Chronic pyelonephritis WHO classification

What is pyelonephritis

One of the most common infectious and inflammatory diseases of the urinary system is what pyelonephritis is. Affects kidney disease. The inflammatory process involves its calyces, pelvis and predominantly interstitial parenchyma tissue. In more advanced stages, the disease affects the blood vessels and glomeruli of the kidneys. In the absence of treatment, the excretory and filtering function of the organ is impaired. Using clinical and morphological data, doctors divided this disease into acute and chronic pyelonephritis.

Chronic

If the cause of kidney inflammation is a congenital kidney abnormality or changes in the urinary system, then the disease itself is chronic. Otherwise it is called obstructive or secondary. What is chronic pyelonephritis? This is the same inflammation of the kidneys, only characterized by a latent course. Due to changes in the urinary system, the outflow of urine is disrupted, as a result of which the infection reaches the kidneys through the ascending route. A typical form of this disease is calculous pyelonephritis, which develops due to kidney stones.

Spicy

According to the pathogenesis, acute pyelonephritis can be determined - which is what this disease is called when microorganisms enter the kidneys in another way - hematogenously, i.e. with blood from other organs where the primary focus of inflammation is located. This is possible with tonsillitis, caries, bronchitis, sinusitis, otitis, cystitis, sore throat and other similar ailments. The inflammation that develops against this background is primary or obstructive. This is the answer to the question of what acute pyelonephritis is.

Classification

The disease is divided into types according to several characteristics. Acute and chronic pyelonephritis - classification according to the nature of the course and severity of symptoms. There are also the following forms of this disease:

1. Due to development - primary (acute, or non-obstructive) and secondary (chronic, or obstructive). The first form is a consequence of infections and viruses in other organs, and the second is an abnormality of the kidneys.
2. According to the location of inflammation - bilateral and unilateral. In the first case, both kidneys are affected, in the second - only one; the disease can be left- or right-sided.
3. The form of kidney inflammation is serous, purulent and necrotic.

Consequences of the disease

An acute renal process that occurs openly usually leaves no consequences if treatment is started in a timely manner and the chosen medical tactics eliminate foci of inflammation. The danger is posed by hidden forms of the disease, as well as negligent attitude towards health. Late visit to the doctor or attempts at self-medication become the reasons for the development of severe pathology, often taking a chronic course:

• An extensive focus of inflammation provokes severe intoxication, which threatens septic complications.
• Septic shock, general blood poisoning, spread of infection with the formation of multiple foci, capsule rupture with peritonitis, involvement of subcutaneous fatty tissue in the inflammatory process. The listed types of pathology in modern medicine are considered the consequences of incorrect or untimely treatment. With early diagnosis, problems can be avoided and the pathology can be completely cured.
• Acute pyelonephritis, with the progression of the infectious process, leads to the sequential development of all stages preceding the kidney abscess. The only treatment option for extensive purulent inflammation is surgical removal of the organ.
• The parenchymal tissue of the kidneys, affected by inflammatory processes, undergoes necrosis, as a result of which the organ completely loses the physiological functions of filtering blood and excreting urine.
• Acute renal failure due to extensive nephron damage is a life-threatening condition and requires urgent hospitalization.

The transition to a chronic form puts a person in front of the need to constantly undergo preventive treatment in order to avoid relapse, which inevitably limits the possibilities for a normal life.

Pyelonephritis - causes

This disease occurs more often against the background of severe infectious pathologies that can be caused by fungus, viruses or bacteria. Another reason for the development of inflammation is abnormalities in the development of the kidneys, for example, very small size. There may be other structural abnormalities that cause urine to enter the kidney - stones, bladder overflow, prostate enlargement, obstructed urine outflow. The consequence of such processes is kidney disease - the causes of this pathology can be combined into the following list:

• Escherichia coli or Pseudomonas aeruginosa, Proteus, enterococci;
• previous viral or infectious diseases;
• decreased ureteral peristalsis during pregnancy;
• blockage of the urinary tract by a tumor;
• microtraumas received during sexual intercourse;
• crushing of urinary stones;
• use of intrauterine contraceptives;
• hypothermia;
• injuries in the lumbar region;
• pathologies of the endocrine system;
• neglect of the rules of intimate hygiene;
• surgical intervention on the urinary tract.

