Among all women who suffer from pyelonephritis, about 7-12% of pregnant women. Pyelonephritis is a very dangerous condition for the health of patients, and during pregnancy it also threatens the child. Compared to men, in women, renal inflammation occurs eight times more often than men. Such a woman's predisposition is conditioned by the genitourinary anatomy: just the urethra is located near the vagina, so the infection can spread unimpeded from one organ to another.
Pyelonephritis in pregnancy
Pyelonephritis is called a pathology in which inflammatory processes affect interstitial kidney tissues, and then the bowel-and-pelvis structures. In pregnant patients, the lesion affects mainly the right kidney and is often called gestational pyelonephritis, although acute and chronic forms of the disease are possible. By itself, pathology is quite dangerous, and pregnancy only provokes its aggravation. Often the presence of pyelonephritis in expectant mothers causes severe gestosis and anemia.
If pyelonephritis is cured in a timely manner, then it will not be a threat to the fetus and pregnancy as a whole. But in the absence of therapy, the pathology progresses and can provoke spontaneous miscarriage. For untreated fetal pyelonephritis, spontaneous interruption is more common on a 16-24-week period. Besides, intrauterine fetal death is possible.
The formation of pyelonephritis during pregnancy is due to several factors:
- In the process of gestation, there is an inevitable increase in the uterine body, causing neighboring tissues to squeeze. Compression is also observed on the ureters, which makes it difficult to remove urine from the kidneys. As a result, in the second half of the gestation, when the uterine body is increased to the maximum size, inflammatory processes develop.
- The development of pyelonephritis is also provoked by the restructuring of the hormonal sphere. In the body, the ratio of progesterone and estrogen changes, which breaks the ureter's peristalsis, worsening the progress of urine. Hence the urinary cells and inflammation of the kidney structures.
- In addition, pregnant women who have previously suffered from kidney or bladder inflammation are prone to developing pyelonephritis.
- Also, pyelonephritis develops against a background of low immune status, hypodynamic life or hypothermia.
A variety of microorganisms such as Gram-negative enterobacteria, intestinal or Pseudomonas aeruginosa, Streptococcus or enterococcus, Candida fungi, Proteus, etc., provoke pyelonephritis in women. These microorganisms begin to multiply actively against the background of the urinary cells in the kidney structures. Even carious problems with teeth or respiratory infections can become a source of infection.
The clinical picture of the renal inflammatory process is determined by the type of disease. The acute form of inflammation arises unexpectedly, the clinical picture is clearly manifested after several hours or days. With competent therapy, pathology is quickly eliminated in 1.5-3 weeks.
In acute pyelonephritis, the following symptoms appear:
- Urine clouding, sometimes acquiring a brick tint;
- The patient is concerned about lumbar pains of a different nature;
- The condition is accompanied by hyperthermia;
- Appetite is reduced;
- There is weakness and exhaustion;
- Urine with an unpleasant and pungent odor;
- Sometimes, nausea-vomiting reactions worry;
- Beats chills, etc.
In chronic pyelonephritis, pathological bacterial processes are periodically exacerbated, sluggish in nature. Against the backdrop of neglected chronic pyelonephritis, arterial hypertension or kidney failure often occurs. Chronic inflammation in pregnant women is often asymptomatic, sometimes there is a long, but mild hyperthermia. With exacerbation of chronic pyelonephritis, there are manifestations typical of the acute form of pathology.
For the detection of pathological renal inflammation, the patient will have to undergo a complex of diagnostic procedures of laboratory and instrumental character such as blood tests( general, biochemistry), urine( bacteriological, according to Zimnitskiy and Nechiporenko, general), ultrasound of renal structures and chromocystoscopy,ureteral catheterization, etc.
With pyelonephritis, blood biochemistry will show an elevated level of urea and creatinine, and a general blood test will reveal an excessiveobsession of leukocytes, which are activated to fight and destroy the inflammatory disease. Urine is examined for the detection of an agent of the inflammatory process, and ultrasound diagnostics will help visually determine the characteristic increase in the kidney.
What diagnostic methods to assign to a particular patient are determined by the nephrologist in conjunction with the obstetrician-gynecologist. If a pregnant woman shows an exacerbation of a chronic or acute inflammation, then she is shown hospital treatment.
The basis of treatment for pregnant women with pyelonephritis is bed rest, until the pathological symptoms come to naught. To normalize the urine flow, the pregnant woman should stand in the knee-elbow position, or lie down on the opposite side of the diseased kidney. Do not get pregnant with pyelonephritis and without special diet therapy, whose goal is to improve intestinal activity and reduce swelling. To improve urinary flow, ureteral catheterization is performed.
Regardless of the presence of pregnancy, medication is always prescribed. The main drugs, the most effective against pyelonephritis, are antibiotics. The doctor has to choose very carefully how to treat pyelonephritis with antibiotics to avoid a dangerous effect on the fetus.
- Penicillin preparations like Oxacillin and Ampicillin;
- Macrolides of the type Erythromycin;
- Cephalosporins - Suprex or Ceporin;
- Amingglycoside preparations like Netilmetin, etc.
The duration of antibiotic therapy is about one and a half to two weeks. Antibiotic drugs from the group of tetracyclines and streptomycins are contraindicated for pregnant women.
In addition, antispasmodics such as Baralgina and No-shpami, antimicrobial medicines( 5-NOC), desensitizers like Tavegil or Diazolin, vitamins and sedatives are also prescribed.
Consequences and complications of
Prolonged course of the inflammatory kidney process without treatment leads to tissue destruction, which in the future is fraught with organ failure. Against the background of lesions of the kidneys, Renovascular hypertension develops, which is incredibly dangerous for pregnant women.
There are certain degrees of risk of renal inflammation:
- The first degree is assigned to acute pyelonephritis, uncomplicated. If you start treatment in time, then there will be no threat from pyelonephritis. Fertility and delivery will be successful.
- The second degree of risk is given in chronic acute inflammation. Here, pathology can provoke complications in 20-30% of pregnant women. If there are no complications, then bearing and childbirth will flow perfectly, but with complications, the risk of miscarriage increases significantly.
- At the third degree, pyelonephritis is complicated by hypertension and kidney failure. At a similar degree of risk, pregnancy is highly undesirable.
For the pregnant
A sudden consequence of pyelonephritis can be sudden abortion. In addition, inflammatory pathology often acts as a provocateur of premature discharge of water or labor early in the late pregnancy. Inflammation can lead to heavy blood loss and placental detachment, weak bouts in the process of delivery. About half of pregnant women with pyelonephritis suffer from severe gestosis, which leads to increased blood pressure, hypertension, convulsive attacks, etc.
If the pregnant woman has a single kidney, inflammatory kidney lesions are a contraindication for pregnancy. If the kidney function is violated, then the pregnancy is interrupted.
What is the danger of pyelonephritis for babies? First, the pathology can pass to the baby. With intrauterine infection, a baby can develop cardiac or kidney pathologies. In addition, inflammation of the kidneys is fraught with newborns with pathologically weakened immunity, against which the child will be constantly ill.
Also, pyelonephritis leads to fetal hypoxia( in half the cases), which leads to the birth of a premature baby. Often against the background of pyelonephritis, babies are born with prolonged jaundice, nervous systemic lesions or hypothermia. A successful outcome of pregnancy and the birth of a healthy, full-term baby is possible only with timely access to specialists and proper treatment, as well as the prevention of complications of kidney inflammation.
On the video about kidney disease during pregnancy: