Chronic interstitial nephritis (CIN)- chronic damage to the tubulo - interstitial tissue of the kidneys, due to the influence of infectious, metabolic, immune, toxic factors, the clinical picture of which is dominated by impaired tubular functions.

Code according to the international classification of diseases ICD-10:

Classification. By pathogenesis.. Primary CIN - primarily occurring in the kidney.. Secondary CIN - nephritis is one of the manifestations of a general or systemic disease. By etiology (see below Etiology).

Statistical data. Accurate data are not available due to underdiagnosis.
Etiology. HP (see Interstitial Acute Nephritis). Metabolic disorders: hyperuricemia, hypercalcemia. immune disorders: SLE, Sjögren's syndrome, chronic active hepatitis, thyroiditis, renal transplant rejection. Heavy metals: gold, lead, mercury, lithium, etc. . Infections such as chronic pyelonephritis. Malignant neoplasms Key words: multiple myeloma, light chain disease. Amyloidosis. Kidney dysplasia: polycystic, Allport's syndrome, etc. . Obstruction of the urinary tract.

The reasons

Pathogenesis. Of particular importance in the development of tubulo-interstitial inflammation is the predominance of the mechanisms of toxic and metabolic damage to the kidneys over the immune one.

Pathomorphology. Lymphohistiocytic infiltration of the interstitium. Stroma sclerosis. Degeneration or atrophy of the epithelium of the tubules. With analgesic nephropathy, the following changes: .. sclerosis of the capillaries of the urinary tract mucosa .. papillary necrosis .. focal segmental glomerulosclerosis.

Symptoms (signs)

Clinical picture. Syndrome of tubular disorders. Proximal tubular disorders (complete Fanconi syndrome or partial disorders - proximal tubular acidosis, glucosuria, proteinuria). Distal tubular disorders (distal acidosis, hyper- or hypokalemia, hyper- or hyponatremia). Partial disorders of tubular functions - depend on the etiological factor. Arterial hypertension (rarely in the early stages, in the later stages and with chronic renal failure - often). With secondary CIN - symptoms of the underlying disease

Diagnostics

Laboratory data. In the blood - anemia, acidosis, increased ESR (more often with immune or infectious genesis). In the urine - an increase in volume (polyuria), hypostenuria, water and electrolyte disturbances, alkaline urine reaction, tubular proteinuria, glucosuria, erythrocyturia, leukocyturia. Hyperuricemia (with gouty nephropathy).

instrumental data. With all CIN according to ultrasound - a decrease in the size of the kidneys and an increase in the echogenicity (density) of the kidneys. With analgesic nephropathy: .. excretory urography - signs of papillary necrosis (see Renal papillary necrosis) .. CT - calcification of the border of the renal papillae .. cystoscopy - pigmentation of the triangle of the bladder.

CLINICAL - LABORATORY FEATURES OF SOME CIN
Medicinal nephropathies
. Analgesic nephropathy.. Develops when taking metamizole sodium or combinations of analgesics (paracetamol, phenacetin, acetylsalicylic acid) more than 3 g / day .. More often observed in women over 45 years old .. Episodes of renal colic in combination with aseptic leukocyturia, macrohematuria .. Microhematuria, moderate proteinuria (massive proteinuria more than 3 g / day - with the development of focal segmental glomerulosclerosis .. Polyuria, hypostenuria, thirst (100%) .. Renal tubular acidosis (10-25%) .. Reduction in the size of the kidneys .. degree of CRF .. Hyperuricemia .. Half of the patients have arterial hypertension .. ORF (obstruction by a torn papilla, arterial hypertension, dehydration) .. High risk of developing malignant tumors of the urinary tract .. Analgesic syndrome - a lesion of other organs combined with kidneys: gastrointestinal tract (ulcer stomach, stomatitis), hematopoietic organs (anemia, splenomegaly), cardiovascular system (arterial hypertension, atherosclerosis), neuropsychiatric sphere (holo pain, psychosis, personality disorders), reproductive system (infertility, pregnancy toxicosis), skin (pigmentation skin pale yellow).

