Chronic pyelonephritis how to treat during exacerbation. Chronic pyelonephritis. Pathogenic microorganisms are activated

Pyelonephritis is an acute or chronic kidney disease that develops as a result of the influence of certain causes (factors) on the kidney that lead to inflammation of one of its structures, called the pyelocaliceal system (the structure of the kidney in which urine accumulates and is excreted) and adjacent to this structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.

The definition of "Pyelonephritis" comes from Greek words (pyelos- translated as, pelvis, and nephros-bud). Inflammation of the kidney structures occurs in turn or simultaneously, it depends on the cause of pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms(pain in the lumbar region, fever up to 39 0 C, nausea, vomiting, difficulty urinating), with it proper treatment After 10-20 days, the patient recovers completely.

Chronic pyelonephritis, is characterized by exacerbations (most often in the cold season) and remissions (symptoms subside). Its symptoms are mild, most often it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, abnormalities of the urinary system, prostate adenoma and others).

Women, especially young and middle-aged women, get the disease more often than men, approximately in a ratio of 6:1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men more often develop pyelonephritis at an older age; this is most often associated with the presence of prostate adenoma. Children also get sick, more often early age(up to 5-7 years), compared to older children, this is due to the body’s low resistance to various infections.

Kidney anatomy

The kidney is an organ of the urinary system that is involved in removing excess water from the blood and products released by body tissues that are formed as a result of metabolism (urea, creatinine, medications, toxic substances and others). The kidneys remove urine from the body, then through the urinary tract (ureters, bladder, urethra), it is released into the environment.

The kidney is paired organ, bean-shaped, dark brown, located in the lumbar region, on the sides of the spine.

The weight of one kidney is 120 - 200 g. The tissue of each kidney consists of medulla(in the shape of pyramids), located in the center, and cortical located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyces (on average 2-4 in one kidney). Later, the large renal calyces become one large renal pelvis (the cavity in the kidney, funnel-shaped), it in turn passes into the next organ of the urinary system, called the ureter. From the ureter, urine flows into the bladder (a reservoir for collecting urine), and from it through the urethra to the outside.

It is accessible and understandable about how the kidneys develop and work.
Inflammatory processes in the calyces and pelvis of the kidney are called pyelonephritis.

Causes and risk factors in the development of pyelonephritis

Peculiarities urinary tract
Congenital anomalies(improper development) of the urinary system	R develop as a result of exposure to the fetus during pregnancy unfavorable factors(smoking, alcohol, drugs) or hereditary factors(hereditary nephropathy, occurs as a result of mutation of the gene responsible for the development of the urinary system). Congenital anomalies leading to the development of pyelonephritis include the following malformations: narrowing of the ureter, underdeveloped kidney (small), prolapsed kidney (located in the pelvic region). The presence of at least one of the above defects leads to stagnation of urine in the renal pelvis, and disruption of its excretion into the ureter; this is a favorable environment for the development of infection and further inflammation of the structures where urine has accumulated.
Anatomical features of the structure genitourinary system among women	In women, compared to men, the urethra is shorter and larger in diameter, so sexually transmitted infections easily penetrate the urinary tract, rising to the level of the kidney, causing inflammation.
Hormonal changes in the body during pregnancy
The pregnancy hormone, progesterone, has the ability to reduce the tone of the muscles of the genitourinary system, this ability has, positive effect(preventing miscarriages), and negative effect(impaired urine outflow). The development of pyelonephritis during pregnancy is caused by impaired outflow of urine (a favorable environment for the proliferation of infection), which develops as a result of hormonal changes and compression of the ureter by the enlarged (during pregnancy) uterus.
Reduced immunity
The task of the immune system is to eliminate all substances and microorganisms foreign to our body; as a result of a decrease in the body's resistance to infections, pyelonephritis can develop. Young children under 5 years old get sick more often because their immune system is not sufficiently developed compared to older children. Pregnant women normally have a decreased immune system; this mechanism is necessary to maintain pregnancy, but is also a favorable factor for the development of infection. Diseases that are accompanied by a decrease in immunity, for example: AIDS, cause the development of various infectious diseases, including pyelonephritis.
Chronic diseases genitourinary system
Stones or tumors urinary tract , chronic prostatitis	lead to impaired urine excretion and stagnation;
Chronic cystitis	(inflammation of the bladder), in case ineffective treatment or its absence, the infection spreads up the urinary tract (to the kidney), and its further inflammation.
Sexually transmitted infections of the genital organs	Infections such as chlamydia, trichomoniasis, when penetrating through the urethra, enter the urinary system, including the kidney.
Chronic lesions infections	Chronic amygdalitis, bronchitis, intestinal infections, furunculosis and others infectious diseases are a risk factor for the development of pyelonephritis . In the presence of a chronic focus of infection, its causative agent (staphylococcus, Escherichia coli, Pseudomonas aeruginosa, candida and others) can enter the kidneys through the bloodstream.

Symptoms of pyelonephritis

• burning and pain during urination, due to inflammation in the urinary tract;
• the need to urinate more frequently than usual, in small portions;
• beer-colored urine (dark and cloudy) is the result of the presence of a large number of bacteria in the urine,
• bad smell urine,
• often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).

1. Pasternatsky's symptom is positive - when a light blow is applied to the lumbar region with the edge of the palm, pain appears.
2. Swelling, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appears on the face (under the eyes), legs, or other parts of the body. Swelling appears in the morning, soft dough-like consistency, symmetrical (on the left and right sides). right side bodies of the same size).

Diagnosis of pyelonephritis

General urine analysis - indicates deviations in the composition of urine, but does not confirm the diagnosis of pyelonephritis, since any of the deviations may be present in other kidney diseases.
Correct urine collection: In the morning, the external genital organs are toileted, only after this the morning, first portion of urine is collected in a clean, dry container (a special plastic cup with a lid). Collected urine can be stored for no more than 1.5-2 hours.

Indicators of general urine analysis for pyelonephritis:

• High level of leukocytes (normally in men there are 0-3 leukocytes in the field of view, in women up to 0-6);
• Bacteria in urine >100,000 per ml; the excreted urine is normal and must be sterile, but when collecting it, hygienic conditions are often not observed, so the presence of bacteria up to 100,000 is allowed;
• Urine density
• Urine pH is alkaline (normally acidic);
• The presence of protein, glucose (normally they are absent).

Urinalysis according to Nechiporenko:

• Leukocytes are elevated (normally up to 2000/ml);
• Red blood cells are elevated (normally up to 1000/ml);
• Presence of cylinders (normally they are absent).

Bacteriological examination of urine: used when there is no effect from the accepted course of antibiotic treatment. A urine culture is performed to identify the causative agent of pyelonephritis, and in order to select an antibiotic sensitive to this flora for effective treatment.

