Symptoms of pyelonephritis

Symptoms of acute pyelonephritis (or exacerbation of chronic) is often characterized by a sudden onset of the disease with the development of the triad of symptoms:

• increase in body temperature (up to 38-40 ° C, sometimes even higher) with tremendous chills and torrential sweat;
• pain of varying intensity in the lumbar region (one- or two-sided), which are amplified by palpation, walking, fretting around the area of the projection of the kidneys (pain in the lateral abdomen is possible);
• pyuria (leukocyturia).

In some cases, more often in women, acute pyelonephritis begins with acute cystitis (frequent and painful urination, pain in the bladder, terminal hematuria). Other symptoms of acute myelonephritis: general weakness, weakness, muscle and headaches, lack of appetite, nausea, vomiting. Purulent forms (apostematous nephritis, carbuncle, kidney abscess, necrotic papillitis) are more common in acute pyelonephritis, which occurs against the background of urinary tract obstruction, diabetes mellitus, immunosuppressive therapy, etc. (5-20%). In obstructive pyelonephritis, pain in the lumbar region is an intense bursting character, often there are pronounced signs of general intoxication, an increase in the level of nitrogenous slag in the blood, jaundice is possible.

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

Symptoms of chronic pyelonephritis

Chronic pyelonephritis can be the outcome of acute (in 40-50% of cases with obstructive pyelonephritis, in 10-20% - with gestational). It is possible to develop gradually, gradually, often beginning with childhood (more often in girls). The patient can not disturb anything or there are general complaints about weakness, fatigue, sometimes subfebrile condition, cognition (long after catarrhal diseases), aching pain in the lumbar region, pain in the right side with right-sided pyelonephritis, disorders of urination (polyuria or nocturia) , the appearance of pastovoznosti century in the morning, increasing blood pressure (hypertension is first transient, then it becomes stable and high).

Often the only symptoms of chronic pyelonephritis are:

• isolated urinary syndrome (insignificant bacteriuria, leukocyturia);
• decreased relative density of urine;
• anemia difficult to treat (in the absence of signs of kidney failure, it is due to prolonged intoxication).

Sometimes the latent flowing chronic pyelonephritis for the first time clinically manifests itself as symptoms of chronic renal failure. Appear pallor, dry skin, nausea, vomiting, nosebleeds. Patients lose weight, anemia increases; pathological elements disappear from the urine. The rate of progression of chronic renal failure is determined by:

• activity of the infectious process;
• virulence of the pathogen;
• severity of hypertension and other factors.

In the absence of structural abnormalities and metabolic disturbances, progression to the terminal stage of chronic renal failure is rare (2-3%) [Massry S., 1983]. The recurrent course of pyelonephritis leads to a decrease in renal function much faster: 10 years after the diagnosis, only 20% of patients have normal kidney function.

An important role in the chronicity of the disease is given to urinary passage disorders (vesicoureteral reflux, nephrolithiasis, etc.).

In elderly patients, the symptoms of chronic pyelonephritis can be diverse - from a mildly asymptomatic or asymptomatic latent urinary infection, an isolated intoxication syndrome, severe anemia to severe bacteriemic shock with sudden collapse, signs of disseminated intravascular coagulation (DVS), septicemia, acute CBS disorders. Urogenous acute pyelonephritis often begins immediately with the development of purulent inflammation.

The frequency of purulent forms, according to the morphological study, in men is close to 25%, in women - to 15%. The manifestations of intoxication may be accompanied by changes in the leukocyte formula, an increase in ESR. Differential diagnostic difficulties often arise when assessing the activity of the process in elderly people due to the fact that pyelonephritis develops or worsens against the background of multi-organ senile pathology, manifestations of systemic vascular diseases, tumor processes or metabolic disorders. In weakened cachex patients even purulent pyelonephritis, complicated by parainfrit, can be virtually asymptomatic or manifest as an intoxication syndrome and anemia.

Symptoms of pyelonephritis in pregnancy

Acute pyelonephritis of pregnant women (including exacerbation of chronic pyelonephritis) occurs in about 10% of cases. The most frequent (about 80%) exacerbations develop in the second trimester (with a period of 22-28 weeks) pregnancy, less often in the III trimester. Among the risk factors for pyelonephritis during pregnancy, the most significant are:

• asymptomatic bacteriuria, untreated before pregnancy (30-40% of women);
• malformations of the kidneys and urinary tract (6-18%);
• stones in the kidneys and ureters (about 6%);
• refluxes at various levels of the urinary tract;
• chronic kidney disease, etc.

Development of gestational pyelonephritis is facilitated by violations of urodynamics caused by pregnancy:

• hyperprogestinemia and associated with it hypotension, expansion of the cup-and-pelvic system and ureters already in the early stages of pregnancy;
• uterine pressure on the urinary tract, increasing as the duration of pregnancy increases;
• borderline and pathological variants of the course of pregnancy (large fetus, polyhydramnios, multiple fetuses, narrow pelvis).

In the postpartum period, the risk of pyelonephritis remains high for 2-3 weeks (usually on the 4th, 6th, 12th days after birth) while the dilatation of the upper urinary tract remains. Acute pyelonephritis in pregnant women and puerperas is characterized by a sudden onset, high body temperature, chills, severe intoxication. As the disease develops, the common symptoms of pyelonephritis are combined with local pain in the lumbar region on the side of the lesion. In the absence of the effect of ongoing therapy, further intensification of pain and an increase in signs of intoxication, it is necessary to exclude purulent forms: apostematous nephritis, kidney carbuncle, inflammation of the pericardial cellulose. With these forms it is possible to develop septic shock, acute renal failure. Pyelonephritis in pregnant women can also occur with dimly expressed symptoms, the so-called "erased" form (especially in women who received antibacterial therapy during pregnancy), which makes diagnosis difficult.