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Patient B., aged 27, nursing mother. 3 weeks after birth, pain appeared in the area of ​​the right mammary gland. Right breastfeeding became painful. On the 3rd day of illness, the patient developed chills, body temperature rose to 39o C. Objectively: the patient's condition is not satisfactory. Forced position of the body, the patient is inclined to the right. The right mammary gland is outwardly stagnant - edematous, palpation of the gland is painful. Enlarged regional lymph glands in the armpit are also painful on palpation. A laboratory study revealed: the number of leukocytes - 12.4x109 / l; ESR - 35 mm / h. Questions: Are there signs indicating the inflammatory nature of the disease in a woman? Specify local and general signs of inflammation, their pathogenesis. What is meant by the term “hematological syndrome” in inflammation, its pathogenesis The role of the immune system in the development of inflammation The pathogenesis of the development of a febrile reaction in inflammation

CHRONIC HEPATITIS IS A GROUP OF LIVER DISEASES CAUSED BY VARIOUS CAUSES, CHARACTERIZED WITH VARIOUS DEGREES OF EXPRESSION OF HEPATIC CELL NECROSIS AND INFLAMMATION, AND CURRENT WITHOUT IMPROVEMENT FOR AT LEAST 6 MONTHS. CHRONIC HEPATITIS IS A GROUP OF LIVER DISEASES CAUSED BY VARIOUS CAUSES, CHARACTERIZED WITH VARIOUS DEGREES OF EXPRESSION OF HEPATIC CELL NECROSIS AND INFLAMMATION, AND CURRENT WITHOUT IMPROVEMENT FOR AT LEAST 6 MONTHS.

Etiology Viruses A, B, C, E viruses A, B, C, E, alcohol alcohol toxic substances toxic substances of the digestive organs of digestive diseases Various drugs - anti -TB drugs, antibiotics during prolonged therapy various drugs - anti -TB drugs, antibiotics, antibiotics FOR LONG-TERM THERAPY

Hepatotropic toxic substances directly damage hepatocytes to necrobiosis, then a secondary inflammatory reaction develops in the liver mesenchyme. Hepatotropic toxic substances directly damage hepatocytes to necrobiosis, then a secondary inflammatory reaction develops in the liver mesenchyme. Toxic-allergic factors - under the influence of these factors, the sensitivity of the liver to certain substances increases. Toxic-allergic factors - under the influence of these factors, the sensitivity of the liver to certain substances increases.

CLINIC depends on the form of the disease and the degree of activity of the process. Chronic hepatitis - occurs more often in middle age, among adult men. The disease is usually caused by a virus and the virus with alcohol together. There are few clinical signs. Chronic hepatitis - occurs more often in middle age, among adult men. The disease is usually caused by a virus and the virus with alcohol together. There are few clinical signs.

1. Pain syndrome is expressed in the appearance of dull pains and heaviness in the right hypochondrium 1. Pain syndrome is expressed in the appearance of dull pains and heaviness in the right hypochondrium 2. Asthenovegetative syndrome - fatigue, weakness, decreased performance, sleep disturbance, emotional instability and rapid weight loss body 2. Astheno-vegetative syndrome - fatigue, weakness, decreased performance, sleep disturbance, emotional instability and rapid weight loss 3. Dyspeptic syndrome - anorexia, loss of appetite, nausea, bitterness in the mouth, constipation, sometimes alternating with diarrhea 3. Dyspeptic syndrome - anorexia, loss of appetite, nausea, feeling of bitterness in the mouth, constipation, sometimes alternating with diarrhea 4. Liver failure syndrome - bleeding, jaundice, ascites, encephalopathy 4. Liver failure syndrome - bleeding, jaundice, ascites, encephalopathy