Kidney ultrasound: is the most reliable method for determining the presence of pyelonephritis. Defines different sizes kidneys, a decrease in the size of the affected kidney, deformation of the pyelocaliceal system, identification of a stone or tumor if present.

Excretory urography, is also a reliable method for detecting pyelonephritis, but compared to ultrasound, it is possible to visualize the urinary tract (ureter, bladder), and if there is a blockage (stone, tumor), determine its level.

CT scan, is the method of choice, using this method you can assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)

Treatment of pyelonephritis

Drug treatment of pyelonephritis

1. Antibiotics, are prescribed for pyelonephritis; based on the results of a bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.

Therefore, self-medication is not recommended, since only the attending physician can select the optimal medications and the duration of their use, taking into account the severity of the disease and individual characteristics.
Antibiotics and antiseptics in the treatment of pyelonephritis:

• Penicillins(Amoxicillin, Augmentin). Amoxicillin orally, 0.5 g 3 times a day;
• Cephalosporins(Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
• Aminoglycosides(Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg/kg 2 times a day;
• Tetracyclines (Doxycycline, 0.1 g orally 2 times a day);
• Levomycetin group(Chloramphenicol, 0.5 g orally 4 times a day).

• Sulfonamides(Urosulfan, 1 g orally 4 times a day);
• Nitrofurans(Furagin, orally 0.2 g 3 times a day);
• Quinolones(Nitroxoline, 0.1 g orally 4 times a day).

1. Diuretics: prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
2. Immunomodulators: increase the body's reactivity in case of illness, and to prevent exacerbation of chronic pyelonephritis.

• Timalin, intramuscularly 10-20 mg 1 time per day, 5 days;
• T-activin, intramuscularly 100 mcg once a day, 5 days;

1. Multivitamins , (Duovit, 1 tablet 1 time per day), Ginseng tincture – 30 drops 3 times a day, also used to improve immunity.
2. Nonsteroidal anti-inflammatory drugs (Voltaren), have an anti-inflammatory effect. Voltaren orally, 0.25 g 3 times a day, after meals.
3. To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Chime, 0.025 g 3 times a day.

Herbal medicine for pyelonephritis

Herbal medicine for pyelonephritis is used as an addition to drug treatment, or to prevent exacerbation of chronic pyelonephritis, and it is best used under the supervision of a physician.

Cranberry juice has antimicrobial effect, drink 1 glass 3 times a day.

Bearberry decoction has an antimicrobial effect, take 2 tablespoons 5 times a day.

Boil 200 g of oats in one liter of milk, drink ¼ glass 3 times a day.
Kidney collection No. 1: A decoction of a mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.
It has a diuretic and antimicrobial effect.

Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, lingonberry. Finely chop all these herbs, add 2 tablespoons of water and boil for 20 minutes, take half a glass 4 times a day.

Chronic pyelonephritis - inflammatory disease, affecting primarily the pyelocaliceal system of the kidneys. It can develop at any age, in men and women, and can be an independent disease or a complication of other diseases or developmental anomalies.

According to statistics, up to 20% of the population suffers from this disease, but experts believe that in fact its prevalence is even higher.

What clinical symptoms are typical for chronic pyelonephritis?

In chronic pyelonephritis, the inflammatory process is localized in the area of ​​the calyces and pelvis of the kidneys.

• Lower back pain is often mild, aching, and usually asymmetrical. It has been noticed that pain often appears not on the affected side, but on the opposite side. There may be a feeling of discomfort and heaviness in the lower back, especially when walking or standing for long periods of time. Patients complain that their lower back is cold and try to dress warmer. Severe or cramping pain is more typical for urolithiasis. With a low-lying or mobile kidney, as well as in children under 10-12 years of age, pain can be localized in the abdomen.
• Temperature rise, not higher than 38 C, usually in the evening, without visible reasons.
• , especially at night.
• Increased blood pressure. During remission, this may be the only symptom.
• Deterioration of health, fatigue and weakness, more pronounced in the morning, decreased mood, headaches.
• Slight swelling of the face, hands, more in the morning, feet and legs - towards the end of the day.

Laboratory signs of chronic pyelonephritis

• Decrease in hemoglobin in general analysis blood.
• Triple urine tests reveal increased amount leukocytes (normally no more than 4-6 per field of view); bacteriuria more than 50-100 thousand microbial bodies in 1 ml; red blood cells (especially with urolithiasis); sometimes - protein, but not more than 1 g/l, and there are no cylinders at all.
• In Zimnitsky's sample, the specific gravity often decreases (in no single portion does it exceed 1018).
• In a biochemical blood test, total protein is within normal limits, albumin may decrease slightly, and when signs of renal failure appear, creatinine and urea increase.

Treatment of pyelonephritis

Elimination of the pathogen. For this purpose, antibiotics and uroseptics are used. The main requirements for the drugs: minimal nephrotoxicity and maximum effectiveness against the most common infectious agents: E. coli, Proteus, Klebsiella, staphylococcus, Pseudomonas aeruginosa, etc.

It is optimal to conduct a urine culture before starting treatment to determine sensitivity to antibiotics - then the choice will become more accurate. Most often prescribed

• penicillins (amoxicillin, carbenicillin, azlocillin) – with minimal nephrotoxicity, they have a wide spectrum of action;
• 2nd and 3rd generation cephalosporins are not inferior to the first in effectiveness, however, the bulk of the drugs are intended for injection, therefore they are used more often in hospitals, and in outpatient practice Suprax and Cedex are most often used;
• fluoroquinolones (levofloxacin, ciprofloxacin, ofloxacin, norfloxacin) are effective against most pathogens of urinary tract infections, non-toxic, but they are prohibited for use in children, pregnant and lactating women. One of the side effects is photosensitivity, so during use it is recommended to avoid visiting the solarium or going to the beach;
• sulfonamide drugs (in particular Biseptol) were used so often in our country at the end of the 20th century to treat literally any infections that now most bacteria are insensitive to them, so it should be used if culture has confirmed the sensitivity of the microorganism;
• nitrofurans (furadonin, furamag) are still very effective for pyelonephritis. However sometimes side effects- nausea, bitterness in the mouth, even vomiting - force patients to refuse treatment with them;
• hydroxyquinolines (5-Nok, nitroxoline) are usually well tolerated, but sensitivity to these drugs, unfortunately, has also decreased recently.

The duration of treatment for chronic pyelonephritis is at least 14 days, and if complaints and changes in urine tests persist, it can last up to a month. It is advisable to change medications once every 10 days, repeating urine cultures and taking their results into account when choosing the next medication.

