Acute pyelonephritis is an inflammatory process that affects the intermediate tissue and the renal calyx-pelvis system, which is of a nonspecific nature.
In urological practice, acute pyelonephritis is the most frequent inflammatory process affecting the kidneys. It can occur in childhood, a favorable condition for which is the lack of formation of the urinary system and a high load on it. Adults also do not fall under the exception, women under the age of 40 are more likely to suffer from the disease.
Doctors distinguish between primary and secondary acute pyelonephritis. The primary one occurs due to a violation of the outflow of urine from the kidneys themselves, and the secondary is caused by a violation of its passage due to obstruction of the urinary tract.
Pyelonephritis in the acute phase differs from chronic pyelonephritis:
- The course of the inflammatory process in acute pyelonephritis is fast, and in chronic pyelonephritis it is slow.
- Symptoms in acute illness are pronounced, and in chronic cases, the symptoms are often blurred or completely absent.
- Acute pyelonephritis ends with the patient’s recovery, or the transition to the chronic stage.
- Chronic pyelonephritis is characterized by frequent relapses of diseases.
- Chronic pyelonephritis is more difficult to treat.
Acute pyelonephritis can affect both one and two kidneys. On average, 1% of the world’s population falls ill with pyelonephritis every year. Moreover, it is acute pyelonephritis that accounts for 14% of kidney diseases, and a purulent complication occurs in 1/3 of patients.
- Symptoms of acute pyelonephritis.
- Causes of acute pyelonephritis.
- Complications and consequences of acute pyelonephritis.
- Diagnostics of the acute pyelonephritis.
- Treatment of acute pyelonephritis.
- Diet for acute pyelonephritis.
Symptoms of Acute Pyelonephritis
Symptoms of acute pyelonephritis depend on the form of the disease and the stage at which it is located.
The initial stage of serous inflammation. The kidney increases in size, strains, and the tissue located near the film swells. If the disease is started to be treated at this stage, then acute pyelonephritis will be successfully eliminated.
The stage of acute purulent pyelonephritis is divided in turn into three phases: apostematous pyelonephritis, carbuncle and organ abscess. At the beginning, small pustules form in the cortical layer of the kidney, which, if untreated, merge and form a carbuncle. In the foci of fusion of carbuncles, the parenchyma of the organ melts and an abscess of the kidney tissue develops.
The symptoms of non-obstructive pyelonephritis in the acute phase are as follows:
- The disease develops very quickly, almost with lightning speed. Sometimes a few hours are enough for the patient’s condition to become serious, sometimes it worsens over the course of a day.
- A person experiences malaise and weakness, the body temperature rises sharply, reaching 40 °C.
- Sweating intensifies, a headache appears, heartbeat increases.
- The disease is accompanied by a feeling of nausea and vomiting, arthralgia, diarrhea or constipation.
- A person experiences pain in the lumbar region, it radiates to the thigh, back, abdomen. The nature of the pain is either dull or intense.
- As a rule, there are no signs of urinary disorders.
- There is a not too pronounced decrease in daily urine output, since the patient loses large volumes of water with sweating.
- The urine becomes cloudy and gives off an unpleasant odor.
Symptoms of secondary pyelonephritis in the acute phase:
- The onset of the disease proceeds as renal colic, which is associated with urinary tract obstruction.
- At the peak of pain, a person’s body temperature rises, up to the development of fever.
- The patient shivers, he is thirsty and suffers from vomiting.
- When profuse sweating stops, body temperature sometimes drops to critically low levels, sometimes to normal values. The state of health is somewhat normalized.
- The colic attack returns after a few hours if the urinary tract obstruction is not eliminated.
Symptoms of purulent pyelonephritis in the acute stage:
- Persistent pain occurs in the lumbar region.
- A person suffers from a fever proceeding according to the hectic type (changes in body temperature are 3-4 degrees and occur 2-3 times a day).
- The rise in temperature is accompanied by chills.
- The muscle walls of the peritoneum are tense, the same applies to the lumbar muscles.
- When the intoxication of the body reaches its peak, it is possible that consciousness becomes clouded and delirium develops.