5. Cholestasis syndrome - skin itching, increased levels of direct bilirubin, alkaline phosphatase and glutamyl transpeptidase 5. Cholestasis syndrome - skin itching, increased levels of direct bilirubin, alkaline phosphatase and glutamyl transpeptidase 6. Small "liver" signs - spider veins, palmar erythema, gynecomastia 6 Small "liver" signs - spider veins, palmar erythema, gynecomastia 7. Jaundice - often scleral icterus 7. Jaundice - often scleral icterus

In the "reactive" form of chronic hepatitis, interstitial metabolism in the liver is disturbed due to a lack of proteins, vitamins and dysproteinemia In the "reactive" form of chronic hepatitis, interstitial metabolism in the liver is disturbed due to a lack of proteins, vitamins and dysproteinemia violation of primary bile formation, bile stasis The basis of the pathogenesis of cholestatic hepatitis is a violation of primary bile formation, bile stasis

CLASSIFICATION OF CHRONIC HEPATITIS S.D. PODIMOVOY, 1983 WITH CHANGES OF THE CENTER OF GASTROENTEROLOGY OF THE REPUBLIC, 2003 BY ETIOLOGY VIRUSES A, B, C, D, E VIRUSES A, B, C, D, E ALCOHOL ALCOHOL TOXIC SUBSTANCES TOXIC SUBSTANCES DIGESTIVE DISEASES DIGESTIVE DISEASES – ANTI-TB DRUGS, ANTIBIOTICS FOR LONG-TERM THERAPY VARIOUS MEDICINES – ANTI-TB DRUGS, ANTIBIOTICS FOR LONG-TERM THERAPY

CLINICAL FORMS: PERSISTENT HEPATITIS - MINIMAL ACTIVITY HEPATITIS PERSISTENT HEPATITIS - MINIMUM ACTIVITY HEPATITIS ACTIVE HEPATITIS AUTOIMMUNE (LUPOID) HEPATITIS AUTOIMMUNE (LUPOID) HEPATITIC CHOLESTITIS HEPATITIS CHOLESTITIS

DIAGNOSIS HISTORY HISTORY CLINICAL FORMS CLINICAL FORMS LABORATORY AND INSTRUMENTAL STUDIES (increased ESR, leuko- and thrombocytopenia, hypergammaglobulinemia, increased ALT and AST, bilirubin, dysproteinemia) , bilirubin, dysproteinemia) RESULTS OF HISTOLOGICAL STUDY OF LIVER BIOPTY

TREATMENT OF CHRONIC HEPATITIS IN THE STAGE OF EXAMINATION HOSPITALIZATION IN THE STAGE OF EXAMINATION HOSPITALIZATION DIET TABLE 5 – FRIED, SPICY FOOD PRODUCTS ARE EXCLUDED. DIET TABLE 5 – FRIED, SPICY FOOD PRODUCTS ARE EXCLUDED. SPASMOLITICS - NOSHPA, PLATIFILLIN. SPASMOLITICS - NOSHPA, PLATIFILLIN. HEPATOPROTECTORS-ESSENTIALE, CARSIL, VITAMINS HEPATOPROTECTORS-ESSENTIALE, CARSIL, VITAMINS

The prognosis depends on the stage of the disease, histological signs of the activity of the process, the type of necrosis. Complete recovery is insignificant. The prognosis depends on the stage of the disease, histological signs of the activity of the process, the type of necrosis. Complete recovery is insignificant. In 10-25% of patients, spontaneous remission In 10-25% of patients, spontaneous remission In 30-50% of patients, the transition to liver cirrhosis In 30-50% of patients, the transition to liver cirrhosis Hepatocellular carcinoma Hepatocellular carcinoma Malignancy Malignancy

Presentation on theme: "Pyelonephritis in children. Etiology, pathogenesis, clinic, diagnosis, treatment, prevention.» - Transcript:

1 Pyelonephritis in children. Etiology, pathogenesis, clinic, diagnostics, treatment, prevention.

2 Lecture plan 1. Etiology, pathogenesis of pyelonephritis. 2. Classification of pyelonephritis in children. 3. Clinical and diagnostic criteria for pyelonephritis. 4. Treatment, prevention of pyelonephritis in children.

