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.
Look at how kidneys chronic pyelonephritis?M/h3>
Macroscopically two kidneys are reduced, with different sizes. Their surface is uneven, with characteristic different sized scars that affect unevenly kidney. Deformations are formed on the surface of the kidney and renal pelvis cups.
Microscopic establish lymphocytic infiltrates and sclerosis. Around glomeruli form fibrosis. Tubules with severe atrophy. Renal pelvis is a chronic inflammatory changes.
What is the clinical picture?
Manifestations of chronic pyelonephritis are varied, often atypical and are determined by the activity of infection, the spread of the disease process in the renal parenchyma and the degree of impairment of renal function. The disease occurs with periods of exacerbation and remission.
In exacerbation of chronic pyelonephritis temperature rises – from low-grade to septic, with fever, chills, aches appear in the lumbar region and over the symphysis, dizurichni interference sukusio renalis is highly positive. There are signs of general intoxication – adinamiya, fatigue, anorexia. Laboratory establishes increased diuresis, reduced density of urine sediment – leucocyturia (white blood cells in the urine) bacteriuria (bacteria in the urine), proteinuria (protein in the urine).
In latent course of disease infection all the time with little activity and manifested scarce symptoms – chills, low-grade fever, discomfort or weak dull backache, less painful or negative sukusio renalis, short dizurichni complaints insignificant leucocyturia and proteinuria. Sometimes infectious process asymptomatic without clinical and laboratory abnormalities and disease is detected at the stage of renal failure.
Progressive distribution of the inflammatory process in the renal parenchyma and engaging tubular-interstitial apparatus leads to progressive renal impairment. Damaging to the concentration ability of the kidneys, with increased radiation of salt and water, with retention of the branching capability of the kidneys, occurs limiting the renal blood flow, reduces the emission of ammonia and H + -ions – develops metabolic acidosis. Patients are tired, sleepy, tired easily weaken. Appears polyuria and nocturia. The skin becomes pale, gray-yellowish, dry, cold, face swell.
In connection with the decreased production of erythropoietin (a hormone responsible for hematopoiesis) of damaged kidneys develop anemia. Distort the renal regulatory mechanisms of blood pressure in most patients appears hypertension than diastolic type. Add complaints of dizziness, headaches, angina, hypertensive crisis, cardiac failure. The progress of renal impairment gradually leads to the development of chronic renal insufficiency.
Urine tests showed low grade proteinuria leucocyturia, bacteriuria in calculous pyelonephritis – and eritrotsituriya. Concentration ability is reduced, is reduced glomerular filtration. With blood tests are established anemia, accelerated ESR, especially in exacerbation of infection.
Chronic pyelonephritis diagnosis
Besides clinical and laboratory findings are particularly indicative of instrumental studies. The most accurate diagnosis given intravenous urography – changes that occur are:
– Increase the size of the basin (atony deformed cups reflux);
– Impaired broadcast of contrast media by the kidneys;
– Change in the shape and dimensions of the kidneys;
Nefrograma isotopes provide information about disturbances in blood supply to the kidneys and excretory-secretory function disorders drainage. Renal scintigraphy reflects the accumulation of the isotope in healthy skin and outbreaks of disease changes no accumulation. Ultrasound of the kidney parenchyma shows narrow, altered index parenchyma / pelvis – more than 1; uneven border between parenchyma and pelvis; reduced size of the kidney and others.
Chronic pyelonephritis complications and prognosis
Hypertension, anemia, nephrosclerosis, chronic renal failure. Disease is progressive inflammatory process covers more new areas of the renal parenchyma. The end result is the development of chronic renal failure.