Chronic pyelonephritis is a pathology of the kidney tissue( code N11 for ICD-10), which is provoked by pathogens lasting for years, worsening when immunity is weakened.
Exacerbation of chronic pyelonephritis
The morbidity statistics show that the disease is common, and after death, one in ten is recorded. Among women, the disease is noted more often, which is caused by a short urethra in comparison with the male.
Chronic pyelonephritis( ICD 10 code - N11) is able to not show itself for a long time, it is concealed. In this form, the disease sometimes exists until death, which comes from non-causative kidney causes.
The cause of recurrence of chronic pyelonephritis is the weakening of immunity, a long stay in the cold, an infection. Provoke a relapse of E. coli, enterococci, staphylococcus, streptococcus, fungi, viruses, Pseudomonas aeruginosa.
When pregnant with E. coli, 85% of women develop chronic pyelonephritis. Pregnant women also have Klebsiella, Proteus, Pseudomonas aeruginosa.
Pathogenic microorganisms are activated:
- by subcooling;
- climate change;
- irrational power;
- by diabetes;
- with hepatitis.
Exacerbations of kidney inflammation are accompanied by:
- violation of urination;
- by pressure increase;
The temperature may not rise above 37.2 ° C, but sometimes there is a fever of 39 ° C with chills. High fever is infrequent, usually in patients there is an increase in temperature to subfebrile condition in the evening, signs of intoxication in the recurrence of chronic pyelonephritis are erased.
The exacerbation of chronic pyelonephritis manifests with dull pain in the lower back, the lateral sections of the abdomen giving off in the groin, the front side of the thigh. Pain in chronic pyelonephritis is sometimes very similar to sensations in radiculitis, gastritis, cystitis, and ovarian inflammation.
You can confirm the renal origin of the pain with the symptom of Tofilo. To conduct the test, the patient is asked to lie on his back, bend his leg in the knee, press it to his chest on inspiration. If the pain in this situation increases, it increases the likelihood of chronic pyelonephritis.
Hypertension is noted in 75% of patients with chronic pyelonephritis. At the beginning of the disease, pressure increases appear only during periods of exacerbations, but over time, hypertension becomes frequent for patients, and in 10% of patients it becomes complicated.
Disruption of daily urination is manifested:
- by pollakiuria;
During periods of exacerbation there is a decrease in the specific gravity of urine, the presence of protein, and leukocytes in the urine. When urinating, you can feel pain, stitching.
Exacerbation of chronic pyelonephritis causes a decrease in the production of erythropoietin, which causes anemia. In pregnancy, chronic pyelonephritis often worsens in the 2nd trimester. There is a danger of an exacerbation 3 weeks after childbirth.
With exacerbation of chronic pyelonephritis, it is necessary to limit the motor activity regime. At high blood pressure, acute pain, bed rest is recommended, only allowed to get up to go to the toilet and the dining room.
In case of severe pain, immediately call a doctor at home. Do not put a heater on the patient, give painkillers or offer a plentiful drink. It is necessary to wait for the doctor's arrival.
Treated with exacerbation of antibiotics, sulfonamides, nitrofurans, supplementing drug therapy with phytotherapy. Antibiotics are prescribed according to the results of bacterial inoculation.
Antibiotics against kidney infection are prescribed:
- with E. coli - ampicillin, cephalosporin, levomycetin;
- proteome - ampicillin, carbenicillin, gentamicin;
- Pseudomonas aeruginosa - gentamicin, carbenicillin;
- enterococcus - ampicillin, carbenicillin;
- with Staphylococcus aureus - penicillins, ampicillin;
- streptococcus - penicillins, cephalosporins;
- mycoplasma - erythromycin.
In addition to antibiotics, for the treatment of recurrences of chronic pyelonephritis, derivatives are used:
- nitrofuran - furazolidone, furadonin, furagin;
- nalikidovoj acids - navigramon, the negroes;
- 8-hydroxyquinoline-nitorxoline, 5-NOC.
Treatment during pregnancy
The task of treatment of exacerbation of pyelonephritis becomes more complicated during pregnancy, the requirements to drug safety increase. What to treat depends on the pathogenic flora, with the treatment should be absolutely safe for the fetus.
Treatment is carried out in a hospital, the course lasts 2 weeks. Begin treatment with intravenous administration of drugs, moving in the future to take the tablets inside. Do not use furazolidone during pregnancy, biseptol, levomycetin, tetracycline, fluoroquinolone, streptomycin because of the risk to the fetus.
The drug of choice for this task is inhibitor-protected penicillin ampicillin + sulbactam, amoxicillin + clavunate. Use in pregnancy macrolides, cephalosporins.
Cephazolosporins during pregnancy are used:
- first 2 trimester - drugs 2 generations Cefaclor, Cefuroxime;
- in the 3rd trimester - preparations 3, 4 generations of Cedex, Maxipin, Fortum.
If the exacerbation is caused by Pseudomonas aeruginosa, use cefaperazone + sulbactam, ceftazidime. With an allergy to penicillins, cephalosporins, the reserve drug serves aszreonam. The drug is prescribed strictly according to the indications, with caution.
In case of a particularly complicated course of exacerbation, thienes( carbapenems) are used. A special feature of chronic pyelonephritis therapy is the elimination of sulfonamides and nitrofurans 20 days before delivery because of the possibility of complications in the fetus. Do not prescribe ototoxic antibiotics( gentamicin), which cause damage to the hearing in the fetus.
Breastmilk practically does not penetrate aztreonam, gentamicin, furadonin, furagin, cephalosporin cefaclor, ceftributene. This allows you to use medicines without interrupting breastfeeding.
Temporarily stop breastfeeding with antibiotics from the group of fluoroquinolones - ofloxacin, ciprofloxacin, perfloxacin.
Use for treatment can be both herbal preparations Fitonefrol, Kanefron H, and medicinal herbs, preparations for the preparation of decoctions.
The drug Kanefron contains lovage, rosemary, centenarius. Take the drug course, it enhances the effect of antibiotics, which are used in basic therapy, is an aseptic, diuretic, has an anti-inflammatory effect.
The use of Kanefron reduces proteinuria, reduces protein loss in the urine due to a decrease in the permeability of the blood capillaries.
Medicinal plants that are used for the preparation of decoctions at home with chronic pyelonephritis should have the following properties:
- anti-inflammatory - bearberry, cowberry, chamomile, St. John's wort, marshmallow, nettle;
- diuretic - birch leaves, juniper, parsley, kidney tea, cornflower flowers, corn stigmas, elecampane, bearberry.
It is recommended to take multivitamin preparations, tincture of magnolia vine, ginseng. It is useful for chronic pyelonephritis, sanatorium treatment, mineral water.
Features of the diet
In chronic pyelonephritis in the acute stage, diet No. 7 is recommended, in which:
- drastically reduce the amount of salt( or exclude on the recommendation of a doctor);
- is slightly limited to protein products;
- increases plant products containing vitamin C, thiamine, riboflavin, iron, nicotinic acid, potassium, magnesium;
- excludes seasonings, smoked products;
- is prescribed food up to 6 times a day;
- drinking mode for exacerbation - up to 1, 5 l / day.
Preventing exacerbations is that in food, include foods high in iron( raspberries, pomegranates, apples), potassium( dried apricots, raisins, figs).It is recommended for the period of illness a milky-vegetable diet with a small amount of additions in the form of boiled meat, fish.
On the video about the symptoms and treatment of exacerbation of chronic pyelonephritis: