 people. Women are susceptible to pathology 1.5 times more often than men.

Table of contents:

Classification of chronic pyelonephritis

Primary chronic pyelonephritis is distinguished; damage to the microbial flora is considered the root cause for its development. There are no obstacles to the outflow of urine.

Secondary chronic pyelonephritis develops against the background of diseases leading to disturbances in urodynamics:

anomalies in the development of the structure of the organs of the genitourinary system;
nephrourolithiasis;
narrowing of the ureter;
reflux;
retroperitoneal sclerosis;
neurogenic disorders of the bladder of the hypotonic type;
sclerosis of the bladder neck;
prostatic hyperplasia and sclerotic changes;
malignant and benign formations.

Pyelonephritis can be unilateral or bilateral.

During chronic pyelonephritis, the following phases are distinguished:

active;
latent;
remission;
clinical recovery.

Symptoms and signs of chronic pyelonephritis

Complaints in chronic pyelonephritis are present during the period of exacerbation. The patient complains of dullness. Dysuric disorders are not typical, but may be present. Common symptoms include the following:

weakness, apathy;
decreased performance;
heaviness in the lower back;
an unreasonable increase in temperature to 37 - 37.2 degrees.

If the process is complicated by the accession, then signs of loss of functional ability of the kidneys appear.

During the latent phase or remission phase there are no manifestations, and when making a diagnosis, laboratory test data are taken into account.

The following are considered predisposing factors to the development of chronic pyelonephritis:

immunodeficiency states;
in severe form;
infectious diseases;
gestation;
history of diseases of the urogenital tract;
foci of chronic infection (, etc.);
surgeries on the urinary system.

A physical examination reveals pain on palpation of the kidney/kidneys and a positive symptom of tapping in the lumbar region. With a long-term process, there may be polyuria (an increase in the daily amount of urine).

In secondary chronic pyelonephritis against the background of kidney abnormalities, an increase in blood pressure is often noted.

Laboratory and instrumental examination methods

You can use decoctions of diuretic and anti-inflammatory herbs:

Sanatorium and resort treatment in Pyatigorsk, Truskavets, Essentuki, Zheleznovodsk is possible only during the period of remission.

If a patient has chronic pyelonephritis accompanied by increased blood pressure, then limit salt to 5-6 g/day. Liquids can be drunk up to 1000 ml.

For nephrogenic hypertension supported by chronic pyelonephritis, ACE inhibitors are prescribed, since the increase in pressure is associated with an increase in renin in the blood.

In case of intolerance due to side effects, angiotensin II receptor antagonists are used.

Tactics for managing patients with exacerbation of chronic pyelonephritis with some concomitant pathology

If the patient has diabetes mellitus as a concomitant disease, aminopenicillins and ciprofloxacins are used.

For patients with chronic renal failure, drugs with hepatic or dual route of elimination are selected:

Pefloxacin;
Ceftriaxone;
Cefoperazone.

A competent choice of antibacterial drugs ensures safe use and simplifies dosage selection.

Patients with chronic renal failure are not prescribed aminoglycosides and glycopeptides due to their nephrotoxicity.

In patients and drug addicts, the causative agent of pyelonephritis may be uncharacteristic. Preference is given to fluoroquinolones (levofloxacin), aminoglycosides and cephalosporins, since they are not metabolized in the body and are excreted by the kidneys.

Exclusion from the group of cephalosporins:

Cefatoxime;
Cefoperazone;
Ceftriaxone.

Exacerbation of chronic pyelonephritis associated with resistant hospital strains of bacteria is extremely rare. This may be a complication of medical procedures or a history of inadequate antibiotic use.

In these cases, Ceftazidimi and Amikacin are used.

Cefazidime is prescribed as a single antibiotic, or in combination with Amikacin.

Carbapenems are considered reserve drugs (with the exception of ertapenem).

Surgical treatment

Indications for surgery are all violations of the outflow of urine.

If chronic pyelonephritis is complicated by the formation of apostema or renal carbuncle, an operation involving decapsulation is performed, followed by the installation of nephrostomy drainage.

In the most advanced cases, nephrectomy is resorted to.

