Symptoms and treatment of chronic kidney pyelonephritis. Pyelonephritis: what it is, why it is dangerous, symptoms and treatment of pyelonephritis Treatment of chronic pyelonephritis in adults

About 2/3 of all urological diseases occur due to acute or chronic pyelonephritis. This pathology is infectious in nature and is accompanied by damage to one or two kidneys. Their inflammation is provoked by various bacteria, although sometimes the disease develops against the background of other diseases of the internal organs. Women are more prone to pyelonephritis, which is explained by the individual characteristics of the anatomical structure of the vagina and urethra. Treatment of the disease is carried out comprehensively by taking medications and following a number of rules.

What is pyelonephritis

The disease is an infectious-inflammatory process in the kidneys caused by the action of pathogenic bacteria. They affect several parts of these paired organs at once:

interstitial tissue - the fibrous base of the kidney;
parenchyma - functionally active epithelial cells of these paired organs;
pelvis - cavities in the kidney, similar to a funnel;
renal tubules.

In addition to the pyelocaliceal system, damage can also affect the glomerular apparatus with blood vessels. At an early stage, the disease disrupts the main function of the kidney membrane - urine filtration. A characteristic sign of the onset of inflammation is aching pain in the lumbar region. The disease can be acute or chronic. If you suspect pyelonephritis, you should contact a nephrologist. If diagnosis is not made in a timely manner and treatment is not started, the following complications may develop:

kidney abscess;
hypotension;
sepsis;
bacterial shock;
kidney carbuncle;
renal failure.

Spicy

Acute pyelonephritis develops as a result of the influence of exogenous or endogenous microorganisms that penetrate the kidney tissue. More often, right-sided localization of inflammation is noted, which is explained by the structural features of the right kidney, which causes its tendency to stagnation. In general, the following signs indicate the acute stage of this pathology:

chills, fever;
increasing weakness;
tachycardia;
dull pain in the lower back;
dyspnea;
temperature 38.5-39 degrees;
fatigue;
disturbance of urine outflow;
headaches and muscle pain.

With bilateral inflammation of the kidneys, the patient complains of pain throughout the back and abdomen. The purulent form of the disease causes pain similar to renal colic. Impaired urine flow is manifested by an increased urge to urinate. In addition, nocturnal diuresis predominates over daytime diuresis. These symptoms may cause swelling and increased blood pressure.

Chronic

In most cases, chronic pyelonephritis is a continuation of its acute form. The most common cause is improperly selected or missing treatment. Also at risk are patients who have impaired urine passage through the upper urinary tract. A third of patients suffer from this disease since childhood due to low-grade inflammation of the parenchyma of the renal collecting apparatus.

Chronic pyelonephritis has a wave-like character: remissions are replaced by periods of exacerbation. This is the reason for the change in the clinical picture. During an exacerbation, the symptoms are similar to the acute form of the pathology. During the period of remission, the signs are weakly expressed. Patients complain of periodic throbbing or aching pain, which most often occurs at rest. Against their background appear:

asthenia – episodic weakness;
rapid fatigue;
slight increase in pressure or temperature.

Causes

The common cause of the development of the disease is bacteria: staphylococci, enterococci, chlamydia, Klebsiella, salmonella, Pseudomonas aeruginosa. They reach the kidneys in different ways. With cystitis, this occurs by the urinogenic (ascending) route: microorganisms penetrate into the pyelocaliceal system from the urethra in the following pathologies:

cystitis;
colpitis;
prostate adenoma;
urolithiasis disease;
abnormalities in the structure of the urinary system.

Bacteria are introduced during manipulation of catheters. Another route of infection is hematogenous, when microbes enter the kidneys through the bloodstream from another source of inflammation in the following diseases:

angina;
pneumonia;
ear infection;
pulpitis;
flu.

At-risk groups

Doctors identify several risk groups, which include patients prone to developing pyelonephritis. The first group consists of people with abnormalities in the structure of the urinary tract, such as:

Congenital anomalies. They are formed under the influence of hereditary or negative (smoking, drugs, alcohol) factors during pregnancy. The result is that malformations develop: narrowing of the ureter, underdeveloped or prolapsed kidney.
Anatomical structure of the genitourinary system in women. They have a shorter urethra compared to men.

Women more often suffer from this disease not only because of the special structure of the genitourinary organs. The reason for their development of this disease may be hormonal and other changes during pregnancy:

The hormone progesterone reduces the tone of the muscles of the genitourinary system to prevent miscarriage, but at the same time disrupts the outflow of urine.
The growing fetus enlarges the uterine cavity, which compresses the ureter, which also disrupts the process of urine outflow.

The last risk group consists of patients with reduced immunity. In this condition, the body cannot fully defend itself against all foreign microorganisms. A weakened immune system is typical for the following categories of patients:

children under 5 years old;
pregnant women;
people with autoimmune diseases such as HIV infection and AIDS.

Provoking factors

Pyelonephritis is secondary when it develops against the background of other diseases. These include diabetes mellitus, frequent hypothermia, poor hygiene, and chronic inflammatory infections. The general list of factors provoking pyelonephritis includes:

Tumors or stones in the urinary tract, chronic prostatitis. Cause stagnation and disruption of urine outflow.
Chronic cystitis. This is an inflammation of the bladder in which the infection can spread up the urinary tract and cause kidney damage.
Chronic foci of inflammation in the body. These include bronchitis, furunculosis, intestinal infections, and amygdalitis.
Sexually transmitted diseases. Trichomonas and chlamydia can penetrate through the urethra into the kidneys, which will lead to their inflammation.

Treatment of pyelonephritis at home

The disease is treated with conservative methods, but the approach must be comprehensive. Therapy, in addition to taking medications, includes adherence to a special regime. The rules concern correction of the patient’s lifestyle and nutrition. The goal of therapy is to eliminate the causative agent of pyelonephritis. Additionally, measures are being taken to normalize urine flow and strengthen the immune system. Treatment of pyelonephritis in women and men is carried out according to the same scheme, including:

Compliance with a special regime. Involves avoiding intense physical activity and avoiding hypothermia.
Drink plenty of fluids. Prescribed if the patient does not have edema.
Medical nutrition. A balanced diet helps reduce the load on the kidneys, reduce the level of creatinine and urea in the blood.
Taking non-hormonal medications. They are part of etiotropic and symptomatic therapy. The first one eliminates the cause of the disease, the second one copes with its symptoms.
Physiotherapy. It is used to speed up recovery and relieve unpleasant symptoms of pathology.

Compliance with the regime

Taking into account the severity of the disease, the doctor determines where pyelonephritis will be treated. Uncomplicated forms are treated at home, and the first days must be kept in bed. The patient should not overcool and play sports. In case of exacerbation, only visiting the toilet and kitchen to eat is allowed. In case of intoxication and complications, the patient needs treatment in a hospital under the supervision of a doctor. Indications for hospitalization are:

progression of chronic pyelonephritis;
severe exacerbation of the disease;
disturbance of urodynamics, in which it is necessary to restore the passage of urine;
development of uncontrolled arterial hypertension.

Drink plenty of fluids

For pyelonephritis, it is necessary to increase fluid intake to 3 liters per day, but only if there is no edema. Water flushes the urinary canals, removes toxins and restores normal water-salt balance. You need to drink 6-8 glasses at regular intervals. In addition to water, to ensure an anti-inflammatory effect and normalize metabolic processes, it is useful to consume:

rosehip decoction;
dried fruits compote;
mineral water with alkalis;
weak green tea with milk or lemon;
lingonberry and cranberry fruit drinks.

Medical nutrition

A strict diet is not required. The patient is advised to avoid salty, spicy and fatty foods, smoked foods and alcoholic beverages. Preference is given to products with vitamins B, C, P. You need to eat more vegetables and fruits, especially those that have a diuretic effect: watermelon, melon. The list of recommended products additionally includes the following products:

baked apples;
bright orange pumpkin;
fermented milk;
cauliflower;
young beets;
carrot.

