Ср, 21 сен 2016 Автор: врач-терапевт ЕленаKornilov
Pyelonephritis is a non-specific infectious inflammatory.
kidney disease in which the renal pelvis is affected,
tubular apparatus and parenchyma.
In women, the disease is five times more common than in men.
This is due to the anatomical structure of the urethra:
it is wide and short (its length in women is about two
centimeters), which allows infection to quickly reach the urinary
bubble and spread higher. In addition, the urethra women
is located near the anus and the entrance to the vagina, from where
urethra and pathogens enter the disease. Have
male urethra is long, narrow and convoluted – this
inhibits the spread of bacteria.
Pyelonephritis is a serious illness, its better
warn than cure. Makes 30% of all diseases.
genitourinary system, i.e. the most common due to the fact that
often completely asymptomatic, without breaking the general
conditions. Now nephrologists are more involved in the treatment of pyelonephritis,
than therapists. В течение последних 10 лет quantity пиелонефритов
decreased 10 times.
Pyelonephritis classification:
1 – primary (acute);
– secondary (chronic);
2 – uncomplicated (pyelonephritis occurs in women with normal
urinary tract and with normal renal function);
– complicated (pyelonephritis develops on pathologically
altered urinary tract (cysts, etc.) and impaired function
kidney).
Both both kidneys and one of them can be affected.
Contents
Pyelonephritis in women – causes
Causes of pyelonephritis in women is conditionally pathogenic
microflora, which is normally found in the human body.
Most often pyelonephritis is caused by E. coli – 90%
cases of staphylococci, Proteus, enterococci and Pseudomonas purulent
wand. Infiltration of the pathogen into the kidneys is associated with urine reflux
(urine reflux) due to overflowing bladder due to
obstructed urine outflow from stones, structural anomalies,
increased intravesical pressure. Have женщин в связи с
the anatomical structure of the urethra and its location in
close proximity to the anus is frequent
an upward spread of infection
by.
There is a descending (hematogenous) path of pyelonephritis
in the presence of chronic infection in the body.
Predisposing factors for pyelonephritis in women
are:
– obstruction of the urinary tract (in its background may develop
hydronephrosis);
– existing bacteriuria (may be asymptomatic);
– pregnancy
– advanced age (often polymicrobial flora is planted; play
role living conditions).
To the factors provoking the development of pyelonephritis in
women include:
– hypothermia;
– stress;
– reduced immunity;
– overwork;
– comorbidities (diabetes);
– various diagnostic and therapeutic interventions on organs
urinary system (bladder catheterization in almost
all cases leads to pyelonephritis);
– congenital anomalies of the development of the organs of the genitourinary system;
– prolapse of the uterus;
– spinal cord injuries.
Have женщин пиелонефрит чаще всего бывает вторичным — возникает на
background of existing chronic diseases.
Pyelonephritis in women – symptoms
Pyelonephritis is an insidious disease, it can be acute and
chronically.
1. The acute course of pyelonephritis has pronounced
symptoms:
– high temperature, chills, palpitations;
– pain in the projection of the kidneys or in the side;
– frequent urination;
– small swelling under the eyes and legs;
– manifestations of intoxication: nausea, vomiting, severe weakness,
fatigue, unmotivated fatigue;
– apathy, irritability;
– changes in general clinical analysis of blood (leukocytosis,
increased ESR), in general clinical analysis of urine (the presence of bacteria and
leukocytes).
2. Chronic pyelonephritis in women
characterized by less severe symptoms, erased clinical
picture, calm blood (no signs of inflammation), in urine –
большое quantity лейкоцитов, а бактерий может и не быть. With
chronic pyelonephritis in women has no pathognomous signs.
Symptoms of chronic pyelonephritis in women may
all or some one or two of
listed:
– pain;
– dysuric;
– urinary;
– arterial hypertension.
1. Что касается болевого синдрома, необходимо
to know that there are no pain receptors in the kidney – they are present in the fibrous
capsule, and its stretching (with an increase in kidney size)
leads to pain. Therefore, pain in acute pyelonephritis
intense and painful, difficult to bear because
macroscopically, the kidney can increase significantly in volume. With
purulent forms, purulent foci occur, causing an increase in
pains.
Withчиной длительной боли при хроническом пиелонефрите у женщин
is the occurrence of adhesions formed between the fibrous capsule
and a fatty kidney capsule. More often asymmetrical pains, on the one hand
– more; and they can occur on the opposite side
defeat: the process on the right, and pain – on the left. This is due
a cross of innervation at the level of the pelvic plexus. Therefore, on ultrasound
need to look at both kidneys. The symptom of Pasternack may be
positive not only with pyelonephritis, but also with cholecystitis,
pancreatitis.