Chronic pyelonephritis is a kidney disease that poses a threat to the general condition of the body. What is chronic pyelonephritis and how can it be dangerous? Read our article.

Causes of chronic pyelonephritis

Most often, chronic pyelonephritis is a consequence of improper treatment of diseases of the genitourinary system (cystitis, urethritis, acute pyelonephritis or urolithiasis). However, doctors also identify other causes of chronic pyelonephritis:

Hormonal imbalances and gynecological diseases in women;
Decreased immunity;
Promiscuous sexual intercourse;
Stress and emotional stress;
Hypothermia;
Diabetes mellitus.

The disease can be caused by different types of bacteria:

Escherichia coli;
Enterococci;
Proteus;
Staphylococcus;
Streptococci.

All of them have varying degrees of resistance to antibiotics, so in order to prescribe adequate treatment it is important to correctly determine the etiology of the disease. Regardless of the cause, the chronic form is always preceded by an acute attack. Chronicity of the disease is caused by untimely outflow of urine. It can be caused by urolithiasis, the peculiar structure of the ureter, nephroptosis and prostate adenoma. Diseases not related to the genitourinary system can also maintain inflammation in the body:

Cholecystitis;
Appendicitis;
Enterocolitis;
Tonsillitis;
Otitis;
Sinusitis, etc.

Decreased immunity, obesity and intoxication of the body contribute to the development of infection.

Incorrectly prescribed therapy threatens the patient with an increase in recovery time and the development of complications. Reliable identification of the etiological factor is the key to successful treatment and recovery of the patient.

Classification of chronic pyelonephritis

According to the WHO classification, there are many forms of this disease. According to the activity of infection, chronic pyelonephritis is divided into three phases:

Active inflammation phase;
Latent inflammation phase;
Remission phase.

Each phase has differences both in symptoms and research results. Adequate treatment contributes to the transition of the acute period to the latent period. The latent period is expressed very weakly, almost imperceptibly. The patient may be bothered by general fatigue, low-grade body temperature and headaches. There may be no symptoms specifically indicating a genitourinary disease. After several months, the disease, which had been latent, gives way to recovery (remission) or a new attack. In the acute stage, it is already possible to clearly distinguish the symptoms inherent in pyelonephritis. Urine culture during this period also indicates pathology. Bacteria and leukocytes are released into the urine (bacteriuria and leukocyturia), as well as protein up to 3 g/l (proteinuria).

Based on their occurrence, there are two forms of chronic pyelonephritis:

Primary – not associated with previous urological diseases. When studying the pathology of this form, doctors usually do not find factors that could contribute to the retention of bacteria in the kidney tissues.
Secondary – if there were previously lesions of the urinary tract. For example, the calculous form develops against the background of urolithiasis.

Depending on the location of pyelonephritis, the following forms are distinguished:

Left-handed;
Right-handed;
Bilateral.

Symptoms

The symptoms of pyelonephritis will vary depending on the stage of pathogenesis (development of the disease), as well as in different categories of patients (men, women or children). Doctors suspect chronic pyelonephritis even with the following signs:

Increased body temperature;
Pain in the lumbar region;
Dysuria;
Headaches and general malaise;
Increased fatigue;
The presence of swelling and bags under the eyes.

It should be noted that symptoms in the acute phase are more pronounced and require immediate treatment. The feeling of pain becomes unbearable. A symptom of exacerbation such as high temperature can reach a critical point (up to 41 C).

The latent period of pyelonephritis is characterized by sluggish symptoms. Most often, they are indirect and are not attributed either to the patient or to the doctors to a disease of a urological nature. Thus, chronic pyelonephritis can result in high blood pressure (hypertension). Kidney function and the cardiovascular system are closely related. If the condition of the kidneys worsens, a hypertensive crisis occurs. Increased blood pressure is quite common in patients with kidney disease (about 40%).

Symptoms of pyelonephritis in women do not differ from the general clinical picture. However, if in parallel the patient suffers from cystitis or another urological disease, the symptoms become mixed, making it difficult to make an accurate diagnosis and treatment. In men, symptoms of pyelonephritis may be signs of other urological or andrological diseases. Therefore, it is important to contact a specialist in a timely manner. Manifestations of pyelonephritis can even occur in infants and infants. In children, pyelonephritis most often has obvious symptoms. A feature of the course of pyelonephritis in children is very rapid intoxication due to a rise in temperature. At home, you can help your baby with symptomatic treatment methods:

Bed rest;
Anesthesia;
Decreased body temperature.