Drug therapy

It is divided into two types: etiotropic and symptomatic. The first is necessary to eliminate the cause that caused the disturbance of renal circulation, especially venous circulation, or urine passage. Surgical interventions help restore the flow of urine. Taking into account the cause of the disease, the following is carried out:

removal of prostate adenoma;
nephropexy for nephroptosis;
plastic surgery of the urethra;
removal of stones from the urinary tract or kidneys;
plastic surgery of the ureteropelvic segment.

Etiotropic treatment additionally includes anti-infective therapy - taking antibiotics depending on the causative agent of the disease. This method is used for primary and secondary pyelonephritis. Symptomatic therapy helps eliminate signs of the disease and restore the body after treatment. To perform these tasks, the following groups of drugs are prescribed:

diuretics – eliminate swelling;
non-steroidal anti-inflammatory drugs – provide relief of inflammation;
improving renal blood flow - effective for chronic pyelonephritis;
immunomodulators, adaptogens – strengthen the immune system.

Physiotherapy

In medicine, physiotherapy refers to the study of the influence of natural factors on the body. The use of the latter helps reduce the number of medications a person takes. The indication for physiotherapy is chronic pyelonephritis. The procedures increase blood supply to the kidney, improve the delivery of antibiotics to the kidneys, and eliminate spasms of these paired organs. This makes it easier for mucus, bacteria and urinary crystals to pass away. These effects have:

Electrophoresis of furadonin on the kidney area. The solution for this procedure includes: 100 ml of distilled water, 2.5 g of sodium hydroxide, 1 g of furadonin. To achieve results, 8-10 procedures are performed.
Ultrasound at a dose of 0.2-0.4 W/cm2 in pulsed mode. An ultrasound therapy session lasts 10-15 minutes. Contraindication: urolithiasis.
Electrophoresis of erythromycin on the kidney area. Using an electric current, a solution of 100 g of ethyl alcohol and 100 thousand units of erythromycin is delivered to the organs.
Thermal procedures. These include ozokerite and paraffin applications, diathermo mud, therapeutic mud, diathermy.

Drugs for the treatment of pyelonephritis

The selection of drugs for etiotropic treatment is carried out on the basis of general and biochemical blood and urine tests, during which the causative agent of the disease is identified. Only under this condition will therapy bring a positive result. Different antibiotics are effective against certain bacteria:

Names of bacteria	Names of antibiotics and uroantiseptics
Escherichia coli	Carbenicillin; Gentamicin; Levomycetin; phosphacine; nitrofuran compounds; Nalidixic acid; Ampicillin.
Enterobacter	Levomycetin; Ciprofloxacin; Nitrofurans; Tetracycline; Gentamicin.
	Ampicillin; Nalidixic acid; Carbenicillin; Cephalosporins; Levomycetin; Gentamicin; nitrofurans; sulfonamides.
Enterococcus	Gentamicin; Ampicillin; tetracyclines; Carbenicillin; Nitrofurans.
Pseudomonas aeruginosa	Gentamicin; Carbenicillin.
Staphylococcus aureus	Gentamicin; Oxacillin; Methicillin; Tetracyclines; Cephalosporins; nitrofurans.
Streptococcus	Penicillin; Carbenicillin; Tetracyclines; Gentamicin; Ampicillin; sulfonamides; nitrofurans; cephalosporins.
Mycoplasmas	Erythromycin; Tetracycline.

Antibacterial therapy based on the results of bacteriological examination of urine

The condition for the success of antibacterial therapy is that the drug corresponds to the sensitivity of the pathogen to it, which is identified during bacterial testing. If the antibiotic does not work within 2-3 days, which is confirmed by a high level of leukocytes in the blood, then it is replaced with another drug.

Indications for use are determined by the type of pathogen. In general, the following groups of drugs are used:	Name of antibiotic group	Examples of drugs	Method of administration
Daily dosage	Penicillins	Ampicillin	Intramuscularly
	1 g every 6 hours.		Amoxicillin
	0.5 g every 8 hours.	Ampicillin	Augmentin
1.2 g every 4 hours.	Aminoglycosides	Garamycin (Gentamicin)	Intravenous, intramuscular
	3.5 mg/kg in 2-3 dilutions.		Amikacin
	15 mg/kg in 2 doses.		Tobramycin
3-5 mg/kg in 2-3 injections.	Tetracyclines	Doxycycline	Intravenously, orally
	0.1 g up to 2 times.		Metacycline
	0.3 g up to 2 times		Vibramycin
0.2 g 1 time at the initial stage of treatment, then in a maintenance dosage of 0.1 g.	Levomycetins	Levomycetin succinate	Intramuscular, intravenous
	0.5-1 g up to 3 times.		Chloramphenicol
0.5 g up to 3-4 times.	Sulfonamides		Urosulfan
	1 g up to 2 times.		Co-Trimoxazole
	480 mg 2 times.	Biseptol	Drip
960 mg 2 times.			Nitrofurans
	0.2 g 3 times.		Furadonin
	0.1-0.15 g three times.		Furazidin
50-100 mg three times.	Quinolones		Nitroxoline
			0.1 g 4 times.
	2 tablets 4 times.		Ofloxacin
100-300 mg 2 times.	Cephalosporins	Cephalothin	Intravenously or intramuscularly
	1-2 g every 4-6 hours.	Cephalothin	Ceftriaxone
	0.5-1 g up to 1-2 times.		Cephalexin

0.5 g up to 4 times.

Diuretics

In the presence of edema and high blood pressure, it is necessary not only to limit the amount of fluid consumed. Additionally, the patient is prescribed diuretics. They are used only for prolonged pyelonephritis to relieve swelling. The most common diuretic is Furosemide:
composition: substance of the same name – furosemide;
release forms: capsules and solution for injection;
therapeutic effect: short-term but pronounced diuretic effect;
dosage for adults: 0.5-1 tablet or 20-40 mg by slow intravenous administration;

Furosemide has a very long list of side effects, so herbal preparations are often used as an alternative. Examples of such drugs are:

Canephron. It has antispasmodic and anti-inflammatory effects. The composition contains centaury, rosemary, and lovage. The dose is determined by the disease, on average 2 tablets three times a day. The advantage is that it is well tolerated. Contraindications include only individual intolerance to the drug.
Phytolysin. It is a paste from which a suspension is prepared. Contains parsley root and lovage, birch leaves, goldenrod, sage and peppermint oils. Dosage – 1 tsp. paste in half a glass of water 3 times every day. Contraindications: pregnancy, renal failure.

Nonsteroidal anti-inflammatory drugs

The need to use non-steroidal anti-inflammatory drugs (NSAIDs) is because they help reduce inflammation in the kidneys. They inhibit cyclooxygenase, which is a key enzyme in triggering responses. As a result of taking NSAIDs, the production of inflammatory proteins slows down and cell proliferation (proliferation) is prevented. This helps to increase the effectiveness of etiotropic treatment, i.e. taking antibiotics. When taking NSAIDs, they penetrate into the inflammation site more easily.

For this reason, such drugs are used in conjunction with antibiotics. NSAIDs are not used without etiotropic therapy. The drug Indomethacin is also not used, since it leads to necrosis of the renal papillae. Among the effective NSAIDs are:

Voltaren. The basis is diclofenac, which has anti-inflammatory, antipyretic, antirheumatic and antiaggregation effects. Contraindications and side effects should be studied in the instructions, they are numerous. The average dosage of tablets is 100-150 mg in several doses, the injection solution is 75 mg (3 ml ampoule). The advantage is that in case of kidney pathologies, diclofenac accumulation is not observed.
Movalis. Based on meloxicam, a substance with antipyretic and anti-inflammatory activity. Contraindications: severe renal failure, chronic pyelonephritis in patients undergoing hemodialysis. Dosage of different release forms: 1 tablet per day, 15 mcg intramuscularly once. The advantage is high bioavailability. Side effects are presented in a large list, so it is better to study them in the detailed instructions for Movalis.
Nurofen. Contains ibuprofen - an analgesic and anti-inflammatory substance. Used for fever in patients with infectious and inflammatory diseases. The dosage of tablets is 200 mg up to 3-4 times daily. The advantage is that it can be used in the 1st-2nd trimester of pregnancy. The disadvantages of Nurofen include a large list of contraindications and adverse reactions.