Detoxification

If there is no high blood pressure and severe swelling, it is recommended to increase the amount of fluid you drink to 3 liters per day. You can drink water, juices, fruit drinks, and at high temperatures and symptoms of intoxication - rehydron or citroglucosolan.

Phytotherapy

Most effective means herbal medicine for chronic pyelonephritis is bearberry leaf.

These folk remedies for treating pyelonephritis are effective as an addition to antibacterial therapy, but do not replace it, and should not be used during an exacerbation. Herbal infusions should be taken for a long time, in monthly courses after completion antibacterial treatment or during remission, for prevention. It is optimal to do this 2-3 times a year, in the autumn-spring period. Undoubtedly, herbal medicine should be abandoned if there is a tendency to allergic reactions, especially hay fever.
Examples of fees:

• Bearberry (leaf) – 3 parts, cornflower (flowers), licorice (root) – 1 part each. Brew in a ratio of 1 tablespoon per glass of boiling water, leave for 30 minutes, drink a tablespoon 3 times a day.
• Birch leaf, corn silk, horsetail 1 part each, rose hips 2 parts. Pour a tablespoon of the mixture into 2 cups of boiling water, leave for half an hour, drink half a glass 3-4 times a day.

Drugs that improve renal blood flow:

• antiplatelet agents (trental, chimes);
• drugs that improve venous drainage(escusan, troxevasin) are prescribed in courses of 10 to 20 days.

Spa treatment

It makes sense because healing effect mineral water is quickly lost during bottling. Truskavets, Zheleznovodsk, Obukhovo, Kuka, Karlovy Vary - which of these (or other) balneological resorts to choose is a matter of geographical proximity and financial capabilities.

About 2/3 of all urological diseases occur in acute or chronic pyelonephritis. This pathology is infectious in nature and is accompanied by damage to one or two kidneys. Their inflammation is provoked various bacteria, although sometimes the disease develops against the background of other diseases internal organs. Women are more prone to pyelonephritis, which is explained by the individual characteristics of the anatomical structure of the vagina and urethra. Treatment of the disease is carried out comprehensively by taking medications and following a number of rules.

What is pyelonephritis

The disease is an infectious-inflammatory process in the kidneys caused by the action pathogenic bacteria. They affect several parts of these paired organs at once:

• interstitial tissue - the fibrous base of the kidney;
• parenchyma – functionally active epithelial cells these paired organs;
• pelvis - cavities in the kidney, similar to a funnel;
• renal tubules.

In addition to the collecting system, the lesion can also affect glomerular apparatus with vessels. On early stage the disease disrupts main function kidney membranes - urine filtration. A characteristic sign of the onset of inflammation is aching pain in the lumbar region. The disease can be acute or chronic. If you suspect pyelonephritis, you should contact a nephrologist. If diagnosis is not made in a timely manner and treatment is not started, it is possible to develop the following complications:

• kidney abscess;
• hypotension;
• sepsis;
• bacterial shock;
• kidney carbuncle;
• renal failure.

Spicy

Acute pyelonephritis develops as a result of the influence of exogenous or endogenous microorganisms that penetrate the kidney tissue. More often, right-sided localization of inflammation is observed, which is explained by the structural features of right kidney, which causes her tendency to stagnation. Overall on acute stage This pathology is indicated by the following signs:

• chills, fever;
• increasing weakness;
• tachycardia;
• dull pain in the lower back;
• dyspnea;
• temperature 38.5-39 degrees;
• fatigue;
• disturbance of urine outflow;
• headaches and muscle pain.

With bilateral inflammation of the kidneys, the patient complains of pain throughout the back and abdomen. Purulent form The disease causes pain similar to renal colic. Impaired urine flow is manifested by an increased urge to urinate. In addition, nocturnal diuresis predominates over daytime diuresis. These symptoms may cause swelling and increased blood pressure.

Chronic

In most cases, chronic pyelonephritis is a continuation of its acute form. The most common cause is improperly selected or missing treatment. Also at risk are patients who have impaired urine passage through the upper urinary tract. A third of patients suffer from this disease since childhood due to low-grade inflammation of the parenchyma of the renal collecting apparatus.

Chronic pyelonephritis has a wave-like character: remissions are replaced by periods of exacerbation. This is the reason for the change clinical picture. During an exacerbation, symptoms are similar to acute form pathology. During the period of remission, the signs are weakly expressed. Patients complain of periodic pulsating or aching pain, which most often occur at rest. Against their background appear:

• asthenia – episodic weakness;
• rapid fatigue;
• slight increase pressure or temperature.

Causes

Common cause development of the disease are bacteria: staphylococci, enterococci, chlamydia, Klebsiella, salmonella, Pseudomonas aeruginosa. They go to the kidneys different ways. With cystitis, this occurs by the urinogenic (ascending) route: microorganisms penetrate into the pyelocaliceal system from the urethra in the following pathologies:

• cystitis;
• colpitis;
• adenoma prostate gland;
• urolithiasis disease;
• abnormalities in the structure of the urinary system.

Bacteria are introduced during manipulation of catheters. Another route of infection is hematogenous, when microbes enter the kidneys through the bloodstream from another source of inflammation in the following diseases:

• angina;
• pneumonia;
• ear infection;
• pulpitis;
• flu.

At-risk groups

Doctors identify several risk groups, which include patients prone to developing pyelonephritis. The first group consists of people with abnormalities in the structure of the urinary tract, such as:

1. Congenital anomalies. They are formed under the influence of hereditary or negative (smoking, drugs, alcohol) factors during pregnancy. The result is that malformations develop: narrowing of the ureter, underdeveloped or prolapsed kidney.
2. Anatomical structure genitourinary system in women. They have a shorter urethra compared to men.

Women more often suffer from this disease not only because of the special structure of the genitourinary organs. The reason for their development of this disease may be hormonal and other changes during pregnancy:

1. The hormone progesterone reduces the tone of the muscles of the genitourinary system to prevent miscarriage, but at the same time disrupts the outflow of urine.
2. The growing fetus enlarges the uterine cavity, which compresses the ureter, which also disrupts the process of urine outflow.

The last risk group consists of patients with reduced immunity. In this condition, the body cannot fully protect itself from all foreign microorganisms. Weakened immune system typical for the following categories of patients:

• children under 5 years old;
• pregnant women;
• people with autoimmune diseases such as HIV infection and AIDS.

Provoking factors

Pyelonephritis is secondary when it develops against the background of other diseases. These include diabetes, frequent hypothermia, insufficient hygiene, chronic inflammatory infections. Common list factors provoking pyelonephritis include:

1. Tumors or stones in the urinary tract, chronic prostatitis. Cause stagnation and disruption of urine outflow.
2. Chronic cystitis. This is an inflammation of the bladder in which the infection can spread up the urinary tract and cause kidney damage.
3. Chronic foci of inflammation in the body. These include bronchitis, furunculosis, intestinal infections, and amygdalitis.
4. Sexually transmitted diseases. Trichomonas and chlamydia can penetrate through the urethra into the kidneys, which will lead to their inflammation.