Causes

Every two patients out of 100 who consult specialists suffer from pathology. The disease may be primary chronic or a consequence of another pathology of the kidneys or pelvic organs.

The main causes of chronic pyelonephritis are infection of the kidney tissue by microbial agents or impaired urodynamics.

Kidney tissue is affected by bacteria, viruses or pathogenic fungi. They can enter the kidneys in two ways:

• through the blood - in the presence of an extrarenal infectious (purulent) focus;
• from the urinary tract - against the background of reflux, or reflux, of stagnant bladder contents into the ureters, then into the kidneys.

Often the pathology occurs as a consequence of untreated acute kidney inflammation, in which microbes gradually become more resistant to antibiotics.

If the outflow of urine is impaired, chronic obstructive pyelonephritis develops. Its most common causes are the following:

• congenital anomalies of the structure of the ureters and bladder;
• urolithiasis disease;
• narrowing or compression of the ureter or bladder from the outside due to pelvic cancer;
• prostate adenoma.

Chronicity of the process is especially likely in old age, with diabetes, poor immune defense, and hypothermia. Also risk factors are injuries to the lumbar region, the presence of chronic foci of infection, and medical manipulations on the organs of the genitourinary system.

Pyelonephritis - symptoms and treatment

With acute inflammation, the temperature rises sharply, often up to 38-39 degrees. Signs of intoxication appear - nausea or vomiting, weakness. Another person begins to go to the toilet frequently, and urination is painful. All this is accompanied by lower back pain, chills and increased sweating. The chronic form manifests itself differently - its symptoms and treatment differ from those characteristic of the acute form. The pain increases gradually, chills and fever appear from time to time. Signs vary depending on the gender and age of the person.

Symptoms in women

The weaker sex is more susceptible to this disease, but only in the first two age periods, i.e. until about 45-50 years old. Everything is explained by the structure of the urethra - it is short and located next to the intestine and genital tract. This increases the risk of developing the disease - symptoms in women are as follows:

• nausea or vomiting;
• poor appetite;
• weakness and high temperature;
• frequent trips to the toilet;
• cloudy or bloody urine and pain when urinating;
• aching in the lower back, worse in cold weather;
• colic and pain in the lower abdomen;
• unusual discharge.

Find out in more detail what treatment of pyelonephritis in women includes - drugs and folk remedies.

The child has

The disease pyelonephritis is often diagnosed in a child - the symptoms are almost the same, but there are some signs that are characteristic only of children. Such a disease can be suspected by a temperature of 39-40 degrees without any features characteristic of a cold. The child is capricious, easily irritated and may complain of a headache. The baby may begin to go to the toilet more often, or, conversely, less often. The color of urine also changes - it becomes cloudy, brownish or red, provided that the child has not consumed any medications or products that contribute to this.

In men

Representatives of the stronger sex are more susceptible to inflammation at the age of 60 years. This is due to the development of tumors or prostate hypertrophy. Symptoms of pyelonephritis in men are very similar to those in women. The first cause for concern is dysuric manifestations, such as frequent urination with pain and pain, urinary incontinence, or even false urges. Other symptoms are as follows:

• elevated temperature;
• headache;
• aching joints and lower back;
• nausea;
• vomit;
• decreased performance;
• surges in blood pressure.

Diagnosis of pyelonephritis

To confirm the diagnosis, a urology specialist prescribes a number of measures. The following tests are indicated for the patient:

• culture and general urine analysis;
• Ultrasound of the kidneys and abdominal cavity;
• computed tomography or x-ray to detect changes in the structure of the affected kidney;
• blood analysis.

