Internal illnesses. Chronic pyelonephritis (most important)

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Internal illnesses. Chronic pyelonephritis (most important)

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47. CHRONIC PYELONEPHRITIS

Inflammatory process involving the renal pelvis, calyces and renal parenchyma and predominantly affecting the interstitial tissue.

Etiology. 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. The infection leads to disruption of urodynamics and stagnation of urine in the pelvis. Pyelovenous or pyelo-papillary refluxes, impaired lymphatic drainage, stasis, and hemodynamic changes develop. An inflammatory reaction develops.

Clinic. It 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.

Diagnostic study. A general blood test is performed (neutrophilic leukocytosis with a shift to the left, an increase in ESR during exacerbation, anemia), a general urine test (reduced specific gravity, moderate proteinuria, slight cylindruria, microhematuria, severe pyuria - there are many leukocytes, they predominate over red blood cells). With Kakovsky-Addis and Nechiporenko tests, an increase in the number of leukocytes is noted. In case of latent progression, a prednisolone or pyrogenal test is performed.

Chronocystoscopy, excretory urography, ultrasound examination (expansion and deformation of the pelvis, calyces are noted, the structure of the parenchyma, echogenicity changes) and x-ray examination (visible expansion of the pelvis, necks, changes in the structure of the calyces, asymmetry of the lesion is characteristic even with a bilateral process).

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 (non-vigramon, 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, 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. Long-term, with periods of exacerbations and remissions.

Forecast. Favorable for uncomplicated forms, unfavorable for complications.

Prevention. 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.K.

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