Chronic pyelonephritis and prostate adenoma

Complication of prostatitis: Pyelonephritis

Many of you have probably heard about such a complication of prostatitis as pyelonephritis, but few people know enough information about it. So, let's understand. Pyelonephritis is an inflammatory bacterial disease of the kidneys, which is characterized by damage to the calyces and pelvis of the kidneys, as well as the kidney tissue itself. In simple terms, pyelonephritis is a disease that is characterized by the formation of pus in the kidneys during its bacterial inflammation. It should be noted that with pyelonephritis, most often (in 80% of cases) only one kidney is affected.

Reason for development.

The most common causes of pyelonephritis in men are diseases that lead to stagnation of urine in the kidneys. Most often these are diseases such as: narrowing of the urethra, prostatitis, prostate adenoma, prostate carcinoma (cancer), primary or secondary wrinkled kidney, kidney stones, etc. All these diseases lead to a violation of urodynamics (discharge and even stagnation of urine). In turn, urine stagnates in the kidneys, pathogenic bacteria multiply in it and an inflammatory process develops. It should also be noted that pyelonephritis can also develop against the background of reduced immunity, if there are chronic foci of infection in the human body, as well as against the background of hypothermia.

• temperature rise to 39 C;
• severe chills;
• headache, dizziness;
• malaise;
• weakness;
• lethargy;
• aches all over the body;
• nausea, vomiting;
• edema (mainly face);
• increased blood pressure;
• frequent and painful urination in small portions;
• pain at the site of the affected kidney, radiating to the sacrum, perineum (pain can be dull, aching or sharp).

Prevention of pyelonephritis.

To prevent the development of this disease, it is enough to adhere to a simple set of measures:

• 1. Eat right, excluding irritating foods from the diet (smoked meats, spicy, spicy, etc.).
• 2. Avoid hypothermia.
• 3. Conduct courses of immunostimulating therapy.
• 4. Lead an active lifestyle.
• 5. Carry out hygiene of the genitourinary organs.

How to treat chronic pyelonephritis in women and men at home?

Chronic pyelonephritis is a disease characterized by periodic exacerbations. This disease is understood as a nonspecific inflammatory process in which the kidneys are affected, followed by sclerosis of the parenchyma. According to medical statistics, about 20% of the population suffers from pyelonephritis.

In childhood, from 2 to 15 years, girls are more likely to suffer from it, in old age, the disease affects more men. Despite this, pyelonephritis is considered a predominantly female disease due to the anatomical location of the genitourinary organs and other functional features of the female body.

What is it?

Chronic pyelonephritis is a disease of an infectious and inflammatory nature in which the calyces, pelvises and tubules of the kidneys are involved in the pathological process, followed by damage to their glomeruli and vessels.

According to statistics, among all diseases of the genitourinary organs with an inflammatory nonspecific nature, chronic pyelonephritis is diagnosed in 60-65% of cases. Moreover, in 20-30% of cases it is the result of an acute form of the disease.

The main causes of pyelonephritis are microbes - Escherichia coli, staphylococcus aureus, enterococci, proteus, Pseudomonas aeruginosa. In the development of chronic pyelonephritis, forms of microbes that are resistant to negative factors and antibiotics are especially relevant. They can persist for a long time in the area of the calyx and pelvis, with a decrease in immune defense, causing activation of inflammation.

Why does an acute process turn into a chronic one?

The causes of chronic pyelonephritis can be considered:

• poor-quality treatment of acute pyelonephritis, non-compliance by the patient with the doctor's clinical recommendations, disruption of dispensary observation of a child or adult;
• untimely diagnosis and treatment of diseases that interfere with the outflow of urine (urolithiasis, nephroptosis, vesicoureteral reflux, congenital anomalies of narrowing of the urinary tract, prostate adenoma);
• the presence of concomitant chronic diseases that undermine the body's immunity, or are constant foci of infection (obesity, diabetes, sinusitis, tonsillitis, diseases of the gallbladder, intestines, pancreas);
• the ability of some pathogens to form L-forms, which can be inactive in the kidney tissue for a long time, but cause an exacerbation with a decrease in protective forces or immunodeficiency states.

There is no standard risk group for chronic pyelonephritis, but practitioners believe that the infection is most dangerous for:

• pregnant women;
• Children up to three years of age, predominantly formula-fed;
• girls during the onset of sexual activity;
• people in old age.

These patients are most indicated for the prevention of chronic pyelonephritis.

Classification

Forms of chronic pyelonephritis:

Exacerbation of chronic pyelonephritis clinically resembles a picture of acute inflammation. As the process progresses, the leading syndrome becomes hypertensive, which is manifested by headache, dizziness, visual impairment, pain in the heart. Sometimes, as a result of long-term pyelonephritis, an anemic syndrome develops. The outcome of the disease is chronic renal failure.

In chronic pyelonephritis, there are three stages of disease progression:

• the initial degree is characterized by the development of the process of inflammation, swelling of the connective tissues of the inner layer of the urinary organ, as a result of which the vessels are compressed, atrophy of the tubules appears, and renal bleeding decreases;
• the second degree is detected by means of a nephrogram, where there is a diffuse narrowing of the arterial renal bed, the size of the cortex becomes smaller, there are no interlobar arteries;

The degree of manifestation of symptoms of pyelonephritis depends on the localization of inflammation (on one side or both kidneys), on the degree of inflammation activity, on the accompanying obstructions to the outflow of urine and previous treatment. In the remission stage, there may be no manifestations at all, or they may be minimal - minor changes in urine tests.

The main symptoms of pyelonephritis in women and men:

In the remission stage, all symptoms of pyelonephritis are minimal, but the longer there is pyelonephritis, the higher the likelihood of arterial hypertension, cardiac hypertrophy, the development of chronic renal failure and secondary dystrophic changes in the kidneys. In the later stages, polyneuritis, bone pain, hemorrhage, polyuria with the release of up to 3 or more liters of urine with thirst and dry mouth, anemia may occur.

Complications

With the progression of chronic pyelonephritis, chronic renal failure develops. It is manifested by an increase in the amount of daily urine and especially a night portion, a decrease in the density of urine, thirst, dry mouth.

A sharp exacerbation of chronic pyelonephritis may be accompanied by the development of acute renal failure.

Diagnosis

Acute and chronic pyelonephritis is diagnosed on the basis of patient complaints and the clinical picture of the disease. The doctor finds out whether attacks of acute pyelonephritis, cystitis, inflammation of the urinary tract and kidneys were tolerated in childhood or during pregnancy in women.

When interviewing men, special attention is paid to past injuries of the spine, bladder and inflammation of the urogenital organs. The doctor detects the presence of factors that predispose to the occurrence of pyelonephritis - the presence of chronic diseases (prostate adenoma, diabetes mellitus, etc.).

Differential diagnosis is carried out with a number of such diseases:

Examination of a patient with chronic pyelonephritis in this way will help to avoid medical errors and prescribe effective treatment.

How to treat chronic pyelonephritis?

Therapy should be aimed at eliminating such problems:

• elimination of the causes that caused a violation of the normal functioning of the kidneys;
• use of antibacterial medicines and other medicines;
• immunity boost.

The most effective drugs are: Levofloxacin, Amoxicillin, Biseptol, Furadonin, as well as their analogues.

Drug treatment

Antibiotics during an exacerbation of the disease are prescribed for up to 8 weeks. The specific duration of therapy will be determined by the results of the laboratory tests performed. If the patient's condition is severe, then combinations of antibacterial agents are prescribed to him, they are administered parenterally or intravenously and in large doses. One of the most effective modern uroseptics is the drug 5-NOC.

Self-medication is strictly prohibited, although there are many drugs for the treatment of pyelonephritis. This disease is exclusively within the competence of specialists.

Typically, the following drugs are used to treat chronic pyelonephritis:

Before choosing one or another antibacterial drug, the doctor should familiarize himself with the acidity of the urine of patients, as it affects the effectiveness of drugs.

Physiotherapy treatment

Physiotherapy techniques have the following effects:

• increase the blood supply to the kidney, increase the renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
• relieve spasm of smooth muscles of the renal pelvis and ureters, which contributes to the discharge of mucus, urinary crystals, bacteria.

Physiotherapeutic treatment is used in the complex therapy of chronic pyelonephritis.

Sanatorium treatment

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

Damp cold, smoking and alcohol adversely affect the course of pyelonephritis. And regular examinations with monitoring of urine tests, and preventive courses of treatment contribute to long-term remission and prevent the development of renal failure.

Diet and nutrition rules

The chronic course of the disease requires a serious attitude to the diet. Recommended:

• cereals, dairy products and vegetarian options;
• watermelons, melons and pumpkin dishes;
• increase fluid intake to 2.5 liters;
• include a small amount of meat or fish broths in the diet;
• boil fish and meat of non-fatty varieties, or steam only;
• fresh and boiled vegetables and fruits;
• horseradish, garlic and radish should be excluded from the diet;
• Limit salt intake per day to 8 grams.

A balanced diet promotes a quick recovery. With an exacerbation of the disease, fresh fruits and vegetables, as well as at least 2 liters of liquid, should be included in the diet. Unacceptable in the diet - fried, spicy, fatty and salty foods.

Prevention

Even in the absence of signs of active infection, it is necessary to periodically (once a year or every six months) examine the function of a previously affected kidney. In the presence of frequent exacerbations in women, long-term use of antibacterial agents in low doses (biseptol or furadonin) is recommended.

All pregnant women in the first trimester need to conduct a bacteriological study of urine. If bacteriuria is detected, they are treated with penicillins or nitrofurans.

As a prevention of exacerbations, it is also recommended to conduct 10-day antibacterial courses, and then for 20 days a course of herbal medicine is carried out (a decoction of bear's eye grass, birch leaves, horsetail, juniper fruits, cornflower flowers). It is necessary to conduct several such courses, it is recommended to change the antibacterial agent every month.

Chronic pyelonephritis

Content

Chronic pyelonephritis is usually a consequence of acute pyelonephritis. The most important reasons for the transition of an acute infectious-inflammatory process in the kidney into a chronic one are as follows.

1. Causes of urinary outflow disorders (urolithiasis, urinary tract strictures, prostate adenoma, vesicoureteral reflux, nephroptosis, etc.) that have not been recognized and eliminated in a timely manner.

2. Incorrect or insufficient duration of treatment for acute pyelonephritis, as well as the lack of systematic follow-up of patients who have had acute pyelonephritis.

3. The formation of L-forms of bacteria and protoplasts in pyelonephritis, which are able to stay in the interstitial tissue of the kidney in an inactive state for a long time, and with a decrease in the protective immune forces of the body, go into the initial state and cause an exacerbation of the disease.

4. Chronic concomitant diseases (diabetes mellitus, obesity, diseases of the gastrointestinal tract, tonsillitis, etc.), which weaken the body and are a constant source of kidney infection.

5. Immunodeficiency states.

Chronic pyelonephritis often begins in childhood, more often in girls, after a typical attack of acute pyelonephritis. During or after acute infectious and viral diseases (flu, tonsillitis, pneumonia, otitis media, enterocolitis, etc.), new exacerbations of chronic pyelonephritis occur, which are often masked by these diseases and go unnoticed. The weakening of the body by the transferred infectious process and insufficient antibacterial treatment contribute to the progression of chronic pyelonephritis.

In the future, its course in the child has a wave-like character. The phase of remission of the disease is replaced by a latent phase of the inflammatory process, and then active. In children, there are two types of clinical course of chronic pyelonephritis: latent and undulating. The latent type is characterized by poor symptoms.In most children, this disease is detected during a dispensary examination or during examination in connection with intercurrent diseases. Much less often - in the presence of complaints of periodic fatigue, poor appetite, unclear subfebrile condition and extremely rarely - abdominal pain.

The undulating type is characterized by periods of remission and exacerbations. More often it is recorded in children with vesicoureteral reflux and severe hydronephrotic transformation caused by various malformations of the kidneys and urinary tract.

Classification of chronic pyelonephritis

Chronic pyelonephritis is classified according to the activity of the inflammatory process in the kidney.

I. Phase of the active inflammatory process:

A) - leukocyturia - 25000 or more in 1 ml of urine;

B) bacteriuria - 100,000 or more in 1 ml of urine;

C) active leukocytes (30% or more) in the urine of all patients;

D) Sternheimer-Malbin cells in urine in 25-50% of patients;

E) the titer of antibacterial antibodies in the passive hemagglutination reaction (PHA) is increased in 60-70% of patients;

E) ESR - above 12 mm/hour in 50-70% of patients;

G) an increase in the number of medium molecules in the blood by 2-3 times.

II. The phase of the latent inflammatory process:

A) leukocyturia - up to 2500 in 1 ml of urine;

B) bacteriuria is absent or does not exceed 10,000 in 1 ml of urine;

C) active urine leukocytes (15-30%) in 50-70% of patients;

D) Sternheimer-Malbin cells are absent (with the exception of patients with a reduced concentration ability of the kidneys);

E) the titer of antibacterial antibodies in the PHA reaction is normal (with the exception of patients who had an exacerbation of the disease less than 1.5 months ago);

E) ESR - not higher than 12 mm/hour;

G) an increase in the blood of medium molecules by 1.5-2 times.

III. Phase of remission, or clinical recovery:

A) there is no leukocyturia;

B) no bacteriuria;

C) there are no active leukocytes; d) Sternheimer - Malbin cells are absent;

E) the titer of antibacterial antibodies in the PHA reaction is normal;

E) ESR - less than 12 mm/h;

G) the level of medium molecules is within the normal range.

The active phase, as a result of treatment or without it, passes into the latent phase of chronic pyelonephritis, which can last for a long time (sometimes several months), giving way to remission or the active phase. The remission phase is characterized by the absence of any clinical signs of the disease and changes in the urine.

An attack of acute pyelonephritis in young women often occurs during pregnancy or after childbirth. A prolonged decrease in the tone of the urinary tract caused by pregnancy makes it difficult to treat pyelonephritis, and it can remain in the active phase of inflammation for a long time. Repeated pregnancy and childbirth in most cases lead to exacerbation of chronic pyelonephritis.

This eventually leads to kidney shrinkage and, if bilateral, to chronic renal failure, uremia, and death

Chronic pyelonephritis in children, as in adults, proceeds for a long time, with alternating phases of an active, latent inflammatory process in the kidneys and remission. If pyelonephritis in a child is in remission or latent, then his health usually does not suffer. Only pallor of the skin, the periodic appearance of "shadows" under the eyes, and slight fatigue are noted.

When the disease passes into the phase of active inflammation, the child's well-being noticeably worsens: weakness, malaise, fatigue, loss of appetite appear, pallor of the skin and "shadows" under the eyes become more pronounced. Some children develop aching pains in the abdomen, lumbar region, urination disorders and even enuresis.

Antibacterial therapy usually quickly stops the exacerbation and the pyelonephritic process acquires a latent course. With intercurrent diseases, an exacerbation of chronic pyelonephritis sometimes occurs. With an increase in the number of exacerbations, the success of ongoing antibiotic therapy decreases. In children with chronic pyelonephritis caused by anomalies in the development of the urinary system, the pyelonephritic process is characterized by extremely rapid progression, especially in young children.

Changes in the kidneys in chronic pyelonephritis

Pathological anatomy. Since in pyelonephritis the infection in the kidney spreads unevenly, the morphological picture of the disease is focal. However, due to periodically occurring exacerbations of pyelonephritis in the kidney tissue, an inflammatory process of various prescription is detected: along with the changes characteristic of the old process, there are foci of fresh inflammatory changes in the form of infiltrates from polymorphonuclear leukocytes.

