Chronic pyelonephritis after the reduction of stone from the ureter

The study of remote results endovascular remove stones in ureter showed that pyelonephritis were the most frequent and dangerous complication. The penetration of infected urine in the kidney occurs more frequently in the period of the Stone in the ureter. After the removal of the stone inflammatory process already is chronic. In chronic pyelonephritis inflammatory process applies to the soft tissues of the kidney and damages mostly tubular system. Thus at the beginning suffer distal segments tubules that sooner lose the ability to reabsorption of urine. Clinically, this is expressed in reduction concentrate ability kidney. In the terminal stage of the disease the disease process extends to the glomeruli.
According to literary data, the detection of "chronic of pyuria" in the remote terms after ureterostomy varies from 30.5 to 70.2% (Esch, 1959; B. S. Karpenko, 1961; I. M. Petrov, 1966, and others).
I. F. Novikov (1968) of 90 patients surveyed in remote terms after ureterolithotripsy, observed Juriy 32.2%. B. N. Pashkovsky (1971) - 4 people (3.3 percent).
Urine culture showed a variation of the microbial flora.
According to M. Ya. Karpekina (1962), S.A. Kagan (1966), I. F. Novikov (1968) and other authors, most often met growth of Staphylococcus, then Escherichia coli, gram of diplococci finally, Streptococcus and Proteus.
Treatment of chronic pyelonephritis after extracting stone from the ureter is very difficult. Full treatment of chronic pyelonephritis in terms of restoration of the anatomical and physiological correlations impossible. The main objective of therapy is to prevent exacerbations and the elimination of inflammatory foci in renal tissue.
A study of the sensitivity of bacterial flora to antibiotics in patients showed that microbial flora over time has become more resistant to common antibiotics (bicillin, penicillin, streptomycin).
Effective tool in the fight against urinary infection are nitrofurans (furadonin, furaltadone, furagin, furazolidone), in combination with a semisynthetic penicillins (oxacillin, ampicillin, pentrexyl, aniccam and others) and sulfonamides (prosulfuron, etizolam, spiedino, madrilenos). These drugs have a wide range of actions, which covers both gram-positive and gram-negative bacteria. Nitrofurans destroy even such resistant microbes as proteaceae and Pseudomonas aeruginosa.
Currently, for the treatment of pyelonephritis apply chloramphenicol (chloramphenicol), Siberian ginseng, nalidixic acid (blacks, nevigramon), 5-NOK, immunotherapy, and so on, But whatever effective drugs, they will be powerless, if will be ignored problem of nosocomial infection. Only strict observance of aseptic and antiseptic rules in combination with an active antibiotic therapy can reduce the number of patients with pyelonephritis after ureterolithotripsy.
The basis of all modern schemes of treatment of chronic pyelonephritis is a complex therapy, including antibiotikoterapii and methods of increase of immunobiological reactivity of the organism (autovaccine, fractional blood transfusion, plasma, the introduction of polyhemoglobin, serum Bogomolets, and so on). The duration of treatment for some patients should be between 6-9 months to several years (A. F. Cugina, 1966; A. M. Voino-Yasenetsky, 1966; A. I. Pytel and C. D. Goligorsky, 1971, 1972; O. L. Tiktinsky, 1972; B. N. Tkachuk and E. I. Turin, 1972, and others).
We are convinced of the advisability of appointing furadonina in combination with sulfonamides and antibiotics tetratziklinovogo stimulants or semisynthetic penicillins. After the reduction of stone and some time later these drugs were given to 22 people with chronic pyelonephritis. Furadonin appointed 0.1 to 4 times a day course for 15-20 days. At the same time, patients received etazol 0.5 to 5 times a day in combination with oletetrina or 5-NOK 100 mg 4 times a day. The use of this combination has led to a persistent lack of pyuria 17 people, and in 5 patients, where the count was covered field of view, their number has fallen to 10-20 in sight.
Therefore, the removal of the stone from the ureter does not mean recovery of sick because of the continuing pyelonephritis. This indicates the necessity of organization of dispensary observation and outpatient treatment after discharge from hospital.