Pyelonephritis of the kidneys in women
Pyelonephritis is a kidney disease that is infectious and inflammatory. The disease develops as a result of the spread of pathogenic microorganisms that enter the kidneys from the lower parts of the urinary system. The most common cause of pyelonephritis is Escherichia coli - E. Coli. It is found when performing a urine test in sick women in large quantities. Less commonly, other gram-negative bacteria, staphylococci and enterococci, act as causative agents of the disease. In 20% of cases, pyelonephritis occurs as a result of a mixed infection.
Pyelonephritis is a serious illness characterized by a severe course. Patients suffer from severe pain, overall health is disturbed. Experts are unanimous in the opinion that the disease is much easier to prevent than to get rid of it.
Pyelonephritis refers to infections of the urinary system. If pathogenic bacteria capture its lower sections, and therapy with antibacterial agents is chosen incorrectly or is completely absent, then microorganisms begin to multiply rapidly and spread to the kidneys. This leads to the onset of symptoms of pyelonephritis. A nephrologist is involved in the diagnosis and treatment of the disease.
- Pyelonephritis facts and statistics
- Symptoms of pyelonephritis
- Causes of pyelonephritis
Diagnostics of the pyelonephritis
- What tests are taken for pyelonephritis?
- Indicators of urine with pyelonephritis
- Complications and consequences of pyelonephritis
Answers to popular questions:
- How many people live with pyelonephritis?
- How long does the temperature last with pyelonephritis?
- How much water to drink with pyelonephritis?
- Is it possible to warm up, go to the bathhouse with pyelonephritis?
- Is it possible to have sex with pyelonephritis?
- How many are in the hospital with pyelonephritis?
- How and how to treat pyelonephritis?
Pyelonephritis facts and statistics
- It has been established that female representatives suffer from pyelonephritis 5 times more often than men. The acute form of the disease is diagnosed more often in women of reproductive age who are sexually active.
- In the United States of America, 1 in 7000 people are ill each year. 192,000 patients need and receive hospitalization annually.
- With adequate treatment, up to 95% of all patients notice a significant improvement in the first two days.
- Pyelonephritis affects children, both girls (in 3% of cases) and boys (in 1% of cases). In childhood, the disease is dangerous for its complications. So, cicatricial changes in the renal parenchyma are diagnosed in 17% of children who have recovered, hypertension in 10-20% of children.
Drinking plenty of fluids is essential for the treatment of the disease. For drinking it is necessary to use clean water, which normalizes the balance in the body, thins the blood, promotes the early elimination of pathogenic microorganisms and toxic products of their vital activity. The effect is achieved by increasing the amount of urination as a result of drinking plenty of fluids.
- You should not give up drinking plenty of fluids because of painful sensations during emptying of the bladder, as this is the only way to remove bacteria from the body. You should urinate as often as possible to avoid such a serious complication as blood poisoning, as a result of which a person may die.
- Alcoholic drinks, coffee, carbonated water - all this is prohibited for pyelonephritis. It is believed that cranberry juice can help fight disease. It is consumed in its pure form, or diluted with water.
Symptoms of pyelonephritis
Symptoms of acute pyelonephritis are as follows:
- The onset of a feeling of nausea, which may be accompanied by vomiting.
- High body temperature with chills. Sweating increases, appetite disappears, headaches occur.
- Increased fatigue, malaise and weakness.
- Painful sensations with localization in the side from which the kidney is damaged. The pain can also be shingles with a predominant localization in the lower back. "Spreading" of pain occurs with a bilateral inflammatory process. For an exacerbation of the disease, Pasternatsky's symptom is characteristic, which boils down to the appearance of pain during tapping in the lumbar region and an increase in erythrocyturia for a short time. When the position of the body changes, the intensity of the pain does not change, but it intensifies during deep breathing and palpation of the abdomen.
- An increase in the number of urination, regardless of the sex of the patient.
- Laboratory tests of urine and blood indicate inflammation. Pathogenic bacteria and leukocytes are found in the urine.