Morphologically, in chronic pyelonephritis, there are three stages in the development of the inflammatory process.

In stage I, leukocyte infiltration is detected in the interstitial tissue of the medulla of the kidney and atrophy of the tubules with intact glomeruli. The predominant lesion of the tubules is a characteristic feature of this stage of chronic pyelonephritis.

This leads to the death of the distal nephrons and compression of the collecting ducts. As a result, there is a violation of the function and expansion of those parts of the nephroi, which are located in the cortex of the kidney. The areas of the dilated convoluted tubules are filled with proteinaceous masses, in structure they resemble the thyroid gland. In this regard, "thyroidization" of the kidney is considered a characteristic feature of the morphological picture of chronic pyelonephritis. The inflammatory process in the vessels and tissue surrounding the vessels leads to obliteration of some and narrowing of others.

Symptoms of chronic pyelonephritis

Chronic pyelonephritis can proceed for years without clear clinical symptoms due to a sluggish inflammatory process in the interstitial tissue of the kidney. Manifestations of chronic pyelonephritis largely depend on the activity, prevalence and stage of the inflammatory process in the kidney. Different degrees of their severity and combinations create numerous variants of clinical signs of chronic pyelonephritis. So, in the initial stage of the disease with a limited inflammatory process in the kidney (latent phase of inflammation), there are no clinical symptoms of the disease, and only the presence in the urine of a slightly increased number of leukocytes with the detection of active leukocytes among them testifies in favor of pyelonephritis. In parents of children with chronic pyelonephritis, only after persistent questioning, it is sometimes possible to establish an episode of short-term pain when urinating a child, an increase in body temperature during this period, and fatigue. The term of detection of an accidentally detected urinary syndrome is for the most part considered as the onset of the disease.

Often, when examining these children, significant urodynamic disturbances are found. Such a latent course of chronic pyelonephritis is typical for children, therefore, in all cases of ascertaining the urinary syndrome, a comprehensive urological examination of such a child is indicated. The initial stage of chronic pyelonephritis in the active phase of inflammation is manifested by slight malaise, loss of appetite, increased fatigue, headache and weakness in the morning, mild dull pain in the lumbar region, slight chilling, pallor of the skin, leukocyturia (over 25-103 leukocytes in 1 ml of urine). ), the presence of active leukocytes and, in some cases, Sternheimer-Malbin cells in the urine, bacteriuria (105 or more microorganisms per 1 ml of urine), an increase in ESR and an increased titer of antibacterial antibodies, low-grade fever.

In a later stage of pyelonephritis, not only the active and latent phases, but also the remission phase are manifested by general weakness, fatigue, decreased ability to work, lack of appetite. Patients note an unpleasant taste in the mouth, especially in the morning, pressing pains in the epigastric region, instability of the stool, flatulence, dull aching pains in the lumbar region, which they usually do not attach importance to.

Decrease in kidney function leads to thirst, dry mouth, nocturia, polyuria. The skin is dryish, pale, with a yellowish-gray tint. Common symptoms of chronic pyelonephritis are anemia and arterial hypertension. Shortness of breath that occurs with moderate exertion is most often due to anemia. Arterial hypertension caused by chronic pyelonephritis is characterized by high diastolic pressure (over 110 mm Hg) with an average systolic pressure of 170-180 mm Hg. Art. and the practical absence of the effect of antihypertensive therapy. If in the early stages of pyelonephritis arterial hypertension is observed in 10-15% of patients, then in the later stages - in 40-50%.

Diagnosis of chronic pyelonephritis

In the diagnosis of chronic pyelonephritis, a correctly collected anamnesis is of great help. It is necessary to find out with perseverance in patients with diseases of the kidneys and urinary tract transferred in childhood. In women, attention should be paid to attacks of acute pyelonephritis or acute cystitis noted during pregnancy or shortly after childbirth. In men, special attention should be paid to past injuries of the spine, urethra, bladder and inflammatory diseases of the genitourinary organs.

