Internal illnesses. Chronic pyelonephritis (lecture notes)

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Internal illnesses. Chronic pyelonephritis (lecture notes)

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LECTURE No. 39. Chronic pyelonephritis

Chronic pyelonephritis is an inflammatory process involving the renal pelvis, calyces, and renal parenchyma and predominantly affecting the interstitial tissue.

Etiology. Etiological factors are the old focus of the inflammatory process in the urinary tract, cystitis, pyelitis. The disease can also be the result of untreated acute pyelonephritis.

Pathogenesis. Infection leads to a violation of urodynamics, stagnation of urine in the pelvis. Develop pyelovenous or pyelo-papillary refluxes, impaired lymphatic drainage, stasis, changes in hemodynamics. An inflammatory response develops.

Classification. Flow forms: latent, hypertonic, azotemicheskaya.

Clinic. The disease is detected many years after suffering inflammation of the urogenital area. Women get sick more often. The process can be one- or two-sided. It is characterized by low-symptomatic manifestations, it is possible to establish the disease by chance in the study of urine, an increase in blood pressure. The main symptoms: fatigue, headaches, epigastric pain, subfebrile condition, development of cystitis, dysuria, temperature rises only during exacerbation, chilling; unexplained fevers. Pain in the lumbar region is dull, constant, aggravated by bimanual palpation. Anemia develops even before kidney failure. Arterial hypertension is associated with renal ischemia, for a long time patients are subjectively well tolerated. Polyuria, pollakiuria, nocturia develop.

Additional diagnostic study. A complete blood count is performed (neutrophilic leukocytosis with a shift to the left is noted, an increase in ESR during exacerbation, anemia), a study of a general urinalysis: the specific gravity is reduced, moderate proteinuria, slight cylindruria, microhematuria, severe pyuria - there are many leukocytes, prevail over erythrocytes. With samples of Kakovsky-Addis, Nechiporenko to determine the ratio of erythrocytes, leukocytes, cylinders, an increase in the number of leukocytes is noted. With a latent course, a prednisone or pyrogenal test is indicative (positive, when after the administration of the drug 0,4 x 10⁹/_л and more leukocytes in 1 hour).

They also perform chronocystoscopy, excretory urography (there is a decrease in concentration ability, a violation of the tone of the pelvis, calyces and ureter, expansion of the calyces and pelvis with deformation of the fornixes), ultrasound examination (expansion and deformation of the pelvis, calyces is noted, the structure of the parenchyma changes, echogenicity) and X-ray examination ( visible expansion of the pelvis, necks, change in the structure of the cups, asymmetry of the lesion is characteristic even with a bilateral process).

Complications. Complications of the disease are secondarily wrinkled kidney, chronic renal failure, kidney tumor.

Differential diagnostics. Should be carried out with chronic glomerulonephritis, amyloidosis of the kidneys, nephrosclerosis.

Treatment. Nitropreparations are used: furagin or furadonin 0,1 g 3 times a day, nitroxoline (5-NOC) 0,1 g 4 times a day, nalidixic acid (nevigramon, blacks) 0,5-1 g 4 times a day 2-3 weeks, fast-acting sulfonamides (etazol, urosulfan) 4-6 g per day, prolonged action (biseptol-480) 1-2 g per day up to 2 weeks, sulfalene 0,25 g 1 time per day for a long time time, broad-spectrum antibiotics (with the ineffectiveness of nitrofurans and sulfonamides, with exacerbations), the course should be short, but adequate. Recommend the use of 1,5-2 liters of liquid during the day in the form of water, fruit and vegetable juices, herbal medicine for 2-3 weeks, spa treatment.

Flow. The course of the disease is long, with periods of exacerbations and remissions.

Forecast. The prognosis is favorable for uncomplicated forms, unfavorable for complications.

Prevention. Prevention measures are: timely treatment of acute pyelonephritis, treatment of coprostasis, chronic colitis, cholecystitis, sanitation of the oral cavity, proper nutrition with plenty of vitamins, preventive therapy with herbal preparations.

Author: Myshkina A.A.

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