Diagnostics

It is easiest to diagnose chronic pyelonephritis in a hospital setting. To make a diagnosis, an experienced nephrologist usually only needs to order a standard examination. Diagnosis of chronic pyelonephritis includes:

Blood and urine tests;
Ultrasound examination of the kidneys;
Analysis of smears in women (if gynecological diseases are suspected).

The test results will help the doctor determine the nature of the disease (etiopathogenesis). The main criteria by which the disease is determined through tests are leukocyturia, bacteriuria and proteinuria. An increase in the number of leukocytes is not always associated with a severe course of the disease. Therefore, test data are always compared with the patient’s complaints and the overall clinical picture. An ultrasound will show possible diffuse changes in the kidneys. To more accurately formulate a diagnosis, the doctor may prescribe additional tests. There are often cases when the disease is diagnosed by chance, during examination for another disease.

Treatment

Chronic pyelonephritis is treated comprehensively. Antibiotics and uroseptics are used. The doctor may also prescribe herbal remedies. The successful outcome of treatment largely depends on preliminary urine culture to determine drug sensitivity. In this way, the doctor determines which antibiotics should be used to treat the disease in each individual case. Most often, pyelonephritis in the acute stage can be cured with the following medications:

Penicillins (amoxicillin, carbenicillin, azlocillin);
Cephalosporins;
Fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin).

Nitrofurans (furadonin, furagin, furamag) cope well with pyelonephritis, but have many side effects (nausea, vomiting, bitterness in the mouth). Sulfanilamide (Biseptol) and hydroxyquinoline drugs (Nitroxoline) are well tolerated by humans, but bacteria have also recently become less sensitive to them. Treatment can be prescribed either in tablet form or in injections.

In the treatment of pyelonephritis, the most important thing is to adhere to the specified treatment regimen. The drug must be taken exactly as many days as prescribed by the doctor. Otherwise, the therapy will not cope with the bacteria completely and after some time they will begin to attack the body again. Successful treatment of an exacerbation leads to the disease going into remission.

Treatment in the remission stage comes down to preventive measures:

Diet;
Drinking regime;
Alternation of oxidizing and alkalizing foods in the diet;
Herbal teas;
Strengthening immunity;
Moderate physical activity;
Sanatorium-resort treatment.

The latter, by the way, is one of the most effective ways to maintain the patient’s quality of life at the proper level. The main factor when choosing a sanatorium for kidney treatment is the availability of mineral waters. Using the healing properties of water, harmful substances are removed from the kidneys and inflammatory processes are eliminated. The medical standard of modern resorts involves a nursing process. This is an integrated approach to treating patients, including the provision of professional medical care and patient care. Modern clinics also provide quality nursing care.

If you follow all the doctor’s clinical recommendations, the prognosis for chronic pyelonephritis can be quite favorable. The disease can be cured completely, forever forgetting about its unpleasant symptoms. In this case, the patient may even be removed from the register if he had previously been seen by a doctor. Ignoring medical instructions can have serious consequences for the patient. Untreated pyelonephritis is dangerous due to numerous complications (carbuncle or kidney abscess, sepsis). They can cause disability or bacteriotoxic shock, which is fatal. Bilateral pyelonephritis leads to liver damage (hepatorenal syndrome).

Therefore, despite the fact that the disease is in remission, take care of your health. Do not self-medicate, get tested on time and visit a specialized doctor. He will tell you how to properly treat pyelonephritis.

The unique remedy ASD-2 helps in the treatment of kidney diseases. The main active ingredient of the drug is folic acid. Under its influence, the process of reabsorption of necessary substances occurs faster in the renal tubules. In addition, ASD-2 helps restore the body’s adaptive capabilities, normalizing Ph-balance and increasing resistance to pathogenic factors (physical, emotional overload and stress). At the remission stage, this is an excellent remedy, thanks to which the disease can completely go away.

