Acute and chronic obstructive pyelonephritis: ICD-10 code, causes, symptoms, treatment

Obstructive pyelonephritis may initially not be associated with an infectious process, but is subsequently associated with bacterial inflammation. Treatment of this disease can be difficult - depending on what reason it provoked.

Obstructive pyelonephritis

Under obstructive pyelonephritis, inflammation of the renal pelvis or calyces is associated with the difficulty of outflow of urine from the organ. In other words, if the urinary tract in the kidneys overlap with stones, a tumor or for other reasons, there is an inflammatory process - pyelonephritis. In rare cases, pathology is independent, much more often it is manifested against a background of another disease.

The main manifestations of the pathology are pain, urination disorders and high body temperature. Obstructive pyelonephritis often occurs in adults - in childhood, pathology is much less common.

Code of the disease according to ICD-10:

1. No. 11.1.Chronic obstructive pyelonephritis.
2. №10.Acute tubulointerstitial nephritis.

In obstructive pyelonephritis, it is also possible to switch to conventional acute nephritis - with prolonged absence of treatment, when inflammation products block the urinary excretion of urine from the kidneys. The disease can be complicated by a deadly pathology - kidney failure.

Forms of

Primary obstructive pyelonephritis is a disease that initially affects the kidney, leading to the development of the inflammatory process and the narrowing or complete overlap of the urinary tract. But most often there is a secondary obstructive pyelonephritis - it occurs as a complication of other diseases.

The classification of pyelonephritis for the localization of the inflammatory process is as follows:

1. Left-sided.
2. Right-hand.
3. Two-sided( mixed).

According to the type of flow, pyelonephritis can be acute, chronic. The acute process develops for the first time, has a vivid symptomatology, often it is difficult. Chronic obstructive pyelonephritis is accompanied by periodic relapses and remissions.

Causes and pathogenesis of

In most cases, the pathology arises from a decrease in immunity in the kidneys against the background of long-acting factors, and also due to stagnation of urine, to which such problems lead:

1. Nephrolithiasis, or urolithiasis. This is the most common cause of obstruction of the urinary tract. Concrements can form in the bladder or in the system of calyxes and pelvis, but with urine flow they are able to move and clog any part of the system. Often the stone closes the lumen of the ureter, so the stagnation of urine is formed in the kidney tissue and pelvis.
2. Neoplasms of the kidney, ureter, as well as tumors of neighboring organs, including the intestine. Pressurization of the outflow of urine causes obstruction and subsequent inflammation.
3. Congenital malformations of the structure of the kidneys, ureters. Constrictions, strictures of the ureters in this group of reasons hold leadership, they are also the determining risk factors for the development of pyelonephritis in children. Anomalies in the structure of the organs of the urinary system can also be acquired, for example, after the emergence of injuries or surgeries. Benign prostatic hyperplasia. The lumen of the urethra, squeezed by the adenoma of the prostate, narrows, which causes stagnation of urine, the development of inflammation and its rise to the kidneys.
4. Foreign bodies. Very rarely, but experts diagnose the overlap of the urinary tract in young children with foreign objects. Also this cause can have an effect with an open trauma to the kidney.

For urolithiasis or abnormalities in the structure of the kidney is characterized by prolonged course and partial obstruction, so they become the basis for the development of chronic pyelonephritis. However, a change in the position of the stone can trigger an exacerbation of pyelonephritis. Tumors are characterized by increasing obstruction, which can lead to the development of both forms of pyelonephritis.

Infection can penetrate into the place of stagnation of urine in two ways - hematogenous( with blood flow from other sources of infection) and, much more often, urogenital. In the second case, inflammation begins in the urethra or bladder, and then penetrates into the kidneys. It happens that the infectious process in the kidneys already takes place - it happens in patients with chronic non-obstructive pyelonephritis.

The representatives of pathogenic and conditionally pathogenic microflora, such as:

• Staphylococci, may cause inflammation;
• Enterococci;
• E. coli;
• Pseudomonas aeruginosa;
• Proteus;
• Streptococci;
• Mixed microflora( 2/3 of the cases).

If a patient has chronic pyelonephritis, eventually the tissue in the affected areas of the kidney dies, is replaced by scars, therefore, the kidney parenchyma decreases - organ dysfunction develops with the development of renal failure.