Treatment of pyelonephritis at home

The disease is treated with conservative methods, but the approach must be comprehensive. Therapy, in addition to taking medications, includes compliance special regime. The rules concern correction of the patient’s lifestyle and nutrition. The goal of therapy is to eliminate the causative agent of pyelonephritis. Additionally, measures are being taken to normalize urine flow and strengthen the immune system. Treatment of pyelonephritis in women and men is carried out according to the same scheme, including:

1. Compliance with a special regime. Involves avoiding intense activities physical activity, avoiding hypothermia.
2. Drink plenty of fluids. Prescribed if the patient does not have edema.
3. Medical nutrition. Balanced diet helps reduce the load on the kidneys, reduce the level of creatinine and urea in the blood.
4. Taking non-hormonal medications. They are part of etiotropic and symptomatic therapy. The first one eliminates the cause of the disease, the second one copes with its symptoms.
5. Physiotherapy. Used to speed up recovery and relieve unpleasant symptoms pathology.

Compliance with the regime

Taking into account the severity of the disease, the doctor determines where pyelonephritis will be treated. Uncomplicated forms are treated at home, and the first days must be kept in bed. The patient should not overcool and play sports. In case of exacerbation, only visiting the toilet and kitchen to eat is allowed. In case of intoxication and complications, the patient needs treatment in a hospital under the supervision of a doctor. Indications for hospitalization are:

• progression of chronic pyelonephritis;
• severe exacerbation of the disease;
• disturbance of urodynamics, in which it is necessary to restore the passage of urine;
• development of uncontrolled arterial hypertension.

Drink plenty of fluids

For pyelonephritis, it is necessary to increase fluid intake to 3 liters per day, but only if there is no edema. Water flushes the urinary canals, removes toxins and restores normal water-salt balance. You need to drink 6-8 glasses at regular intervals. In addition to water, to ensure an anti-inflammatory effect and normalization metabolic processes useful to use:

• rosehip decoction;
• dried fruits compote;
• mineral water with alkalis;
• weak green tea with milk or lemon;
• lingonberry and cranberry fruit drinks.

Medical nutrition

A strict diet is not required. The patient is advised to avoid salty, spicy and fatty foods, smoked meats and alcoholic drinks. Preference is given to products with vitamins B, C, P. You need to eat more vegetables and fruits, especially those that have a diuretic effect: watermelon, melon. The list of recommended products additionally includes following products:

• baked apples;
• bright orange pumpkin;
• fermented milk;
• cauliflower;
• young beets;
• carrot.

Drug therapy

It is divided into two types: etiotropic and symptomatic. The first is necessary to eliminate the cause that caused the disturbance of renal circulation, especially venous circulation, or urine passage. Help restore urine flow surgical interventions. Taking into account the cause of the disease, the following is carried out:

• removal of prostate adenoma;
• nephropexy for nephroptosis;
• plastic urethra;
• removal of stones from the urinary tract or kidneys;
• plastic surgery of the ureteropelvic segment.

Etiotropic treatment additionally includes anti-infective therapy - taking antibiotics depending on the causative agent of the disease. This method is used for primary and secondary pyelonephritis. Symptomatic therapy helps eliminate signs of the disease and restore the body after treatment. To carry out these tasks are assigned the following groups drugs:

• diuretics – eliminate swelling;
• non-steroidal anti-inflammatory drugs – provide relief of inflammation;
• improving renal blood flow - effective for chronic pyelonephritis;
• immunomodulators, adaptogens – strengthen the immune system.

Physiotherapy

In medicine, physiotherapy is understood as the study of the influence of natural factors on the body. The use of the latter helps reduce the number of medications a person takes. The indication for physiotherapy is chronic pyelonephritis. The procedures increase blood supply to the kidney, improve the delivery of antibiotics to the kidneys, and eliminate spasms of these paired organs. This makes it easier for mucus, bacteria and urinary crystals to pass away. These effects have:

1. Electrophoresis of furadonin on the kidney area. The solution for this procedure includes: 100 ml of distilled water, 2.5 g of sodium hydroxide, 1 g of furadonin. To achieve results, 8-10 procedures are performed.
2. Ultrasound at a dose of 0.2-0.4 W/cm2 in pulsed mode. An ultrasound therapy session lasts 10-15 minutes. Contraindication: urolithiasis.
3. Electrophoresis of erythromycin on the kidney area. Using an electric current, a solution of 100 g is delivered to the organs. ethyl alcohol and 100 thousand units of erythromycin.
4. Thermal treatments. These include ozokerite and paraffin applications, diathermo mud, therapeutic mud, diathermy.

Drugs for the treatment of pyelonephritis

Selection of drugs for etiotropic treatment carried out on the basis of general and biochemical tests blood and urine, during which the causative agent of the disease is identified. Only under this condition will therapy bring positive result. Various antibiotics effective against certain bacteria:

Names of bacteria	Names of antibiotics and uroantiseptics
Escherichia coli	Carbenicillin; Gentamicin; Levomycetin; phosphacine; nitrofuran compounds; Nalidixic acid; Ampicillin.
Enterobacter	Levomycetin; Ciprofloxacin; Nitrofurans; Tetracycline; Gentamicin.
	Ampicillin; Nalidixic acid; Carbenicillin; Cephalosporins; Levomycetin; Gentamicin; nitrofurans; sulfonamides.
Enterococcus	Gentamicin; Ampicillin; tetracyclines; Carbenicillin; Nitrofurans.
Pseudomonas aeruginosa	Gentamicin; Carbenicillin.
Staphylococcus aureus	Gentamicin; Oxacillin; Methicillin; Tetracyclines; Cephalosporins; nitrofurans.
Streptococcus	Penicillin; Carbenicillin; Tetracyclines; Gentamicin; Ampicillin; sulfonamides; nitrofurans; cephalosporins.
Mycoplasmas	Erythromycin; Tetracycline.

Antibacterial therapy based on the results of bacteriological examination of urine

The condition for the success of antibacterial therapy is the correspondence of the drug and the sensitivity of the pathogen to it, which is detected when bacterial research. If the antibiotic does not work within 2-3 days, which is confirmed by a high level of leukocytes in the blood, then it is replaced with another drug. Indications for use are determined by the type of pathogen. In general, the following groups of drugs are used:

Name of antibiotic group	Examples of drugs	Method of administration	Daily dosage
Penicillins	Ampicillin	Intramuscularly	1 g every 6 hours.
	Amoxicillin		0.5 g every 8 hours.
	Augmentin	Intramuscularly	1.2 g every 4 hours.
Aminoglycosides	Garamycin (Gentamicin)	Intravenous, intramuscular	3.5 mg/kg in 2-3 dilutions.
	Amikacin		15 mg/kg in 2 doses.
	Tobramycin		3-5 mg/kg in 2-3 injections.
Tetracyclines	Doxycycline	Intravenously, orally	0.1 g up to 2 times.
	Metacycline		0.3 g up to 2 times
	Vibramycin		0.2 g 1 time per initial stage treatment, then in a maintenance dosage of 0.1 g.
Levomycetins	Levomycetin succinate	Intramuscular, intravenous	0.5-1 g up to 3 times.
	Chloramphenicol		0.5 g up to 3-4 times.
Sulfonamides	Urosulfan		1 g up to 2 times.
	Co-Trimoxazole		480 mg 2 times.
	Biseptol	Drip	960 mg 2 times.
Nitrofurans			0.2 g 3 times.
	Furadonin		0.1-0.15 g three times.
	Furazidin		50-100 mg three times.
Quinolones	Nitroxoline		0.1 g 4 times.
			2 tablets 4 times.
	Ofloxacin		100-300 mg 2 times.
Cephalosporins	Cephalothin	Intravenously or intramuscularly	1-2 g every 4-6 hours.
	Ceftriaxone		0.5-1 g up to 1-2 times.
	Cephalexin		0.5 g up to 4 times.

Diuretics

In the presence of edema and high blood pressure It is necessary not only to limit the amount of fluid consumed. Additionally, the patient is prescribed diuretics. They are used only for prolonged pyelonephritis to relieve swelling. The most common diuretic is Furosemide:

• composition: substance of the same name – furosemide;
• release forms: capsules and solution for injection;
• therapeutic effect: short-term but pronounced diuretic effect;
• dosage for adults: 0.5-1 tablet or 20-40 mg by slow intravenous administration;
• effectiveness: 20-30 minutes after taking the tablets, 10-15 minutes after infusion into a vein.

Furosemide has a very big list side effects, so it is often used as an alternative herbal preparations. Examples of such drugs are:

1. Canephron. It has antispasmodic and anti-inflammatory effects. The composition contains centaury, rosemary, and lovage. The dose is determined by the disease, on average 2 tablets three times a day. The advantage is that it is well tolerated. Contraindications include only individual intolerance drug.
2. Phytolysin. It is a paste from which a suspension is prepared. Contains parsley root and lovage, birch leaves, goldenrod, sage and peppermint oil. Dosage – 1 tsp. paste in half a glass of water 3 times every day. Contraindications: pregnancy, renal failure.

Nonsteroidal anti-inflammatory drugs

The need to use non-steroidal anti-inflammatory drugs (NSAIDs) is because they help reduce inflammation in the kidneys. They inhibit cyclooxygenase, which is a key enzyme in triggering responses. As a result of taking NSAIDs, the production of inflammatory proteins slows down and cell proliferation (growth) is prevented. This helps to increase the effectiveness of etiotropic treatment, i.e. taking antibiotics. When taking NSAIDs, they penetrate into the inflammation site more easily.

For this reason, such drugs are used in conjunction with antibiotics. Without etiotropic NSAID therapy do not apply. The drug Indomethacin is also not used, since it leads to necrosis of the renal papillae. Among the effective NSAIDs are:

1. Voltaren. The basis is diclofenac, which has anti-inflammatory, antipyretic, antirheumatic and antiaggregation effects. Contraindications and side effects should be studied in the instructions, they are numerous. The average dosage of tablets is 100-150 mg in several doses, injection solution– 75 mg (3 ml ampoule). The advantage is that in case of kidney pathologies, diclofenac accumulation is not observed.
2. Movalis. Based on meloxicam, a substance with antipyretic and anti-inflammatory activity. Contraindications: severe renal failure, chronic pyelonephritis in patients undergoing hemodialysis. Dosage different forms release: 1 tablet per day, 15 mcg intramuscularly once. The advantage is high bioavailability. Side effects are presented in a large list, so it is better to study them in the detailed instructions for Movalis.
3. Nurofen. Contains ibuprofen - an analgesic and anti-inflammatory substance. Used for fever in patients with infectious and inflammatory diseases. The dosage of tablets is 200 mg up to 3-4 times daily. The advantage is that it can be used in the 1st-2nd trimester of pregnancy. The disadvantages of Nurofen include a large list of contraindications and adverse reactions.

Drugs to improve renal blood flow

With a long-term course of the chronic form of pyelonephritis, the blood supply to the kidney tissue deteriorates. Antiaggregation and angioprojective drugs help improve microcirculation, dilate blood vessels and increase the amount of oxygen delivered to the kidneys. The main indication for their use is the treatment of chronic pyelonephritis. Commonly used antiplatelet agents include:

1. Trental. Based on pentoxifylline, it has a vasodilating effect, increases the elasticity of red blood cells. Dose for different release forms: tablets - 100 mg 3 times a day, ampoules - 200-300 mg in the morning and evening.
2. Venoruton. Includes rutoside, has phlebotonic and angioprotective effects. Reduces capillary permeability and swelling. The average dosage is 300 mg three times a day. Similar action has Troxevasin.
3. Chimes. Contains dipyridamole, a substance with immunomodulatory and antiaggregation effects. Taken in a daily dose range of 75-225 mg (1-3 tablets).
4. Heparin. Anticoagulant based on sodium heparin. Has an antithrombotic effect, reduces platelet aggregation. Dose for intravenous administration– 15 IU/kg/h.

Immunomodulators and adaptogens

The cause of pyelonephritis is often a deficiency of the T-suppressor function of lymphocytes. In this regard, patients with this diagnosis need to take immunomodulators and adaptogens. These drugs accelerate the formation of protective antibodies. Indication for use: treatment of chronic pyelonephritis in the acute stage. Examples of immunomodulators and adaptogens are:

1. Timalin. Normalizes the function of B and T lymphocytes. It is administered intramuscularly at 10-20 mg daily. The duration of treatment is 5-6 days.
2. Levamisole (Dekaris). Stabilizes the function of T- and B-lymphocytes, stimulates phagocytosis, thereby increasing the interferon-producing ability of the body. Prescribed in a course of 2-3 weeks. Dose – 150 mg every 3 days.
3. T-activin. Dosage – 100 mcg daily for intramuscular injection.
4. Methyluracil. Take 1 g up to 4 times a day for a course of 15 days.
5. Tincture Chinese lemongrass or ginseng (adaptogens). The recommended dose per day is 30-40 drops up to 3 times. Take adaptogens until the end of treatment of the disease.
6. Multivitamin complexes Duovit, Vitrum or Supradin. Replenishes the lack of vitamins and minerals in the body. Dosage is: 1 tablet per day.

Treatment of pyelonephritis with folk remedies

Herbal medicine is not used as the main method of treatment; it is indicated as a complement to medications and physical procedures. Herbal treatment is considered safer, but products based on them should still be used under the supervision of a doctor. The plants used should have mild diuretic and antiseptic effects. These include:

• lovage;
• violet;
• St. John's wort;
• series;
• nettle;
• yarrow;
• calendula;
• strawberries;
• parsley;
• bearberry;
• sage.

Bearberry (bear ears)

This plant contains unique substance– arbutin, which is oxidized in the body to glucose and hydroquinone. The latter is a natural antiseptic that exhibits antibacterial effect. Use bearberry according to the following instructions:

1. Pour about 30 g of dry herb into 500 ml of boiling water.
2. Boil over low heat for a couple of minutes, then let it brew for about half an hour.
3. Drink 2 tbsp daily. l. up to 5-6 times. Bearberry is effective in alkaline environment, therefore it is additionally necessary to drink Borjomi mineral water, soda solutions and eat more raspberries, apples, pears.

Lingonberry leaves

Choleretic and antimicrobial effects possess lingonberry leaves. These properties are due to the presence in the composition of the same substance that is found in bearberry - hydroquinone. The instructions for preparing and taking a decoction of these two herbs are also the same. It’s better to infuse the lingonberry remedy for about 2 hours. In addition, after a 3-week course of therapy, it is necessary to take a break of 7 days and repeat the treatment cycle.

Cranberry or lingonberry juice

These drinks have antipyretic, anti-inflammatory, healing and antibacterial properties. The high acidity of cranberries and lingonberries makes them effective against urinary tract and kidney infections, but against stomach ulcers or duodenum they cannot be used. Instructions for preparing and using fruit juice:

1. Take 500 g of cranberries or lingonberries, rinse.
2. Grind them until smooth.
3. Through several layers of gauze, squeeze the juice out of the berries, add 2.5 liters clean water.
4. Take 4 glasses of fruit drink daily.

Medicinal preparations for oral administration or external procedures

In herbal medicine, herbal infusions are also effective against this disease. The combination of several components helps reduce their number side effects and dosage. The following recipes are effective:

Recipe number	Ingredients, quantity tsp.	Method of preparation and use
	St. John's wort – 5; bearberry leaf – 5; fennel fruits – 2; elderberry flowers – 4; lemon balm – 3; knotweed – 5; calamus root – 2; kidney tea leaf – 2; flax seeds – 3.	Pour 2-3 tbsp. l. collecting 500 ml of boiling water. Pour into a thermos and leave for 6 hours. Use during the day in 3 doses half an hour before meals.
	Veronica grass – 5; wild rosemary shoots – 5; St. John's wort – 5; horsetail grass – 4; corn silks – 3; pine buds – 3; corn silks – 3; mint leaf – 3.	Brew 2-3 tbsp. l. herbal mixture 0.5 liters of boiling water. Leave in a thermos for 6 hours. Drink the infusion in 3 doses throughout the day, consuming 20-30 minutes before meals.
	chicory roots – 4; dandelion roots – 4; chamomile grass – 4; corn silks – 3; juniper shoots – 3; heather grass – 3; celandine – 4; calamus leaves – 3; cudweed grass – 5; birch leaves – 3.	Pour 100 g of boiling water over a liter herbal collection. Leave for 2 hours, then strain. Add to a bath with water at a temperature of 32-36 degrees. Lie in it for about 10-15 minutes. Dry your body with a towel. Go to bed. Course – 10-15 procedures, 1 per day.

Spa treatment

Complex therapy pyelonephritis, especially chronic, requires sanatorium treatment. It helps patients cope with exacerbations and recover faster. Although this type of treatment also has contraindications: chronic renal failure, high pressure, anemia. The following procedures are recommended for other patients with pyelonephritis:

• drinking cure mineral waters in the sanatoriums of Zheleznovodsk, Jermuk, Slavyanovsky and Smirnovsky mineral springs;
• diet therapy;
• heat therapy;
• hardening;
• mud applications;
• balneotherapy through vibration, radon, aromatic, mineral baths and Charcot shower (massage with jet water).

Video

Exacerbation of pyelonephritis is always followed by periods of remission. Pyelonephritis is a kidney disease of infectious etiology, which is accompanied by inflammatory process and can occur in acute or chronic form.

Suffering from kidney disease a large number of of people. About one in three people have experienced symptoms of kidney disease. IN at a young age Women are more susceptible to this pathology reproductive age, and in the older ones, on the contrary, men. The prerequisites for morbidity in women is the structural feature of the genitourinary system, due to which they are more prone to getting into and spreading pathogenic bacteria V genitourinary organs. Pyelonephritis very often affects children, mainly under 3 years of age. Among young patients, girls are more common.

Exacerbations of pyelonephritis require immediate treatment, because the kidneys play a very important role important role in the human body. Correct diagnosis in conjunction with adequate treatment will help you deal with this dangerous disease. Without treatment, kidney failure can develop, which can be fatal if the organ fails.

Pyelonephritis is divided into primary and secondary, acute and chronic, unilateral and bilateral.

Types of pyelonephritis

The primary type is characterized by the penetration of infection through the blood, and the secondary type is associated with disorders in the urinary system. Pathologies such as the presence of tumors, stones and narrowing of the urinary tract lead to stagnation of urine. The disease becomes chronic with seasonal exacerbations. Often with cold infections there is a relapse.

Routes of infection and forms of the disease:

1. The infection spreads through the bloodstream - in this case, the disease takes on an acute form.
2. The infection enters the kidneys through urinary system- in this case, the disease has a chronic course.

Acute pyelonephritis is often unilateral with to varying degrees intensity. May end with recovery, become chronic, or have death. The duration of the disease is up to three months.

Chronic pyelonephritis has a sluggish form with periodic exacerbations, leading to sclerosis and deformation of the kidneys, increased blood pressure and chronic renal failure.

The danger of exacerbation of the disease lies in the involvement of new kidney tissue in the inflammatory process. The latter can die off and be replaced by scars, and this negatively affects the functioning of the kidneys. The duration of the chronic form of the pathology lasts more than three months.

The insidiousness of the disease lies in the ability of asymptomatic development. Irreversible processes occur in the kidney tissues, as a result of which the organ may cease to function.

Symptoms of acute pyelonephritis

An attack of acute pyelonephritis occurs unexpectedly, intoxication of the body develops due to infection entering the bloodstream.