Diet

Diet is the basis for the treatment of chronic pyelonephritis. For patients who have suffered acute pyelonephritis, the “Table 7” diet is indicated. The diet of a patient with pyelonephritis should include natural foods, steamed or boiled. It is necessary to reduce salt intake to a minimum. It is better to replace purified tap water with mineral water.

What you can eat:

Low-fat poultry, meat and fish;
1 egg per day;
Yesterday's bread;
Pasta from durum wheat;
Cereals;
Fruits and vegetables;
Fruit drinks (especially cranberry).;
Weak black and green tea;
Vegetable and butter oils.

What not to eat:

Strong broths from fatty meats;
mushrooms;
Spicy and fatty dishes;
Fried foods;
Chocolate, confectionery;
Strong coffee;
Legumes;
Fresh bread and rolls.

Eating this therapeutic diet is not so difficult. It is enough to get used to the natural taste of the products. Thematic books with dietary recipes will help to diversify medical nutrition.

Prevention

Prevention of chronic pyelonephritis includes timely treatment of the acute phase of the disease. To prevent acute pyelonephritis, you need to avoid overcooling and eliminate foci of infections in the body in a timely manner. It is very important to strengthen the immune system from the inside with vitamins, proper balanced nutrition and hardening procedures. Once a year or more often, be sure to take blood and urine tests.

During pregnancy

Chronic pyelonephritis and pregnancy are quite common. The reason for this is the growth of the fetus, due to which the kidneys are displaced. There is a violation of the outflow of urine, bacteria are not removed from the body in time - inflammation occurs. Pregnancy itself with chronic pyelonephritis can proceed quite normally. However, the condition of the expectant mother leaves much to be desired. To complicate the situation, antibiotic therapy is contraindicated during pregnancy. After passing all the necessary tests and confirming the diagnosis, the attending physician prescribes the most appropriate medications with minimal risk to the child. Many mothers are concerned about the question of whether it is possible to give birth if this disease was discovered during pregnancy. Doctors say that timely detection of pathology and control over it allows women to give birth independently in 95% of cases.

Do they take into the army with chronic pyelonephritis?

Conscripts with chronic pyelonephritis may not serve in the army. However, there are many nuances here. To make a diagnosis, leukocyturia and bacteriuria must be observed in the urine for 12 months. It is known that during the remission stage these indicators can be reduced. Therefore, to make the most accurate diagnosis, a commission is appointed several times.

Chronic pyelonephritis develops against the background of a long-term untreated acute form of the disease and can cause the development of renal failure and disability of the patient.

Chronic pyelonephritis is an infectious-inflammatory disease characterized by involvement of the kidney tubules in the pathological process and subsequent damage to the glomeruli and blood vessels. According to medical statistics, chronic kidney pyelonephritis is diagnosed in 60% of cases among possible infectious diseases of the genitourinary system and occupies a leading place as one of the causes of patient disability.

What is this disease and who is at risk?

Representatives of the weaker sex are more often susceptible to the development of chronic pyelonephritis, which is due to the structural features of their urethra - it is short and wide in women. Pathogenic microorganisms easily penetrate through the urethra into the bladder and then into the kidneys, causing an inflammatory process in them.

The main difference between acute pyelonephritis and the chronic form is that in the second case the pathological process spreads to both kidneys, while acute inflammation is observed mainly on one side only (usually in the right kidney). The chronic form of the disease is characterized by periods of remission and exacerbation, during which the symptoms are pronounced, as with.

If in acute pyelonephritis recovery does not occur within 3 months, then the disease gradually subsides and becomes chronic. Further, any predisposing factor will cause an exacerbation, and each exacerbation, in turn, will cause parenchymal changes in the structure of the kidneys. Gradually, changes in the structure of the organ completely disrupt its functioning, which is a direct path to kidney failure and disability.

Symptoms of chronic pyelonephritis

Symptoms of chronic pyelonephritis directly depend on the localization of the inflammatory process in the kidneys, on the degree of spread of inflammation to the organ (one or both kidneys at once), on the presence of associated complications in the form of narrowing of the lumen of the ureters or urethra. Signs of chronic pyelonephritis may not be felt at all for many years, but meanwhile the inflammation will slowly spread to all tissues and parts of the kidney.