It is also necessary to identify the presence of factors predisposing to the occurrence of pyelonephritis, such as abnormalities in the development of the kidneys and urinary tract, urolithiasis, nephroptosis, diabetes mellitus, prostate adenoma, etc.

Laboratory, X-ray and radioisotope research methods are of great importance in the diagnosis of chronic pyelonephritis.

Leukocyturia is one of the most important and common symptoms of chronic pyelonephritis.However, a general urine test is of little use for detecting leukocyturia in pyelonephritis in the latent phase of inflammation. The inaccuracy of the general analysis lies in the fact that it does not strictly take into account the amount of supernatant urine remaining after centrifugation, the size of the drop taken for research, and the coverslip. In almost half of patients with a latent phase of chronic pyelonephritis, leukocyturia is not detected in a general urine test. As a result, if chronic pyelonephritis is suspected, leukocyturia is indicated using the methods of Kakovsky - Addis (the content of leukocytes in daily urine), Ambyurge (the number of leukocytes released in 1 min), de Almeida - Nechiporenko (the number of leukocytes in 1 ml of urine), Stensfield - Webb (the number of leukocytes in 1 mm3 of non-centrifuged urine). Of the above, the most accurate is the Kakovsky-Addis method, since urine for research is collected over a long period of time. However, in order to avoid false positive results, urine should be collected in two containers: the first portions of urine are collected in one (30-40 ml with each urination), and the rest of the urine is collected in the other. Since the first portion contains a large number of leukocytes due to flushing from the urethra, it is used only to account for the total amount of urine excreted. The study of urine from the second container allows you to determine the leukocyturia of urinary or renal origin.

If the doctor assumes that the patient has chronic pyelonephritis in remission, provocative tests (prednisolone or pyrogenal) are used. The introduction of prednisolone or pyrogenal provokes the release of leukocytes from the focus of inflammation in a patient with chronic pyelonephritis. The appearance of leukocyturia after the administration of prednisolone or pyrogenal indicates the presence of chronic pyelonephritis. This test becomes especially convincing if active leukocytes and Sternheimer-Malbin cells are simultaneously detected in the urine.

A decrease in the osmotic concentration of urine (less than 400 mosm / l) and a decrease in endogenous creatinine clearance (below 80 ml / min) also have a diagnostic value in chronic pyelonephritis. A decrease in the concentration ability of the kidney can often be observed in the earlier stages of the disease. It indicates a violation of the ability of the distal tubules to maintain an osmotic gradient in the direction of the blood - tubules. There is also a decrease in tubular secretion as an earlier symptom of chronic pyelonephritis.

Methods for assessing immunological reactivity, studying the characteristics of proteinuria and determining antibacterial antibody titers are important. Immunological reactivity is currently assessed using a set of methods that involve the determination of cellular and humoral factors of immunity. Of the cellular methods, methods for determining the number of immunocompetent cells in peripheral blood and their functional usefulness are most widely used. The number of immunocompetent cells is established in the rosette reaction, and various modifications make it possible to determine the number of thymus-dependent, thymus-independent and so-called null immunocompetent cells. Information about the functional usefulness of immunocytes is obtained during the reaction of blast transformation of peripheral blood lymphocytes.

Cystoscopy rarely reveals changes in the bladder mucosa. Chromocystoscopy makes it possible to establish various degrees of slowing down the excretion and reducing the intensity of urine staining with indigo carmine in about 50% of patients. With advanced pyelonephritis, urine staining with indigo carmine is barely noticeable and appears 12-15 minutes after its intravenous administration.

Significant assistance in the diagnosis of chronic pyelonephritis is provided by X-ray methods of examination. The main radiological symptoms of the disease are the following:

1) changes in the size and contours of the kidneys;

2) impaired excretion of a radiopaque substance by the kidney;

3) pathological indicators of the renal-cortical index (RCI);

4) deformity of the pyelocaliceal system;

5) Hodson's sign;

6) changes in the angioarchitectonics of the kidney.

