Acute pyelonephritis

Clinical picture, diagnosis and treatment
For acute pyelonephritis characteristic signs of severe infection with a deep intoxication and local symptoms. The last in the secondary pyelonephritis more pronounced than in the primary hematogenous. The disease begins with a high fever (up to 40 degrees), chills, heavy pot. Exacerbated pain in the affected kidney. Pain is not iradionet in iliac region, accompanied by the muscles of the lumbar region. Especially sharp pain celebrated palpation in costovertebral corner. Due to the rapidly growing intoxication condition of patients is rapidly deteriorating.
Usually 3-5-day sickness felt tight and painful infiltrate in the lumbar region. In the first days of the disease is marked leukocytosis, may be perverted response disappearance leukocytosis with clear deterioration of the patient. This terrible symptom is usually combined with euphoria.
In spite of different ways of introducing infection in the kidney, clinical course of the disease is more or less similar and can be subdivided into two phases. In the first phase during the week of the disease characterized by strong reaction to the inflammatory process in the kidneys. In the second phase of the disease is more severe and is accompanied by infringement of function of kidneys, liver and other systems.
The diagnosis. Of great importance in determining the localization of the parties of the disease and the degree of increase of the inflammatory process in the kidney has a comparative leukocytosis (take blood from the skin of the lumbar region on the right and left and finger). When hematogenous acute pyelonephritis a urine sample is usually not sets of changes in it. Peoria characteristic for patients with urinogenny form P. acute P. usually have more than 100 000 of bacteria in 1 ml of urine. If the urine is not determined by a large number of bacteria, but there are clinical signs of acute P., it should be assumed violation of patency of the ureter.
For diagnosis widely used x-ray examination. On the overview picture one of the kidneys is slightly enlarged (on average 1.5 cm in length and width) and around it is determined by a halo of exhaustion. On the excretory programme no shadow of the urinary tract with the affected side or filling their contrasting substance is greater than with a healthy side. Acute pyelonephritis, manifested pustular jade or carbuncle kidneys, often accompanied by a jet edema perinephral fatty tissue and renal sinus, and sometimes diffuse spreading of inflammatory process in the retroperitoneal fat. This leads to the limitation of mobility of kidney when breathing that can be recognized by excretory urography or retrograde pielografii produced in the act of respiration. Overview the x ray sets uncertainty and absence of the path of lumbar muscles, sometimes diffuse shading on the place of the kidney and a small scoliosis-concavity in the affected side.
Treatment. In the initial stages of the disease good effect can be expected from the reception of patients within 2-3 days medicine containing the amidopirina and hexamethylenetetramine (Amidopyrini 2,0; Нехаmethylentetramini 3,0; Aq. destill. 200,0; 5 times a day for 20 ml), and in the next 2-3 days sulfa drugs. In cases where a painful process is not stopped, patients should enter antibiotics based on indicators of antibiogram. If the severity of the disease increases that there is often extremely virulent and drug resistant flora or obstruction of the ureter, it is necessary surgical intervention: pyelostomy, nephrostomy, decapsulate kidneys, nephrectomy (see Kidneys, surgery).