Symptoms appear clearly during the period of exacerbation of the disease and are characterized by the following:

high body temperature (up to 38.5-39.0 degrees);
dull pain in the lumbar region on one side or both sides;
various dysuric phenomena - impaired urine outflow, a feeling of incomplete emptying of the bladder, pain and pain at the time of urination, decreased daily diuresis;
severe headaches and increased blood pressure;
nausea, general weakness;
swelling of the limbs and face;
vomiting and symptoms of general intoxication of the body;
pale skin and rapid pulse.

Important! During the period of subsidence of pronounced clinical symptoms, it is very difficult to diagnose the disease, since pyelonephritis passes into a latent (hidden) form of the course.

During the period of remission, intermittent symptoms may appear, to which the patient does not pay attention:

rare pains in the lumbar region of a dull, pulling nature - they intensify after exercise, consumption of salty, spicy, alcohol;
minor dysuric phenomena - oliguria, frequent urge, discomfort when urinating;
body temperature rises to subfebrile levels (37.0-37.4), but the general condition of the patient is not impaired;
frequent headaches and swelling of the face and limbs in the morning, especially after eating pickles, large amounts of liquid, or alcohol.

If the disease is not diagnosed for a long time and is not treated in any way, then the symptoms progress.

The patient develops the following symptoms:

itching and flaking of the skin (the skin becomes yellowish or sallow);
secondary arterial hypertension appears;
frequent nosebleeds occur.

You can learn more about how pyelonephritis manifests itself in chronic form in the video in this article - the information is for informational purposes only and cannot replace consultation with a urologist.

Why does chronic pyelonephritis develop: the main reasons

The causes of chronic pyelonephritis are directly related to kidney damage by pathogenic microorganisms. In order for the infection to enter directly into the kidney structure and inflammation to develop, favorable conditions are required.

Most often, the development of acute and then chronic pyelonephritis is promoted by Escherichia coli, Pseudomonas aeruginosa, Amoeba Proteus, streptococci and staphylococci. The development of a chronic pathological process in the kidneys is facilitated by microorganisms that are resistant to antibiotics and other drugs, and this happens in situations where the patient self-medicates or voluntarily stops the course of therapy prescribed by the doctor, believing that he has already recovered.

Chronic pyelonephritis is always preceded by an acute inflammatory process, and predisposing factors to the transition of the disease to chronicity are:

Diseases of the urinary system, which are accompanied by impaired urine outflow. Such pathologies include kidney prolapse, prostate adenoma in men, urolithiasis, narrowing of the bladder sphincter, and oncological formations in the ureters and bladder.
Untreated acute inflammatory process in the kidneys or self-medication. It is strictly forbidden to arbitrarily begin a course of therapy or stop taking antibiotics prescribed by a doctor. Persons who have suffered acute pyelonephritis should be under the supervision of a urologist for 3 months, since this is a critical period when the disease can silently become chronic.
Immunodeficiency states - weakened individuals with weak immunity are more susceptible to chronic inflammatory processes than people with a good immune response.
Chronic pyelonephritis often develops as a complication of previous tonsillitis, ARVI, influenza, measles pneumonia, scarlet fever.
The presence of chronic inflammatory processes in the body - tonsillitis, sinusitis, sinusitis, gastritis and colitis. Carious neglected teeth can also be a source of the spread of bacterial flora, causing inflammatory processes in the kidneys.
In women, a predisposing factor to the development of acute and then chronic pyelonephritis is pregnancy. In the later stages, as the fetus grows, all internal organs, including the bladder, are compressed in the uterus. Stagnation of urine and disruption of its outflow contributes to the proliferation of bacteria in the bladder, and with weakened immunity in the expectant mother, the risk of infection spreading to the kidneys increases.
Anomalies of the development of the urinary system organs - hydronephrosis of the kidney, bladder diverticula, narrowing of the lumen of the ureters. All these conditions prevent the full outflow of urine and create the preconditions for the active proliferation of microbes.
Severe hypothermia of the body, especially the lumbar region.