3 Pyelonephritis is a microbial-inflammatory disease of the kidneys with damage to the pelvicalyceal system, interstitial tissue of the kidney parenchyma and tubules

4 Microbial-inflammatory disease of the kidneys and urinary tract occupy the first place in the structure of nephropathies in children. These diseases (cystitis, urethritis, pyelonephritis) account for 19.1 per 1000 children. In adults, in % of cases, the disease begins in childhood In adults, in % of cases, the disease begins in childhood

5 Acute pyelonephritis - in the majority, one type of microorganism is isolated. Chronic pyelonephritis - microbial associations in 15% of patients Chronic pyelonephritis - microbial associations in 15% of patients

6 The etiological structure of pyelonephritis in children 1. E. coli - 54.2%. 2. Enterobacter spp - 12.7%. 3. Enterococcus spp - 8.7%. 4. Kl. Pneumoniae - 5.0%. 5. Proteus spp - 4.5%. 6. P. aeruginosa - 4.4%. 7. Sfaphylococcus spp - 4.3%.

7 Pathogenesis 1. Violation of urodynamics - anomalies of the urinary tract, vesicoureteral reflux. 2. Bacteriuria both in acute disease and due to the presence of chronic foci of infection. 3. Previous damage to the interstitial tissue of the kidneys as a result of metabolic nephropathy, past viral diseases, drug damage, and others. 4. Violation of the reactivity of the body, in particular immunological. - The ascending (urinogenic) route of infection is the leading one in the entry of the pathogen into the pelvis of the tubules of the interstitium

8 Chronic pyelonephritis. Specific immune inflammation - Infiltration of the interstitium of the kidneys by lymphocytes and plasma cells - Intensive synthesis of immunoglobulins - Formation of immune complexes and their deposition on the basement membranes of the tubules - Release of biologically active lymphokines - Increased destruction - Increased synthesis of collagen fibers with the formation of scars in the kidney tissue and nephrosclerosis

12 Classification (A.F.Vozianov, V.G.Maidannik, I.V.Bagdasarova, 2004) Clinical forms: 1) Non-obstructive pyelonephritis. 2) Obstructive pyelonephritis: against the background of organic or functional changes in hemo- or urodynamics, metabolic nephropathies, disembryogenesis

13 Nature of the process 1) Acute 2) Chronic: - undulating - undulating - latent - latent Activity 1) Active stage (I, II, III degree) (I, II, III degree) 2) Partial clinical and laboratory remission. 3) Complete clinical and laboratory remission

14 Stage of the disease 1) Infiltrative 2) Sclerotic State of kidney function 1) Without impaired renal function 2) With impaired renal function 3) Chronic renal failure

15 Criteria for determining the activity of pyelonephritis in children Signs Degree of activity ІІІІІІ — Body temperature — Symptoms of intoxication — Leukocytosis, x 10 9 /l — SHOE, mm/hour — C-reactive protein — B-lymphocytes — CEC, us. units N or subfebrile Absent or insignificant Up to 10 Up to 15 No / + 38.5 ° C Significantly pronounced 15 and > 25 and > +++ / and > 0.20 and > 38.5 ° C Significantly pronounced 15 and > 25 and > +++ / ++++ 40 and > 0.20 and >»>

16 Diagnosis example: 1. Non-obstructive acute pyelonephritis, grade II activity, infiltrative stage without impaired renal function. 2. Obstructive chronic pyelonephritis, undulating course, II degree activity, sclerotic stage, without impaired renal function. Exchange nephropathy: oxaluria 2. Obstructive chronic pyelonephritis, undulating course, activity II degree, sclerotic stage, without impaired renal function. Exchange nephropathy: oxaluria