No less important is differential diagnosis to determine the chronic form - this is how this disease can be distinguished from glomerulonephritis, tuberculosis and kidney hypoplasia. In the latter case, an x-ray examination is more often prescribed. Inflammation of the kidney is characterized by wrinkling of the organ, and hypoplasia is characterized by a miniature pelvis and undeformed calyces. In addition to tests, the urologist examines the patient’s medical history to determine whether the disease is acute or chronic.

How to treat pyelonephritis

The first treatment measure is to eliminate the causes that led to the improper outflow of urine. This is often done surgically - removal of stones, adenomas, urethral plastic surgery or other necessary operations. Antibacterial therapy is then carried out. Drugs are prescribed taking into account the sensitivity of the microorganisms that cause the disease to them. In general, the methods of treating kidney pyelonephritis depend on the form of the disease, age and gender of the patient.

Treatment regimen

The main drugs in the treatment of kidney inflammation are antibiotic therapy, which are prescribed on the basis of an antibiogram. Before receiving its results, the patient is prescribed broad-spectrum antibiotics for an initial course of 6-8 weeks. This may be Ceftriaxone, Nolitsin or Ampicillin, which can also be prescribed in the form of injections. In addition to antibiotics, the patient is prescribed other medications:

• analgesics to relieve pain;
• Diclofenac or Metamizole to reduce kidney inflammation;
• Furadonin, which normalizes kidney function;
• Phytolysin to restore immunity during remission.

Treatment of the chronic form

Therapy against the chronic form can be carried out at home. The basis is also antibacterial drugs. Along with them, non-steroidal anti-inflammatory drugs are prescribed. They help antibiotics reach the site of kidney damage. Pyelonephritis - it is already known that this disease can be treated with physiotherapy and symptomatic drugs such as Adelphan, Reserpine and Cristepine. They normalize blood pressure during exacerbation. These are the main ways to treat the chronic form.

Acute form

If the diagnosis is confirmed, treatment of acute pyelonephritis in children and adults is carried out in a hospital. Complex therapy immediately includes:

1. Bed rest. Its timing is determined depending on the course of the disease.
2. Diet. The patient is prescribed a balanced diet with sufficient vitamins and fluids.
3. Antibacterial therapy. Includes broad-spectrum antibiotics from the group of cephalosporins or fluoroquinols. The course of treatment should be less than 2 weeks long.
4. Antifungal drugs. They are prescribed for prolonged antibacterial therapy. It could be Levorin or Nystatin.
5. Antihistamines. Also prescribed for long-term use of antibiotics. Suprastin, Diphenhydramine, Tavegil are most often used.

Treatment in children

The most difficult thing is the treatment of childhood pyelonephritis. The baby will have to take several medications at once – the doctor will tell you what these medications are. Antibiotics, homeopathic medicines, and antihistamines will be prescribed. How long does it take to treat pyelonephritis? For complete recovery in different cases it takes from 2 to 8 months. At the end of treatment, the child will also be prescribed probiotics to restore normal intestinal microflora.

Among women

The methods for treating pyelonephritis in women are not particularly different. They are also prescribed antibacterial drugs, bed rest in case of acute forms, plenty of fluids and diet. Ways to treat pyelonephritis in women include anti-inflammatory and restorative agents, multivitamin complexes and herbal medicines. Among the latter, medicines based on ginseng and eleutherococcus are particularly successful.

Treatment at home

Chronic inflammation can be cured not in the clinic, but at home. Taking antibiotics remains mandatory. Using herbal infusions based on oats, chamomile, plantain, nettle or rosehip will help. The same effect will be obtained from taking herbal medicines Canephron, Fitolysin. Additionally, you need to monitor your fluid intake - at least 1.5-2 liters per day. Under no circumstances should the kidneys be heated. This is the basic advice on how to treat pyelonephritis at home.

Acute pyelonephritis

Lasts less than six months. The inflammatory process begins suddenly in the kidneys. Body temperature rises greatly. The person begins to shiver, nausea, vomiting, a feeling of weakness, and aching pain in the lumbar region appear. Intoxication of the body has a pronounced character. In the first stages of the disease, the content of nitrogen compounds in the blood exceeds the norm. Red blood cells, pus, protein are detected in the urine; the number of bacteria exceeds the norm. If you sharply touch the patient in the lumbar region, pain will appear (Pasternatsky's symptom).