With exacerbation of pyelonephritis, the symptoms are as follows:

1. Painful sensations during urination.
2. Pain from the affected organ, which is acute and increasing in nature.
3. Temperatures can reach 40 °C.
4. Severe chills and sweating.
5. Aches in the joints.
6. Nausea accompanied by vomiting.
7. Headache.
8. Prostration.
9. Change in urine color.

Diagnostics

To make a diagnosis, blood and urine tests are of paramount importance. A urological and X-ray examination is carried out, radioisotope scanning, Ultrasound, computed tomogram and echography.

As a result of the urine analysis, it is necessary to take into account that with primary pyelonephritis there may be no changes in the fluid.

In acute and purulent diseases, protein, casts, and red blood cells may be present in the urine due to exposure to toxic substances. An increase in leukocyturia may be associated not with kidney damage, but with an inflammatory process in bladder or genitals. Also, leukoceturia may be absent in the first days of the onset of the disease.

Due to increased catabolism and fluid loss through the lungs and skin, oliguria and the overall relative density of urine changes. Proteinuria is insignificant. The majority of patients have microhematuria. The latter occurs due to renal colic. Bacteriuria is constantly diagnosed. To determine the microflora and sensitivity to antibacterial drugs, it is necessary to bacteriological examination. If in this case it is not determined high level bacteria, then you should pay attention to the patency of the upper urinary tract.

A reliable research method is a comparative blood test for leukocytosis. The number of leukocytes in blood taken from a finger or the skin of the lumbar region on the right and left sides is counted. This determines which kidney is affected.

Chromocystoscopy makes it possible to detect the release of turbid fluid from the ureter and delayed excretion of indigo carmine.

A valuable examination method is x-ray. An X-ray examination clearly shows negative changes in the size of the kidneys. On the urogram, the shadow of the affected urinary tract is weakly expressed or absent altogether. To clarify the functional and morphological state of the kidneys, isotope radiography and scanning are used.

An ultrasound will help to see enlargement of the kidneys and restriction of their movement during breathing. In controversial situations of diagnosis, it is used CT scan. Diagnosis of acute pyelonephritis is made on the basis of only a comprehensive examination.

Symptoms of chronic pyelonephritis

Chronic pyelonephritis is often difficult to determine, because its symptoms may resemble cystitis or a cold. It happens that it is mistaken for radiculitis or osteochondrosis of the lumbar region.

The signs are similar to acute pyelonephritis character.

Exacerbation of chronic pyelonephritis is accompanied by the following symptoms:

1. An increase in temperature, accompanied by chills and increased sweating.
2. Frequent and painful urination with a decrease in the amount of daily urine.
3. Blood pressure increases.
4. There is pain in the lumbar region, often unilateral.
5. Loss of appetite, nausea with bouts of vomiting.
6. Prostration.
7. Swelling of the face and limbs.
8. Paleness of the skin.

An important criterion is a history of acute pyelonephritis. Relapse of chronic pyelonephritis can provoke the development of pathologies in the organs of the cardiovascular system. There is pain in the head, more in temporal region, heart rate increases, tinnitus is felt. May develop hypertensive crisis. At diagnostic examination blood test reveals leukocytosis and increased ESR indicator. Leukocyturia, bacteriuria, proteinuria appear. Active white blood cells are often detected.

With chronic pyelonephritis of a protracted nature, patients note loss of appetite, weight loss, drowsiness and fatigue. Pain in the bones is alarming, hemorrhagic syndrome is present, swelling is almost not observed. In the later stages of the disease, the kidneys decrease in volume and take on a wrinkled, shrunken appearance, which indicates severe renal failure.

Treatment of pyelonephritis

The symptoms of acute and chronic pyelonephritis and the treatment of pathologies are similar. If the disease worsens, hypothermia should be avoided and physical activity should be limited or eliminated altogether.

After diagnosis, treatment is prescribed, which is carried out under the strict supervision of a doctor in a hospital. Therapy for this disease involves taking anti-inflammatory, vasodilator and diuretic drugs. Analgesics are prescribed to relieve pain. Apply antibacterial drugs, corresponding to a specific pathogen. Bed rest and a therapeutic diet must be observed.

If there is an exacerbation of chronic pyelonephritis, then physiotherapeutic procedures have a positive effect - electrophoresis, applications therapeutic mud, ozokerite and paraffin. Analysis to determine the type of microbe and its resistance to medical drugs determined at the onset of the disease, then repeated after 10 days.

With properly prescribed treatment, the temperature decreases, lumbar pain subsides and test results improve. To maintain stable remission of the disease, it is recommended to repeat the medications for six months every month for 7 days. Control examinations must be carried out every 3 months for 2 years.

Treatment of pyelonephritis has 3 main principles - restoring the function of normal urine passage, suppressing infection with antibiotics and preventing the inflammatory reaction.

Disease prevention

Prevention of pyelonephritis requires compliance with several requirements:

1. The daily dose of fluid consumed should be at least 3 liters.
2. Prolonged retention of urination is not allowed.
3. Any infectious diseases cannot be left without attention and treatment.
4. Don't get too cold.
5. Follow a diet. Eliminate carbonated drinks, smoked foods, pickles, fatty and fried foods from your diet.
6. Take multivitamins.
7. News healthy image life without bad habits.

Prevention of exacerbations of this disease involves the use of medicinal herbs. The latter should have anti-inflammatory, bactericidal and diuretic properties. It is recommended to eat juniper fruits, parsley roots and leaves, hop cones, birch buds, corn silk, and strawberry leaves.

Chronic pyelonephritis is a pathology of renal tissue (code N11 according to ICD-10), which is provoked by pathogenic agents, lasting for years, worsening when the immune system is weakened.

Exacerbation of chronic pyelonephritis

Morbidity statistics show that the disease occurs quite often, and after death it is recorded in every tenth person. Among women, the disease is more common, which is caused by a short urethra compared to men.

Chronic pyelonephritis (ICD 10 code - N11) can not manifest itself for a long time and proceed hidden. In this form, the disease sometimes exists until death, which occurs from causes unrelated to kidney disease.

With stones, narrowing of the urinary canals, urine retention, decreased immunity, the disease can intensify and progress.

Causes

The cause of relapse of chronic pyelonephritis is weakening of the immune system, long stay in the cold, infection. Relapse is provoked by E. coli, enterococci, staphylococcus, streptococcus, fungi, viruses, Pseudomonas aeruginosa.

During pregnancy from coli 85% of women suffer from chronic pyelonephritis. Klebsiella, Proteus, and Pseudomonas aeruginosa are also found in pregnant women.

Pathogenic microorganisms are activated:

• hypothermia;
• climate change;
• poor nutrition;
• diabetes;
• hepatitis.

