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Gestational pyelonephritis
Last reviewed: 11.03.2024
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Pyelonephritis is a nonspecific infectious and inflammatory process with a predominant initial lesion of the interstitial tissue, the calyceal system and the renal tubules, followed by the involvement of the glomeruli and renal vessels into the pathological process.
ICD-10 code
- 023.0 Infection of the kidneys that occurs during pregnancy.
The inflammatory process in the kidneys that occurs during pregnancy is called "gestational pyelonephritis".
Causes of the gestational pyelonephritis
Causes of gestational pyelonephritis
Types of microorganisms that cause urinary tract infections are similar in pregnant and nonpregnant women, which confirms the common mechanisms of infection in the urinary tract.
The etiology of gestational pyelonephritis is directly related to the obligate and facultative intestinal microflora. The most frequent pathogens are the bacteria of the Enterobacteriaceae family , of which Escherichia coli is up to 80-90%. The importance of other microorganisms: both gram-negative (Proteus, Klebsiella, Enterobacter, Pseudomonas, Serratia), and Gram-positive bacteria (Enterococcus faecalis, Staphylococcus sp. (Saprophyticus and aureus) bacteria - significantly increases in case of hospital infection.
As rare pathogens, fungi of the genera Candida, stronglastomyces, causative agents of sexually transmitted diseases (Chlamydia trachomatis, Neisseria gonorrhoeae) can act .
What causes gestational pyelonephritis?
[Where does it hurt?
Diagnostics of the gestational pyelonephritis
Diagnosis of gestational pyelonephritis
Clinically, gestational pyelonephritis takes place in acute or chronic form. With exacerbation of chronic pyelonephritis, the disease should be considered as an acute inflammation. The clinical picture of gestational pyelonephritis in different periods of pregnancy has its own typical features. They are caused, mainly, by the degree of violation of the passage of urine from the upper urinary tract. If in the first trimester of pregnancy there can be pronounced pain in the lumbar region with irradiation to the lower abdomen, external genitalia, resembling renal colic, in the II and III trimesters pain is less intense.
For acute pyelonephritis, pregnant women are characterized by symptoms of general intoxication of the body, fever with chills and excessive sweating, arthralgia and muscular pain, which is combined with complaints of pain in the lumbar region, often with irradiation to the upper abdomen, inguinal region, thigh. They also note discomfort during urination, dysuria. In an objective examination, painfulness is noted when pressing in the bone-vertebral corner on the side of the lesion, a positive symptom of effleurage. With simultaneous bimanual palpation of the lumbar and subcostal areas, local soreness in the lumbar region and muscle tension of the anterior abdominal wall are noted.
What do need to examine?
What tests are needed?
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Treatment of the gestational pyelonephritis
Treatment of gestational pyelonephritis
The optimal antimicrobial means of empirical therapy in the first trimester of pregnancy from the results of in vitro and in vivo studies are inhibitor-protected aminopenicillins. The use of inhibitor-protected penicillins allows to overcome the resistance of enterobacteria producing chromosomal broad-spectrum and extended-spectrum beta-lactamases, as well as staphylococci that produce plasmid beta-lactamases of class A.
In the II trimester, inhibitor-protected penicillins and cephalosporins are considered as empirical therapy.
Aminopenicillins are not recommended for prescribing as choice drugs for this pathology due to proven global and high regional resistance rates.
When choosing doses of antibacterial drugs, their safety for the fetus must be taken into account: fluoroquinolones can not be used throughout the pregnancy; sulfonamides are contraindicated in I and III trimesters, aminoglycosides are used only for vital indications.