Drugs to improve renal blood flow

With a long-term course of the chronic form of pyelonephritis, the blood supply to the kidney tissue deteriorates. Antiaggregation and angioprojective drugs help improve microcirculation, dilate blood vessels and increase the amount of oxygen delivered to the kidneys. The main indication for their use is the treatment of chronic pyelonephritis. Commonly used antiplatelet agents include:

Trental. Based on pentoxifylline, it has a vasodilating effect, increases the elasticity of red blood cells. Dose for different release forms: tablets - 100 mg 3 times a day, ampoules - 200-300 mg in the morning and evening.
Venoruton. Includes rutoside, has phlebotonic and angioprotective effects. Reduces capillary permeability and swelling. The average dosage is 300 mg three times a day. Troxevasin has a similar effect.
Chimes. Contains dipyridamole, a substance with immunomodulatory and antiaggregation effects. Taken in a daily dose range of 75-225 mg (1-3 tablets).
Heparin. Anticoagulant based on sodium heparin. Has an antithrombotic effect, reduces platelet aggregation. The dose for intravenous administration is 15 IU/kg/hour.

Immunomodulators and adaptogens

The cause of pyelonephritis is often a deficiency of the T-suppressor function of lymphocytes. In this regard, patients with this diagnosis need to take immunomodulators and adaptogens. These drugs accelerate the formation of protective antibodies. Indication for use: treatment of chronic pyelonephritis in the acute stage. Examples of immunomodulators and adaptogens are:

Timalin. Normalizes the function of B and T lymphocytes. It is administered intramuscularly at 10-20 mg daily. The duration of treatment is 5-6 days.
Levamisole (Decaris). Stabilizes the function of T- and B-lymphocytes, stimulates phagocytosis, thereby increasing the interferon-producing ability of the body. Prescribed as a course of 2-3 weeks. Dose – 150 mg every 3 days.
T-activin. Dosage – 100 mcg daily for intramuscular administration.
Methyluracil. Take 1 g up to 4 times a day for a course of 15 days.
Tincture of Chinese lemongrass or ginseng (adaptogens). The recommended dose per day is 30-40 drops up to 3 times. Take adaptogens until the end of treatment of the disease.
Multivitamin complexes Duovit, Vitrum or Supradin. Replenishes the lack of vitamins and minerals in the body. Dosage is: 1 tablet per day.

Treatment of pyelonephritis with folk remedies

Herbal medicine is not used as the main method of treatment; it is indicated as a complement to medications and physical procedures. Herbal treatment is considered safer, but products based on them should still be used under the supervision of a doctor.

The plants used should have mild diuretic and antiseptic effects. These include:
lovage;
violet;
St. John's wort;
series;
nettle;
yarrow;
calendula;
strawberries;
parsley;
bearberry;

sage.

Bearberry (bear ears)

This plant contains a unique substance - arbutin, which is oxidized in the body to glucose and hydroquinone. The latter is a natural antiseptic that exhibits an antibacterial effect. Use bearberry according to the following instructions:
Pour about 30 g of dry herb into 500 ml of boiling water.
Boil over low heat for a couple of minutes, then let sit for about half an hour.

Drink 2 tbsp daily. l. up to 5-6 times. Bearberry is effective in an alkaline environment, so it is additionally necessary to drink Borjomi mineral water, soda solutions and eat more raspberries, apples, and pears.

Lingonberry leaves

Lingonberry leaves have choleretic and antimicrobial effects. Such properties are due to the presence in the composition of the same substance that is found in bearberry - hydroquinone. The instructions for preparing and taking a decoction of these two herbs are also the same. It’s better to infuse the lingonberry remedy for about 2 hours. In addition, after a 3-week course of therapy, it is necessary to take a break of 7 days and repeat the treatment cycle.

Cranberry or lingonberry juice

These drinks have antipyretic, anti-inflammatory, healing and antibacterial properties. The high acidity of cranberries and lingonberries makes them effective against urinary tract and kidney infections, but they should not be used for stomach or duodenal ulcers. Instructions for preparing and using fruit juice:
Take 500 g of cranberries or lingonberries, rinse.
Grind them until smooth.
Through several layers of gauze, squeeze the juice out of the berries, add 2.5 liters of clean water.

Take 4 glasses of fruit drink daily.

In herbal medicine, herbal infusions are also effective against this disease. The combination of several components helps reduce the number of side effects and dosage. The following recipes are effective:

Recipe number	Ingredients, quantity tsp.	Method of preparation and use
	St. John's wort – 5; bearberry leaf – 5; fennel fruits – 2; elderberry flowers – 4; lemon balm – 3; knotweed – 5; calamus root – 2; kidney tea leaf – 2; flax seeds – 3.	Pour 2-3 tbsp. l. collecting 500 ml of boiling water. Pour into a thermos and leave for 6 hours. Use during the day in 3 doses half an hour before meals.
	Veronica grass – 5; wild rosemary shoots – 5; St. John's wort – 5; horsetail grass – 4; corn silks – 3; pine buds – 3; corn silks – 3; mint leaf – 3.	Brew 2-3 tbsp. l. herbal mixture 0.5 liters of boiling water. Leave in a thermos for 6 hours. Drink the infusion in 3 doses throughout the day, consuming 20-30 minutes before meals.
	chicory roots – 4; dandelion roots – 4; chamomile grass – 4; corn silks – 3; juniper shoots – 3; heather grass – 3; celandine – 4; calamus leaves – 3; cudweed grass – 5; birch leaves – 3.	Pour 100 g of herbal mixture with a liter of boiling water. Leave for 2 hours, then strain. Add to a bath with water at a temperature of 32-36 degrees. Lie in it for about 10-15 minutes. Dry your body with a towel. Go to bed. Course – 10-15 procedures, 1 per day.

Spa treatment

Complex therapy of pyelonephritis, especially chronic, involves sanatorium-resort treatment. It helps patients cope with exacerbations and recover faster. Although this type of treatment also has contraindications: chronic renal failure, high blood pressure, anemia.

The following procedures are recommended for other patients with pyelonephritis:
drinking treatment with mineral waters in the sanatoriums of Zheleznovodsk, Jermuk, Slavyanovsky and Smirnovsky mineral springs;
diet therapy;
heat therapy;
hardening;
mud applications;

balneotherapy through vibration, radon, aromatic, mineral baths and Charcot shower (massage with jet water).

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is a chronic nonspecific bacterial inflammation that occurs predominantly with the involvement of the interstitial tissue of the kidneys and the pyelocaliceal complexes. Manifested by malaise, dull pain in the lower back, low-grade fever, dysuric symptoms. During the diagnostic process, laboratory tests of urine and blood, ultrasound of the kidneys, retrograde pyelography, and scintigraphy are performed. Treatment consists of following a diet and gentle regimen, prescribing antimicrobial therapy, nitrofurans, vitamins, and physiotherapy.

ICD-10

N11 Chronic tubulointerstitial nephritis

General information

Causes

The etiological factor causing chronic pyelonephritis is microbial flora. These are mainly colibacillary bacteria (paracoliform and Escherichia coli), enterococci, Proteus, staphylococci, Pseudomonas aeruginosa, streptococci and their microbial associations. A special role in the development of the disease is played by L-forms of bacteria, formed as a result of ineffective antimicrobial therapy and changes in the pH of the environment. Such microorganisms are characterized by resistance to therapy, difficulty in identification, ability to persist for a long time in the interstitial tissue and become more active under the influence of certain conditions.

In most cases, chronic pyelonephritis is preceded by an acute attack. There are cases of a combination of pyelonephritis with chronic glomerulonephritis. Chronic inflammation is promoted by:

unresolved disturbances in the outflow of urine caused by kidney stones, ureteral stricture, vesicoureteral reflux, nephroptosis, prostate adenoma;
other bacterial processes in the body (urethritis, prostatitis, cystitis, cholecystitis, appendicitis, enterocolitis, tonsillitis, otitis, sinusitis, etc.);
general somatic diseases (diabetes mellitus, obesity), conditions of chronic immunodeficiency and intoxication.