Symptoms

Exacerbations of kidney inflammation are accompanied by:

• pain;
• temperature;
• swelling;
• intoxication;
• urinary disorders;
• increased blood pressure;
• anemia.

The temperature may not rise above 37.2 0 C, but sometimes a fever of 39 0 C with chills is observed. Heat observed infrequently, patients usually experience an increase in temperature to low-grade fever in evening time, signs of intoxication during relapse of chronic pyelonephritis are erased.

Exacerbation of chronic pyelonephritis manifests itself with dull pain in the lower back, lateral areas of the abdomen, radiating to the groin, and the front side of the thigh. Pain in chronic pyelonephritis is sometimes very similar to sensations in radiculitis, gastritis, cystitis, and inflammation of the ovaries.

Confirm renal origin pain can be relieved using Tofilo's symptom. To carry out the test, the patient is asked to lie on his back, bend his leg at the knee, and press it to his chest while inhaling. If the pain in this position intensifies, this increases the likelihood of chronic pyelonephritis.

Indirect signs of exacerbation are swelling of the face after sleep, increased temperature, oppressive character lower back pain. Exacerbation of chronic pyelonephritis is accurately diagnosed using ultrasound, laboratory tests urine and blood.

Hypertension is observed in 75% of those suffering from chronic pyelonephritis. At the beginning of the disease, increases in pressure appear only during periods of exacerbation, but over time, hypertension becomes a common occurrence for patients, and in 10% of patients it takes a complicated course.

Violation of daily urination manifests itself:

• nocturia.

During periods of exacerbation, there is a decrease in the specific gravity of urine, the presence of protein, and leukocytes in the urine. When urinating, you may feel pain and stinging.

Exacerbation of chronic pyelonephritis causes a decrease in the production of erythropoietin, which causes anemia. During pregnancy, chronic pyelonephritis often worsens in the 2nd trimester. There remains a danger of exacerbation 3 weeks after birth.

First aid

In case of exacerbation of chronic pyelonephritis, it is necessary to limit the regimen motor activity. At high blood pressure, acute pain Bed rest is recommended; you are only allowed to get up to go to the toilet and dining room.

If the pain is severe, you should immediately call a doctor at home. You should not put a heating pad on the patient, give painkillers or offer plenty of fluids. You must wait for the doctor to arrive.

Treatment

Treat exacerbations with antibiotics, sulfonamides, nitrofurans, supplementing drug therapy with herbal medicine. Antibiotics are prescribed based on the results of bacterial culture.

Antibiotics are prescribed against kidney infections:

• Escherichia coli – ampicillin, cephalosporin, chloramphenicol;
• Proteem – ampicillin, carbenicillin, gentamicin;
• Pseudomonas aeruginosa – gentamicin, carbenicillin;
• enterococcus - ampicillin, carbenicillin;
• Staphylococcus aureus - penicillins, ampicillin;
• streptococcus - penicillins, cephalosporins;
• mycoplasmas - erythromycin.

In addition to antibiotics, derivatives are used to treat relapses of chronic pyelonephritis:

• nitrofuran – furazolidone, furadonin, furagin;
• nalixidic acid – navigramone, negram;
• 8-hydroxyquinoline – nitorxoline, 5-NOK.

Surgery is necessary if the exacerbation is caused by apostema,. The purpose of the operation is to drain the kidney, aimed at restoring the outflow of urine.

Treatment during pregnancy

The task of treating exacerbation of pyelonephritis during pregnancy becomes more complicated, and the requirements for drug safety are increased. How to treat depends on pathogenic flora, and the treatment must be absolutely safe for the fetus.

Treatment is carried out in a hospital, the course lasts 2 weeks. Treatment begins with intravenous administration of drugs, subsequently moving on to taking tablets orally. Do not use furazolidone, biseptol, chloramphenicol, tetracycline, fluoroquinolone, streptomycin during pregnancy due to the risk to the fetus.

The drug of choice for solving this problem is the inhibitor-protected penicillin ampicillin + sulbactam, amoxicillin + clavunate. Macrolides and cephalosporins are used during pregnancy.

Cefazolosporins are used during pregnancy:

• first 2 trimesters - 2nd generation drugs Cefaclor, Cefuroxime;
• in the 3rd trimester - 3rd and 4th generation drugs Tsedex, Maxipin, Fortum.

If an exacerbation is caused by Pseudomonas aeruginosa, use cefaperazone + sulbactam, ceftazidime. If you are allergic to penicillins or cephalosporins, aztreon is used as a reserve drug. The drug is prescribed strictly according to indications, with caution.

For particularly complex exacerbations, tienam (carbapenems) is used. A feature of the treatment of chronic pyelonephritis is the abolition of sulfonamides and nitrofurans 20 days before birth due to the possibility of complications in the fetus. Ototoxic antibiotics (gentamicin), which cause hearing damage in the fetus, are not prescribed.

During lactation

IN breast milk Aztreonam, gentamicin, furadonin, furagin, cephalosporins cefaclor, ceftributen practically do not penetrate. This allows you to use medications without interrupting breastfeeding.

Temporarily stopped breast-feeding when treated with antibiotics from the fluoroquinolone group - ofloxacin, ciprofloxacin, perfloxacin.

Herbal preparations

Both herbal preparations Fitonephrol, Canephron N, as well as medicinal herbs and preparations for preparing decoctions can be used for treatment.

The drug contains lovage, rosemary, centaury. The medicine is taken in a course, it enhances the effect of antibiotics, which are used in the main therapy, is aseptic, diuretic, and has an anti-inflammatory effect.

The use of Canephron can reduce proteinuria, reduce protein loss in the urine due to a decrease in the permeability of blood capillaries.

Medicinal plants that are used to prepare decoctions at home for chronic pyelonephritis must have the following properties:

• anti-inflammatory - bearberry, lingonberry, chamomile, St. John's wort, marshmallow, nettle;
• – birch leaves, juniper, parsley, kidney tea, cornflower flowers, corn silk, elecampane, bearberry.

Diet features

For chronic pyelonephritis in the acute stage, diet No. 7 is recommended, in which:

• sharply reduce the amount of salt (or exclude it on the recommendation of a doctor);
• protein products are slightly limited;
• increases herbal products containing vitamin C, thiamine, riboflavin, iron, niacin, potassium, magnesium;
• seasonings and smoked foods are excluded;
• meals are prescribed up to 6 times a day;
• drinking regimen during exacerbation - up to 1.5 l/day.

Prevention of exacerbations is that the diet includes foods high in iron (raspberries, pomegranates, apples), potassium (dried apricots, raisins, figs). A dairy-vegetable diet with a small amount additions in the form boiled meat, fish.

In the video about the symptoms and treatment of exacerbation of chronic pyelonephritis: