Pyelonephritis

Pyelonephritis is a nonspecific inflammatory process renal parenchyma, cups and pelvis (pielit). In the urine of patients with pyelonephritis often find Escherichia coli, Proteus, Staphylococcus.
Distinguish between acute and chronic pyelonephritis. As the one and the other are divided into primary and secondary. Primary pyelonephritis include hematogenous and secondary forms of pyelonephritis, which are based on organic and functional abnormalities in the urinary tract that violate outflow of urine (stones, stricture, tumors, and so on). On the routes of infection are distinguished pyelonephritis is an ascending (urinogenous) and downward, recurrent (hematogenous, lymphogenous). Hematogenous pyelonephritis, and lymphogenous arise when skidding bacteria in the blood stream (respectively lymph from the infection of any Department of the organism. When pyelonephritis is an ascending infection first penetrates the bladder wall and from there the ureter, up to the kidney. For pathological anatomy of acute pyelonephritis typical local changes in which are lymphocytic and lymphoid infiltrates, mainly around intralobular vessels of the kidney.
In chronic pyelonephritis inflammatory process is distributed under the interstitial tissue of the kidney, affecting mainly tubular system (see Kidneys).
Acute pyelonephritis is manifested high fever, chills, drenching sweat, pain in the area of the affected kidney. Palpation determine pain in costovertebral corner, positive symptom of Pasternatskogo (see Pasternatskogo symptom). On the 3rd to 5th day of the disease can also be noticed increased painful kidney. In the first days in the blood is marked leukocytosis, in the future against the background of severe intoxication leukocytosis can disappear.
The diagnosis of acute pyelonephritis is based on objective research of the patient, the examination of the urine and x-ray examination. About the third day of the disease appears Peoria (pus in the urine), bacteriuria (more than 100 000 in 1 ml of urine). To distinguish primary from secondary pyelonephritis, produce chromolithography (see Cystoscopy). Lack of selection of Indigo Carmine from the mouth of one of the ureters indicates the existence of obstacles to the flow of urine and, consequently, on the presence of secondary pyelonephritis. Review on an x-ray picture , you can see that the affected kidney increased. On the excretory programme (see Urography) at primary pyelonephritis is observed or normal filling by contrast agent of the urinary tract, or fill them with the affected side is later.
Treatment. When the primary P. appoint strict bed rest, antibiotics, heavy drinking: the kidney tea, mineral water, fruit juices. With secondary pyelonephritis shown catheterization of the ureter for the establishment of urine outflow. With the failure of these measures to perform surgery decapsulate the kidneys, lithotomy or nephrostomy.
Chronic pyelonephritis appears dull pain in the lumbar region, headache, malaise, and thirst; may increase blood pressure. Sometimes there subfebrile temperature, polyuria, accelerated ROHE, pyuria and bacteriuria. The diagnosis of chronic pyelonephritis difficult.
For the diagnosis of great importance is the determination in urine so-called active cells. Review on an x-ray picture, you can see the small size of the kidneys. On the excretory programme determined by the decrease of secretion of the ability of the kidneys, deformation of cups, reduction and disappearance of papillae. When angiography caliber renal vascular affected kidney towards healthy reduced due to the obliteration of small vessels.
Data scanning (see) allow you to set the amount and location of sclerotic foci in the kidney.
The observed sometimes in pregnant pyelonephritis is often exacerbation of chronic current previously undiagnosed pyelonephritis during pregnancy are created conditions conducive to violations of the outflow of urine (an increase of the uterus, compression of the ureters). When Troubleshooting pay attention to the data of the anamnesis, the analysis of urine, the indices of functional state of the kidneys.
The primary treatment of chronic pyelonephritis is a long time (months) antibacterial therapy, secondary pyelonephritis is to restore the normal flow of urine and subsequent prolonged antibiotic therapy: antibiotics, sulfa drugs, drugs nitrofuranovye series (furadonin, furazolidone, furagin). For the last resistance of microorganisms occurs slowly, and so you may intermittently to apply for months.
In chronic pyelonephritis, complicated urolithiasis, removal of stones, violate outflow of urine, contributes to the success of antibiotic therapy.
In chronic pyelonephritis shown Spa treatment in Zheleznovodsk, Truskavets.
Complications of chronic pyelonephritis: nephrogenic hypertension, chronic renal failure.
For the prevention of pyelonephritis recommended rehabilitation of all infectious foci in the body, elimination of the causes leading to the violation of the outflow of urine, body training (see Hardening).

Pyelonephritis (pyelonephritis; from the Greek. pyelos - pelvis and nephros - Bud) - nonspecific inflammatory process in the renal pelvis, cups and renal parenchyma with predominant lesion of the interstitial tissue. P. - the most common form of kidney disease. P. may lead to hypertension (see below) is the most common cause of kidney failure. It is established that pyelitis is not a stand-alone inflammation of the renal pelvis and is a disease with obligatory participation in this process renal parenchyma, so it is seen as P.

epistemology jade
Fig. 2. Epistemology jade.

P. causes death from uraemia 1/3 of cases. An increase in the incidence of P., manifested in the form apostatizing (pustular) jade (printing. Fig. 2), carbuncle kidney and papillary necrosis.
Epistemology jade is a purulent metastatic affection of kidneys with predominant location of purulent foci in the cortical layer. The penetration of the infection to the kidney is mainly hematogenous route (see Kidney, inflammatory diseases).
There are acute and chronic P. Chronic P. divided into primary and secondary. Primary P. otherwise referred to as uncomplicated and secondary complicated.
Secondary P. include those forms, which are based on organic and functional processes in the urinary tract that violate the passage of urine. Secondary P. observed in 84%, and primary - in 16% of cases.
Increasingly ill women, especially young. Men P. observed mainly in old age.


Pyelonephritis - simultaneous disease of the renal pelvis and the kidneys. In this disease in inflammatory process that involves not only prilagaetsya area of renal parenchyma, but the substance of the kidney, particularly its interstitial tissue, or diffuse alopecia. Pyelonephritis been much heavier than pyelitis, the consequences are much more serious.
Pyelonephritis occurs as a result of introduction of the infection to the kidney hematogenous or ascending path of the pelvis. The process can be one - or two-way. The causative agent is predominantly E. coli, less aureus.
When pyelonephritis hematogenous origin infected in the first place cortical layer (balls), from here goes to the brain layer kidney and forth on the renal pelvis.
More often pyelonephritis develops an ascending path. The stagnation of urine in the renal pelvis plays a major role. The infection spreads from the pelvis to the kidney due to the increase vnutriorgannogo pressure, which leads to retrograde introduction of infection in renal parenchyma by palavinskas, palatovelars and interstitial (bilolypetska) reflux.
Sometimes there is a stagnation of urine, which periodically replaced more or less satisfactory drain. In such cases, pyelonephritis takes the intermittent nature.
Under normal or a little disturbed evacuation of urine from the renal pelvis pyelonephritis may years chronically leaking, little is being reflected on the General condition of the patient, appearing only in occasional presence in the urine of leukocytes, sometimes in small quantities. In the terminal stage of the disease in the sediment of urine may be missing leukocytes.
However, weak current pyelonephritis, chronic inflammatory process leads to a gradual sclerosis renal tissue and education wrinkled kidneys, sometimes with necrosis of renal papillae (papillitis necroticans).
In the basis of necrotic papillae lies ischemia of papillae on the soil spasm of blood vessels and increased vnutriorgannogo pressure. Necrosis of renal papilla is particularly common when pyelonephritis in patients with diabetes because of the reduced resistance and favorable conditions for the development of microorganisms.
When hematogenous infection acute pyelonephritis proceeds. Pyelonephritis is an ascending often takes chronic or intermittent nature, such as stone, an adenoma prostate, bladder diverticulum, congenital atony of the urinary tract.
In acute pyelonephritis, kidney increased in size, on the surface it visible regions of red or bluish-red colour. In the context of the kidney is worthwhile, with multiple hemorrhages. Microscopically found leukocyte infiltration in the form of chains, along the small canals and between the pyramids. In interstitial tissue multiple miliary abscesses. In acute cases, there purulent fusion of renal tissue: miliary abscesses merge to form a larger abscesses in the brain and cortical layers. Purulent cavities connected to the pelvis or isolated from it. Pyelonephritis enters Pioneros.
The clinical picture of acute pyelonephritis is manifested hectic temperature with a spectacular chills and drenching sweat, General weakness, a complete lack of appetite, low back pain, thirst, nausea. Language dry, crimson red. Symptom of Pasternatskogo positive, often probed increased kidney, wall over her belly tense (muscle protection). Palpation painful. The white blood cell count increased leukocyte formula shifted to the left, there limfopenia.
Albuminuria in most cases does not exceed 10/00, as the inflammatory process occurs mainly in the soft tissues of the kidney. The more involved in the inflammatory process parenchyma, the higher albuminuria - sometimes up to 3 PPT.
During cystoscopy is often seen as one or both ureters allocated cloudy with cereals urine. The Indigo Carmine is allocated for acute pyelonephritis with considerable delay or not allocated quite unlike pielit, in which paint is allocated on time.
Chronic pyelonephritis clinically manifested subfebrile temperature, sometimes falling to normal and periodically rising up to 39-40 degrees. Striking a General depression, pale skin. Bad appetite. Persistently or with intervals holds pyuria and albuminuria. With bilateral pyelonephritis gradually increase the effects of kidney failure: Hypo - and isosthenuria, progressive increase of residual nitrogen, indican and creatinine in the blood. Chronic pyelonephritis is one of the most frequent causes of uraemia and deaths.
In addition, the ischemic kidney caused by inflammation and squeezing her blood vessels, increases blood pressure. Renal form of hypertension is often a consequence of chronic pyelonephritis, even a unilateral.
Treatment. In the early stages of the disease should first eliminate the root cause of the disease is an obstacle to the flow of urine from the kidneys. Depending on the cause of the disease may require catheterization of the ureter, peelo - or ureterolithotomy, removal of prostate adenomas and so on, the sooner restored free outflow of urine, the more chances to suppress the infection with antibiotics, furadonin, sulfonamides and other antibacterial drugs.
In the absence of indications of activities and with partial preservation of renal parenchymal, as well as with bilateral acute pyelonephritis shown draining the kidney by imposing renal fistula (nephrostomy). Exposing the kidney on the lateral edge, not bringing it to a wound, an incision of fibrous capsule 1-2 cm in diameter and stupid conducted by forceps through the renal parenchyma within the pelvis; educated through the channel in the pelvis enter drainage and fix it with catgut to the fibrous capsule kidneys, silk against the skin. In addition, to cut the kidneys fail second rubber tube to drain perinephral fiber in case flowing back urine.
When advanced purulent melting with the atrophy of the renal parenchyma shows the removal of the kidney - nephrectomy.
Lumbar oblique vnebrachnyi a cut from XII ribs to the point lying on 3-4 cm in front of spina iliaca anterior superior, reveal kidney, stands out from the growths and take in the wound. Tied up and cross the ureter and vascular leg. A kidney removed. To kidney box down the drain tube gauze and graduate, after that the wound is sutured (Fig. 70). Treatment with massive doses of antibiotics is required before and after the operation.

Fig. 70. Removal of the kidney (nephrectomy).
a - tubal ureter; b - ureter is crossed; the imposition of ligatures on renal stem; in - crossing renal legs.

Prevention
For primary prevention of pyelonephritis necessary liquidation in the body infectious foci of potential sources hematogenous drift of microorganisms in the kidney; in secondary - timely treatment of those urological diseases, which is complicated by P., eliminating all the causes that lead to the violation of the outflow of urine from the upper urinary tract. For the prevention of calculous P. you earlier surgical interventions on the urinary tract for the extraction of stone, and if infection - drainage pelvis (nephrostomy). From the positions should be expanded indications for surgical removal of kidney stones and especially of the ureter.