Chronic pyelonephritis and hypertension

Chronic pyelonephritis is one of the first places among the causes of renal hypertension. Often P. proceeds with hypertension, which is observed both at bilateral and at one-way process and sometimes gets malignant course, that is quite progresses rapidly and is accompanied by a significant increase of pressure, especially diastolic, and serious changes in the fundus of the eye. Hypertension may occur during exacerbations of chronic pyelonephritis, but severe and more resistant hypertension develops more often in the latent, hidden, period, which is especially important for clinic P.
The causal relationship between hypertension and chronic pyelonephritis is established by the presence of anti-hypertensive effect of unilateral nephrectomy P. Studying this degree granulation yukstaglomerulyarnogo apparatus (which is the place of education renin kidney) and renin activity in remote kidneys, and to compare these data with the degree hypotensive effect nephrectomy shows not only causal role P. in the pathogenesis of hypertension, but also demonstrates the role it repressing mechanisms in the pathogenesis of this disease.
The inclusion repressing mechanism for chronic P. associated mainly with progressive multiple sclerosis interstitial tissue and organic lesions of the renal vessels of type hyperplastic and productive endarteritis, and necrotizing nodular lesions, which leads to the development of hypertension in repressione mechanism Goldblatt.
However, in earlier periods of development of chronic pyelonephritis organic changes arterioles of the kidneys may not be. Find a violation of renal blood flow (renal ischemia) is this unstable character and, possibly related to the infiltration interstice and renal parenchyma inflammatory elements, and also with the extension of the renal pelvis and cups at exacerbation of the inflammatory process.
In the development of hypertension in chronic P. addition repressing mechanism Goldblatt, can have a value and renovawky mechanism, especially in the later stages of the disease. The inclusion of this mechanism is associated with a significant reduction in renal tissues and a decrease in production by the kidneys depressant substances, which counteract the influence of pressure factors renal and non-renal origin.
Among non-renal factors important role belongs to the hormones of the adrenal glands, particularly mineralocorticoid aldosterone, which could have a hypertensive effect by influencing the exchange of electrolytes. Secondary aldosteronism, revealed in patients with chronic pyelonephritis, accompanied by hypertension.
Acute pyelonephritis is not accompanied by hypertension.
The diagnosis of chronic P. in patients with hypertension is quite complex, as it is mostly chronic P., accompanied by hypertension, is latent. For patients with chronic P. with hypertension relatively young age (most of the patients up to 40 years).
For the diagnosis of chronic P. hypertension great importance specific methods of research: methods Kakhovskogo - Addis; special color of urine for Sternheimer - Malunu and bacteriological examination of urine.
Diagnosis of bilateral chronic pyelonephritis in patients with hypertension contribute a total of studies of the kidneys. In connection with the preferred and earlier defeatist the distal tubules with chronic P. there is a relatively early tendency to polyuria and disturbance of the concentration function of the kidneys. A separate study of the kidney, particularly when using radioisotopes (renography, scanning), showing the asymmetry of the two functions of the kidneys, has an important, though preliminary, the value in the diagnosis of chronic P., particularly one-sided.
Crucial diagnostic value have rentgenograficheskie methods (intravenous and retrograde pyelography), which reveal the characteristic of chronic pyelonephritis changes of kidney and uneven kidney damage. In addition, for the diagnosis of chronic P. also important method of puncture biopsy of the kidneys, which can detect specific chronic P. histological changes.
Detection of chronic P. in patients with hypertension is of great practical importance, as it shows the path of rational therapy. If one-way process, causal therapy of hypertension is nephrectomy, which gives a positive result with timely operations in approximately 80% of cases. The earlier produced nephrectomy, the more chances gipotenzivne, as long hypertension secondary causes changes in the nervous system, regulating blood pressure, and in the vessels of the second intact kidneys (arteriolosclerosis).
Of great importance as a pathogenetic therapy of hypertension in chronic pyelonephritis, in particular bilateral (especially in the period of exacerbation), has anti-infective therapy, i.e. treatment furadonin, sulfa drugs and antibiotics.
The treatment is often hypotensive effect, which once again underlines the dependence of hypertension from infectious inflammatory process in kidneys.
In the absence of etiological therapy (in the case of bilateral wrinkling) treatment is modern hypotensive means.