Primary acute pyelonephritis

Occurs during the normal structure of the urinary system due to the penetration of pathogenic microbes into the kidneys. It is not complicated by disturbances in the functioning of other organs.

It is divided into serous, purulent and necrotizing papillitis. Purulent is divided into apostematous pyelonephritis, kidney carbuncle, kidney abscess.

Manifested by high fever, chills, severe sweating, nausea, vomiting, and a feeling of weakness. A dark coating appears on the tongue. The pulse rises.

Secondary acute pyelonephritis

It develops as a result of existing disturbances in the functioning of the body. Because of this, the kidneys are unable to resist the action of bacteria. The disease is associated with problems in the functioning of other organs. The cause of the disease is also anomalies in the structure of the urinary system.

Local symptoms are pronounced, making the disease easier to recognize and not to be confused with others. Often, abnormalities in the structure of the urinary tract are caused by urolithiasis. In women they occur during pregnancy. In men - due to prostate adenoma.

Classification

Further medical tactics and prognosis for the patient depend on the timeliness and correctness of the established form of the disease.
Methods for classifying pyelonephritis are given special attention in modern medicine, but there is no generally accepted scheme in Russia. Pyelonephritis is divided into types according to the nature of the process, the cause of its occurrence, the presence of obstruction and localization. Classification of acute pyelonephritis according to the nature of the inflammatory process:

1. Serous - the initial stage of development with high fever, chills, indigestion, dull, aching pain on the affected side.
2. Purulent - the second stage of the process with the general serious condition of the patient and the possible development of an abscess and carbuncle of the kidney.
3. Necrotizing is a potentially fatal course of the disease with irreversible destruction of kidney tissue.

By occurrence:

1. Primary, not associated with pre-existing kidney disease.
2. Secondary, against the background of other urological pathologies.

According to the presence of urinary tract obstruction: obstructive and non-obstructive.
The first form occurs with preservation of the free flow of urine. The second is when there is narrowing or complete blockage of the lumen of the ureter or urethra by a stone, tumor, edema, or adhesion. According to the localization of the inflammatory process:

• left-handed;
• right-sided;
• double-sided;
• total;
• segmental.

Chronic pyelonephritis

It has stages of remission and exacerbation, lasting more than six months. It can occur as a result of an acute form of the disease or independently.

Acute pyelonephritis becomes chronic as a result of improper treatment. The inflammatory process is stopped, but the bacteria themselves that caused the inflammation are not destroyed. In addition, the disease may occur due to a violation of the outflow of urine, the cause of which has not been established. The disease takes a chronic form due to diseases that weaken the body (diabetes, various infections, etc.).

Symptoms of chronic pyelonephritis include: severe fatigue, inability to withstand prolonged exercise, lack of appetite, slight increase in body temperature and blood pressure.

To diagnose the disease, blood tests, urine tests, ultrasound and others are prescribed. During illness, there is an increased content of bacteria and leukocytes in the urine, and the ESR is higher than normal.

Primary chronic pyelonephritis

Develops as a result of kidney infection by microbes. Divided into 3 phases:

1. Active inflammation. The body actively fights pathogenic microbes. Analyzes show an excess of leukocytes and bacteria.
2. Latent phase. The inflammatory process in the kidneys occurs hidden.
3. Remission. The result of laboratory tests is satisfactory. The figures are not overestimated. However, unfavorable factors can again cause an inflammatory process.

The result of primary chronic pyelonephritis is pyonephrosis and shrinkage of the kidney.

Secondary chronic pyelonephritis

Has the same phases as the primary. His reasons:

• Prostate adenoma, nephroptosis and other diseases that interfere with the proper outflow of urine.
• Drug-resistant bacteria. They can remain in the kidney tissue for a long time and begin to multiply when favorable conditions arise.
• After suffering from acute pyelonephritis, the patient was not observed by a doctor and did not undergo appropriate tests.
• Decreased immunity.
• The presence of other diseases in the body.

