Acute pyelonephritis

Description:

Acute pyelonephritis is an acute infectious and inflammatory disease of tissue of kidneys and pyelocaliceal system of kidneys. It can be primary or develop against the background of already existing other disease of kidneys.

Symptoms of Acute pyelonephritis:

The clinical picture of acute pyelonephritis is defined by a disease stage, existence or lack of complications and a combination of the general signs of heavy infectious process and local symptoms.

Stages of pyelonephritis correspond to morphological changes in a kidney.

Initial stage of a disease - serous pyelonephritis which duration varies from 6 to 36 h. The subsequent stages of a disease are characterized by purulent, destructive changes which develop in the following sequence: apostematous pyelonephritis, kidney anthrax, kidney abscess, purulent paranephritis.

Apostematous pyelonephritis is characterized by emergence small (1-2 mm) multiple pustules in cortical substance of a kidney and on its surface.

The anthrax of a kidney develops in cortical substance owing to merge of pustules at apostematous pyelonephritis or as a result of hit of a microbic embolus in a final arterial vessel of a kidney that is shown by a combination of ischemic, necrotic and pyoinflammatory processes.

Abscess of a kidney is result of purulent fusion of a parenchyma in the center of merge of apostemas or an anthrax of a kidney. The created abscess can be emptied in pararenal cellulose as a result of purulent fusion of a fibrous renal capsule with the subsequent development of a purulent paranephritis and, even, phlegmons of retroperitoneal space.

Purulent forms of pyelonephritis especially often develop as a result of obstruction of upper uric ways.

The clinical picture of acute secondary pyelonephritis differs from that at primary pyelonephritis in bigger expressiveness of local symptoms. At primary (not obstructive) pyelonephritis on the first place the general symptoms of an infectious disease act, and local symptoms in an onset of the illness can be absent in general that quite often leads to diagnostic mistakes. Symptoms of a disease develop within several hours or one days. The patient against the background of the general weakness and an indisposition has a tremendous fever with the subsequent fervescence to 39-41 °C, pouring sweat, a headache (it is preferential in frontal area), nausea, quite often vomiting. There is diffusion muscular and joint all body pain, sometimes - a diarrhea. Language dry, is noted tachycardia.

At secondary (obstructive) pyelonephritis development of inflammatory process is preceded, as a rule, by renal colic. After it or at height of renal colic there is a tremendous fever which is replaced by strong heat and sharp fervescence to 39-41 °C that can be followed by a headache, nausea, vomiting, muscle, bones and joints pain. After rise in temperature of the patient plentifully sweats, temperature begins to decrease critically to normal or subnormal figures that usually is followed by some improvement of health and reduction of a back pain. This imaginary improvement of a condition of the patient should not be regarded by the doctor as the beginning treatment. If the factor of obstruction of upper uric ways is not liquidated, several hours later pain in lumbar area amplifies again, body temperature increases, tremendous oznoba repeat.

At development of purulent forms of pyelonephritis the clinical picture is aggravated. The back pain which was pristupoobrazny becomes constant and not irradiating, is followed by gektichesky fever and tremendous oznoba. The muscle tension of lumbar area and muscles of a front abdominal wall on the party of defeat is noted. The increased painful kidney is palpated. Owing to violently accruing intoxication the condition of patients quickly worsens. There is dehydration that changes the patient's appearance, there are pointed features. So serious condition can be followed by euphoria.

Not always there is a parallelism between a condition of the patient, expressiveness of clinical symptoms and degree is purulent - destructive changes in a kidney. The weakened patients, elderly people can have very scanty clinical displays of a disease or perverted.

Reasons of Acute pyelonephritis:

In 90% of cases gram-negative microorganisms, from them in 50% - colibacillus are an etiology.
Infectious agents can get into a kidney in three ways:

  1.gematogennym, in the presence of primary centers of an inflammation in bodies of urinogenital system (a salpingo-oophoritis, cystitis, prostatitis, etc.) or other bodies (tonsillitis, sinusitis, carious teeth, bronchitis, a furunculosis, etc.);
  2.voskhodyashchim urinogenny (on an ureter gleam);
  3.voskhodyashchim on subepithelial spaces of a wall of an ureter.

Treatment of Acute pyelonephritis:

Patients with acute pyelonephritis need hospitalization. Approach to treatment of primary and secondary pyelonephritis various.

At detection of secondary (obstructive) pyelonephritis the very first and urgent action is recovery of outflow of urine from the affected kidney. If since the beginning of a disease there passed no more than 2 days and there are no manifestations is purulent - destructive changes in the affected kidney, recovery of outflow of urine is possible by pelvis catheterization (a usual ureteric catheter or a catheter stent). At impossibility of carrying out an ureteric catheter above the place of obstruction the puncture transdermal nephrostomy is shown.

At primary pyelonephritis and after recovery of outflow of urine from the affected kidney at secondary pyelonephritis pathogenetic treatment which cornerstone antibacterial therapy is is appointed at once. Antibacterial drugs have to be a broad spectrum of activity with obligatory influence on gram-negative flora (cephalosporins, ftorkhinolona, aminoglycosides). At identification of the activator as a result of a bacteriological research of urine antibacterial drugs are chosen taking into account an antibiotikogramma. The drugs have to be administered parenterally in the most admissible therapeutic dose. Besides, the non-steroidal anti-inflammatory drugs, drugs improving blood circulation, a complex of intoksikatsionny therapy are appointed. Lack of effect of wire therapy during 1-1,5 days or an aggravation of symptoms of the patient testifies to progressing is purulent - destructive process in a kidney that is the indication to an open operative measure.

If the long anamnesis of a disease takes place (more than 3 суг) and it is available manifestations is purulent - destructive pyelonephritis (the expressed intoxication, dehydration, repeated oznoba considerable tachycardia, hypotonia, protective tension of muscles of a waist and a front abdominal wall on the party of defeat, the destructive centers according to KT), then an open operative measure is a choice method.

The operation purpose - to stop pyoinflammatory process, to create conditions for its elimination, and also to prevent its possible complications by improvement krovo-and lymphokineses in the struck body. For this purpose carry out decapsulation of a kidney that allows to reduce intra renal pressure, to reduce hypostasis of intersticial fabric and by that to expand a gleam of circulatory and absorbent vessels. Operation comes to the end with a nephrostomy. In case of detection during operation of an anthrax or abscesses make their section. When involving in it is purulent - destructive process of a considerable part of a renal parenchyma (2/3 and more) and impossibility of organ-preserving operation carry out a nephrectomy.

After completion of surgery antibacterial, antiinflammatory, disintoxication therapy is appointed.