Pyelonephritis is focal nonspecific inflammatory disease of the renal parenchyma and pelvis caused by the direct ingress of bacteria therein. It is the most common kidney disease. It occurs more in women because of the shorter urethra and its proximity to the vagina, of which the conditions for contamination. As we age and occurrence of prostate adenoma leading to obstructive disorders drainage of urine pyelonephritis becomes more common among men.
The most frequent causes are Gram negative bacteria – E. coli, Proteus, Klebsiella, Pseudomonas and others. Under the influence of the treatment, the pH and other factors bacteria may lose their cell envelope and turn into the so-called. L-forms. They are hard to find and contribute to the maintenance of the inflammatory process in the kidney.
We are predisposing factors for the development of pyelonephritis by microorganisms: high virulence, the ability to separate the enzymes (coagulase, urease and the like.). Common predisposing factors: gout (deposition of crystals in the interstitial facilitates infection of the kidney), diabetes mellitus (decreased immune defense), pregnancy (resulting in dilation of the urinary tract) and others.
In the kidney infection penetrates in two ways: hematogenous (blood) – a rare and ascending (ascending) – more frequent (80%). Astsendentiniyat way of occurrence of infection is possible in terms of embarrassed drainage of stagnant urine (urostaza) and reflux (return of urinary current).
The main source of the bacteria flora of the colon. Under certain conditions, these microorganisms colonize consistently perineum, vagina, urethra and bladder. When the protective mechanisms of the lining of the bladder are damaged, the bacteria can cause ulceration (ulceration) of the bladder lining, enter the bloodstream and interact with the immune system. High antibody titers are accepted as a sign of damage to the renal parenchyma.
In acute pyelonephritis the surface of kidneys see little bleeding and abscesses. Simultaneously with the affected areas there are areas without changes. When urinary obstruction and ascending infection cavity of the basin has expanded lining is red and swollen, often covered with gnoeviden coating. They differ serous and purulent interstitial acute pyelonephritis.
The disease has a sudden onset with fever – 39-40 ° C, chills, then sweats occur. Appear constant pain in the lumbar region – unilaterally or bilaterally with varying intensity. In serous inflammation pain is dull, and at purulent – strong, stabbing and accompanied by high fever and general intoxication. In obstruction pain is cramping character. There are dizurichni interference – burning urination, irritation, urinary frequency and urgency. Sukusio renalis (tapping in the lumbar region) is very positive, there is pain in the ureters and bladder. The general condition of the patients is impaired. Blood pressure is normal. Swollen missing.
What are the laboratory changes?
Polyuria (excessive urination), urine showed plenty leucocyturia (a characteristic symptom of acute pyelonephritis) bacteriuria, mild proteinuria, many epithelial cells, sometimes eritrotsituria. Of blood tests – highly elevated ESR and leukocytosis (elevated leukocytes in the blood). The values of nitrogen substances in the blood are normal.
What are the complications?
Renal papillary necrosis – occurs with hematuria (blood in urine), worsening of renal function;
Paranefrit – inflammation of the kidney tissue – occurs with very high fever, severe lumbar pain
Acute renal failure.