. Cyclosporine nephropathy.. Develops in a transplanted kidney when using high doses of cyclosporine - 10-15 mg / kg / day .. Interstitial fibrosis .. Arterial hypertension .. Slowly progressive CRF .. Angiosclerosis obliterans .. Focal segmental glomerulosclerosis with high proteinuria, uncontrolled arterial hypertension and rapidly progressive CKD.

. Nephropathy due to NSAIDs.. Increased blood pressure.. Edema - primary renal sodium retention due to inhibition of Pg.. Acute tubular necrosis with acute renal failure.
Toxic nephropathies

. « Golden" nephropathy(in the treatment of rheumatoid arthritis) .. Glomerulonephritis - membranous, with minimal changes or proliferative.. Tubular dysfunctions.. Vasculitis of the renal vessels.. Full recovery of functions 11 months after discontinuation of gold treatment.

. Lithium nephropathy.. ADH non-responsive nephrogenic non diabetes, incomplete distal tubular acidosis and azotemia (rare) .. Nephrotic syndrome.
. Cadmium nephropathy.. Violations of the functions of the proximal tubules.. Progression to CRF.
. lead nephropathy.. Decreased GFR, renal blood flow, minimal proteinuria, unchanged urinary sediment, hyperuricemia, low urate clearance, sometimes arterial hypertension, hyperkalemia and acidosis.
. Nephropathy with the introduction of copper - rarely observed (Wilson's disease), clinically similar to cadmium nephropathy.
. Mercury nephropathy.. Membranous and proliferative glomerulonephritis.. Atrophy of the proximal tubules with the development of Fanconi syndrome.. Progression of CRF.

Metabolic nephropathies. Urate, or gouty, nephropathy - damage to the tubules by uric acid and urates during alcoholism, treatment with tumor cytostatics, gout, lead intoxication - it happens three types.. CIN .. Urate stones .. Acute uric acid nephropathy (obstruction of the renal tubules by urates with frequent development of acute renal failure). Treatment: purine-free diet, allopurinol, forced polyuria, urine alkalinization. Oxalate-calcium nephropathy - damage to the tubules by calcium oxalate crystals in case of ethylene glycol poisoning, formation of ileojejunal anastomosis, pyridoxine or thiamine deficiency. Interstitial nephritis. Oxalate-calcium nephrolithiasis.

Other nephropathies developing secondarily in the following diseases. Amyloidosis (see Amyloidosis). Sarcoidosis (see Sarcoidosis) .. Kidney size usually normal, slight proteinuria. Hypercalcemia and/or hypercalciuria in sarcoidosis can lead to AKI, nephrocalcinosis, or nephrolithiasis. SLE and other systemic connective tissue diseases. With hereditary nephropathy - polycystic, Allport's syndrome. With obstruction of the urinary tract (prostate adenoma, urolithiasis, etc.). With urinary tract infections (chronic pyelonephritis).

Treatment

Treatment. Cancellation or reduction of the dose of drugs, replacement with an alternative drug. In most cases, a diet that alkalizes urine. Sufficient volume of fluid to achieve polyuria. With immune CIN - GC. Correction of water-electrolyte disorders and acid-base balance. Treatment of arterial hypertension. Anemia treatment. Treatment of OPN.

Prevention. It must be remembered that in the presence of kidney disease (especially with gout, myeloma nephropathy, diabetic glomerulosclerosis) or episodes of acute renal failure in the past, as well as in old age, with heart failure, cirrhosis of the liver, alcoholism and drug addiction, the risk of nephrotoxic effects increases .. Dieting. Achieving forced polyuria with the threat of obstruction of the tubules by oxalates, urates.. Prohibition of taking analgesics (paracetamol is less toxic) and exclusion of nephrotoxic drugs.. Refusal of X-ray contrast studies in the presence of CIN risk factors. Reduction of doses of cyclosporine to 5 mg / kg / day with monitoring of its content in the blood. Early detection and treatment of the underlying disease.

Course and forecast. Spontaneous recovery of function or improvement in the course of the disease is possible with rapid withdrawal toxic factor, drugs (for example, gold preparations). CRF is irreversible, more often with analgesic nephropathy.
Reduction: CIN - chronic interstitial nephritis.

ICD-10. N11 Chronic tubulo - interstitial nephritis.

Classification. Flow.. Acute: serous or purulent .. Chronic: latent and recurrent (occurs with exacerbations). Primary (developing in a healthy kidney without disturbing urodynamics) and secondary (developing against the background of kidney disease, developmental anomalies or impaired urodynamics: ureteral stricture, benign prostatic hyperplasia, urolithiasis, urinary tract atony, reflux dyskinesia). Phases: exacerbation (active pyelonephritis), remission (inactive pyelonephritis). Localization: unilateral (rarely), bilateral. With the presence of arterial (symptomatic) hypertension. Complications: uncomplicated (usually in outpatients), complicated - abscess, sepsis (more often in inpatients, during catheterizations, with urodynamic disorders - urolithiasis, polycystic kidney disease, benign prostatic hyperplasia, in immunodeficiency states - diabetes, neutropenia). Kidney function - intact, impaired function, chronic renal failure. Community-acquired pyelonephritis (outpatient) and nosocomial (nosocomial) - developed within 48 hours of hospital stay. Special clinical forms.. Pyelonephritis of newborns and children.. Pyelonephritis of the elderly and senile age.. Gestational pyelonephritis - pregnant, childbirth, postpartum.. Calculous pyelonephritis.. Pyelonephritis in patients with diabetes.. Pyelonephritis in patients with lesions spinal cord.. Xanthogranulomatous pyelonephritis (rare) .. Emphysematous pyelonephritis (rare) caused by gas-forming bacteria with the accumulation of gas bubbles in the tissues of the kidney and its surrounding tissue.

Statistical data. The morbidity rate is 18 cases per 1000 population per year. Women get sick 2-5 times more often than men, girls - 6 times more often than boys. In older men with benign prostatic hyperplasia, pyelonephritis occurs more often than in younger men.
Etiology. In acute pyelonephritis, monoflora is more common, in chronic - associations of microbes. Staphylococcus and Mycobacterium tuberculosis. With community-acquired pyelonephritis, E. coli is sown in 80% of cases; with nosocomial pyelonephritis, it also prevails, but the frequency of coccal flora increases.
Pathogenesis. Urodynamic disorders. Previous kidney disease, especially interstitial nephritis. Immunodeficiency states (treatment with cytostatics and / or prednisolone, diabetes, defects in cellular and humoral immunity) . Hormonal imbalance (pregnancy, menopause, long-term use contraceptives) . Ways of penetration of infection. .
Pathomorphology. In acute pyelonephritis, the kidney is enlarged, the capsule is thickened. In the interstitial tissue (cortex and medulla) - perivascular leukocyte infiltrates with a tendency to form abscesses. With the fusion of pustules or blockage of the vessel by a septic embolus, necrotic papillitis, abscess, and carbuncle of the kidney may occur. Chronic pyelonephritis goes through stages from perivascular infiltration, focal sclerosis to wrinkling of the kidney - the kidney is reduced in size, the surface is bumpy, there are tissue retractions in places of sclerosis, the capsule is fused with the kidney parenchyma, it is removed with difficulty.

Symptoms (signs)