10% in» title=»Criteria for staging pyelonephritis in children Signs Infiltrative stage Sclerotic stage — Hodson's symptom — Kidney area — Renal-cortical index — Hodson's index — Effective renal plasma flow Absent Increased > 10% in» class="link_thumb"> 17 Criteria for determining the stages of pyelonephritis in children Signs Infiltrative stage Sclerotic stage - Hodson's symptom - Kidney area - Renal-cortical index - Hodson's index - Effective renal plasma flow Absent Increased > 10% of the age N Increased NPositive Decreased > 10% of the age norm Increased Decreased 10% in " > 10% age N Increased — — NPositive Decreased > 10% age norm Increased Decreased»> 10% in» title=»Criteria for determining stages of pyelonephritis in children Signs Infiltrative stage Sclerotic stage — Hodson's symptom — Kidney area — Reno-cortical index — Index Hodson - Efficient renal plasma flow Absence no Increased > 10% in «> 10% in» title=»Criteria for determining the stages of pyelonephritis in children Signs Infiltrative stage Sclerotic stage - Hodson's symptom - Kidney area - Renal-cortical index - Hodson's index - Effective renal plasma flow Absent Increased > 10% in »>

18 Clinic 1. Pain syndrome - pain in the lower back and abdomen. 2. Dysuric disorders. 3. Intoxication syndrome: increased body temperature with chills, headache, weakness, lethargy, pallor. 4. Urinary syndrome: - Proteinuria - up to 1 g / l - Proteinuria - up to 1 g / l - Neutrophilic leukocyturia - Neutrophilic leukocyturia - Microhematuria - Microhematuria - Increased cell epithelium. - Increased cellular epithelium.

). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch» title=»Diagnostics General analysis of urine in dynamics Test by Nechiporenko Urine cultures Determination of the degree of bacteriuria (in 1 ml of urine 100,000 microbes and >). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch» class=»link_thumb»> 19 Diagnosis General urinalysis in dynamics Nechiporenko test Urine cultures Determination of the degree of bacteriuria (in 1 ml of urine of microbes and >). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Biochemical blood test (creatinine, urea, total protein, cholesterol, sialic acids, C-reactive protein).). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch»>). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Biochemical blood test (creatinine, urea, total protein, cholesterol, sialic acids, C-reactive protein).»>). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch» title=»Diagnostics General analysis of urine in dynamics Test by Nechiporenko Urine cultures Determination of the degree of bacteriuria (in 1 ml of urine 100,000 microbes and >). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch»>). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch» title=»Diagnostics General analysis of urine in dynamics Test by Nechiporenko Urine cultures Determination of the degree of bacteriuria (in 1 ml of urine 100,000 microbes and >). Determination of the functional state of the kidneys: - Zimnitsky's test - endogenous creatinine clearance. 6. Bioch»>

Chronic pyelonephritis in children

Chronic pyelonephritis is an inflammatory disease that contributes to the destruction of the pyelocaliceal system and the renal parenchyma. This disease can affect people of all ages, from children to older people. But, most often, children under 5-7 years of age suffer from pyelonephritis (this is facilitated by the features of the urinary system), as well as girls aged 17-30 years (several factors are the cause of the development of this disease: the onset of sexual activity, pregnancy and childbirth). Older men can also suffer from this disease (prostate adenoma contributes to this).

To date, doctors believe that the main reason for the development of chronic pyelonephritis is inadequate treatment of the acute process. After premature termination of therapy, unexpected transformations of the pathogen into the L-form may occur.

In the event that doctors observe relapses of the disease, they begin to conduct various urine tests to most accurately determine the pathogen. Also, other diseases can contribute to the development of pyelonephritis from an acute form to a chronic one: sinusitis, gastritis, colitis, pancreatitis, tonsillitis and diabetes mellitus. Influence on the development of pyelonephritis can have hemodynamic and hormonal disorders, as well as kidney nephrolithiasis.

Doctors divide chronic pyelonephritis into several stages: primary and secondary, as well as one and two-sided.

In turn, the activity of this disease is assessed using three phases:

Latent course of the disease Acute inflammatory process Remission

How does chronic pyelonephritis proceed?