In young women, the impetus for the development of chronic pyelonephritis may be the onset of sexual activity, pregnancy or childbirth. In young children, the disease is often associated with congenital anomalies (ureterocele, bladder diverticula) that disrupt urodynamics.

Classification

Chronic pyelonephritis is characterized by three stages of inflammation in the kidney tissue.

At stage I, leukocyte infiltration of the interstitial tissue of the medulla and atrophy of the collecting ducts are detected; the renal glomeruli are intact.
At stage II of the inflammatory process, cicatricial sclerotic damage to the interstitium and tubules is noted, which is accompanied by the death of the terminal sections of nephrons and compression of the tubules. At the same time, hyalinization and desolation of the glomeruli, narrowing or obliteration of blood vessels develop.
In the final stage III, the kidney tissue is replaced by scar tissue, the kidney is reduced in size and looks wrinkled with a bumpy surface.

Based on the activity of inflammatory processes in the renal tissue in the development of chronic pyelonephritis, the phases of active inflammation, latent inflammation, and remission (clinical recovery) are distinguished. Under the influence of treatment or in its absence, the active phase is replaced by a latent phase, which, in turn, can go into remission or again into active inflammation. The remission phase is characterized by the absence of clinical signs of the disease and changes in urine tests. According to clinical development, erased (latent), recurrent, hypertensive, anemic, azotemic forms of pathology are distinguished.

Symptoms of chronic pyelonephritis

The latent form of the disease is characterized by scant clinical manifestations. Patients are usually worried about general malaise, fatigue, low-grade fever, and headache. Urinary syndrome (dysuria, lower back pain, edema) is usually absent. Pasternatsky's symptom may be weakly positive. There is slight proteinuria, intermittent leukocyturia, and bacteriuria. Impaired renal concentration function is manifested by hyposthenuria and polyuria. Some patients may exhibit mild anemia and moderate hypertension.

The recurrent version of chronic pyelonephritis occurs in waves with periodic activation and subsidence of inflammation. Manifestations of this clinical form are heaviness and aching pain in the lower back, dysuric disorders, and periodic febrile states. In the acute phase, the clinical picture of typical acute pyelonephritis develops. With progression, hypertensive or anemic syndrome may develop. Laboratory testing, especially during exacerbation, reveals severe proteinuria, constant leukocyturia, cylindruria and bacteriuria, and sometimes hematuria.

In the hypertensive form, hypertensive syndrome becomes predominant. Arterial hypertension is accompanied by dizziness, headaches, hypertensive crises, sleep disturbances, shortness of breath, and heart pain. Hypertension is often malignant. Urinary syndrome is usually not expressed or has an intermittent course. The anemic variant of the disease is characterized by the development of hypochromic anemia. Hypertensive syndrome is not expressed, urinary tract is inconsistent and scanty. The azotemic form includes cases when the disease is detected only at the stage of chronic renal failure. Clinical and laboratory data of the azotemic form are similar to those of uremia.

Diagnostics

The difficulty of diagnosing chronic pyelonephritis is due to the variety of clinical variants of the disease and its possible latent course. Diagnostic tactics include:

Urine tests. A general urine test reveals leukocyturia, proteinuria, and cylindruria. Urine examination using the Addis-Kakovsky method is characterized by a predominance of leukocytes over other elements of the urinary sediment. Bacteriological urine culture helps to detect bacteriuria, identify pathogens of chronic pyelonephritis and their sensitivity to antimicrobial drugs. To assess the functional state of the kidneys, Zimnitsky and Reberg tests, biochemical tests of blood and urine are used.
General blood analysis. Hypochromic anemia, accelerated ESR, and neutrophilic leukocytosis are detected in the blood.
Instrumental research. The degree of renal dysfunction is clarified using chromocystoscopy, excretory and retrograde urography, and nephroscintigraphy. A decrease in the size of the kidneys and structural changes in the renal tissue are detected by ultrasound, MRI and CT scan of the kidneys. Instrumental methods objectively indicate a decrease in the size of the kidneys, deformation of the pyelocaliceal structures, and a decrease in the secretory function of the kidneys.
Kidney biopsy. In clinically unclear cases of chronic pyelonephritis, a kidney biopsy is indicated. Meanwhile, sampling of unaffected renal tissue during a biopsy can give a false negative result during a morphological examination of the biopsy specimen.

In the process of differential diagnosis, renal amyloidosis, chronic glomerulonephritis, hypertension, and diabetic glomerulosclerosis are excluded.

Treatment of chronic pyelonephritis

Patients are advised to follow a gentle regimen with the exception of factors that provoke exacerbation (hypothermia, colds). Adequate therapy for all intercurrent diseases, periodic monitoring of urine tests, and dynamic observation by a nephrologist are necessary.

Diet

Dietary recommendations include avoiding spicy foods, spices, coffee, alcoholic beverages, fish and meat infusions. The diet should be fortified, containing dairy products, vegetable dishes, fruits, boiled fish and meat. It is necessary to consume at least 1.5–2 liters of fluid per day to prevent excessive concentration of urine and ensure rinsing of the urinary tract. During exacerbations of chronic pyelonephritis and its hypertensive form, restrictions are imposed on the intake of table salt. Cranberry juice, watermelons, pumpkin, melons are useful.

Conservative therapy

An exacerbation requires the appointment of antibacterial therapy taking into account the microbial flora (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) in combination with nitrofurans (furazolidone, nitrofurantoin) or nalidixic acid preparations. Systemic chemotherapy is continued until bacteriuria ceases according to laboratory results.

In complex drug therapy, vitamins B, A, C are used; antihistamines (mebhydrolin, promethazine, chloropyramine). In the hypertensive form, antihypertensive and antispasmodic drugs are prescribed; for anemic - iron supplements, vitamin B12, folic acid.

Of the physiotherapeutic techniques, SMT therapy, galvanization, electrophoresis, ultrasound, sodium chloride baths, etc. have proven themselves especially well. In case of development of uremia, hemodialysis is required.

Surgery

Far advanced chronic pyelonephritis, not amenable to conservative treatment and accompanied by unilateral shrinkage of the kidney and arterial hypertension, is the basis for nephrectomy.

Prognosis and prevention

With latent chronic inflammation, patients remain able to work for a long time. In other forms, ability to work is sharply reduced or lost. The timing of the development of chronic renal failure is variable and depends on the clinical variant of chronic pyelonephritis, the frequency of exacerbations, and the degree of renal dysfunction. The death of the patient can occur from uremia, acute cerebrovascular accidents (hemorrhagic and ischemic stroke), and heart failure.

Prevention consists of timely and active treatment of acute urinary infections (urethritis, cystitis, acute pyelonephritis), sanitation of foci of infection (chronic tonsillitis, sinusitis, cholecystitis, etc.); elimination of local urodynamic disorders (removal of stones, dissection of strictures, etc.); correction of immunity.

Chronic pyelonephritis is a bacterial process of a nonspecific nature, which in most cases affects the renal tissues and pyelocaliceal structures. The disease manifests itself as pain in the renal-lumbar region and symptoms of urinary dysfunction.

Most often, pyelonephritis is diagnosed in women and girls, since the structural features of the urethra in the female half of the population are conducive to the development of this disease. As a rule, both organs are involved in the process at once, which is why the chronic form differs from the acute form.

The acute form of the disease is accompanied by a sharp and rapid development of pathology, while chronic pyelonephritis in many cases is asymptomatic - long-term remission is replaced by an acute process. According to statistics, pyelonephritis is diagnosed more often than its acute form.

We can talk about a chronic form of pyelonephritis when the disease is not completely cured within 3 months.