On a survey radiograph in chronic pyelonephritis, a decrease in the size of one of the kidneys, a noticeable increase in the density of the shadow and a vertical location of the axis of the affected kidney are found.

Excretory urography in various modifications is the main method of X-ray diagnosis of chronic pyelonephritis

Chronic pyelonephritis is characterized by asymmetry of kidney damage and a decrease in their function, which is more clearly detected on excretory urograms made in the early stages (after 1, 3, 5 minutes) after the introduction of a radiopaque substance and delayed (after 40 minutes, 1 hour, 1.5 h).On late urograms, a slowdown in the release of a radiopaque substance by a more affected kidney is determined due to its retention in the dilated tubules.

In stage I of chronic pyelonephritis, when infiltrative processes predominate, x-rays show expansion of the calyces, spasm of their necks and pelvis. Since spasms last 20-30 seconds, they are more often detected according to urocinema than excretory urography.

Various deformations of the cups appear: they become mushroom-shaped, club-shaped, shift, their necks lengthen and narrow, the papillae smooth out.

Approximately 30% of patients with chronic pyelonephritis have Hodson's symptom. In a healthy kidney, this line is evenly convex, without depressions, parallel to the outer contour of the kidney.

Retrograde pyelography is used in chronic pyelonephritis extremely rarely due to the risk of kidney infection, especially with hospital strains of bacteria.

In chronic pyelonephritis, there is a gradual decrease in the parenchyma-kidney, which can be more accurately determined using the renal-cortical index (RCI). It is an indicator of the ratio of the area of the pelvicalyceal system to the area of the kidney. The value of the RCT lies in the fact that it indicates a decrease in the renal parenchyma in patients with chronic pyelonephritis in stages I and II of the disease, when this cannot be established without a calculation method.

Important information about the architectonics of the kidney in chronic pyelonephritis can be established by renal arteriography. There are three stages of vascular changes in the kidney in chronic pyelonephritis.

Stage I is characterized by a decrease in the number of small segmental arteries up to their complete disappearance. Large segmental renal arteries are short, conically narrowed towards the periphery and have almost no branches - a symptom of a "burnt tree"

In the II stage of the disease, when more pronounced changes occur in the parenchyma of the kidney, narrowing of the entire vascular arterial tree of the kidney is detected On the nephrogram, a decrease in size and deformation of the contours of the kidney

In stage III, characterized by wrinkling of the kidney, a sharp deformation, narrowing and decrease in the number of kidney vessels occur. From radioisotope research methods for chronic pyelonephritis, renography is used as a method for separately determining kidney function and determining the side of the greatest lesion. The method also allows for dynamic monitoring of the restoration of kidney function during treatment.

To determine the quantity and quality of the functioning parenchyma, it is advisable to use dynamic scintigraphy

In case of a pyelonephritically wrinkled kidney, static and dynamic scintigraphy allows you to determine the size of the kidney, the nature of the accumulation and distribution of the drug in it. Indirect renoangiography at the same time allows you to determine the state of the blood supply to the kidney and its restoration in the course of treatment.

Chronic pyelonephritis treatment

In chronic pyelonephritis, treatment should include the following main activities:

1) elimination of the causes that caused the violation of the passage of urine or renal circulation, especially venous circulation;

2) prescribing antibacterial agents or chemotherapy taking into account the antibiogram data;

3) increase in the body's immune reactivity.

Restoration of urine outflow is achieved primarily by the use of one or another type of surgical intervention (removal of prostate adenoma, stones from the kidneys and urinary tract, nephropexy with nephroptosis, plastic surgery of the urethra or ureteropelvic segment, etc.). Often, after these surgical interventions, it is relatively easy to obtain a stable remission of the disease without long-term antibacterial treatment. Without a sufficiently restored urine passage, the use of antibacterial drugs usually does not give a long-term remission of the disease.