CLINICAL MANIFESTATIONS
Acute pyelonephritis often occurs with a vivid clinical picture, with purulent pyelonephritis similar to a septic or infectious disease. Febrile fever with chilliness, profuse sweat. Pain in the lumbar region, tenderness on palpation, Pasternatsky's symptom is positive, on the side of pyelonephritis - tension of the anterior abdominal wall (peritonism phenomena). Urinary syndrome - polyuria (more often) or oliguria (less often) with loss of fluid through the lungs and skin, dysuria - frequent and painful urination. Intoxication syndrome - headache, nausea, vomiting. With bilateral acute pyelonephritis, the development of acute renal failure is possible.
Chronic pyelonephritis in most patients (50-60%) has a latent course. Subfebrile condition, sweating, chilling. Pain in the lumbar region, Pasternatsky's symptom is positive. Urinary syndrome - polyuria, nocturia, rarely dysuria. Symptoms of intoxication. Arterial hypertension (more than 70% of cases). Anemia (in some patients). Clinical signs of exacerbation- an increase in body temperature (not always), an increase in blood pressure, an increase or appearance of pain in the lower back, polyuria, dysuria, nocturia.
Laboratory research . Acute pyelonephritis .. Blood test ... Increased ESR, neutrophilic leukocytosis, sometimes leukopenia, shift of the leukocyte formula to the left (with purulent pyelonephritis) ... Increased urea and creatinine in the blood (with acute renal failure) .. Urine. May be turbid (mucus, bacteria, desquamated epithelium), leukocyturia (neutrophils), active leukocytes (Sternheimer-Malbin, "pale", arachnid) - are formed in the urine with low osmolarity (with hematogenous infection, infections may be absent in the early days, with obstruction ureter are absent), bacteriuria, proteinuria, erythrocyturia (less often hematuria - with necrosis of the renal papillae), hypostenuria (hyperstenuria is possible with oliguria). Chronic pyelonephritis. In the analysis of urine: moderate proteinuria, leukocyturia, bacteriuria, microhematuria, Sternheimer-Malbin cells, active leukocytes, hypostenuria, alkaline urine reaction (especially characteristic of infection with Proteus, Klebsiella and Pseudomonas species). Mandatory bacteriological culture of urine (more than 103-5 microbes in 1 ml of urine) with the determination of the sensitivity of the isolated microflora to antibiotics.
instrumental data
. Ultrasound of the kidneys .. In acute pyelonephritis - an increase in size, a decrease in echogenicity, a spasm of the pelvicalyceal system, the contours of the kidney are even, with a carbuncle of the kidney - a cavity formation in the parenchyma .. In chronic pyelonephritis - a decrease in size, an increase in echogenicity, deformation and expansion of the pelvicalyceal system, tuberosity of the contours of the kidney, asymmetry in size and contours .. With obstruction of the urinary tract - signs of hydronephrosis on the side of the lesion, calculi.
. Plain radiography: an increase or decrease in one of the kidneys in volume, tuberosity of the contours, sometimes a shadow of a calculus.
. Excretory urography (contraindicated in the active phase, with chronic renal failure) .. In acute pyelonephritis - late contrasting on the side of the lesion, a decrease in the intensity of contrasting, slowing down the excretion of contrast .. In chronic pyelonephritis, in addition to these symptoms, expansion and deformation of the cups and pelvis.
. Angiography: in the early stages - a decrease in the number of small branches of segmental arteries up to their disappearance, in the later stages - the shadow of the kidney is small, there is no border between the cortical and medulla layers; reveal deformations of vessels, narrowing and decrease in their quantity.
. Radioisotope renography and scintigraphy: the size of the kidneys is normal or reduced, the accumulation of the isotope is reduced, the secretory and excretory phases of the curve are lengthened.
. Chromocystoscopy .. In acute pyelonephritis - the discharge of turbid urine from the mouth of the ureter of the affected kidney (or both kidneys), delayed or weakened release of indigo carmine on the side of the lesion .. In chronic pyelonephritis, a violation of the functions of the affected kidney is also determined, however, in many patients, violations of the release of indigo carmine are not found .

Diagnostics

Diagnostics
. The diagnosis of active pyelonephritis (acute or exacerbation of chronic) is based on the clinical "triad" - fever, back pain, dysuria; laboratory data confirm the diagnosis (see above), incl. results of bacteriological culture of urine and determination of sensitivity to antibiotics, instrumental data.
. With a latent course of pyelonephritis, it is advisable to conduct a prednisolone test (30 mg of prednisolone in 10 ml of 0.9% r - ra sodium chloride IV). The test is positive if, after the administration of prednisolone, the content of leukocytes and bacteria in the urine doubles.
. The study of urine according to Nechiporenko, the leukocyte formula of urine makes it possible to differentiate chronic pyelonephritis and glomerulonephritis: .. with glomerulonephritis, the number of erythrocytes exceeds the number of leukocytes, with pyelonephritis, the number of leukocytes is higher .. with glomerulonephritis, lymphocytes predominate in the leukocyte blood formula, with pyelonephritis - neutrophils.
. In chronic pyelonephritis, the concentration ability of the kidneys is disturbed early (Zimnitsky test), with glomerulonephritis - later, at the stage of development of chronic renal failure.
. Differential Diagnosis . infectious diseases accompanied by fever (typhoid fever, malaria, sepsis). Pyonephrosis. Hydronephrosis. Acute purulent disease of the lower urinary tract. Kidney infarction. Acute glomerulonephritis. Pneumonia. Cholecystitis. Acute pancreatitis. Acute appendicitis. Spleen infarction. Dissecting aortic aneurysm. Shingles.
Accompanying illnesses. Obstruction of the urinary tract. Anomalies of the urinary tract. Pregnancy. Nephrolithiasis. SD. immunodeficiency states.

Treatment

TREATMENT
Diet. In the acute period - table number 7a, then number 7. Fluid intake up to 2-2.5 l / day. With calculous pyelonephritis, the diet depends on the composition of the calculi: with phosphaturia - acidifying urine, with uraturia - alkalizing.
General tactics. Restoration of patency of the upper and lower urinary tract. Antibacterial therapy - an average of 4 weeks (2-6 weeks). Drugs that have an antispasmodic effect (platifillin, papaverine hydrochloride, belladonna extract, etc.). With oliguria - diuretics. Fight against dehydration (with polyuria, fever). With metabolic acidosis - sodium bicarbonate inside or in / in. antihypertensive therapy. In chronic pyelonephritis without exacerbation - resort treatment in Truskavets, Essentuki, Zheleznovodsk, Sairma. Surgery- if necessary.
Drug therapy. The goal is to eliminate the activity of the process, eradicate the pathogen. The criterion for the effectiveness of therapy is the normalization of clinical and laboratory parameters, abacteriuria. Antibacterial therapy for at least 2 weeks in courses of 7-10 days, empirical (before seeding the pathogen) and targeted (after determining the sensitivity of the microflora to antibiotics) penicillins such as amoxicillin + clavulanic acid, ampicillin + sulbactam) or oral cephalosporins (cephalexin, cefuroxime, cefaclor); it is also possible to prescribe co-trimoxazole, doxycycline. alternative drugs - protected penicillins, II-III generation cephalosporins, gentamicin + ampicillin (amoxicillin, carbenicillin), imipenem + cilastatin. priming inside) .. Exacerbation of chronic nosocomial pyelonephritis - start with fluoroquinolones, drugs of choice except for the above - imipenem + cilastatin, gentamicin + ampicillin (cephalosporins II-III, azlocillin, carbenicillin, piperacillin), cephalosporins III + protected penicillins .. If staphylococcal is suspected pyelonephritis - vancomycin + oxacillin + gentamicin (amikacin) .. anti-relapse therapy spend for 3-12 months for 7-10 days of each month, with purulent pyelonephritis - with antibiotics (see above), with serous - with uroantiseptics, in turn: nalidixic acid 0.5-1 g 4 r / day, nitrofurantoin 0 15 g 3-4 r / day, nitroxoline 0.1-0.2 g 4 r / day. It is also effective to prescribe uroantiseptics 1 time at night: co-trimoxazole, trimethoprim or nitrofurantoin 100 mg at night or 3 r / week (prophylactically). Immunocorrection. With acidosis - sodium bicarbonate 1-2 g orally 3 r / day or 100 ml of 4% r - ra in / in. With anemia - iron preparations, blood transfusion, erythrocyte mass.
Surgery. In case of purulent pyelonephritis, in case of failure of conservative therapy, decapsulation of the kidney, pyelonephrostomy and drainage of the renal pelvis. With carbuncle of the kidney - dissection of the inflammatory-purulent infiltrate or resection of the affected area of ​​the kidney. In obstructive pyelonephritis, interventions are aimed at removing the obstruction to the outflow of urine (for example, removing a stone). With xanthogranulomatous pyelonephritis, a partial excision of the kidney is performed.