The acute form of the disease becomes chronic for a number of reasons:

the presence of stones or narrowing of the urinary ducts, which leads to disruption of the outflow of urine;
urine reflux - urine reflux;
the process of inflammation in organs that are located in close proximity - prostatitis, enterocolitis, cystitis, urethritis and others;
general diseases - diabetes, obesity, immunodeficiency;
intoxication – work in hazardous work, alcohol abuse, smoking;
poor quality treatment of acute pyelonephritis.

The cause of the disease is the following pathological microorganisms:

Proteus;
coli;
cocci;
Pseudomonas aeruginosa;
associations of microorganisms.

L-forms of bacterial flora can remain in the body for a long time, and sooner or later enter paired organs through the bloodstream.

In the chronic form of pyelonephritis, organs decrease in size, and the upper layer of the kidneys becomes lumpy. In advanced stages, the kidney shrinks and interstitial necrosis develops.

Risk factors are:

pregnancy - this is due to hormonal changes in the body, in addition, the uterus, increasing in size, can put pressure on the urinary organs and impede the outflow of urine;
promiscuous sex life - increases the risk of infection with microorganisms that pose a danger to human health - gonococci, chlamydia;
hereditary predisposition;
disruptions in the innervation of the bladder.

The process of transition from acute to chronic

The infection can get to the kidneys in the following ways:

through blood;
urinogenic method;
along the wall of the urinary ducts - the ascending path.

Normally, bacteria that penetrate the bladder quickly disappear - this is due to the fact that urine has an antimicrobial property, as well as due to the washing out of the bacterial flora by urine. When the outflow of urine is disrupted, bacteria are retained in the ducts and begin to actively multiply.

Hemogenic spread of bacteria is most often observed in people with immunodeficiency or in severely weakened patients.

Once in the kidney tissue, the pathogens begin to actively release toxins that negatively affect the functioning of the organs. An inflammatory process develops, which, with a long course of the disease, becomes the cause of the proliferation of connective tissue. This phenomenon leads to shrinkage of the organ.

Processes that lead to disturbances in the outflow of urine provoke urinary retention and increased pressure in the ducts, which contributes to the chronicity of the disease. Subsequently, reflux develops, which allows the infection to easily penetrate the kidney.

Classification and stages of development

In nephology, all forms of pyelonephritis are divided into primary and secondary. If the first form develops as an independent disease, then the second occurs in the presence of other ailments, which are aggravated by congestive processes and urodynamic disorders.

Pyelonephritis varies according to age:

children's;
during pregnancy;
senile.

There is a Lopatkin scheme, which includes the following types of illness:

primary and secondary;
one-sided and two-sided;
necrotic;
purulent;
serous;
latent;
active inflammation phase;
abscess;
carbuncle;
pyonephrosis;
nephrosclerosis.

According to the severity of the disease, pyelonephritis can be as follows:

latent – symptoms are either completely absent or slightly developed;
recurrent – exacerbations are replaced by subsidence of the disease. The frequency of changes depends on the influence of provoking factors;
anemic – the hemoglobin level drops, anemic syndrome develops;
azotemic – renal failure develops;
hypotensive - accompanied by an increase in pressure in the arteries.

The stages of chronic pyelonephritis are as follows:

Stage 1 – the inflammatory process is actively developing, symptoms are pronounced;
Stage 2 – the clinical picture is blurred, so the disease can only be determined through laboratory tests;
Stage 3 – remission – temporary attenuation of the disease and absence of symptoms; in the case of a 5-year relapse, the doctor can say about a complete cure for the disease.

Symptoms of the disease

Symptoms of chronic pyelonephritis are very diverse.

Pathological processes occurring in paired organs can be confused with other ailments of the urinary system, so differential diagnosis in this case is extremely important.

The symptoms of the disease directly depend on the form of the disease. With a latent course of the disease, there are practically no symptoms. The patient may only be concerned about weakness and, in rare cases, a slight increase in temperature. Swelling, pain, disturbance of the urinary process and other signs are absent. Polyuria appears; leukocytes and bacterial flora can be detected in a urine test.

In the anemic form, the clinical picture may be as follows:

dyspnea;
pallor of the skin;
weakness;
sometimes there are complaints of pain in the cardiac region.

As for changes in urine, they are minor and cannot always be detected.

The hypertensive form is accompanied by:

dizziness;
shortness of breath;
insomnia;
pain in the projection of the heart.

The azotemic form develops with renal failure and is characterized by:

anemia;
increased blood pressure;
stool disorders;
nausea;
decreased appetite;
muscle weakness;
numbness of the limbs.

There is a decrease in calcium concentration in urine.

In severe renal failure, the following may occur:

joint pain;
secondary gout;
changes in heart rhythm;
development of atrial fibrillation;
swelling of the salivary glands;
swelling of the face;
unpleasant taste in the mouth.

In the recurrent form, the patient complains of discomfort in the kidney area, increased temperature and fever, and dysuria.

With an exacerbation of the chronic process, other symptoms of the acute form of the disease appear:

headache;
anemia;
increased blood pressure;
visual impairment.

A blood test can detect increased ESR, anemia and leukocytosis.

Complications

Complications of a chronic illness can be very serious, so ignoring the disease is strictly not recommended.

As for the kidneys themselves, two types of complications can arise in them:

Nephrosclerosis. This phenomenon occurs most often against the background of a latent course of the disease, the primary form, in which obstruction of the urinary ducts is not observed. Nephrosclerosis itself can be complicated by an increase in blood pressure of the nephrogenic type, and if there is damage to two kidneys at once, then the development of renal failure is possible.
Pyonephrosis. This is the final stage of pyelonephritis, developing in a purulent-destructive form. Most often, the pathological process is observed on one side. The disease occurs with secondary pyelonephritis, in the presence of disruptions in the flow of urine or with kidney tuberculosis. The organ greatly increases in size, the parenchyma becomes thinner, and the cavities are filled with purulent exudate. Chronic inflammation, fatty degeneration and sclerosis are also observed. The fatty capsule grows to the kidney, and the fibrous capsule becomes very thick, the urine contains pus, and the kidney moves poorly when palpated.

With a prolonged course of the chronic process, inflammation can spread to the fiber that surrounds the renal pedicle.

Diagnostic methods

Pyelonephritis is diagnosed as follows:

studying the patient's medical history;
assessment of symptoms and complaints;
urine examination using the Kakovsky-Addis method;
determining the number of active leukocytes in urine;
tank urine analysis;
renal biopsy.

Very often, specialists fail to recognize the chronic form of the disease and determine the form of the disease, especially if the disease occurs in a latent form or the clinical symptoms are varied.

To determine pyelonephritis, the patient may be referred for a blood test to determine creatinine, urea and residual nitrogen.

X-ray examination makes it possible to assess the size of the kidneys, their deformation, decreased tone of the urinary ducts, and when using the radioisotope research method, each organ can be studied in detail separately.

Retrograde and intravenous pyelography, echography (echosigns of the inflammatory process), chromocystoscopy, scenography are additional studies of chronic pyelonephritis.

Pyelonephritis must be clearly distinguished from chronic glomerulonephritis and hypertension.

Glomerulonephritis, in contrast to pyelonephritis, is accompanied by a high content of red blood cells in urine, a lack of active leukocytes, and the presence of microbial flora in the urine. As for hypertension, it is more often observed in people of older age groups, and occurs with changes in the cerebral vessels of the coronary vessels, and is also accompanied by hypertensive crises.

Principles of treatment

Pyelonephritis includes several areas of therapy. The patient’s regimen is determined by the doctor based on the severity of the patient’s condition, the phase of the disease and clinical characteristics. Indications for hospitalization are:

pronounced course of the disease;
development of arterial hypertension;
progression of chronic renal failure;
significant disruptions in urodynamics that require restorative procedures,
a sharp deterioration in the condition of the kidneys.

Patients in any phase of the disease should not allow hypothermia and avoid physical activity.

If the disease occurs in a latent form, with normal blood pressure and while maintaining kidney functionality, no special restrictions are required in the regimen. In the acute stages of the disease, the patient is prescribed bed rest.

It is recommended to increase the amount of fluid consumed to 2.5 liters per day. With high blood pressure, the amount of fluid per day should not exceed a liter. As for salt, its consumption should be reduced to 5 grams per day.

Naturally, the patient should be prescribed antibiotics. Modern antibacterial drugs make it possible to prescribe empirical therapy, as they have a wide spectrum of action.

Most doctors consider it inappropriate to use highly toxic drugs for treatment, however, it is possible to select an adequate drug only after the results of urine culture.

It is very important to choose the correct dosage of the drug so that in the future the pathogenic microflora does not develop resistance to the active substance of the drug.

If the patient has not received antibacterial therapy for several years, then the probability that the causative agent is E. coli is 90%.

The most commonly prescribed antibacterial agents are:

Ceftoxime;
Ceftriaxone;
5-Nok;
Furomag.

If a patient has chronic renal failure, he is prescribed the following medications:

Pefoloxacin;
Cefaperazone.

Surgery. If conservative treatment of chronic pyelonephritis remains ineffective, surgical intervention is prescribed. Any disruption in the outflow of urine is an indication for surgical intervention.

If the chronic course of the disease is complicated by the appearance of a carbuncle, then surgical treatment and installation of nephrostomy drainage are prescribed.

In severe cases, nephrectomy is prescribed; indications for such an operation are:

pyonephrosis;
nephrosclerosis;
loss of kidney function;
persistent hypertension that does not respond to conservative therapy.

Also, during conservative and surgical treatment, nutritional therapy and folk remedies therapy have been used.

Traditional methods of therapy

When treating a disease at home, with the permission of a doctor, you can use folk therapy.

When using medicinal herbs, you must make sure that the patient does not have allergies or individual intolerance to herbal components.

You can use lingonberry infusion. This water is a good diuretic, it is easy to prepare an infusion from it - you need to pour a tablespoon of leaves with a glass of boiling water and leave for half an hour. Then strain and take a third of a glass three times a day. This remedy is approved for the treatment of children.

Corn silk is another very common diuretic, which is prepared and consumed in the same way as lingonberry infusion.

Aspen is used very often to treat pyelonephritis, since this plant copes well with various kidney ailments. To prepare a decoction of aspen, you can use leaves, young twigs and tree bark. A tablespoon of plant material is poured into a glass of boiling water and boiled for several minutes. You need to drink half a glass of the decoction several times a day.

A decoction of flaxseed should be taken every 2 hours for 2 days. To prepare it, you will need a glass of boiling water and 30 seeds; the product must be boiled for 10 minutes over low heat.

The treatment of kidney problems with watermelon has been known to residents of the southern regions since ancient times. The healthy berry is not only eaten, but also a medicine is prepared from its crusts. Pour boiling water over the dried peel in a ratio of 1:10, leave for several hours, and then drink instead of tea.

Juniper berries are an ancient remedy against pyelonephritis. 10 berries are poured with boiling water, left for a couple of hours, and then taken before eating.

In addition to the above remedies, birch leaves, cloudberries, elderberry, St. John's wort, marsh calamus and other herbs are used.

It must be remembered that folk remedies can be effective in the initial stages of the disease, in the future they can only be additional methods that should not exclude treatment with medications.

Diet

Nutritional therapy is an important component of the treatment of chronic pyelonephritis; it is very important to strictly follow the doctor’s recommendations, since this disease can be quite dangerous and can provoke irreversible pathological phenomena in the kidneys.

For pyelonephritis, the following foods should be present in the diet:

Fruits and vegetables that have a diuretic effect - pumpkin, watermelon, cucumbers, zucchini.
Juices and fruit drinks made from berries that have anti-inflammatory and antimicrobial effects - cranberries, lingonberries.
In case of exacerbation of the disease and intoxication processes in the body, it is recommended to exclude from the diet foods containing protein - milk, meat and others. At this time, it is better to switch to vegetarian cuisine and consume vegetable purees, juices from vegetables and fruits.
During the remission stage, protein foods can be consumed within normal limits.
Whole grain cereals and bran.
Olive oil.
Green unsweetened tea.
Water containing calcium and chlorides.

It is necessary to exclude the following from your diet:

hot and spicy seasonings and sauces;
products that contain essential oils - onions, garlic, radishes, basil, parsley and others,
strong broths;
sour fruits and vegetables;
pickles and marinades;
confectionery and sugar;
products with artificial additives and dyes;
products containing oxalic acid;
coffee, strong tea, sweet soda, alcoholic drinks.

It is not allowed to consume salty mineral waters;
to avoid constipation, for this it is necessary to introduce cereals, coarse fiber, and whole grain bread into the diet;
in the absence of edema, increase the drinking regime;
reduce salt intake;
periodically carry out prophylaxis with decoctions of diuretic herbs;
avoid hypothermia;
boost immunity;
if there are phosphates or oxalates in the urine, adhere to diet No. 6;
if alkalization of urine is observed, switch to diet No. 14.

Prognosis and prevention

If the disease is mild, the prognosis is favorable. But of course, the presence of concomitant pathologies is of great importance. With the timely elimination of all provoking factors, the pathological process subsides, and a complete cure for the disease is possible.

In some cases, pyelonephritis may have a poor prognosis. The fact is that advanced stages of the disease are difficult to treat, and very often cause complications that can lead to the development of irreversible pathological processes in paired organs.

The prognosis of chronic pyelonephritis largely depends on the occurrence of complications. If a secondary infection is added to the inflammatory process, the prognosis worsens significantly; a worsening prognosis is also observed in the presence of kidney stones.

The most unfavorable outcome of the disease can be considered renal failure. This disease leads to kidney dysfunction, edema and problems with the cardiovascular system.

Drug therapy for the chronic form of the disease is usually long-term and requires careful and strict adherence to all medical recommendations. With improper therapy, life expectancy can be significantly reduced.

As for preventive measures, it is necessary to promptly treat the underlying disease, which can cause pathological processes in the kidneys. If not treated correctly, ordinary cystitis can lead to serious consequences.

To prevent pyelonephritis it is necessary:

strengthen immunity;
Healthy food;
fight bacterial infections;
to live an active lifestyle;

Many acute urinary infections for certain reasons become chronic. This is an unfavorable condition for the body as a whole. Patients wonder whether chronic pyelonephritis can be cured completely. Let's take a closer look at what this disease is and why it is dangerous.

Features of the development of the disease

Chronic pyelonephritis means a long-term microbial inflammatory process of the interstitial tissue and tubules of the kidneys, simultaneously or sequentially moving to the parenchymal layer and calyces. The terminal stage of development includes damage to blood vessels and glomeruli. The consequence of such widespread gross changes is chronic kidney disease. Its outcome is considered to be renal failure (CKD).

The modern classification of chronic pyelonephritis involves dividing it into several stages. The division is based on clinical and laboratory data. There are 3 stages of activity of the inflammatory process in this disease:

The listed phases successively replace each other, regardless of medical intervention. Also, for nephrologists and urologists, a conditional division based on the location of the lesion is important. There are 2 types:

unilateral;
double-sided

In chronic pyelonephritis, this classification is needed when forming risk groups for complications. This is also important for predicting the outcome. Bilateral pyelonephritis is the most unfavorable form. Such patients are characterized by early and rapid development of end-stage renal failure.

Causes of the disease

The danger of the problem is dictated by several reasons:

Wide coverage of all age groups of the population, including children of the first year of life.
Rapid development of chronic renal failure without early diagnosis and therapy.
Blurred clinical picture.
Complications of chronic pyelonephritis lead to death.
Early disability of patients.
Duration of treatment.
More often it affects females with preserved reproductive function, complicating the course of pregnancy.

Chronic pyelonephritis is always a consequence of an acute process. The reasons for this particular scenario are:

staphylococci;
Proteus;
streptococci;
E. coli, etc.

Provoking factors for exacerbation of the process are:

How dangerous is the disease? Chronic pyelonephritis is prone to gradual involvement in the pathological process with each new exacerbation of a larger volume of kidney tissue. The result is shrinkage of the organ with gross violations of its basic functions.

What do patients complain about?

