Pyelonephritis in the elderly

Pyelonephritis in the elderly is a nonspecific infectious and inflammatory disease of the kidneys, affecting the renal parenchyma, mainly interstitial tissue, pelvis and calyx. The disease can be one- and two-sided, primary and secondary, relapsing and latent.

More common secondary pyelonephritis in the elderly (against the background of diabetes, benign prostatic hyperplasia), which has latent flow.

[1], [2], [3], [4], [5], [6], [7]

Causes of the pyelonephritis in the elderly

Development of the disease is facilitated by:

Changes in organs and systems due to aging:

• lengthening and tortuosity of the ureters (often due to nephroptosis), a decrease in the tone of smooth muscles, which slows the progress of urine along the urinary tract;
• reduction of local and general immunity;
• the presence of refluxes at different levels of the urinary system;
• development of sclerotic processes in the kidneys;

Circumstances that increase the risk of urinary tract infection:

• prolonged stay on bed rest (after injuries, with severe general illness);
• incontinence of faeces and urine;
• the need for urinary bladder catheterization in case of urine retention, research;

Diseases that lead to the violation of urodynamics: benign prostatic hyperplasia, compression of the urinary tract by calories in case of stool retention, dehydration (with insufficient fluid intake, vomiting, diarrhea), tumors of the abdominal cavity and pelvis;

Diseases accompanied by a change in the composition of urine:  diabetes, urolithiasis, progressive osteoporosis, gout, myeloma;

When taking medications (eg, analgesics).

[8], [9], [10]

Symptoms of the pyelonephritis in the elderly

For chronic recurrent pyelonephritis in elderly and senile people, the severity of dysuric and pain syndromes is characterized by manifestations of intoxication in the form of severe fever and disturbances of homeostasis with chills, impaired consciousness, dyspnea, a high risk of developing infectious-toxic shock and acute renal disease insufficiency.

In the latent course of chronic pyelonephritis, the clinical picture has an erased character: low-grade pain in the lumbar region (more often as a "feeling of heaviness"), an unpleasant taste in the mouth in the morning, periodic temperature rises to subfebrile digits, fatigue, decreased appetite, unstable stools, flatulence, the appearance of the edema of the eyelids in the morning. Exacerbation of the disease, depending on the prevailing symptoms, may have several options;

1. hypertensive - increased blood pressure, stopping anti-inflammatory therapy;
2. anemic - the development of normochromic anemia;
3. tubular dysfunction syndrome - polyuria, isohypostenuria, thirst, dry mouth, nocturia, decreasing with antibacterial treatment;
4. transient hyperosotemia - accumulation of nitrogenous slags in the body and manifestations in the form of fatigue, drowsiness, apathy, gastritis and enterocolitis.

When specifying the diagnosis, multiple urine tests are used according to Nechiporenko, bacteriological analysis, general analysis, according to the Zimnitsky method, as well as: ultrasound, excretory urography, renography,

Treatment of the pyelonephritis in the elderly

Hospitalization and adherence to bed and half-bed regimen are shown to elderly and senile patients with exacerbation of chronic pyelonephritis with pronounced homeostasis disorder. The choice of diet depends on the presence and severity of renal failure: in the absence of signs of kidney failure, a conventional geriatric diet with the maximum possible increase in the fluid intake (about 1.5 liters) and salt restriction to 6-8 g per day (with arterial hypertension) is used; In the case of azotemia, a diet No. 7 with a significant protein restriction is prescribed.

Antibacterial therapy of the disease, if possible, should be determined by the sensitivity of the pathogen, but usually begins with the use of a wide spectrum of action: co-trimoxazole, amoxicillin, cefuroxime, fluoroquinolones (ofloxacin, ciprofloxacin), oxacillin and gentamicin (with caution). Aminoglycosides, lolomixins, amphotericin B are not recommended for the treatment of geriatric patients. Doses of drugs should be 30-50% below the average therapeutic dose.

After chronic pyelonephritis in elderly people, it was necessary to maintain a long-term (6-12 months) maintenance therapy. Monthly, 10-14 days of treatment with one of the antibacterial drugs - nitrofurans (furazolidone, furadonin), nitroxaline, biseptope, urosulfan. Then, phytotherapy is applied to medicinal plants with a diuretic effect (cranberry leaf, strawberry flowers and leaves, grass and parsley root, horsetail, chamomile) and bactericidal action (birch leaf and buds, leaf of large plantain, linden flowers, marigold, eucalyptus, , cranberry berries four-petalled). In the presence of hypertension, drugs of such medicinal groups as calcium antagonists, beta-blockers, ACE inhibitors, diuretics are used.

As symptomatic therapy in the presence of anemia, iron preparations are used in combination with ascorbic acid,

To improve the reactivity of the body of an elderly person, such agents as multivitamins, pentoxyl, methyluracil, etc., are used.

When caring for a geriatric patient with pyelonephritis, it is necessary to ensure compliance with the prescribed diet, periodic (at least 1-2 times a week) measurement of water balance, more frequent monitoring of the status of parameters of hemodynamics and body temperature. It is important to help the patient with hygienic procedures, preparing for instrumental research, collecting urine. Special attention is required by elderly and elderly people on bed rest, having mental disorders, a high risk of developing acute vascular insufficiency.