- If pyelonephritis is purulent, then the body temperature can manifest itself abruptly - to rise to high values and fall to subfebrile levels several times a day. Most often, the fever continues for a week.
- Bacteremic shock is typical for 10% of patients.
There are also symptoms nonspecific for acute pyelonephritis that may indicate an illness:
- An increase in body temperature to high values, up to the development of a feverish state.
- Dehydration of the body.
If the disease has turned into a chronic form (which often occurs with an untreated acute stage of the disease, although sometimes it is possible to chronize the process without a previous exacerbation), then the symptoms of pyelonephritis may be less pronounced, but they persist for a long time period. When donating blood for analysis, signs of inflammation may not be detected. Leukocytes are present in the urine, but the bacterial component may be absent. When pyelonephritis is in remission, all laboratory parameters will be normal.
In addition, every third patient notes the following symptoms (characteristic of inflammation of the lower urinary system):
- Pain during emptying of the bladder, like a cut.
- The presence of blood impurities in the urine.
- Constant urge to empty the bladder even when it is not full.
- Darkening of urine, the presence of turbidity in it, the presence of an unpleasant fishy odor.
Causes of pyelonephritis
The penetration of bacteria into the kidneys along the ascending path
The development of the disease is provoked by bacteria. They, through the urethra, enter the urinary system and inseminate the bladder. If the infection is not eliminated, then gradually it will rise higher and higher, seizing the organs located in its path and ultimately affecting the kidneys. In 90% of cases, the disease occurs due to the penetration of Escherichia coli into the bladder. She, starting her life in the intestine, enters the urethra from the anus. This happens most often during the emptying process. Due to the fact that the urethra and anus in women are located nearby, and the main source of infection is E. coli, they suffer from pyelonephritis much more often.
In addition, the urethra in women is short, and the anatomy of the external genital organs is such that E. coli can easily penetrate the bladder and then into the kidneys. Therefore, the ascending route of infection is the most common cause of infection, resulting in acute pyelonephritis.
However, E. coli is not always the only cause of kidney inflammation.
Among other causes of pyelonephritis are:
- Mycotic microorganisms;
Vesiculourethral reflux (vesicoureteral reflux)
This pathology is characterized by the fact that urine from the bladder flows back into the ureters and is partially thrown into the renal pelvis. When the disease remains undetected at an early stage, it leads to regular stagnation of urine, reflux and multiplication of pathogenic agents in the kidney tissues, which leads to an inflammatory process.
The more exacerbations of pyelonephritis a child suffers, the more the structure of the kidneys is disturbed. As a result, normal tissue is replaced by scar tissue and the organ is unable to perform its functions in the same volume. This development of the disease is typical mainly for young children who have not reached the age of five. However, scarring of kidney tissue in adolescence against the background of a previous illness is not excluded.
It is children's kidneys that are more susceptible to scarring, since:
- Reverse flow or reflux in childhood occurs under less pressure than in adults.
- The immune system of children is more vulnerable to the pathogenic influence of bacterial agents than in adults. This is especially true for children under one year old.
- Pyelonephritis is more difficult to detect at a young age, especially in infancy.
Vesicoureteral reflux is found in most children under six years of age with pyelonephritis (from 20 to 50% of all patients), while in adults this pathology is diagnosed only in 4% of cases.
Pyelonephritis, transferred at an early age, leads to irreversible changes in kidney tissue. Thus, of all patients on hemodialysis, 12% were sick with acute pyelonephritis in childhood.
As for other causes of pyelonephritis, they are of low prevalence. It is possible for the causative agent of infection to penetrate not from the bladder, but through the bloodstream from other organs.
The possibility of developing the disease increases against the background of urolithiasis, when the ureter is blocked by a stone. As a result, urine is not excreted in full, stagnates, which is a favorable environment for the reproduction of pathogenic microorganisms. (See also: Urolithiasis - causes and symptoms)
There are risk factors that increase the likelihood of developing the disease, including:
- Deposition of calculi in the kidneys with kidney stones.
- Pathologies of the development of the organs of the urinary system of a congenital nature.