Causes of Acute Pyelonephritis
The causes of acute pyelonephritis are the penetration of pathogenic microorganisms into the kidney. In 50% of cases, Escherichia coli becomes this agent, in other cases the disease is provoked by Proteus, Pseudomonas aeruginosa, streptococci, staphylococci, viruses and fungi. Modern urological practice indicates a rare detection of only one causative agent of pyelonephritis. Most often, the disease is caused by the association of several microorganisms. Hospital strains of pathogenic agents are especially dangerous in terms of the development of inflammation, since they are very difficult to eliminate.
There are two ways in which pathogens can penetrate the kidney:
Hematogenous pathway, in which infection occurs through the bloodstream. This is the rarest cause of kidney inflammation; the hematogenous pathway leads to disease in only 5% of cases. The primary foci of infection can be: the genitourinary organs, in the presence of inflammation (cystitis, adnexitis, prostatitis, etc.), distant organs with sinusitis, bronchitis, caries, tonsillitis, cholecystitis, furunculosis, etc…
The urinogenic route of infection is the most common route of infection to the kidney. Microorganisms enter them from the lower urinary tract. Another method of infection is called ascending.
It is worth considering that, normally, only the distal urethra can be infected.
In order for the further spread of the infection to occur, additional provoking causes or factors are needed, including:
Prevalence in the periurethral region and in the area of the perineum of Escherichia coli. This can occur due to intestinal dysbiosis, with vaginal dysbiosis in a woman.
An increase in the acidic environment of the vagina in women during menopause, which is associated with a lack of estrogen.
A woman’s active sex life and frequent change of sexual partners facilitate the penetration of infection into the bladder.
Vesicoureteral reflux can cause the development of the disease. In this case, the retrograde pathway of urine facilitates the movement of microorganisms from upward along the mucous membrane of the urinary tract. This is also facilitated by increased intrarenal pressure.
The likelihood of acute pyelonephritis increases significantly when several causes are combined, which happens most often.
Complications and Consequences of Acute Pyelonephritis
Complications and consequences of acute pyelonephritis can be very serious and pose a threat to the life and health of the patient.
The danger can be:
- Bacterial shock.
- Apostematous pyelonephritis.
- Kidney carbuncle.
- Kidney abscess.
- Renal papillary necrosis.
- Pyonephrosis of the renal tissues with their purulent fusion.
- Acute renal failure.
Diagnostics of The Acute Pyelonephritis
Diagnosis of acute pyelonephritis most often does not cause difficulties for a nephrologist. This is primarily due to the presence of vivid symptoms of the disease.
Often such patients have a history of chronic diseases or acute purulent inflammation. The clinical picture in acute pyelonephritis is always accompanied by an increase in body temperature to high values and parallel pain in the lumbar region, mainly one-sided. Patients complain of difficulty urinating and changes in the smell and color of urine. It takes on a reddish tint, and dregs are visible in it.
Laboratory tests reveal the presence of protein and bacteria in the urine. To determine the type of infectious agent, a urine culture will be required.
It is also necessary to donate blood for a general analysis. Acute pyelonephritis will be indicated by an increase in ESR and leukocytosis. Identification of the pathogen is possible with the performance of specialized tests.
Plain urography indicates that one kidney is increasing in volume compared to the other.
Excretory urography indicates a pronounced limitation of the mobility of the affected organ, which is noticeable during orthopedics. If the patient has apostematous pyelonephritis, then from the side of inflammation, the excretory function is noticeably reduced, which can be seen during a diagnostic study. A bulging of the kidney contour, deformation of the pelvis and calyces as a result of compression will indicate a carbuncle or abscess.
To assess the structural changes in the kidneys that caused pyelonephritis, it is advisable to perform an ultrasound scan. To assess the concentration capabilities of organs, a Zimnitsky test is used, which will require urine collection.
CT is a method that allows you to exclude or confirm the presence of urolithiasis, as well as to identify possible anatomical abnormalities in the structure of organs.
Treatment of Acute Pyelonephritis
Non-drug treatment is a prerequisite for the patient’s recovery. It boils down to maintaining a sufficient daily urine output. For this, the patient must drink liquid in a volume of 2 to 2.5 liters.
To replenish water reserves, you can use fortified decoctions in the form of fruit drinks, which have antiseptic effects. These are cranberries, lingonberries and rose hips. In addition, the use of diuretic fees is shown.