Symptoms of

Acute obstructive pyelonephritis in children and adults begins acutely - with sharp pain in the lumbar region. When overlapping the ureter, a stone causes renal colic with unbearable pain, which is poorly helped by analgesics. Pain gives in the groin, thigh. There are also signs of high body temperature( up to 40 degrees), abundant sweating, and they appear already against the background of renal colic - by the end of the first day.

On the side of the affected organ( left or right) there is a tension in the anterior wall of the peritoneum, there is a strong soreness in palpation in the projection of the kidney. There are violations of the process of urination, urinary retention, and sometimes there is blood in the urine. A person complains of weakness, malaise, headache, nausea, often vomiting. The maximum signs of intoxication reach 3-4 days after the onset of pain in the kidney.

With chronic obstructive pyelonephritis, aching pain that occurs regularly is not intense. There is also general weakness, decreased efficiency, increased urge to urinate, discomfort when going to the toilet. With prolonged ongoing illness, a person may develop urinary incontinence.

Diagnosis

In the diagnosis the main role is played by the collection of anamnesis and elucidation of the existing chronic pathology of the kidneys( strictures, nephrolithiasis, etc.), as well as a comparison of the anamnesis with the current clinical signs. During the physical examination, soreness of the affected area is revealed, impaired mobility of the kidney and its increase due to edema, muscle tension of the back and abdomen.

From laboratory and instrumental diagnostic methods the following are carried out:

1. General urine analysis. In the urine there is a protein, a moderate amount of red blood cells, a large number of white blood cells.
2. Bacteriological culture of urine. Bacteria - pathogens of the inflammatory process are detected.
3. General blood test. There is an increase in leukocytes, ESR, neutrophils, as well as anemia.
4. Survey radiography. There is an increase in the kidney, visually noticeable tumors, stones, strictures, foreign bodies.
5. kidney ultrasound. It makes it possible to detect all inflammatory foci in the kidneys, the destruction zone for chronic pyelonephritis, to establish the cause of the pathology.
6. MRI, CT.Most often recommended for differentiation of kidney tumors or clarification of the type of concrements for the selection of treatment.

Treatment of

To eliminate the cause of the disease and the inflammation that has arisen, in most cases a combined method is used. Concrements from the kidney are removed with the help of surgical intervention, or minimally invasive techniques for crushing stones. With complete blockage of the urinary tract, an emergency operation is most often performed. With tumors of the kidneys, surrounding organs, if possible, surgical intervention and radiation therapy, chemotherapy. Structures of ureters and other abnormalities of the structure of the urinary system in children and adults are removed by endoscopic surgeries.

Conservative treatment is aimed at eliminating the infectious process and removing symptoms. These types of drugs are used:

1. Spasmolytics - extract of belladonna, Platifillin, No-shpa.
2. Anti-inflammatory drugs - Ibuprofen, Nurofen.
3. Directional antibiotics - Negra, Nevigramon, and uroseptics - Furadonin, Furomag.
4. Antibiotics of a wide spectrum of action - Ampicillin, Oletetrin, Kanamycin, Ceporin, Tetracycline.

In chronic obstructive pyelonephritis, in addition to these drugs, immunomodulators( Urovaksom), plant anti-inflammatory drugs( Kanefron) are recommended. In children with severe disease, it is often practiced with hormonal anti-inflammatory drugs( Prednisolone).In general, the treatment of a chronic form of pathology can be carried out for years with the use of various antibiotics and antiseptics, alternating and combining among themselves. It is useful to use in the treatment of cranberries, extract of this berry and preparations based on it. Treatment is shown in sanatoriums, physiotherapy( electrophoresis, magnetotherapy, CMV therapy).

The diet is required to reduce the burden on the kidneys, to help normalize the outflow of urine. Should be discarded from salted, fatty foods, sharp and fried foods, confectionery, baking. It is necessary to drink a lot of liquid - from 2.5 liters per day.

Prognosis and complications

Acute obstructive process in the kidneys threatens the development of renal failure, necrosis of the renal papillae, parainfrit. Rare, but the most dangerous complications are sepsis, bacterial shock. In the chronic form of pathology, patients often suffer from nephrogenic arterial hypertension, chronic renal failure. The prognosis largely depends on the cause of the disease and the speed of medical care. Congenital anomalies in the structure of organs are usually successfully corrected, as are most forms of urolithiasis. With tumor kidney pathology, the prognosis depends on the stage of the disease and the type of tumor.