- Changes in the urinary system due to age.
- Neurogenic dysfunction of the bladder, which is observed in diabetes mellitus. This condition requires re-insertion of the catheter, which increases the risk of developing the disease.
- Spinal cord injury resulting from trauma.
The period of childbearing, which can lead to a decrease in tone and a decrease in the motility of the ureters. This is due to their compression by the growing uterus, with polyhydramnios, with a narrow pelvis, with a large fetus, or against the background of the existing insufficiency of the vesicoureteral valves.
- Complete or partial displacement of the uterus outside the vagina.
- Inserting a catheter into the bladder, resulting in obstruction.
- Prostate pathology in men.
- Sexual activity of a young woman. During intercourse, the muscles of the urogenital diaphragm contract as a result of massaging the urethra, which increases the risk of infection along the ascending pathway.
- Operations on the organs of the urinary system.
Diagnostics of the pyelonephritis
The diagnosis is typically straightforward. The patient's complaints of pain in the lumbar region, intoxication syndrome become the basis for taking tests and passing an instrumental examination, which makes it possible to diagnose pyelonephritis.
Instrumental studies are reduced to:
- Ultrasound of the kidneys, which makes it possible to detect the presence of calculi in them, gives information about the size of organs, about changes in their density. In the chronic course of the disease, the echogenicity of the parenchyma increases, and in the acute course it decreases unevenly.
- CT makes it possible to assess not only the density of the parenchyma, but also the state of the perirenal tissue, vascular pedicle and pelvis.
- Excretory urography provides information about the limitation of the mobility of the affected kidney, the tone of the urinary tract, the state of the cups, etc.
- Cystography is done to check for intravesical obstruction and vesicoureteral reflux.
- Angiography of the renal arteries is used more often with an already established diagnosis of chronic pyelonephritis, since this method is not routine to identify the acute stage of the disease.
- Women must undergo a gynecological examination.
What tests are taken for pyelonephritis?
With pyelonephritis, you must pass the following tests:
- Urine analysis according to Nechiporenko.
- Zimnitsky test.
- Bacteriological examination of urine.
- It is possible to perform a prednisolone test, which allows you to identify the latent course of the disease. For this, a special drug (Prednisolone with Sodium Chloride) is injected intravenously, after which an hour, two and three hours later, and then, a day later, urine is collected and analyzed.
Indicators of urine with pyelonephritis
- A general urinalysis for pyelonephritis will give an alkaline reaction, where the pH will range between 6.2 and 6.9. Changes occur as a result of bacterial waste products entering the urine and due to disruption of the functioning of the tubules. The color of urine changes to a darker side, its reddish tint, a cloudy suspension is possible. Protein detection possible.
- Urine analysis according to Nechiporenko will reveal a significant increase in the number of leukocytes over erythrocytes.
- Zimnitsky's test will detect a decrease in urine density. Nocturnal urine output will prevail over daytime.
- Bacteriological examination will reveal in 1 ml of urine the number of bacteria exceeding 10 to the fifth degree. To determine their type and establish the sensitivity to a specific drug, a culture study is performed.
- A prednisolone test will indicate pyelonephritis by an increase in the number of leukocytes.
Complications and consequences of pyelonephritis
The complications and consequences of pyelonephritis can be very serious. The disease is especially dangerous for women carrying a child, as well as for people with diagnosed diabetes mellitus.
Among the possible complications of the disease:
- Renal failure;
- Blood poisoning;
- Kidney abscess.
Sepsis as a complication of pyelonephritis
Most often, diagnostic errors lead to the fact that pyelonephritis cannot be cured. Although it happens that the disease takes on a severe course until the moment of contacting a doctor. Mostly these are people who have various spinal injuries and do not have the natural ability to feel pain in its lower part.
If the treatment is not carried out in full, or is completely absent, then the inevitable progression of the disease occurs. Pathogenic microorganisms multiply when their number reaches the limit point, they penetrate the bloodstream and spread throughout the body along its bed. This is how sepsis develops, which often ends in the death of a person.
