Pyelonephritis in pregnant women

Pyelonephritis sick from 0.6 to 10% of all pregnant women. It is possible that the frequency of the disease is higher than indicated by the authors, as normally considered only the most severe cases requiring hospitalization, and outpatient patients with a chronic form of the disease are run without. Pyelonephritis is observed more often in pervoverhovnyh. The disease is detected mainly in the second half of pregnancy (5-6 months). Affected in equal measure one or both kidneys. At one-way process dominated by the defeat of the right kidney.
P. rarely occurs for the first time during pregnancy. More common is the exacerbation of chronic pyelonephritis, which took place before pregnancy or proceeding latent and not diagnosed before it happens. When pregnancy are especially favorable conditions for such deterioration.
In healthy pregnant significant expansion of the renal pelvis and upper two thirds of the ureters above their intersection with iliac arteries. The enlargement process begins with early pregnancy, especially progresses from the second half, reaching a maximum at 7-8 th month. pregnancy and ends shortly after birth. In addition to the expansion of the urinary tract during pregnancy violated tone and motor abilities ureters. There is a kind atony of the urinary tract, which slows the current stagnation of urine and its in the renal pelvis. The weakness begins to develop from 4 months. pregnancy and stand up to the birth. In pregnant women as well as lowering the tone of the bladder and its capacity increased.
Assume that reduction of the tone of the urinary tract during pregnancy is the result of complicated neurohumoral and endocrine effects. Especially important role is attached to hormones yellow body cancer (progesterone), and human chorionic gonadotropin. The expansion of the renal pelvis and ureters, slow current urine of pregnant women are favorable moments for subsidence and implementation in urinary tract infections, and acute exacerbation of chronic pyelonephritis.
The most common cause P. during pregnancy is E. coli. The second most frequently occupied by microbes coccal group - Staphylococcus and less streptococci. Very often flora is mixed. Ways of infection in the kidney are the same as in other forms of P.
In most cases, pyelonephritis during pregnancy begins abruptly, with fever, high temperature, pain in the lumbar region and General malaise. Rarely, the disease develops slowly, and it is preceded by General weakness, headache, back pain and dysuric phenomena. Urine purulent, muddy, contains a large number of leukocytes (Peoria)are leached erythrocytes, single hyaline cylinders and a small amount of protein (below 1% respectively). Diuresis reduced. In the blood, leukocytosis and left shift in leukocytal composition, increase band neutrophils, limfopenia, accelerated ROHE. In a few days under the influence of the treatment of these phenomena are fading, increases diuresis, improves the General condition, the temperature decreases and the decrease of pain in the lumbar region, but often there are relapses of the disease, which terminated only after the delivery.
Chronic pyelonephritis appears dull low back pain, headache, sometimes hypertension and retinopathy. History is transferred mattery-inflammatory processes in the urinary tract. Functional disorders of the kidneys is manifested by a reduced ability concentrate, polyuria, nocturia, mild proteinuria. Pyuria and bacteriuria or constant or alternating.
The diagnosis of acute forms of P. easy. To diagnose chronic P. much more difficult, the more so during pregnancy should be avoided x-ray examination. It is necessary to take into account the data of the anamnesis, urine analysis, indices of functional state of the kidneys through the clearance methods and data in blood pressure.
Forecast for pyelonephritis in pregnant favorable. In most cases leads to recovery. In rare cases due to high temperature and intoxication occurs spontaneous abortion.
Treatment, especially at the acute disease, should be performed in a hospital. Recommend bed rest. At one-way process - the situation on the healthy side to stop pressure gravid uterus on the ureter and thereby improve the outflow of urine from the sick kidneys. For two-sided process recommended several times a day to take a knee-elbow position on 15 - 20 minutes it is Necessary to regulate bowel function using laxatives and enemas. Antibiotics are prescribed depending on the data of antibiogramme within 5-7 days: penicillin (coccal flora), 100 000 IU every 4 hours, streptomycin (E. coli) 0.5 g 2 times a day or antibiotics with wide spectrum of activity (chloramphenicol 0.25-0.5 g 4 times a day, aureomycin 0.1-0.25 g 4 times a day). Recommended heat in the lumbar region (heating pad or a warm compress), diathermy.
Many authors are recommended to start the treatment with the use of sulfa drugs (resultan, etazol 1 g 2-3 times a day for 4-5 days) or with drugs group nitrofuranov (furadonin on 0.05-0.1 g 3 times a day) and only in the absence of the effect of antibiotics.
Recommend a diet with the exception of the hot and spicy food, meat soups, grilled meat. Proteins in the form of cooked meat, fish, fresh cheese. Very useful vegetables, fruits, melons, drink plenty of water to 2 liters per day, especially on an empty stomach. If no effect on the treatment applied catheterization ureters order drainage renal pelvis.
In severe, prolonged, despite of the applied treatment, cases of pyelonephritis, particularly when complications of pregnancy, late toxicosis (nephropathy), have to resort to abortion or premature delivery.
Prevention P. pregnant - timely elimination of bacteriuria appropriate treatment.