After remission, secondary chronic pyelonephritis may return due to lack of vitamins, hypothermia, decreased immunity, fatigue, and also due to infection from diseased organs.

Classifications of pyelonephritis

A.Ya. Pytel (1959) and other authors proposed several classifications of this disease according to a number of criteria.
Pyelonephritis is classified depending on whether the disease is unilateral or bilateral, according to the course of the disease, according to the route of infection into the kidney, according to the characteristics of the clinical course in connection with age, gender, concomitant diseases, and finally, they are divided into primary and secondary. It is advisable to distinguish pyelonephritis by etiological factor. The division of pyelonephritis into one- and two-sided should be considered unnecessary. In the 50s, the long-term existence of unilateral pyelonephritis was allowed and, in order to prevent the spread of the process to the contralateral kidney, nephrectomy was proposed even with preserved kidney function. This surgical tactic was soon abandoned because pyelonephritis developed in the only remaining kidney. With primary pyelonephritis, the unilateral inflammatory process is usually short-lived.

In patients with secondary, especially calculous pyelonephritis, with unilateral kidney stones, pedunculitis, lympho- and venostasis develop due to extravasation of urine into the sinus and perinephric tissue. This creates conditions for hematogenous penetration of bacteria into the contralateral kidney.

According to the course of the disease, A.Ya. Pytel (1969) proposed the following classification.

1. Acute pyelonephritis (serous or purulent). 2. Chronic pyelonephritis. 3. Recurrent pyelonephritis.

Serous pyelonephritis may be the first stage of purulent kidney disease. Chronic pyelonephritis has phases of the disease: latent, active (acute) and remission, which are determined both by clinical symptoms and laboratory signs of inflammatory activity in the kidneys. Recurrent pyelonephritis is a repeated attack of the disease in a previously diseased kidney, where traces of previous inflammation remain in the form of scars in the cortex and especially in the interstitial substance of the medulla of the kidney.

primary pyelonephritis

, i.e., developed in a completely healthy and non-anomalous kidney, and
secondary
, the occurrence of which occurs in the presence of impaired outflow of urine from the kidney due to some urological disease or developmental abnormality. This occurs with urolithiasis, nephroptosis, hydronephrosis, polycystic kidney disease, tumors, adenoma and prostate cancer and other diseases.

Primary pyelonephritis is more common in women - on average up to 56.2%, less often in men - up to 2-3% of cases, which is explained by the presence of inflammatory diseases of the uterine appendages, short urethra, its proximity to the vagina and anus and other factors. In men, pyelonephritis, as a rule, develops in the presence of obstructive factors, mainly with prostate adenoma, i.e. in old and senile age.

Classification of pyelonephritis according to clinical features in connection with age, gender, concomitant diseases and other pathogenesis factors

1. Pyelonephritis of newborns.
2. Pyelonephritis of infants. 3. Pyelonephritis of early childhood. 4. Pyelonephritis of girls. 5. Gestational pyelonephritis. 6. Pyelonephritis in elderly and senile people. 7. Pyelonephritis in diabetes mellitus. 8. Pyelonephritis in spinal patients. 9. Iatrogenic pyelonephritis. 10. Xanthogranulomatous pyelonephritis. 11. Emphysematous pyelonephritis. 12. Pyelonephritis, occurring according to the type of chronic sepsis. 13. Allergic pyelonephritis. 14. Post-radiation pyelonephritis. 15. Post-transplant urinary infection and kidney damage. 16. Pyelonephritis after hemodialysis. F.Renyi-Vamos and F.Balogh (1979) classified this disease as follows:

1. Acute pyelonephritis: a) direct infection; b) ascending infection; c) hematogenous infection; d) transplantation pyelonephritis. 2. Chronic pyelonephritis. 3. Peripyelitis. 4. Perinephritis. 5. Epinephritis. 6. Pedunculitis. 7. Periureteritis.