Anemic. The underlying syndrome of disease development is anemic Latent. All syndromes are presented equally Hypertensive. The following syndrome predominates to a greater extent - arterial hypertension

Recurrent. This type of disease is undulating: frequent changes in episodic exacerbations destroy the latent passage of the disease.

Note the fact that the presence of all variants of the course of the disease in one person is quite common.

Doctors divided the whole process of the disease into several stages:

The connective tissue is carefully preserved, but there are also areas of diffuse infiltration. And the renal glomeruli are not affected. The cicatricial-sclerotic process begins. The glomeruli are partially hyalinized. The necrosis of the nephron tubules begins. The destruction of most of the glomeruli begins, and also, the tubules of the kidneys begin to fill with colloidal masses. "Shriveled kidney". The size of the organ is reduced, and the surface becomes fine-grained, the tissues are compacted and the connective tissues are partially replaced.

In medicine, it is not uncommon for patients to develop all of the above stages at the same time. It is believed that such a combination of events can become quite dangerous for the body of each person.

Main symptoms

The symptoms of chronic pyelonephritis in children are quite diverse, and sometimes it can be quite difficult to detect them. It is possible to detect this disease only if moderate pain or leukocyturia occurs. Chronic pyelonephritis is often characterized by acute relapses, which contribute to the spread of pathological changes to new areas of the kidney parenchyma. It happens that the disease is detected at autopsy.

Patients most often describe their condition as follows:

Accelerated fatigue General weakness Headaches Dry mouth or thirst Sudden changes in temperature Lower back pain

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Also, during the examination, the patient's doctors also find pallor of the skin. And additional and more thorough examinations often reveal anemia, which may not be correctable. Arterial hypertension is also a classic symptom of chronic pyelonephritis, especially in advanced cases.

A special symptom of the disease at all stages is leukocyturia, and the development of false proteinuria is also possible. The most important factors for diagnosing symptoms are bacteriuria and erythrocyturia. And the presence of the above symptoms characterizes the following reasons: the development or occurrence of obstruction of the upper and lower parts of the urinary system, stones, as well as the development of other urological problems.

Features of pyelonephritis

Chronic pyelonephritis in children can develop after suffering an acute form of the disease.

Several factors can contribute to this transition:

Incorrect development of renal tissues Violation of the reactivity of the child's body Vulvovaginitis Cystitis Careless treatment of pyelonephritis

But, you should pay attention to the fact that pyelonephritis in children can occur as the first disease. Then, the general picture of this disease is very similar to pyelonephritis in adults. One of the features of this disease is the manifestation of hypertension as a symptom of pyelonephritis in children.

Treatment of chronic pyelonephritis in children

Of course, only the attending physician will be able to exhaustively answer this question, because first it is necessary to carry out all the tests. But, the most important point in the treatment of this disease is the elimination of all causes that interfere with normal blood circulation and kidney passage. Treatment of chronic pyelonephritis in children with drugs always accompanies surgery and continues after it. Drug therapy is carried out comprehensively and strictly individually. In the event that therapy is carried out individually, progression and the occurrence of inflammatory processes almost always occur.

In turn, complex treatment should be:

Etiological - Antibacterial therapy is carried out under the control of the sensitivity of all pathogens. Pathogenetic - in other words, it is necessary to suppress the inflammatory response. Should improve the functionality of the urinary tract, kidneys and increase their resistance to pathogens of inflammation. It is necessary to improve metabolic processes, microcirculation and blood circulation. With the help of diet therapy and balneotherapy, it is necessary to maintain the body's defenses.

Also, during treatment it is recommended to take the following drugs: derivatives of nitrofuran and natrifidine, Oxyquinolines, phenols, antibiotics and others. When using them, you must carefully follow all the instructions and rules for antagonism, and synergism of drugs.