With a latent course and in the remission stage, there may be no clinical signs of chronic pyelonephritis. During careful questioning, the patient may recall some minor complaints:

In case of chronic pyelonephritis, such a clinic passes very quickly. The patient does not focus on it and forgets after a while.

With a long course of pathology, patients may note:

persistent increase in blood pressure that cannot be adjusted with antihypertensive drugs;
prostration;
decreased performance;
lack of desire to eat;
unpleasant taste in the mouth that appears in the morning;
bowel dysfunction;
pain in the back and stomach;
thirsty;
shortness of breath;
frequent urination, especially at night;
slight chills;
disturbances in urinary flow (weak, intermittent).

Most often, these symptoms are associated with another disease, which increases the diagnostic search time.

With exacerbation of chronic kidney pyelonephritis, the symptoms are quite eloquent:

previous action of provoking factors;
high temperatures;
nagging pain in the lower back;
discomfort when urinating;
loss of strength, headaches;
frequent urge to urinate;
vomiting (more often occurs in children);
nagging pain in the lower abdomen.

It is more difficult to identify the symptoms of chronic pyelonephritis in infants and children under 3 years of age. Due to careful questioning and observation of parents, it is possible to identify the following complaints:

Pediatricians often miss the described symptoms and prescribe inappropriate treatment, equating the manifestations with another pathology. Sometimes parents do not tell their doctor about such situations due to the rapidly passing course of symptoms, not knowing how dangerous such situations are.

This causes the development of severe forms of chronic pyelonephritis in young children. If you suspect renal pathology, you should contact a nephrologist or urologist. Only they are involved in identifying the disease and know the dangers of a hidden disease and how to cure chronic pyelonephritis.

Diagnostic search

Identification of chronic forms of pyelonephritis is a very labor-intensive process. Diagnostics is carried out comprehensively and includes:

Laboratory diagnosis of chronic pyelonephritis involves the appointment of:

For chronic pyelonephritis, diagnosis involves the use of additional methods:

The diagnostic algorithm is selected by the doctor individually for each specific patient. It is also important that the medical institution is equipped with the necessary equipment.

Methods of therapy

The final diagnosis of chronic pyelonephritis is made after all the necessary examinations by summing up the results obtained. Only after this are treatment measures prescribed.

Treatment of chronic pyelonephritis consists of 4 points:

general purposes;
use of medications;
herbal medicine;
physiotherapy

control of chronic comorbidities;
salt-restricted diet;
prevention of viral and infectious diseases;
personal hygiene (especially for girls).

Treatment of chronic pyelonephritis involves the use of:

Antibiotics: Norfloxacin, Ciprofloxacin, Cefotaxime, Ceftriaxone.
Antimicrobial medications: Furagin, 5-NOK, Monural, Nitroxoline.
Immunomodulators: Taktivin, Isoprinosine.
Antispasmodic drugs: No-spa, Papaverine.

In case of chronic pyelonephritis, treatment with synthetic drugs must be combined with the prescription of herbal medicines:

Canephron;
Urolesan;
lingonberry leaf;
Phytolysin.

For any symptoms, treatment includes such combinations in courses of up to 2 months. An explanatory conversation is held with the patient. Its essence lies in the story of how to treat the disease correctly to prevent serious complications. This will eliminate possible errors when patients follow all medical recommendations.

In chronic pyelonephritis, symptoms and treatment are not interdependent. It depends on the results of laboratory and instrumental studies. Only in this case will it be possible to completely overcome the disease, and not just temporarily reduce the symptoms.

Physiotherapy is contraindicated during exacerbation. They are prescribed when the process subsides. The most effective:

electrophoresis;
laser therapy;
magnetotherapy.

Surgical intervention is indicated for diseases that impair the flow of urine. Treatment of chronic pyelonephritis with specific drugs, dosages and duration of use is prescribed by a nephrologist. The patient’s age and concomitant pathologies are taken into account.

Chronic pyelonephritis is an insidious, slowly progressive disease.

The patient’s chances of recovery are higher with early diagnosis and an adequate course of therapy followed by constant monitoring. Therefore, it is important to know what chronic pyelonephritis is and how it manifests itself in order to identify the disease at an early stage.

Treatment of chronic pyelonephritis should be aimed at the pathogenetic mechanisms of the disease. The general treatment plan should include several areas:

remove infectious pathogens;
normalize urine flow;
increase the patient’s own immunity;
eliminate the danger of chronic foci of infection and the possibility of re-infection by hematogenous and lymphogenous routes.

At the same time, we must not forget about the natural mechanisms of protection of the urinary tract. Only their failure causes bacterial aggression. Proper treatment of chronic pyelonephritis should not disrupt the natural properties of the body, but maintain and restore the desired balance.

How does the body get rid of infection in the urinary tract?

Natural defense mechanisms can be supported by caring for your health, diet, and folk remedies from medicinal plants. The kidneys have several options that make the spread of infection much more difficult. Each needs to be addressed to help control inflammation.

An increase in urinary volume causes mechanical flushing of the tract and washes away excess bacteria. This means that in order to cure the disease you need to drink more fluids and use medicinal herbs that increase diuresis.
An increase in acidity (pH less than 7), an increased content of urea and organic acids in the urine prevent the proliferation of microorganisms. Therefore, dietary adjustments affect bacterial viability.
Immune cells are located not only in the blood, but also in the submucosal layer of the urinary tract.
The vagina in women and the prostate in men produce a secreting substance that inhibits the spread of bacterial flora. Therefore, when choosing local contraceptives, adults should not forget to maintain the balance of microorganisms and use proven means for douching and daily toileting.

Using means to activate the immune system in chronic pyelonephritis, we achieve local destruction of harmful pathogens

Treatment for chronic pyelonephritis necessarily includes an integrated approach with the step-by-step use of inpatient facilities and therapy at home.

What is necessary for successful antibacterial therapy?

Antibacterial therapy is of primary importance in the treatment of kidney inflammation. One of the reasons for the chronicity of the process is considered to be insufficient or inadequate use of antimicrobial drugs in the acute stage of the disease.

Therefore, in order to get rid of pyelonephritis forever, you need to follow the principles of using antibacterial agents.

Treatment standards require:

prescribe medications as early as possible;
The duration of the course should be selected individually depending on the activity of pathogenic microorganisms and the severity of inflammation;
strictly take into account the identified sensitivity of the microflora, according to the conclusion obtained by the tank method. urine culture;
If necessary, combine antibacterial drugs using compatibility properties;
replace medications if low sensitivity is detected;
to prevent negative effects, fungal growth, use antifungal drugs in cases of long-term treatment;
simultaneously prescribe vitamins and immunostimulants.

In the treatment of pyelonephritis, choose the drug around which bacteria do not grow

If these principles are not observed, the desired result cannot be achieved from antibacterial therapy, as well as with persistent obstacles to the outflow of urine.

In the later stages of the disease, sclerotic changes occur in the kidney tissues, blood flow in the glomeruli and the filtration process are disrupted. Therefore, it is impossible to create a sufficient concentration of antibacterial agents. Their effectiveness drops sharply, despite high doses.

If treatment is delayed, microorganisms degenerate into drug-resistant strains and form microbial associations with different sensitivities.

Preparations for antibacterial treatment

Chronic pyelonephritis, according to developed recommendations, must be treated simultaneously with a combination of several groups of drugs:

antibiotics;
sulfonamides (Urosulfan, Sulfadimethoxine);
nitrofurans (Furagin, Furazolidone);
preparations from nalidixic acid (Nilidixan, Nevigramon);
hydroxyquinoline derivatives (5-NOK, Nitroxoline);
combined agents such as Biseptol, Bactrim (sulfamethoxazole + trimethoprim).

A drug with the greatest flora sensitivity and the least toxic effect on renal tissue is selected for each patient.

Drugs with minimal toxicity include:

antibiotics of the penicillin group (Ampicillin, Oxacillin);
Erythromycin;
Levomycetin;
cephalosporins (Tseporin, Kefzol).

The following are considered moderately toxic:

nitrofurans;
5-NOK;
nalidixic acid and its derivatives.

