Classification of pyelonephritis
There are many classifications of infections of the urinary tract and urogenital organs. At the same time, the classification of acute pyelonephritis, adopted in Russia, distinguishes only the stages of acute infectious inflammatory process in the interstitium and in the parenchyma of the kidney (serous, purulent), but not the topical forms of damage to the kidney or renal pelvis itself, and the lesion of the pelvis is not reflected in these classifications, which contradicts the very notion of "pyelonephritis".
Classification of pyelonephritis according to S. Kunin (1997):
- acute complicated bacterial pyelonephritis (focal or diffuse);
- lobar nephronia;
- chronic complicated bacterial pyelonephritis;
- emphysematous pyelonephritis:
- papillary necrosis of the kidneys;
- xanthogranulomatous pyelonephritis;
- pyelonephritis Tape (infection, localized in the upper urinary tract);
- kidney abscess and perinephric abscess;
- an infection superimposed on polycystic kidney disease;
- kidney infection caused by less common microorganisms;
- kidney tuberculosis and other mycobacterial infections;
- fungal infections;
- viral infections.
Classification of infections of the urinary tract and urogenital organs according to the Guidelines of the European Urological Association (2006):
- uncomplicated lower urinary tract infections (cystitis);
- uncomplicated pyelonephritis;
- complicated urinary tract infection with and without pyelonephritis;
- Special forms: prostatitis, epididymitis and orchitis.
With the flow, uncomplicated (primary) and complicated (secondary, recurrent) urinary tract infections are distinguished. The term "chronic" for urinary tract infections, as a rule, does not apply, as in most cases it incorrectly reflects the course of the disease. As a rule, chronic pyelonephritis develops after a bacterial infection that appeared against the background of anatomical abnormalities of the urinary tract (obstruction, vesicoureteral reflux), infected stones. It is believed that up to 60% of human infections are associated with a biofilm-infection. By biofilm infection refers to the adhesion of microorganisms to the surface of mucous membranes, stones or biomaterials (catheters, drains, artificial prostheses, sphincters, nets, etc.). Microorganisms at the same time begin to live and multiply on them, periodically developing aggression against the host - the macroorganism.
Uncomplicated infections are more common for young women, for complicated (secondary) infections there is no such difference. Complications of infections occur against the background of functional disorders or anatomical abnormalities of the urinary tract, after catheterization of the bladder or kidney of the kidney and interventions on the urinary tract, against a background of severe co-morbidities: diabetes, urolithiasis, chronic renal failure, etc. In 30% of cases, secondary or complicated infections have nosocomial (hospital, nosocomial) origin. Finally, secondary infections are less treatable, often recur, involve a higher risk of renal parenchyma, the emergence of kidney abscess and urosepsis, and among the pathogens are found resistant to antibacterial drugs strains of microorganisms.
Among recurrent urinary tract infections, recurrent (true relapses), recurrent (reinfection), and resistant or asymptomatic bacteriuria are isolated.