How is acute pyelonephritis treated?

Mode - bed rest in an acute period (intoxication, fever), "warmth of the bed" creates conditions for improving blood circulation in the kidneys and increasing diuresis, reducing the pain syndrome. Half-bed mode is maintained for a period of pronounced activity of the microbial-inflammatory process.

The diet for acute pyelonephritis for 7-10 days is dairy-vegetable. Food should contain in optimal amounts and proportions all essential amino acids, preferably of egg or milk origin. The diet should include fresh fruits and vegetables to maintain the vitamin and electrolyte balance. Patients do not limit the amount of fluid intake and table salt. Restriction of products containing excess sodium is carried out. Salted, fried dishes, marinades, canned products are excluded.

If the function of acidoaminogenesis is violated, products containing acid sulfates and phosphates (legumes, sorrel, spinach, cottage cheese, fish) are excluded. To improve the function of the gastrointestinal tract appoint foods rich in fiber - cabbage, carrots, beets, zucchini, pumpkin, plums, apples, melons, dried fruits (prunes, figs, dried apricots). Porridge from buckwheat, pearl barley. Products that delay the emptying of the intestine, containing astringents: strong tea, coffee, cocoa, chocolate are excluded. Reduces the use of rice, flour products. Useful berries and fruit cockles from cranberries, cranberries, as well as watermelons, melons that have diuretic properties. It is useful to include in the food sour-milk products enriched with bifido- and lactobacilli. The mineral waters of Essentuki No. 20, Slavyanovskaya, Smirnovskaya are used. In pyelonephritis with uraturia, a dairy-vegetative diet is used to ensure an alkaline reaction of urine and prevention of stone formation; alkaline water.

In children with pyelonephritis and phosphaturia, butter, cabbage, cranberry puree, rose hip infusion are included in the diet; The reception of milk, egg yolks is sharply limited. The mineral water of Naftusya is prescribed.

Patients with pyelonephritis are prescribed exercise therapy for muscles of the lumbar region, abdominal press, lower extremities and gluteal region, respiratory exercises.

Great importance for preventing stagnation of urine is the regime of frequent urination: children under 7 years - after 1.1 / 2-2 hours, older than 7 years - every 2-3 hours. Important daily hygiene measures (bath, shower). Access to fresh air.

Drug treatment. Antibacterial therapy of pyelonephritis in outpatient conditions in cases of the first attack: ampicillin, ampiox for 7-10 days at age doses and anti-fouraine therapy with furagin to normal urinalysis, then 1 / 2-1 / 3 doses for 2-3 weeks.

Preparations of nalidixic acid - blacks, neigramone up to 4 weeks. Preparations of 8-hydroxyquinoline (nitroxaline, 5-NOK) for 10 days of each month for 3-4 months. Phytotherapy in the phase of remission of pyelonephritis. Stepwise therapy with antibiotics with maximum activity of the process: within 3-5 days, administration of the drug of one group parenterally (intravenously or intramuscularly), followed by a change to the oral route of administration. Thus it is possible to use preparations of one group.

In a hospital, the course of antibiotic therapy for acute and exacerbation of chronic pyelonephritis is carried out until the agent is completely suppressed - an average of 2-3 weeks with a change in the drug every 7-10-14 days, taking into account the nature of the microflora and the sensitivity of the drug.

With resistant strains of pathogens, fluoroquinolones can be used as an alternative to antibiotics, which, as a rule, are not used in children due to the risk of developing chondropathy. An exception for the use of fluoroquinolones is the excision of a causative agent resistant to other antibiotics.

In chronic pyelonephritis, agents that improve renal blood flow can be used - trental, quarantil; venous outflow - troxeavazan.

When viral infection is prescribed viferon, reaferon, neovir (has a pronounced antichlamydia effect), lysozyme solkourovak (stimulates the formation of local antibodies (IgA), as well as sodium nucleate.

With persistent sowing of the causative agent from urine and feces, with resistant isolated bacteriuria bacteriophages are prescribed, coli-protein, klebsiellezny, pseudomonous, polyvalent orally 10 ml 2 times a day, course 7 days.

In the treatment of pyelonephritis, it is important to sanitize chronic foci of infection.

Treatment of pyelonephritis on the background of neurogenic dysfunction of the bladder.

1. Appointment of drugs that improve metabolic and bioenergetic processes in nerve cells that affect the neurotransmitter systems of the brain: nootropics - nootropil, glutamic acid.
2. Sedation therapy - sibazon, mebikar.
3. Phytotherapy: decoctions of herbs with sedative effect (wild strawberry, calendula officinalis, linden heart, camomile).
4. 4. Preparations that improve metabolic processes in tissues, including in the bladder - B vitamins within 30 days 3-4 courses a year.
5. Potassium orotate, carnitine chloride for 1 month.
6. Massage.
7. LFK - strengthening the muscles of the abdominal press, perineum.

Preventative treatment is given to all children under 5 years old with reflux or other abnormalities of the urinary tract.

Clinical follow-up is provided by a pediatrician and a nephrologist. During the first year the pediatrician watches once a month, then 1 time in 3 months. Nephrologist - every 6 months, with a decrease in renal function - 1 time in 3 months. Inspection ENT-doctor, dentist, ophthalmologist - 1 time in 6-12 months.

Withdrawal from children who underwent acute pyelonephritis - 3-5 years after complete clinical and laboratory remission with mandatory examination in a hospital or diagnostic center. Children with chronic pyelonephritis are observed by a nephrologist before the age of 18, later they are transferred under supervision to the specialists of an adult polyclinic.

Children with a urinary tract infection and cystitis after the first episode are observed for 2 years. In the absence of relapses during the observation after the laboratory-instrumental examination, the question of removal from the register may be raised. Against the backdrop of intercurrent diseases in all forms shows the conduct of anti-relapse treatment.

[1], [2], [3], [4], [5]