However, only a doctor can recommend an abundant drink, since it is contraindicated in heart and pulmonary insufficiency, with arterial hypertension. If the patient suffers from disorders of carbohydrate metabolism, then the fluid consumed should not contain sugar.
Drug Treatment of Acute Pyelonephritis
If the patient does not have signs indicating urinary tract obstruction, then antibiotic therapy is urgently prescribed. Its duration can range from 5 days to two weeks. It is preferable to start treatment with parenteral antibiotics. When the symptoms of the acute phase of the disease are stopped, antibacterial drugs are taken orally.
Modern antibacterial agents include:
Fluoroquinolones, which have bactericidal properties. These drugs include: Levofloxacin, Sparfloxacin, Moxifloxacin, Ciprofloxacin, Ciprinol, Ofloxacin, Pefloxacin, Lomefloxacin. These drugs are not used to treat pregnant women during breastfeeding; it is not recommended to prescribe them to children and adolescents during a period of active growth.
Preparations from the beta-lactam group are common aminopenicillins, such as: Amoxicillin and Ampicillin. The therapeutic effect is observed in relation to Escherichia coli, Proteus, enterococci. However, bacteria often develop resistance to drugs of this group and therefore they are recommended to be prescribed for the treatment of pyelonephritis in pregnant women. For all other patients, protected penicillins are used: Amoxiclav, Flemoklav Solutab and Sultamicillin. If pyelonephritis proceeds in a complicated form, then carboxypenicillins are used: Ticarcillin, Carbenicillin, as well as ureidopenicillins: Piperacillin, Azlocillin.
Cephalosporins, which are more often than other drugs used by specialists to get rid of pyelonephritis. These can be: Cefazolin, Cefuroxime, Cefalexin, Cefradine, Cefixime, Ceftibuten, Ceftriaxone, cefotaxime, Cefoperazone, Cefepime.
For the treatment of severe nosocomial forms of pyelonephritis, as well as for serious complications of the disease, aminoglycosides are prescribed: Netilmicin, Gentamicin, Tobramycin, Amikacin.
In addition to antibiotics, doctors use other antimicrobial drugs, which they continue to take even after the antibacterial drugs are canceled. These are nitrofurans: Furazidin, Nitrofurantoin, combined antimicrobial agents: Co-trixomazole, 8-hydroxyquinolines: Nitroxoline. They affect the activity of microbes, the effect on the acidity of urine.
Surgical Treatment of Acute Pyelonephritis
When the use of antibacterial agents and other drugs is ineffective, and it is also not possible to restore the patency of the upper urinary tract by installing a catheter, surgery is necessary. It is indicated when the patient’s condition worsens. Most often, purulent forms of the disease are operated: apostems and kidney carbuncles.
The nature of the operation often remains open until the moment it is performed; the issue is resolved when visualizing the scale of the kidney involvement in the pathological process. Its main goal is to prevent the further development of the purulent-inflammatory course of the disease in the kidney, to prevent the transition of the disease to a healthy organ, to restore the normal outflow of urine.
Physiotherapy for The Treatment of Acute Pyelonephritis
The following techniques are used as physiotherapy procedures: CMV therapy, UHF and electrophoresis.
It is important to pay attention to the dietary habits of the patient with a predominance of easily digestible protein foods.
Diet for Acute Pyelonephritis
Diet for acute pyelonephritis implies adherence to strict rules. Thanks to her, it is possible to stop the pain syndrome, to correct the acidity of urine. Drinking should be plentiful and at the time of the peak of the disease should be at least 2 liters.
When acute symptoms subside, you should switch to a plant-milk diet. Salt in the patient’s diet is limited. It can be consumed no more than 6 g per day, and in case of complicated forms of the disease, it is completely excluded from the diet.
There must be vegetables and fruits with a diuretic effect on the patient’s table: zucchini, melons, watermelons, cucumbers.
The absolute prohibition includes: broths – meat and fish, legumes, smoked meats, marinades, pickles, mushrooms, canned foods, drinks with gases, alcohol, spices and spices.
At the stage of recovery, meat products and fish are gradually returned to the patient’s menu. First courses should be vegetarian. Meals should be fractional, and the methods of processing products should be gentle.