Complications. Necrosis of the renal papillae. Kidney carbuncle. Apostematous nephritis. Pyonephrosis. Paranephritis. Urosepsis, septic shock. Metastatic spread of purulent infection in the bones, endocardium, eyes, brain membranes (with the appearance of epileptic seizures). Secondary parathyroidism and renal osteomalacia (in chronic pyelonephritis due to renal loss of calcium and phosphates). Pyelonephritic shriveled kidney. Nephrogenic arterial hypertension. Hypotrophy of newborns (with pyelonephritis of pregnant women). Acute and chronic renal failure.
Course and forecast. The prognosis worsens as the duration of pyelonephritis increases, with nosocomial pyelonephritis, microbial resistance to antibacterial agents, urinary tract obstruction, the presence of purulent complications, immunodeficiency states, and frequent relapses. Complete recovery from acute pyelonephritis is possible with early diagnosis, rational antibiotic therapy, absence of aggravating factors. In 10-20% of patients with chronic pyelonephritis, chronic renal failure develops. In 10% of patients with arterial hypertension, its malignancy occurs.
Concomitant pathology. Urolithiasis disease. Tuberculosis of the kidneys. Benign prostatic hyperplasia. Uterine prolapse. Purulent - septic diseases. SD. Spinal disorders.
Pyelonephritis and pregnancy. Acute pyelonephritis affects 7.5% of pregnant women (often right-sided). During the first pregnancy, pyelonephritis most often begins at the 4th month of pregnancy, with a second - at the 6-7th month. Features of the clinical picture: pain in the lower abdomen, dysuria. The disease begins with chills and fever. Intoxication is pronounced, which is due to pelvic-renal reflux resulting from stretching of the renal pelvis. Pyelonephritis during pregnancy is an indication for emergency hospitalization. Termination of pregnancy is indicated only with the threat of urosepsis, the development of acute renal failure, the addition of preeclampsia.

Age features
. Pyelonephritis in childhood .. The disease often occurs against the background of congenital anomalies urinary system(stenosis of the urethra, bending of the ureter, etc.), dysmetabolic processes (oxalaturia, uraturia) .. Perhaps a rapid onset with high temperature body or latent - with subfebrile fever .. Other symptoms: enuresis, soreness or itching in the vulva in girls, gastrointestinal dysfunction, swelling and pain in the lumbar region .. During treatment, a forced urination rhythm is additionally prescribed.
. Pyelonephritis in the elderly and senile. The disease proceeds latently. Characterized by a decrease in reactivity, dim clinical manifestations. The symptoms of general intoxication predominate. In men, pyelonephritis often develops against the background of benign prostatic hyperplasia.
Prevention. Timely treatment of foci of infection. Treatment of diseases of the urinary tract that impede the outflow of urine. Mode: balanced diet, warning of overwork. Rational treatment of acute pyelonephritis.
Synonyms. Ureteropyelonephritis. Ascending jade. Interstitial nephritis.

ICD-10. N10 Acute tubulo - interstitial nephritis. N11 Chronic tubulo - interstitial nephritis.

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

Obstructive pyelonephritis

Obstructive is understood as inflammation of the renal pelvis or calyx, associated with difficulty in the outflow of urine from the organ. In other words, if the urinary tract in the kidneys is blocked by stones, a tumor, or for other reasons, an inflammatory process occurs - pyelonephritis. In rare cases, the pathology is independent, much more often it manifests itself against the background of another disease.

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

ICD-10 disease code:

1. No. 11.1. Chronic obstructive pyelonephritis.
2. No. 10. Spicy .

Ordinary acute nephritis can also go into obstructive pyelonephritis - with prolonged absence of treatment, when inflammation products clog the urine excretion pathways from the kidneys. The disease can be complicated by a deadly pathology - renal failure.

Forms

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

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

1. Left side.
2. Right hand.
3. Bilateral (mixed).

According to the type of flow, pyelonephritis is acute, chronic. An acute process develops for the first time, has vivid symptoms, and often proceeds severely. Chronic obstructive pyelonephritis is accompanied by periodic relapses and remissions.

Causes and pathogenesis

In most cases, pathology occurs due to a decrease in immunity in the kidneys against the background of long-acting factors, as well as due to stagnation of urine, which leads to such problems:

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

The form of obstructive pyelonephritis largely depends on the degree of overlap of the urinary tract. Acute pyelonephritis occurs with a sudden and complete closure of the outflow tract of urine, and it is with absolute obstruction that a severe form of the disease develops with vivid clinical symptoms.

For urolithiasis or anomalies in the structure of the kidneys, a long course and partial obstruction are characteristic, so they become the basis for the development of chronic pyelonephritis. However, a change in the position of the stone can provoke an exacerbation of pyelonephritis. Tumors are characterized by progressive obstruction, which can lead to the development of both forms of pyelonephritis.

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

Representatives of pathogenic and conditionally pathogenic microflora can cause inflammation, such as:

• Staphylococci;
• Enterococci;
• coli;
• Pseudomonas aeruginosa;
• Proteus;
• Streptococci;
• Mixed microflora (2/3 cases).