How does chronic pyelonephritis manifest: stages of the disease

Chronic inflammatory process of the kidneys develops in stages, each of which has its own clinical symptoms:

Disease stage	How does it manifest itself?
First	At this stage of disease development, the glomeruli of the kidneys are not involved in the pathological process. The collecting ducts of the organ are slightly atrophied
Second	Some glomeruli stop working, the vessels of the organ narrow significantly, which complicates the process of filtering urine. Destructive-sclerotic changes in the renal tubules arise and rapidly progress
Third	Most of the renal glomeruli die, the tubules atrophy, most of the organ is replaced by connective tissue
Fourth	Most of the glomeruli of the kidney die, the organ significantly decreases in size and shrinks. Most of the interstitium is replaced by connective tissue

Possible complications

Is it possible to cure chronic pyelonephritis without complications? In the absence of timely diagnosis and therapy, this is almost impossible. A common consequence of long-term untreated chronic inflammatory process in the kidneys is pyonephrosis.

What is pyonephrosis? This is a purulent kidney lesion, which is more typical for patients over 40 years of age; in children, such a complication practically does not occur.

Other common complications of untreated chronic pyelonephritis are:

acute renal failure– a reversible condition characterized by a sudden disruption of the kidneys or complete shutdown of the functions of the organ;
chronic renal failure– a condition caused by the death of kidney cells and the complete cessation of organ function (such patients are tied to renal dialysis and can only live thanks to this procedure or a donor kidney transplant);
urosepsis– a complication that often ends in death and is characterized by the spread of infection from the affected kidneys through the bloodstream throughout the body;
purulent inflammation of the perinephric tissue.

Methods for diagnosing the disease

In order to make an accurate diagnosis to the patient and differentiate chronic pyelonephritis from other urinary tract diseases, it is necessary to conduct a comprehensive examination. It includes laboratory and instrumental diagnostic methods.

Laboratory examination of the patient

A patient with suspected chronic inflammatory process of the kidneys is prescribed:

general blood test - chronic pyelonephritis, which has not yet been treated, is characterized by anemia, increased ESR, a shift in the leukocyte formula to the left, pronounced leukocytosis;
general urine analysis - if treatment for chronic pyelonephritis has not yet been carried out, then the urine analysis reveals an alkaline environment, low density and turbidity, which is due to the high content of bacteria and leukocytes in the material;
– pronounced leukocytosis, active leukocytes;
urine sample according to Zimnitsky - this study reveals a decrease in the density of urine in various daily portions;
biochemical blood test - reveals an increase in urea, sialic acids and seromucoid.

Instrumental diagnostic methods

The presented diagnostic methods are chosen by the attending physician and allow you to clarify the diagnosis and severity of the pathological process:

chromocyotoscopy - a study that allows you to determine a unilateral or bilateral inflammatory process;
Ultrasound of the kidneys - using ultrasound, the doctor assesses the size of the kidneys, the wrinkling of the organ, the presence of gross structural changes;
retrograde pyelography is a study that allows you to diagnose existing deformations of the renal pelvis and calyces;
CT and MRI.

If modified areas of the kidney are detected, in some cases the patient is prescribed a biopsy to clarify the diagnosis. A tissue sample is taken from the suspicious area and sent for further detailed examination in a histological laboratory. This method is highly informative for detecting kidney cancer at an early stage.

Important! When examining a patient, one should differentiate chronic pyelonephritis from renal amyloidosis, hypertension, and diabetes mellitus, since the listed pathologies may have similar clinical symptoms.

Treatment of chronic pyelonephritis

Treatment for chronic pyelonephritis is comprehensive and includes:

regime and strict diet;
antibacterial therapy;
implementation of measures aimed at normalizing the outflow of urine.

How to cure chronic pyelonephritis? First of all, you need to be prepared for the fact that the therapy will be long-term, and during periods of exacerbations the patient must be hospitalized in a hospital.

Regime and diet

During the period of exacerbation of the disease, the patient must observe strict bed rest - failure to comply with this condition increases the risk of complications and renal failure. Dietary nutrition and drinking regimen are integral aspects of effective treatment.

Important! The main mistake of patients with a chronic form of pyelonephritis is a sharp restriction of water in the diet, and yet it is not the water that needs to be limited, but the amount of salt, since it is salt that provokes swelling and disrupts the flow of urine.