The method and timing of the treatment of the disease depends on the nature and severity of the inflammatory process. It must be remembered that nephrotic drugs are intended for use in exceptional cases. The course of treatment begins only after the diagnosis of urine culture and antibiogram. In the course of treatment, it also happens that microorganisms quickly change their biological properties, which leads to an increase in resistance to certain drugs. In this case, it is necessary to carry out an empirical type of treatment: the gradual replacement of past drugs with new, stronger ones. In the event that leukocyturia develops, it is necessary to use broad-spectrum drugs.

Treatment with folk remedies

Doctors do not welcome the treatment of pyelonephritis with folk, so you should not tempt fate. Quite often, such treatment ends with various complications and relapses. To date, medicine believes that long-term antibiotic therapy is considered the most effective. Moreover, it is recommended to combine drugs with various anti-inflammatory drugs, which will achieve the maximum effect. Quite often, diuretics are used, which increase the concentration of antibacterial drugs.

Presentation on the topic: "Acute and chronic pyelonephritis Completed by: Gavrilova V.S." - Transcript:

1 Acute and chronic pyelonephritis Completed by: Gavrilova V.S.

2 Pyelonephritis is an inflammatory disease of the kidneys, predominantly of bacterial etiology, characterized by damage to the renal pelvis, calyces and parenchyma of the kidney.

3 CLASSIFICATION OF PYELONEPHRITIS Primary (non-obstructive) Secondary (obstructive) Pyelonephritis (unilateral or bilateral) Acute Serous Purulent Apostematous Kidney abscess Kidney carbuncle Phase of active inflammation Phase of latent inflammation Phase of remission Shrinkage of the kidney or pyonephrosis Chronic

4 Etiology, pathogenesis: Most often, pyelonephritis is caused by intestinal Escherichia, Enterococcus, Proteus, Staphylococcus, Streptococcus. In 1/3 of patients with acute pyelonephritis and in 2/3 of patients with chronic pyelonephritis, the microflora is mixed. During treatment, the microflora and its sensitivity to antibiotics change, which requires repeated urine cultures to determine adequate uroantiseptics.

5 It is necessary to remember the role of protoplasts and L-forms of bacteria in the occurrence of relapses of pyelonephritis. If the infection in the kidney is supported by protoplasts, then urine culture does not detect them. The development of pyelonephritis largely depends on the general condition of the macroorganism, reducing its immunobiological reactivity.

6 The infection penetrates into the kidney, pelvis and its calyx by hematogenous or lymphogenous route, from the lower urinary tract along the wall of the ureter, along its lumen - in the presence of retrograde refluxes. Important in the development of pyelonephritis are urinary stasis, impaired venous and lymphatic outflow from the kidney. Pyelonephritis is often preceded by latent interstitial nephritis.

7 Acute pyelonephritis Symptoms, course: The disease begins acutely, high (up to 40 ° C) temperature, chills, heavy sweat, pain in the lumbar region appear; on the side of the affected kidney - tension in the anterior abdominal wall, sharp pain in the costovertebral angle; general malaise, thirst, dysuria or pollakiuria. Joining headache, nausea, vomiting indicate a rapidly growing intoxication.

8 Neutrophilic leukocytosis, aneosinophilia, pyuria with moderate proteinuria and hematuria are noted. Sometimes, when the condition of patients worsens, leukocytosis is replaced by leukopenia, which serves as a poor prognostic sign. Symptom Pasternatsky, as a rule, is positive. With bilateral acute pyelonephritis, there are often signs of renal failure. Acute pyelonephritis can be complicated by paranephritis, necrosis of the renal papillae.

9 Diagnosis: An important role in the diagnosis is played by indications in the anamnesis of a recent acute purulent process or the presence of chronic diseases (subacute septic endocarditis, gynecological diseases, etc.). Characterized by a combination of fever with dysuria, pain in the lumbar region, oliguria, pyuria, proteinuria, hematuria, bacteriuria with a high relative density of urine

10 It should be remembered that pathological elements in the urine can be observed in any acute purulent disease and that pyuria may be of extrarenal origin. On a survey radiograph, an increase in one of the kidneys in volume is detected, with excretory urography - a sharp restriction of the mobility of the affected kidney inhalation, the absence or later appearance of a shadow of the urinary tract on the side of the lesion. Compression of the calyces and pelvis, amputation of one or more calyces indicate the presence of a carbuncle.

