Chronic pyelonephritis

Description:

Quite often chronic pyelonephritis develops after acute process, however its gradual development since the early childhood is more often observed.  Primary chronic pyelonephritis is considered as an independent nosology, and secondary is rather a complication of other urological pathology. Irregularity, mosaicity of defeat of a parenchyma of a kidney in its different sites is characteristic of chronic pyelonephritis. The morphological picture is various: at the beginning of a disease limfogistiotsitarny infiltration which is gradually replaced with fibrous fabric prevails or is exposed to purulent fusion and in late stages there occurs death of the functioning kidney parenchyma elements, tubules, then balls in the beginning.

Reasons of Chronic pyelonephritis:

The pathological center forms in one of kidneys that is connected with a necessary combination of the infectious agent, decrease in immune forces and adverse external and internal factors. However if the specified general factors remain, and the urodynamic and a hemodynamics in the second kidney is broken further, in it there is also chronic pyelonephritis. Thus, it is possible to consider chronic pyelonephritis as unilateral, but potentially bilateral disease. Bilateral defeat occurs approximately at 30% of patients with chronic pyelonephritis, its terrible complication – a chronic renal failure.

Symptoms of Chronic pyelonephritis:

Symptoms of chronic pyelonephritis are quite poor that complicates its early recognition. Chronic pyelonephritis it becomes rare the reason of negotiability of the patient, it becomes more often nakhody at inspection of adjacent bodies. It is necessary to carry to the general symptoms of chronic pyelonephritis weakness, subfibrilny body temperature, fatigue, etc., however these manifestations are characteristic of many diseases, in addition to pyelonephritis. Local manifestations in the form of dull aches in a kidney) can be absent or be the erased symptoms of primary disease (a nephrolithiasis, a nephrophthisis, a hydronephrosis). Characteristic of pyelonephritis in a hronicheskogy stage of change of urine can be revealed at microscopic and bacteriological inspection.

In the clinical course of chronic pyelonephritis distinguish a number of stages: an active inflammation, the latent (hidden) current and remission (a zatikhaniye which can be, unlike recovery, temporary). In a stage of active chronic pyelonephritis the following clinical symptoms of this pathology are observed: subfibrilny body temperature, dull aches in a kidney, leukocytes, including active, and bacteria in urine. Upon transition of process to a latent stage body temperature decreases, the pain syndrome disappears, there is only an insignificant bacteriuria and a leukocyturia. In a phase of remission and these changes in urine is not present, but they can arise under the influence of any adverse provocative factors again: the general (overcooling, systemic infections, the inflammatory centers in an organism) or local (pregnancy, gynecologic diseases, other causes of infringement of urodynamic). As a result remission can pass into a phase of latent and even active inflammation.

Diagnosis:

Diagnosis of chronic pyelonephritis is based mainly on results of laboratory and rentgenologicheky researches. In the analysis of urine reveal a proteinuria (not higher than 1 g/l), a leukocyturia (in an active phase with active leukocytes and Shterngeymera-Malbin's cells), a bacteriuria. On secretory Urogramums note change of a configuration of cups of a kidney, their kolbovidny form owing to a smoothness of nipples of pyramids and expansion of cups, the reduction of thickness of a parenchyma of a kidney expressed unevenly in its different segments, in late stages – considerable expansion of cups at the expense of an atrophy and wrinkling of a renal parenchyma.
In this regard on secretory Urogramums the relation of the area of pyelocaliceal system to the area of all kidney considerably increases. Besides, in connection with uneven development of pyelonephritis in different sites of a kidney the distance between cups and an outside contour of a kidney becomes unequal.

Treatment of Chronic pyelonephritis:

Treatment of chronic pyelonephritis represents a difficult problem. At primary chronic pyelonephritis it most often conservative. Antibacterial therapy is carried out according to the same principles, as at acute pyelonephritis, to compliance with a species of microflora of urine and its sensitivity. However at chronic pyelonephritis wide circulation found application of himiopreparat – фурагин, фурадонин, Urosulfanum, Etazolum, нвиграмон, for Blacks, 5-HOK, nitroxoline. Antibiotics are applied only in an acute phase of an inflammation. Also it is necessary to provide elimination of the centers of an infection in an organism: tonsillitis, caries, integuments, etc., regulation of activity of intestines. Follows прменять  broths of herbs (bear ears, a field horsetail, renal tea, etc.). Sanatorium treatment (Zheleznovodsk, Pyatigorsk and other resorts which mineral waters possess diuretic action) is important.
At secondary chronic pyelonephritis it is necessary parallel therapy of a basic disease: or conservative (for example, at a nephrophthisis), or operational (at anomalies of kidneys and uric ways, an urolithiasis, etc.). At the unilateral chronic pyelonephritis from the outcome in wrinkling which was complicated by nephrogenic hypertensia, the kidney needs to be removed. The nephrectomy is necessary also at the pioneforoz posing a threat for all organism including for the second kidney.