2. Almost every third woman has signs.
infections of the lower urogenital system –
цистита: частые мучительные позывы на мочеиспускание даже
with an empty bladder, cramps and burning during urination,
appearance of blood in the urine, change in color and transparency of urine
(dark, muddy), sometimes with a characteristic sharp smell of fish.
Dysuric syndrome – transient: as inflammation decreases
He’s leaving.
3. Urinary syndrome:
– proteinuria – in the urine protein can be detected; quantity
protein – less than 1.0 g / l; if it is more than 1.0 g / l, which is not typical
for pyelonephritis, pyuria (abscesses) or
diabetic nephropathy, possibly in combination with pyelonephritis,
pyelonephritis in combination with glomerulonephritis;
– leukocyturia: normal in women in the urine – up to 8 in the field of view
leukocytes, (in males – up to 4 p / zr); if leukocytes are more than 8 in
p / sp – this is leukocyturia, indicates the presence of inflammation;
– microhematuria is the presence of fresh unchanged red blood cells
up to 40% (more than 40% of erythrocytes is observed in diabetes mellitus,
ICD, urinary diathesis, trauma, nephroptosis);
– bacteriuria – in case of urine biopsy, the type of pathogen is determined and
microbial number: normally microbial number is up to 105, if 105 and more –
It is urgent to begin treatment.
Pyelonephritis is dangerous for its severe
complications:
– abscess (cavity with pus in the parenchyma of the kidney);
– sepsis (severe condition that develops when hit
infections in the blood, can end lethal);
– chronic renal failure.
Diagnosis of pyelonephritis includes:
– general clinical blood and urine tests;
– bacteriological urine culture;
– Kidney ultrasound (estimated kidney deformity and changes in renal
pelvis).
In more severe or incomprehensible cases, a urography is performed or
CT, MRI of the kidneys, if necessary – radioisotope diagnostics for
assessments of the state of the parenchyma.
Pyelonephritis in women – treatment
Treatment of pyelonephritis in women complex, tactics in the treatment
acute and chronic course is somewhat different.
Treatment of acute pyelonephritis begins with the appointment
symptomatic drugs due to severe clinical and severe
over. Then the pathogen is eliminated. First
several days with acute pyelonephritis require bed rest
(duvet mode), i.e. horizontal position and warm.
Be sure to drink plenty of water.
Treatment of chronic pyelonephritis immediately begin with exposure
on the cause of the disease. For this purpose, apply
broad-spectrum antibiotics (pending results
bakposeva) and uroantiseptics. Antibiotics are prescribed empirically,
effect occurs in half of the patients. Further, upon receipt
bakposeva results, treatment is adjusted.
The main group of antibiotics relevant in the treatment of
pyelonephritis in women, these are aminopenicillins, protected
клавулоновой кислотой: они менее токсичны для почек, чем
the rest, and have a wide spectrum of action. Further
possible replacement for an antibacterial drug of another group with
taking into account the result bakposeva. From others, except protected
penicillins, used cephalosporins 3 – 4 – th generation
(ceftriaxone, cefipime, cefotaxime, etc.), fluoroquinolones (Staflo,
Levolet), macrolides (azithromycin, spiramycin, etc). Effectively
the use of nitrofurans (Furamag, Monural). A course of treatment
antibiotics is 7 to 14 days. Antibiotics are usually
appointed in tablet form, because after absorption from
intestinal remains their high concentration. Parenteral
the introduction is indicated for signs of intoxication: nausea and
vomiting.
If after 48 – 72 hours there is no effect, computer
tomography of the abdominal cavity to exclude phlegmon or abscess.
Bacteriological urine culture is also repeated and determined
pathogen sensitivity to antibiotics. If at
additional examination revealed suppurative process
surgery is required.
The big problem is the development of sustainability.
microorganisms to the antibiotic. Currently not allowed
prescribe penicillin group drugs (ampicillin and others), because
E. coli – the main causative agent of uncomplicated
pyelonephritis, sown in 90% of cases – has a natural
resistant to penicillins. Also can not be used to treat
pyelonephritis 5 – NOK and Biseptol!
Fluoroquinolones are prescribed empirically.
Fluoroquinolones I – II generations are effective in chronic
pyelonephritis, mainly caused by E. coli.
In addition to antibiotics are used:
– anti-inflammatory drugs (movalis, diclofenac,
paracetamol);
– multivitamins;
– fortifying agents;
– adaptogens (Eleutherococcus, ginseng).
With proper diagnosis and timely launched adequate
treatment of prognosis for pyelonephritis favorable. Woman is considered
healthy, if after discharge for a year is not determined
pathogen in the urine.