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

Symptoms

Acute obstructive pyelonephritis in children and adults begins acutely - with a sharp pain in the lumbar region. When the ureter is blocked by a stone, renal colic occurs with unbearable pain, from which analgesics do not help well. The pain radiates to the groin, thigh. There are also signs of high body temperature (up to 40 degrees), profuse sweating, and they appear already against the background of renal colic - by the end of the first day.

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

The cause of the main symptom of acute obstructive pyelonephritis - - is the expansion of the calyx and pelvis with stagnant urine, which leads to swelling of the capsule with irritation of the nerve endings.

In chronic obstructive pyelonephritis, the pain is aching, occurring regularly, and not intense. There are also general weakness, decreased performance, increased urge to urinate, discomfort when going to the toilet. With a long-term illness, a person may develop urinary incontinence.

Diagnostics

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

Of the laboratory and instrumental diagnostic methods, the following are carried out:

1. General analysis urine. Protein, a moderate amount of erythrocytes appear in the urine, a large number of leukocytes.
2. Bacteriological culture of urine. Bacteria - causative agents of the inflammatory process are detected.
3. General blood analysis. There is an increase in leukocytes, ESR, neutrophils, as well as anemia.
4. Overview. There is an increase in the kidney, visually noticeable tumors, stones, strictures, foreign bodies.
5. . It makes it possible to detect all inflammatory foci in the kidneys, destruction zones in chronic pyelonephritis, to establish the cause of the pathology.
6. , . Most often recommended for differentiation of kidney tumors or clarification of the type of calculi for the choice of treatment.

Treatment

In most cases, a combined method is used to eliminate the cause of the disease and the resulting inflammatory process. Calculi are removed from the kidney with the help of surgery or minimally invasive stone crushing techniques. With a complete blockage of the urinary tract, emergency surgery is most often performed. With tumors of the kidneys, surrounding organs, if possible, surgical intervention and radiation therapy, chemotherapy are carried out. Ureteral strictures and other anomalies in the structure of the urinary system in children and adults are removed by endoscopic surgery.

Conservative treatment aims to eliminate infectious process and symptom relief. The following types of drugs are used:

1. Antispasmodics - belladonna extract, Platifillin,.
2. Anti-inflammatory drugs - Ibuprofen, Nurofen.
3. directional action - Negram, Nevigramon, as well as uroseptics - Furadonin, Furomag.
4. Broad-spectrum antibiotics - Ampicillin, Oletetrin, Kanamycin, Tseporin, Tetracycline.

In chronic obstructive pyelonephritis, in addition to these drugs, immunomodulators (Urovaxom), herbal anti-inflammatory drugs (Canephron) are recommended. In children at severe course diseases are often treated with hormonal anti-inflammatory drugs (Prednisolone). In general, the treatment of a chronic form of pathology can be carried out for years with the use of various antibiotics and antiseptics, alternating and combining with each other. It is useful to use cranberries, an extract of this berry and preparations based on it in therapy. Shown treatment in sanatoriums, physiotherapy (electrophoresis, magnetotherapy, CMW-therapy).

Only patients with severe stages of renal failure are transferred to, which most often develops in severe forms of urolithiasis. With obstructive pyelonephritis, it is necessary to adjust the diet.

The diet is supposed to reduce the load on the kidneys, help normalize the outflow of urine. You should refuse salted, fatty foods, spicy and fried foods, confectionery, pastries. You need to drink plenty of fluids - from 2.5 liters per day.

Prognosis and complications

An acute obstructive process in the kidneys threatens the development of renal failure, necrosis of the renal papillae, and paranephritis. Rare, but the most dangerous complications sometimes become sepsis, bacterial shock. At chronic form pathology patients often suffer from nephrogenic arterial hypertension, chronic renal failure. The prognosis largely depends on the cause of the disease and the speed of rendering medical care. Congenital organ anomalies are usually successfully corrected, as are most forms of urolithiasis. With tumor pathologies of the kidneys, the prognosis depends on the stage of the disease and the type of tumor.

Pyelonephritis is an inflammatory disease of the kidneys. The pelvis and tissue (mainly interstitial) are directly affected. People of all ages get sick, but in women, due to structural features, pathology is more common than in men.