Pyelonephritis in children is mainly divided into obstructive and primary, or non-obstructive. V.N. Tkachuk and V.S. Pavlov (1980) attach great importance to the clinical and morphological assessment of various forms of pyelonephritis.

The classification of N.A. Lopatkin (1982) provides for the division of pyelonephritis into one- and two-sided, which, in turn, can be primary and secondary, and both acute and chronic. There are acute pyelonephritis, serous, purulent (apostematous, renal carbuncle), necrotic papillitis. Chronic pyelonephritis is considered depending on the phase of inflammation: active, latent and remission. Wrinkling or pyonephrosis is the outcome of chronic pyelonephritis.

The classifications given make it possible to correctly assess the form and stage of pyelonephritis, features of the clinical course and outcomes.

In connection with the widespread identification of previously little-known pathogens of inflammatory diseases of the genitourinary organs (mycoplasma, chlamydia), we have proposed a classification of pyelonephritis depending on the etiology of this disease.

Classification of pyelonephritis by etiological factor

1. Bacterial pyelonephritis: a) caused by gram-positive bacterial flora (staphylococcus, streptococcus);
b) colibacillary; c) caused by Proteus infection and Pseudomonas aeruginosa. 2. Pyelonephritis caused by urogenital infection: a) mycoplasma; b) chlamydial. 3. Viral pyelonephritis. The classification is of clinical importance in pediatric urology, especially with pyelonephritis in girls, where the gates of infection, namely mycoplasmas, are the genitals and vulvovaginitis. Chlamydial infection, as proved by our observations of 32 sick women, under certain conditions can spread upward to the kidneys. Treatment of such patients is complicated by repeated infections of the genital organs through sexual contact, if the sexual partner does not receive simultaneous treatment for chlamydia.

Mycoplasmas can be pathogenic, opportunistic and saprophytic. To identify them, conventional bacteriological methods are insufficient; special techniques are required. The weak antigenic effect that mycoplasmas have allows the use of serological diagnostics for their detection. The most common types of mycoplasmas are M. hominis, M. fermentans, M. hyorhinis.

Recently, mycoplasmas have appeared that cause and support kidney diseases - M. urealiticum, and genital diseases - Ureaplasma.

We observed patients, more often women, who were diagnosed with mycoplasma pyelonephritis, even before the onset of sexual activity. Then they suffered from inflammatory diseases of the genital organs caused by ureaplasmosis. This infection, as established by a number of studies, is sexually transmitted (according to our data - up to 92% of observations). Ureaplasma is now classified as a sexually transmitted disease.

However, ureaplasma can be isolated from the genital organs of men and women and as a monoculture. With mycoplasma infection, pyelonephritis in women is accompanied by cystitis, in men - only prostatitis.

Viral kidney damage is observed in children. During an influenza epidemic, more often caused by group A viruses, pyelonephritis occurs in adults. Pyelonephritis after influenza is initially characterized by an abacterial course. However, already on the 4th-5th day, an opportunistic infection, more often E. coli, joins the viral damage to the kidney, which is observed mainly in women.

The emergence in recent years of new instrumental, physical, endoscopic and other treatment methods in urology has led to the need to pay more attention to secondary pyelonephritis. In our previous monographic works, secondary pyelonephritis was identified in urolithiasis and in anomalies of the kidneys and urinary tract, the symptomatology, clinical course and diagnosis of which are described by us.

Currently, there is a need for a more detailed description of secondary pyelonephritis in benign prostatic hyperplasia, especially when carrying out fundamentally new physical methods of treatment. This has led to the need to propose a classification for secondary pyelonephritis, taking into account new treatment methods and complications.

