How to treat acute pyelonephritis

Regime- bed rest in the acute period (intoxication, increased temperature), "the warmth of the bed" creates conditions for improving blood circulation in the kidneys and increasing diuresis, reducing pain syndrome. Semi-bed rest is maintained during the period of pronounced activity of the microbial-inflammatory process.

Dietin acute pyelonephritis, for 7-10 days, dairy and vegetable. Food should contain all essential amino acids in optimal quantities and ratios, preferably of egg or dairy origin. The diet should include fresh fruits and vegetables to maintain vitamin and electrolyte balance. Patients are not limited in the amount of fluid and table salt they take. Foods containing excess sodium are limited. Salty, fried foods, marinades, and canned foods are excluded.

In case of acidoaminogenesis dysfunction, exclude products containing large amounts of acid sulfates and phosphates (legumes, sorrel, spinach, cottage cheese, fish). To improve gastrointestinal function, prescribe products rich in fiber - cabbage, carrots, beets, zucchini, pumpkin, plums, apples, melons, dried fruits (prunes, figs, dried apricots). Buckwheat and pearl barley porridge. Exclude products that delay bowel movements and contain astringents: strong tea, coffee, cocoa, chocolate. Reduce the use of rice and flour products. Useful are berries and fruit drinks made from lingonberries, cranberries, as well as watermelons, melons, which have diuretic properties. It is useful to include fermented milk products enriched with bifido- and lactobacilli in the diet. The mineral waters Essentuki No. 20, Slavyanovskaya, Smirnovskaya are used. In case of pyelonephritis with uraturia, a milk-vegetable diet is used to ensure an alkaline urine reaction and prevent stone formation; alkaline waters.

In children with pyelonephritis with phosphaturia, butter, cabbage, lingonberry puree, and rosehip infusion are included in the diet; milk and egg yolk intake are sharply limited. Naftusya mineral water is prescribed.

Patients with pyelonephritis are prescribed exercise therapyfor the muscles of the lumbar region, abdominal press, lower limbs and gluteal region, breathing exercises.

Frequent urination is of great importance for preventing urinary stagnation: for children under 7 years old - every 1.1/2-2 hours, over 7 years old - every 2-3 hours. Daily hygiene measures (bath, shower) are important. Access to fresh air.

Drug treatment.Antibacterial therapy of pyelonephritis in outpatient settings in cases of the first attack: ampicillin, ampiox are prescribed for 7-10 days in age-appropriate doses and anti-relapse therapy with furagin until normal urine tests, then 1/2-1/3 of the dose for 2-3 weeks.

Nalidixic acid preparations - negram, nevigramon up to 4 weeks. 8-oxyquinoline preparations (nitroxaline, 5-NOC) for 10 days each month for 3-4 months. Phytotherapy in the remission phase of pyelonephritis. Stepwise antibiotic therapy at maximum activity of the process: for 3-5 days, the introduction of a preparation of one group parenterally (intravenously or intramuscularly) with subsequent change to the oral route of administration. In this case, preparations of one group can be used.

In a hospital setting, a course of antibacterial therapy for acute and exacerbation of chronic pyelonephritis is carried out until the activity of the pathogen is completely suppressed - on average 2-3 weeks with a change of drug every 7-10-14 days, taking into account the nature of the microflora and the sensitivity of the drug to it.

In case of 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. The only exception for the use of fluoroquinolones is the sowing of a pathogen resistant to other antibiotics.

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

For viral infections, Viferon, Reaferon, Neovir (also has a pronounced antichlamydial effect), Solkourovac lysozyme (stimulates the formation of local antibodies (IgA), as well as sodium nucleinate are prescribed.

In case of persistent isolation of the pathogen from urine and feces, in case of persistent isolated bacteriuria, bacteriophages coli-proteus, Klebsiella, Pseudomonas, polyvalent are prescribed orally 10 ml 2 times a day, the course is 7 days.

In the treatment of pyelonephritis, the treatment of chronic foci of infection is of great importance.

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

1. Prescribing drugs that improve metabolic and bioenergetic processes in nerve cells, affecting the neurotransmitter systems of the brain: nootropics - nootropil, glutamic acid.
2. Sedative therapy - sibazon, mebikar.
3. Phytotherapy: herbal infusions with a sedative effect (wild strawberry; calendula officinalis; small-leaved linden; chamomile).
4. 4. Drugs that improve metabolic processes in tissues, including the bladder - B vitamins for 30 days, 3-4 courses per year.
5. Potassium orotate, carnitine chloride for 1 month.
6. Massage.
7. Physical therapy - strengthening the abdominal muscles and perineum.

Preventive treatmentIt is performed on all children under 5 years of age with reflux or other urinary tract abnormalities.

Outpatient observation is carried out by a pediatrician and a nephrologist. During the first year, the pediatrician observes once a month, then once every 3 months. Nephrologist - once every 6 months, with a decrease in renal function - once every 3 months. Examination by an ENT doctor, dentist, ophthalmologist - once every 6-12 months.

Children who have had acute pyelonephritis are removed from the register after 3-5 years of complete clinical and laboratory remission with mandatory examination in a hospital or diagnostic center. Children with chronic pyelonephritis are observed by a nephrologist until they are 18 years old, and are then transferred to the supervision of specialists at an adult polyclinic.

Children with urinary tract infection and cystitis after the first episode are observed for 2 years. In the absence of relapses during observation after laboratory and instrumental examination, the question of deregistration may be raised. Against the background of intercurrent diseases in all forms, anti-relapse treatment is indicated.

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