Antibiotics and chemical antibacterial drugs should be prescribed taking into account the sensitivity of the patient's urine microflora to antibacterial drugs. Until the antibiogram data is obtained, antibacterial drugs with a wide spectrum of action are prescribed.

In the presence of chronic renal failure, the appointment of nephrotoxic antibacterial drugs should be carried out under constant monitoring of their pharmacokinetics (concentration in blood and urine). With a decrease in the indicators of humoral and cellular immunity, various immunomodulatory drugs are used - decaris, taktivin.

After the patient reaches the stage of remission of the disease, antibiotic treatment should be continued in intermittent courses. The timing of interruptions in antibacterial treatment is set depending on the degree of kidney damage and the time of onset of the first signs of an exacerbation of the disease, i.e., the appearance of symptoms of the latent phase of the inflammatory process.

In the interval between taking antibacterial drugs, cranberry juice is prescribed 2-4 glasses a day, an infusion of herbs with diuretic and antiseptic properties, sodium benzoate (0.5 g 4 times a day inside), methionine (1 g each 4 times a day inside). Sodium benzoate and cranberry juice with methionine increase the synthesis of hippuric acid in the liver, which, excreted in the urine, has a strong bacteriostatic effect on pyelonephritis pathogens. If the infection is resistant to antibacterial drugs, then large doses of methionine (6 g per day) are used for treatment in order to create a sharply acidic urine reaction.

As stimulants of nonspecific immunological reactivity in patients with chronic pyelonephritis, methyluracil (1 g 4 times a day orally) or pentoxyl (0.3 g 4 times a day orally) is used for 10-15 days every month.< /p>

Sanatorium-resort treatment of patients with chronic pyelonephritis is carried out in Truskavets, Zheleznovodsk, Jermuk, Sairma, etc. The intake of low-mineralized water increases diuresis, which contributes to the release of inflammation products from the kidneys and urinary tract. Improving the general condition of the patient is associated with rest, the influence of resort factors, balneological, mud treatment, the intake of mineral water, rational nutrition.

Under these conditions, the function of the kidneys and urinary tract, liver, gastrointestinal tract and other organs and systems of the body improves, which has a positive effect on the course of chronic pyelonephritis. It should be remembered that only strictly successive treatment of patients with chronic pyelonephritis in a hospital, clinic and resort gives good results. In this regard, patients with chronic pyelonephritis in the latent phase of inflammation should continue antibacterial treatment in a resort according to the scheme recommended by the attending physician, who observes the patient for a long time.

Forecast. In chronic pyelonephritis, the prognosis is directly dependent on the duration of the disease, the activity of the inflammatory process and the frequency of repeated attacks of pyelonephritis. The prognosis is especially worse if the disease begins in childhood due to abnormalities in the development of the kidneys and urinary tract. Therefore, surgical correction should be performed as early as possible when these anomalies are detected. Chronic pyelonephritis is the most common cause of chronic renal failure and nephrogenic arterial hypertension. The prognosis becomes especially unfavorable when these complications are combined.

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Consultation on treatment with traditional oriental medicine (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug methods of treatment) is held at the address: St. Petersburg, st. Lomonosova 14, K.1 (7-10 minutes walk from the metro station "Vladimirskaya / Dostoevskaya"), from 9.00 to 21.00, without lunch and days off.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of "Western" and "Eastern" approaches. Significantly reduced treatment time, reduces the likelihood of recurrence of the disease. Since the "eastern" approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the "cleansing" of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free of charge and does not obligate you to anything. It highly desirable all the data of your laboratory and instrumental research methods for the last 3-5 years. Having spent only 30-40 minutes of your time, you will learn about alternative methods of treatment, learn how to increase the effectiveness of already prescribed therapy, and, most importantly, how you can fight the disease yourself. You might be surprised how everything will be logically built, and understanding the essence and causes is the first step to successfully solving the problem!