Ordinary clean water is suitable for drinking, including slightly alkaline mineral water without gas, jelly, fruit drinks, compotes, juices, rosehip decoction. During an exacerbation of the disease, the patient can drink up to 2 liters of liquid, not counting first courses. Reducing water in the diet is advisable only with a pronounced increase in blood pressure and complications from the cardiovascular system.

To prevent edema and fluid retention in the body, you should reduce the amount of table salt, and sometimes completely eliminate it for a certain period. The patient is prescribed diet No. 7 with the exception of spicy foods, pork, animal fats, herbs, spices, vinegar, smoked meats and preserves.

Proteins are limited, as they increase the load on the kidneys. The diet is dominated by dishes of plant origin, stewed vegetables, fresh fruits, vegetable soups, porridges (buckwheat, oatmeal, rice).

Drug treatment

If symptoms characteristic of chronic pyelonephritis are diagnosed, treatment cannot be done without antibiotics, which, unfortunately, are not always effective, especially if the pathological process is identified at an advanced complicated stage. The urologist decides how to treat each individual patient, depending on the severity of the disease.

To treat chronic inflammatory process in the kidneys, the following groups of antibiotics are used:

Penicillins with clavulanic acid– Amoxicillin, Amoxiclav, Flemoxin solutab. A distinctive feature of these drugs from conventional penicillins is their ability to dissolve the protective capsule of penicillin-resistant pathogens. These drugs can be prescribed in the form of injections or tablets, depending on the severity of the disease.
Cephalosporins– Ceftriaxone, Loraxone, Cefixime, Ceporin. Drugs in this group can sometimes be combined with aminopenicillin antibiotics in severe cases of the inflammatory process.
Aminoglycosides– Gentamicin, Amikacin. Prescribed by injection in combination with cephalosporins or penicillins for complicated pyelonephritis.
Drugs of the nitrofuran series– Furadonin, Furazolidone. They are uroseptics and enhance the effect of antibiotics.
Sulfonamides- Biseptol. These drugs are combined with antibiotics; they have a bacteriostatic effect, that is, they slow down the growth and reproduction of pathogenic microorganisms.

To maintain the patient’s immune system, injections of Ascorbic acid and vitamins A and E, which are powerful antioxidants and fight free radicals, are prescribed.

Important! For chronic pyelonephritis, a course of antibiotic therapy is prescribed for up to 21 days - in the first 7 days the drugs are administered by injection, and if the test results improve, the patient is transferred to tablets.

The success of drug therapy can be judged by the following signs:

the outflow of urine improves and dysuric phenomena disappear;
urine and blood tests are normalized;
body temperature is within normal limits;
swelling disappears and blood pressure normalizes.

Ancillary drugs

to prevent allergic reactions to numerous medications, the patient must be prescribed antihistamines - Suprastin, Loratadine, Diazolin;
for the treatment of anemia, which is a frequent accompaniment of chronic kidney damage, iron supplements and vitamins B12 are prescribed in the form of injections;
To normalize blood pressure, drugs from the group of antihypertensive drugs are prescribed - Clonidine, Reserpine, Co-prenessa.

During the period of remission, the patient is prescribed sanatorium-resort treatment.

Disease prevention

Below are instructions for actions aimed at preventing the transition of acute pyelonephritis to the chronic form of the course:

after acute pyelonephritis, you should be registered with a urologist for at least 3 months, and in case of a complicated course - 1 year;
after an infection, avoid physical overload and hard work for six months;
do not overcool;
in the first six months after pyelonephritis, be sure to follow diet No. 7, give up alcohol, coffee and spices;
Every 4 weeks during the first year after pyelonephritis, urine and blood tests should be taken - if all indicators are within normal limits, then the patient can be removed from the dispensary register.

Important! If within a year after pyelonephritis there has been a relapse of the disease at least once, then the dispensary registration is extended for 3 years with regular monitoring of tests and the patient’s condition.

To strengthen the body’s immune forces, you should sanitize all foci of chronic infection, including carious teeth, eat well, rest more, and engage in moderate physical activity.