To highly toxic drugs include aminoglycoside antibiotics (Kanamycin, Kolimycin, Gentamicin).

They are used only in severe cases, in the presence of resistance to other drugs, and in short courses (5–7 days).

When choosing the most effective antibiotic, one must take into account such a property as the dependence of activity on the reaction of urine:

Gentamicin and Erythromycin act most effectively in an environment with an alkaline reaction at pH 7.5 – 8. When using them, a dairy and predominantly plant diet and alkalizing mineral waters (Borjomi) are recommended.
Ampicillin and 5-NOK differ in activity in an acidic environment at pH 5–5.5.
Cephalosporins, Levomycetin, tetracyclines are quite effective in both alkaline and acidic urine at pH 2–9.

The most active uroseptics with a wide spectrum of action are:

5-NOK,
Levomycetin,
Gentamicin.

Gentamicin is excreted up to 90% in the urine and reaches the kidneys unchanged, therefore creating a locally high concentration.

Gentamicin is used intramuscularly and intravenously

Antibiotics are combined with drugs of other effects. They enhance each other, accelerating the anti-inflammatory effect. Doctors often resort to the following combinations:

antibiotic + sulfonamide;
antibiotic + nitrofuran (Furagin);
all together + 5-NOK.

Medicines made from nalidixic acid are not recommended to be combined with nitrofurans (they weaken the effect, add up the toxic effect), and are contraindicated during pregnancy in the first trimester and in children under two years of age. These products are characterized by the least ability to produce resistant types of microbes. In addition to Nevigramon, the group includes:

Nagram,
Negro,
Cystidix,
Nilidiksan,
Nalix,
Notricel,
Nalidin,
Nalidixin,
Nalix,
Naligram,
Naxuril,
Nogram.

Examples of effective combinations include:

Carbenicillin or an aminoglycoside antibiotic + nalidixic acid;
Gentamicin + Kefzol;
antibiotics-cephalosporins + nitrofurans;
Penicillin or Erythromycin + 5-NOC.

It is known that nitroxolines (5-NOC) are inhibited by the use of drugs that reduce the acidity of gastric juice, so this should be remembered when concomitantly treating stomach diseases

The duration of antibiotic therapy lasts from four to eight weeks.

How can one judge the success of antibacterial therapy?

The criteria for obtaining a positive result are:

elimination of clinical symptoms of inflammation (fever, pain, dysuric phenomena);
changes in control blood and urine tests to normal levels (leukocytes and ESR in the blood, absence of protein, bacteria in the urine, disappearance of active leukocytes and leukocytosis in the sediment).

You can learn about the clinical signs of exacerbation of chronic pyelonephritis.

Outpatient treatment after relapse of the disease

Relapses of chronic pyelonephritis occur in 60–80% of patients even after effective treatment. Therefore, it is recommended to carry out long-term anti-relapse therapy at home.

The drugs are selected and alternated in courses. The doctor necessarily focuses on the level of leukocyturia, bacteriuria, protein levels in the blood and urine. Various authors suggest keeping the duration of outpatient treatment from six months to two years.

The monthly medication regimen looks like this:

an antibiotic is prescribed for the first 7–10 days, alternating in the next period with other antimicrobial drugs (Urosulfan, 5-NOK);
For the remaining 20 days, it is recommended to take folk remedies.

Tea made from lingonberry leaves washes the urinary tract well

The entire cycle is repeated under the supervision of a doctor and tests.

Bactrim (Biseptol) is contraindicated in cases where the patient has:

leukopenia, agranulocytosis;
aplastic and B 12-deficient anemia;
impaired renal excretory function.

It is not used:

in the treatment of children under 3 months of age;
during pregnancy and lactation.

Folk remedies in the treatment of pyelonephritis

At home, folk remedy therapy includes decoctions and infusions of plant materials that have a diuretic effect, a slight bacteriostatic effect, and increase the tone of the bladder and tract.

A self-prepared drink does not interfere with the action of medications, flushes the kidneys and removes bacteria. Before use, it is better to consult your doctor.

The most popular purpose of bearberry is; it is also known as “bear ears.” You can brew it in a thermos (2 tablespoons of dry herbs per liter of boiling water) for half an hour. After straining, you can drink a partial glass three times a day. To improve the taste, it is recommended to add honey. Cannot be used during pregnancy (the tone of the uterus increases).

A decoction of corn silk is prepared at home by pre-boiling for 5–7 minutes. Then it is infused and taken as bearberry.

Pyelonephritis in children is treated by adding delicious cranberry juice, a decoction of rose hips, and figs to their drink.

You can prepare a combined decoction of viburnum berries, sea buckthorn and rose hips. It is left in a thermos overnight. These products not only have a bactericidal effect, but also activate the immune system and contain the necessary vitamins.

It is useful for pregnant women to brew lingonberry leaves and rose hips.

What other medications are prescribed for pyelonephritis?

To reduce allergenic manifestations, patients are prescribed antihistamines:

Diphenhydramine,
Tavegil,
Suprastin,
Loratadine.

In the treatment of renal hypertension, strong antihypertensive drugs from the group of β-blockers and combinations with calcium channel blockers are used. The appearance of signs of heart failure requires careful use of glycosides in drops and tablets (Digoxin, Celanide). Attacks of suffocation are relieved by intravenous administration of Strophanthin, Korglikon.

When is surgical treatment used?

Surgical treatment is used in advanced stages of chronic pyelonephritis, when the patient is admitted to the urology department with the following complications:

encysted abscesses in the kidneys (abscesses, carbuncles);
paranephritis - inflammation extends beyond the boundaries of the renal tissue into the perinephric tissue;
urosepsis with bacteremic shock (bacterial breakdown products are absorbed into the blood);
hydronephrosis;
urolithiasis;
sclerosis of the affected kidney.

Most often, nephrectomy (removal of the diseased organ) is indicated if it is unilaterally affected.

Rarely, in the presence of a congenital defect in the form of duplication of the kidney and ureters, partial resection of the necrotic area is performed after opening the capsule. At the same time, stones that obstruct the passage of urine (in the pelvis, ureter) are removed. The question of the viability of the kidney and the preservation of functions is resolved during the examination.

In practical application, urologists have an operation to restore the blood supply to the kidney by wrapping it with an omentum. It is indicated for the treatment of renal hypertension.

Nephrectomy has long been considered contraindicated in cases of bilateral disease and severe concomitant diseases that increase the risk of intervention. Currently, it is being replaced by a donor kidney transplant after both of her own have been removed. Before surgery, the patient undergoes systematic hemodialysis.

To reduce symptoms of intoxication, the patient is given the following in the preoperative period:

Hemodez,
plasma,
isotonic solutions,
if necessary, red blood cell mass.

Against the background of high blood pressure, antihypertensive drugs are necessary.

During resection, the renal artery is temporarily clamped. At the end of the operation, a drainage tube is inserted into the perinephric space to drain blood and administer antibiotics. It is removed after 10 days.

To prevent a fistula from forming from urine being sucked into the wound, operating surgeons carefully check the suturing of the walls of the cups and vessels; for this it is better to use chrome-plated catgut.

The prognosis for the patient's life is always favorable. Not in every case it is possible to eliminate hypertension. In the postoperative period, with the only remaining kidney, the patient should be under the supervision of a urologist at the clinic and undergo preventive treatment and examination. Overstrain of one organ significantly increases the risk of infection.

Spa treatment

Treatment is indicated at balneological resorts with natural healing springs. These include: Truskavets, Zheleznovodsk, Kislovodsk, Sairme.

Drinking natural mineral waters helps flush out toxins and bacteria from the kidneys and restore local immunity.

Bottled water from the store most often does not contain bioactive components, is a product of chemical mixing of ingredients, and therefore does not have such strength.

In the presence of hypertension, anemia, or renal failure, spa treatment is not indicated; there is no effect from it.

Measures for the treatment of chronic pyelonephritis are more effective the earlier their use is started. Refusal of medical care seriously worsens the patient's life prognosis.