Classification of secondary pyelonephritis

1. Calculous pyelonephritis: a) postoperative pyelonephritis;
b) pyelonephritis after remote nephro- and ureterolithotripsy. 2. Pyelonephritis in patients with benign prostatic hyperplasia (adenoma): a) in patients with BPH treated conservatively; b) postoperative pyelonephritis as a complication of adenomectomy; c) pyelonephritis after transurethral and laser adenomectomy; d) pyelonephritis after thermotherapy for BPH. 3. Chronic pyelonephritis with anomalies of the kidneys and urinary tract. 4. Pyelonephritis with congestive disease of the pelvic organs. 5. Pyelonephritis in gynecological diseases. O.L. Tiktinsky, S.N. Kalinina

Published by Konstantin Mokanov

Classification by patient groups

In addition to the traditional classification, doctors divide patients into groups. In each case, pyelonephritis is caused by its own causes and requires different treatment. Depending on the nature of the disease, the following groups of patients are distinguished:

Children, including newborns

To newborns, the disease is transmitted from the mother. Contributes to the disease - congenital reflux. In children, the disease can begin after suffering from a sore throat, influenza, ARVI, measles and other diseases.

Aged people

In old age, this disease is diagnosed more often in men than in women. This is due to impaired urodynamics due to prostate adenoma.

Pregnant women

Most often, the disease affects pregnant women, starting in the second trimester, when the uterus enlarges and puts more and more pressure on the kidneys and ureters. During pregnancy, the mother's immunity is weakened in order to bear a healthy child. This reduces resistance to pathogens.

Patients with diabetes mellitus

A quarter of patients with diabetes suffer from pyelonephritis. This is due to decreased immunity. The environment resulting from the disease is an excellent place for bacteria to multiply. Pyelonephritis in diabetics most often occurs hidden.

Treatment and prevention

In acute cases, hospital treatment is necessary. Patients are prescribed bed rest, drinking plenty of fluids, they should avoid hypothermia, and empty their bladder on time. The doctor prescribes antibiotics. Herbal preparations are also used for treatment. It is necessary to regularly visit a doctor, take urine and blood tests, so as not to miss the first symptoms of the disease. Be sure to reduce your salt intake. It is recommended to avoid spicy, fatty and fried foods.

To prevent the disease, it is necessary to eliminate possible sources of infection, consume sufficient amounts of vitamins, and perform an ultrasound of the kidneys and bladder.

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Diagnostics

Detection of acute pyelonephritis in the presence of a clear clinical picture with typical symptoms does not cause difficulties for a nephrologist already at the stage of collecting an anamnesis. According to the history of the disease, provoking factors are detected, there are chronic inflammatory processes. The appearance of temperature and pain in the lumbar region leaves little doubt about the diagnosis.

The further examination plan includes conducting research, based on the results of which the form of pyelonephritis is established, as well as the nature of the pathogenic microflora:

• Laboratory diagnostics of urine and blood. An assessment of physical and biochemical parameters is carried out to identify signs of inflammation in the organ, the degree of kidney dysfunction, and also to determine the type of reaction of the immune system to the spread of infection. An increased level of leukocytes and ESR are detected in the blood. The presence of protein and blood admixtures are determined in the urine; the physical indicators of transparency, density, and alkaline environment change. The inflammatory process is accompanied by the loss of leukocytes in large quantities. A urine test for sterility allows you to establish the bacterial flora, as well as determine sensitivity to various groups of antibiotics for effective treatment.
• Various urine collection methods are used to assess the nature of the urinary system disorder and identify problems with diuresis in relation to the total amount of fluid entering the body. Tests show signs of insufficient kidney function, disruption of the normal proportions of daytime and nighttime urination.
• Ultrasound diagnostics is necessary to clarify the structure of the parenchymal tissue of the kidneys, determine the nature of the pathological process, its localization. Ultrasound is used to assess the risk of renal capsule rupture.
• Survey or contrast urography determines the functional activity of the kidney affected by inflammation in comparison with a healthy organ. A decrease in excretory function on the affected side, deformation, or distortion in the advancement of the contrast agent is an indicator of the involvement of a certain part of the nephrons in the pathological process.
• Modern computer diagnostic methods make it easier to establish a diagnosis without the need for numerous types of examination. All changes are clearly visible, and the risk of missing anatomical defects or signs of urolithiasis is eliminated.

Timely diagnosis using available means should be carried out at an early stage of development; this requires contacting a doctor at the first signs of illness.