Pyelonephritis is essentially a mild illness from which people should not die. It can be successfully treated with antibacterial drugs. Nevertheless, with such complications as: sepsis, septic shock, end-stage pyelonephritis, the risk of death increases many times. Indeed, statistics clearly indicate that sepsis becomes a fatal complication for every third person affected by it. But even those who survive after blood poisoning are often doomed to disability, since it becomes necessary to remove certain parts of the patient's body and organs to save life.
Famous people who have had pyelonephritis with sepsis:
- Jean-Paul II - The Pope died of sepsis in 2005, which was a complication of pyelonephritis.
- Marianne Bridi Costa died of sepsis due to pyelonephritis in 2009. The famous Brazilian model had arms and legs amputated in an attempt to stop the progression of the disease, but the death could not be prevented.
- Etta James, singer and grammy winner, suffered pyelonephritis complicated by sepsis.
Read more: Sepsis - Causes and Symptoms
This complication in 43% of cases leads to the death of the patient. The complication is characterized by a severe course, since as a result of the accumulation of gas in the kidneys, organ necrosis occurs and renal failure develops.
In addition, pyelonephritis, in addition to the above complications, can lead to such consequences as:
- Kidney abscess;
- Development of apostenomatous pyelonephritis;
- Kidney carbuncle.
Answers to popular questions
- How many people live with pyelonephritis? With pyelonephritis, you can live a full life, which will not be limited by any time frame. However, an important condition is the timely and adequate treatment of the disease and the prevention of exacerbations. In addition, it is possible to completely get rid of chronic pyelonephritis if it is detected with early diagnosis and passes against the background of persistent treatment. In general, the prognosis depends on the duration of the disease, on damage to one or two kidneys, on the microflora that led to inflammation. According to statistics, if a person does not change his lifestyle and does not start treatment, after the diagnosis of pyelonephritis, the life span does not exceed 10 years
- How long does the temperature last with pyelonephritis? With pyelonephritis during an exacerbation, the temperature lasts up to one week.
- How much water to drink with pyelonephritis? The body needs as much fluid as possible during an exacerbation of the disease. The patient is advised to drink more than 2000 ml of pure water per day. Only a doctor can reduce the volume if there are appropriate contraindications.
- Is it possible to warm up, go to the bathhouse with pyelonephritis? During an exacerbation of the disease, it is prohibited to visit the bathhouse, as well as perform other warming up procedures. The patient's condition may worsen. In the stage of remission, the bath is not contraindicated, but it is necessary to be completely sure that the disease has receded. For this, tests are taken and an ultrasound of the kidneys is performed.
- Is it possible to have sex with pyelonephritis? Pyelonephritis, as a disease, has no contraindications to sexual activity.
- How many are in the hospital with pyelonephritis? The hospital stay with pyelonephritis for 10 days or more. It all depends on the patient's condition and the presence of complications.
How and how to treat pyelonephritis?
How and what to treat pyelonephritis depends on how the disease progresses. If an exacerbation of a chronic disease, or primary acute pyelonephritis occurs against a background of high temperature, is accompanied by a drop in pressure, severe pain, suppuration and disruption of the normal outflow of urine, surgery will be required. The patient must be hospitalized if it is impossible to carry out drug therapy at home (vomiting after taking pills for pyelonephritis), as well as with severe intoxication. In other situations, at the discretion of the doctor, treatment can be carried out on an outpatient basis.
Pyelonephritis is treated with antibacterial and symptomatic therapy in combination.
To eliminate the symptoms of the disease, the following conditions must be met:
- It is important to observe the drinking regime throughout the entire period of treatment.
- The first few days, the patient must comply with bed rest, that is, stay warm in a horizontal position.
- To reduce body temperature and eliminate pain, it is necessary to use NSAIDs, including: Diclofenac, Metamizole. In childhood, Paracetamol is indicated.
Most of all, wet cold is dangerous for inflamed kidneys. This applies to both the exacerbation of the disease and the chronic course of pyelonephritis. During the period of remission, it is important to take a horizontal position of the body at least once a day for half an hour and to empty the bladder more often.