According to International classification diseases of the tenth revision (ICD-10), the condition is assigned to the XIV class "Diseases of the genitourinary system". The class is divided into 11 blocks. The designation of each block begins with the letter N. Each disease has a three-digit or four-digit designation. Inflammatory diseases of the kidneys are classified under (N10-N16) and (N20-N23).

What is the danger of the disease

1. Inflammatory kidney disease is a common pathology. Any person can get sick. The risk group is extensive: children, young women, pregnant women, elderly men.
2. kidneys- leading body filter. During the day, they pass through themselves up to 2,000 liters of blood. As soon as they get sick, they can not cope with the filtration of toxins. Poisonous substances re-enter the blood. They spread throughout the body and poison it.

The first symptoms are not immediately associated with kidney disease:

• Increase in blood pressure.
• The appearance of itching.
• Edema of the extremities.
• Feeling of fatigue, inappropriate to the load.

Treatment of symptoms without consultation with specialists, at home, leads to a deterioration in the condition.

The disease can be provoked by any factors surrounding modern man: stress, hypothermia, overwork, weakened immune system, unhealthy lifestyle.

The disease is dangerous because it can become chronic. With exacerbation, the pathological process spreads to healthy areas. As a result, the parenchyma dies, the organ gradually shrinks. Its functioning is reduced.

The disease can lead to the formation of renal failure and the need to connect the device "artificial kidney". In the future, a kidney transplant may be required.

The consequences are especially dangerous - the addition of a purulent infection, necrotization of the organ.

The ICD-10 indicates:

Acute pyelonephritis. Code N10

Acute inflammation caused by infection of the tissues of the kidneys. More often affects one of the kidneys. It can develop both in a healthy kidney and proceed against the background of kidney disease, developmental anomalies, or impaired urinary excretion processes.

An additional code (B95-B98) is used to identify the infectious agent: B95 for streptococci and staphylococci, B96 for other specified bacterial agents, and B97 for viral agents.

Chronic pyelonephritis. Code N11

Usually develops as a result of non-compliance with the therapeutic regimen of an acute condition. As a rule, the patient is aware of his illness, but sometimes it can be latent. The symptoms expressed during an exacerbation gradually subside. And it seems that the disease has receded.

In most cases, pathology is detected during medical examination, when analyzing urine in connection with other complaints (for example, high blood pressure) or diseases (for example, urolithiasis).

When collecting an anamnesis, these patients sometimes reveal symptoms of past cystitis and other inflammatory diseases of the urinary tract. During exacerbations, patients complain of pain in the lumbar region, low temperature, sweating, exhaustion, loss of strength, loss of appetite, dyspepsia, dry skin, increased pressure, pain when urinating, and a decrease in the amount of urine.

Allocate:

Non-obstructive chronic pyelonephritis associated with reflux. Code N11.0.

Reflux is the reverse flow (in this context) of urine from the bladder to the ureters and above. Main reasons:

• Bladder overflow.
• Bladder stones.
• Bladder hypertonicity.
• Prostatitis.

Chronic obstructive pyelonephritis. Code N11.1

Inflammation develops against the background of a violation of the patency of the urinary tract due to congenital or acquired anomalies in the development of the urinary system. According to statistics, the obstructive form is diagnosed in 80% of cases.

Non-obstructive chronic pyelonephritis NOS N11.8

With this pathology, the ureters are not blocked by calculi or microorganisms. The patency of the urinary tract is preserved, urination is not disturbed either qualitatively or quantitatively.

Pyelonephritis NOS. Code N12

The diagnosis is made without further clarification (acute or chronic).

Calculous pyelonephritis. Code N20.9

Develops against the background of renal calculi. If the presence of stones is detected in time and treatment is started, then chronicity of the disease can be avoided.

Stones may not make themselves felt for years, so their diagnosis is difficult. The appearance of severe pain in the lumbar region means only one thing - it's time to contact a qualified specialist. It is sad that most patients are reluctant to seek medical attention at the first symptoms of the disease.

From the foregoing, it follows that this ailment is a real chameleon among other pathologies. Insidious in her love to take on the guise of other diseases, it can end sadly. Listen to your body. Do not drown out pain and other symptoms with self-medication. Seek help in a timely manner.