Inflammation of the renal pelvis (pielit)

Inflammation of the renal pelvis is caused by microorganisms that fall into them hematogenous, lymphogenous or upward (urinogenny) way. In the blood stream infection gets into the renal pelvis often in acute General infection: when flu, sore throat, abdominal typhoid, and so on, but also the chronic inflammation of any authority (tonsils, carious teeth, genitals and other) can serve as a source of pyelitis or pyelonephritis. The infection is particularly easy affects the mucosa of the pelvis in the presence of pathological process in the kidney or ureter stones, the pyeloectasia, stricture.
Lymphogenous by disease-causing microbes get into the sack most of the intestines. The lymphatic system of the intestine, especially thick, widely anastomositis on the lymphatic system, kidneys and ureter, more to the right, where there is a direct link lymphatic vessels of the colon with vessels of the renal pelvis. This explains contact E. coli in the urine by constipation, diarrhea and gastrointestinal tract. Through the lymph system infection penetrates into the pelvis also of the lower urinary tract, such as inflammation of the bladder (cystopyelitis).
Lymphogenous by the infection can enter the pelvis also of the genital organs, such as inflammation of the prostate (prostatitis), testicles (orchitis), or seminal vesicle (vesicles). Quite often observed pyelitis on the soil of lymphogenous of introduction of infection, in most cases colibacillosis, from the hymen tears after first intercourse (deflorazione pyelitis).
The infection can spread urinogenny path, i.e., the gap in the ureter, spasmodic contraction of the bladder, accompanied antiperistaltic reductions or atony of the ureter. The mucous membrane of the ureter may not be involved in the process.
Pathogens pielita or pyelonephritis are of different microorganisms. Most often, about 70% of the cases, when pielit found in the urine of Escherichia coli; following frequency place aureus, and then Streptococcus. Often flora is mixed.
Pathological anatomy. The mucosa of the pelvis bright red, velvety, swollen, with multiple small echinosoma and fibrinous-purulent overlays. In chronic diseases it is gray, thickened. In this state is the mucous membrane of the cups. In the inflammatory process always involves renal papillae and lower segments of direct (collectively) tubules.
Microscopically seen a sharp dilation of blood vessels, round-cell infiltration of the mucous and submucous, desquamation of the epithelium. In chronic cases are formed of small cysts and polypoid expansion of the mucous membrane, in some cases occurs metaplasia of the transition in multi-layer flat epithelium with keratinization.
Pyelitis can be one - or two-way. The latter usually occurs when hematogenous infection.
The symptomology. The main symptoms of acute pielita reduced to the triad: a high fever, pain in upper quadrant and the lower back, the presence of pus in the urine.
The temperature usually rises suddenly, reaching up to 39-40°, often with spectacular chills. Broken General condition. No appetite, patients complain of General fatigue, thirst, and sometimes nausea, bloating, constipation. Language dry, lined. The overall picture can cause suspected typhoid fever, malaria, appendicitis. High fever that lasts for 7-10 days, and then decreases to normal. For pielita characterized by political, superiorcasino, less critical temperature drop.
Pain in upper quadrant and the lower back can be quite significant, but unlike renal colic they have a constant, and not paroxysmal character.
Urination at pielit, as a rule, is not disturbed. When pielit, who joined the cystitis (cystopyelitis), dysuria precedes pielit, and then accompanied him. When complications pielita inflammation of the bladder (pielotsistit), dysuric disorders occur in the course of the illness.
Urine in acute pielit contains a lot of cells, with the exception of 1-2-th day of the disease (stage catarrhal inflammation), and in a flash of temperature caused difficulty outflow of urine from the sick kidneys, when blood in the urine little or none. Protein does not exceed 0,1-0,3% respectively. Significant albuminuria (above 1 per thousand) is suspicious on pyelonephritis or epistemology jade.
Reaction urine depends on the nature of the pathogen: when E. coli she sour, when aureus is slightly acidic or alkaline.
For acute pielita favorable. 7-10-day sickness temperature normalized, leukocytes disappear from the urine comes recover without residual effects on the kidney and kidney.
In chronic pyelitis temperature is generally low or normal, occasionally rising. Pain dull, weak. Urine contains leukocytes in different quantities. Chronic pyelitis as an independent disease is extremely rare. If acute pyelitis takes a strong character, this indicates the presence of another disease that supports a protracted course of the disease. This may be due to the stone pelvis or ureter, hydronephrosis, atony of the urinary tract, the transition pielita in pyelonephritis, Pioneros and pustular (epistemology) jade. Resistant, resistant to ordinary treatment of chronic pyelitis causes TB is suspected kidney.
Diagnosis of acute pielita is based on the triad of back pain, high temperature and pyuria. In the acute phase of illness instrumental exploration - cystoscopy, catheterization ureter is contraindicated. It can contribute to a deeper introduction of infection in renal parenchyma and generalization of infection.
If within 2-3 weeks phenomena pielita does not subside, it is shown cystoscopy, the study of the functional ability of the kidneys through indigocarmina samples, catheterization ureters and urine analysis, separately obtained from both kidneys. The presence of pus in the urine obtained from the pelvis, under normal allocation of Indigo Carmine allows you to diagnose pyelitis.
Differential diagnosis pielita simple. A normal result indigocarmina samples allows to differentiate pyelitis from pyelonephritis and Pioneros. Pustular jade and carbuncle kidney to the clinical course is similar to the acute pielit, but they are in the initial stages proceed without piuria, and later accompanied by impaired renal function and pronounced changes in pyelogram.
Treatment. In acute pielit shown in bed, you need to make regular chair (enema, light laxatives). Appointed excessive drinking, table shared with the exception of the hot and spicy food. As analgesic recommended heat on the lumbar area. Medical treatment was to appoint bactericidal and bacteriostatic drugs. The salol (0.5 g 3 times a day), methenamine (in the same dosage or intravenous 10 ml of 40% solution) retained their value to individual cases, but with the advent of sulfa drugs and antibiotics are used less frequently. Urotropine acts only in an acid environment, and salol - in alkaline. Sulfonamides (sulfathiazole, sulfadiazine, resultan 0.5 g 4 times a day) more effective, but it is best to start treatment with antibiotics, and in combination with sulfonamides. In the appointment of the latter should be sufficient fluid intake to avoid anuria on the grounds of blockage of the tubules of the kidney and renal pelvis crystals of sulfonamides.
Of antibiotics prescribed penicillin, streptomycin, syntomycin or chloramphenicol (analogues of Chloromycetin and chloramphenicol from Streptomyces venezuelae), which currently are synthetically, biomitsin (analogue of aureomycin of Actynomyces aureofaciens), terramycin (from Streptomyces rimosus). Penicillin is most effective when coccal flora, streptomycin - intestinal Bacillus. The syntomycin, levomicetin biomitsin, terramycin are almost similar. Due to the fact that they possess a wide spectrum of microflora, it can be assigned with any pathogens pielita.
Thus, the choice of antibiotics can to a certain extent come from morphology urinary infection detected by urine culture. A more precise answer defines the sensitivity of microflora to various antibiotics, although the sensitivity of microbes on a nutrient medium and in the body is not always the same.
Penicillin appoint 200 000-300 000 IU 2-3 times a day, streptomycin - 0.5 g 2 times a day intramuscularly. The syntomycin and chloramphenicol appoint 0.5 g 4 times a day, biomitsin and terramycin - 200 000 IU 4-5 times a day per OS. In recent years in urinary infections with success used drugs group nitrofuranov, in particular domestic product furadonin, 0.1 g 3 times a day.