Treatment of pyelonephritis with antibacterial drugs in adult patients. After confirming the diagnosis, the patient is prescribed an antibacterial drug, most often used to treat pyelonephritis. After the results of the bacterial culture are obtained (more often this happens after 5 days), the antibiotic can be replaced with another, more effective in this case.
Disease therapy is carried out using drugs of the fluoroquinol group, or Ampicillin in combination with beta-lactamase inhibitors, or Cephalosporins.
Such drugs as Cefotaxime and Ceftriaxone are convenient in that they need to be administered no more than twice a day. Ampicillin is used less and less for the treatment of pyelonephritis. This is due to the high resistance of bacteria to it, which occurs in 40% of cases. The course of treatment most often lasts from one to two weeks, which depends on the severity of the course of the disease and the effect obtained.
Ciprofloxacin is prescribed to patients in tablet form, since it is well absorbed from the intestine and retains a high concentration in the kidneys. Nausea and vomiting is an indication for intravenous administration of this antibacterial drug.
When the effect of the therapy is absent in the first 2-3 days, it is advisable to perform a CT scan of the abdominal cavity. This procedure is necessary to exclude renal hydronephrosis and to exclude an abscess. In addition, a bacteriological analysis of urine is required to determine the sensitivity of microorganisms.
Sometimes, after the performed antibacterial course, it is necessary to repeat it, but with drugs of a different group. If the disease has become chronic, then it is necessary to take antibacterial agents for a long time. Difficulties in the treatment of the disease lie in the resistance of the bacterial flora to antibacterial agents.
The prognosis is favorable when the disease is detected in the early stages and with timely treatment. If the pathogen is not detected in the urine all year after therapy, then the person is considered healthy.
- A seven-day course of treatment with Ciprofloxacin. Studies have shown that a weekly course of pyelonephritis treatment with Ciprofloxacin gives an equivalent effect, as in the treatment with drugs of the fluoroquinol group. Two groups of women were treated with different drugs: some subjects were treated for a week with Ciprofloxacin, and others for two weeks with fluoroquinol. As a result, women from both groups (97% of patients) got rid of the disease. In addition, 5 sick women who received fluoroquinol treatment began to suffer from candidiasis. Ciprofloxacin did not give such a negative effect.
- Antibiotic therapy of pyelonephritis in childhood. To get rid of the disease, an intravenous antibiotic will be required. It can be ceftriaxone, cefepin, cefixime. When the effect is achieved, the body temperature will drop, you can use drugs of the cephalosporin series in tablet form. If the disease is mild, then therapy, even in the initial stages, can be carried out with the help of tablets.
- Therapy of pyelonephritis caused by fungi. If the disease is provoked by mycotic microorganisms, then treatment with Fluconazole or Amphotericin is indicated. In this case, it is necessary to monitor the dynamics of excretion of fungi from the kidneys, for which CT, retrograde pyelography, and X-ray contrast urography are performed. Surgery is required if the urinary tract is blocked and urine stagnates in the kidneys. In this case, patients are given a nephrostomy. This method leads to the normalization of the outflow of urine and makes it possible to inject antimycotics directly into the kidney.
- Nephrectomy. Removal of the kidney is necessary against the background of sepsis, which cannot be corrected with drugs. It is especially important to perform nephrectomy in case of renal failure, which tends to increase.
- Herbal medicine, and taking herbal medicines for pyelonephritis
On the subject: Effective treatment of pyelonephritis with folk remedies
The following medicines can be used to treat pyelonephritis and reduce symptoms of the disease:
- Bearberry (for more details: treatment of pyelonephritis with bearberry) and horsetail will reduce edema.
- Oats and orthosiphon can help reduce cramping.
- Nettles and rose hips can help reduce bleeding.
- As prophylactic agents, as well as in the complex treatment of the disease, it is possible to use: Phytolysin, Monurel, Kanefron, Cyston, renal teas.
- To get rid of dyspeptic disorders caused by antibacterial drugs, plantain, chamomile, strawberry leaves allow.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.