11 TREATMENT: - Most cases - conservative (hospital) - Bed rest, diet - Symptomatic therapy - Antibacterial therapy, taking into account sensitivity

12 ANTIBACTERIAL THERAPY: - Fluoroquinolones, cephalosporins, aminoglycosides (antibiogram) - anti-inflammatory, detoxification, therapy - drugs that improve blood circulation

13 Chronic pyelonephritis It may be a consequence of untreated acute pyelonephritis or primary chronic, i.e. it can proceed without acute events from the onset of the disease. In most patients, chronic pyelonephritis occurs in childhood, especially in girls.

14 Symptoms, course: Unilateral chronic pyelonephritis is characterized by dull constant pain in the lumbar region on the side of the affected kidney. Dysuric phenomena are absent in most patients. During an exacerbation, only 20% of patients have a fever. In the urine sediment, the predominance of leukocytes over other formed elements of urine is determined.

15 However, as the pyelonephritic kidney shrinks, the severity of the urinary syndrome decreases. The relative density of urine remains normal. For diagnosis, detection of active leukocytes in the urine is essential.

16 In the latent course of pyelonephritis, it is advisable to conduct a pyrogenal or prednisolone test (30 mg of prednisolone dissolved in 10 ml of isotonic sodium chloride solution is administered intravenously for 5 minutes; after 1; 2; 3 hours and a day after that, urine is collected for examination ). The prednisolone test is positive if, after the administration of prednisolone, more leukocytes are excreted in the urine in 1 hour, a significant part of which are active.

17 The detection of Sternheimer-Malbin cells in the urine only indicates the presence of an inflammatory process in the urinary system, but does not yet prove the existence of pyelonephritis.

18 The functional state of the kidneys is examined using chromocystoscopy, excretory urography, clearance methods (for example, determining the coefficient of purification of endogenous creatinine by each kidney separately), radionuclide methods

19 Diagnosis is often difficult. In differential diagnosis with chronic glomerulonephritis, the nature of the urinary syndrome (the predominance of leukocyturia over hematuria, the presence of active leukocytes and Sternheimer-Malbin cells, significant bacteriuria in pyelonephritis), data from excretory urography, and radionuclide renography are important.

20 Treatment of chronic pyelonephritis should be carried out for a long time. Treatment should begin with the appointment of nitrofurans (furadonin, furadantin), nalidixic acid (nefam, nevifamon), 5-NOC, sulfonamides (urosulfan, atazol, etc.), alternating them alternately. With the ineffectiveness of these drugs, exacerbations of the disease, broad-spectrum antibiotics are used.

21 The appointment of an antibiotic each time should be preceded by a determination of the sensitivity of the microflora to it. For most patients, monthly 10-day courses of treatment are sufficient. However, in some patients with such therapeutic tactics, virulent microflora continues to be sown from the urine.

22 In such cases, long-term continuous antibiotic therapy with drug changes every 5–7 days is recommended. With the development of renal failure, the effectiveness of antibiotic therapy decreases (due to a decrease in the concentration of antibacterial drugs in the urine).

Similar presentations: Chronic pyelonephritis. urinary tract infection in children. Pyelonephritis is an inflammatory disease of the kidneys, predominantly of bacterial etiology, characterized by damage to the renal pelvis, calyces and parenchyma of the kidney.

The causative agents of the disease are E. coli, streptococcus, staphylococcus, proteus, viruses. Microbes enter the renal tissue by hematogenous and ascending routes.

With frequent exacerbations of pyelonephritis, the generally accepted approach is the appointment of monthly preventive courses of antibiotic therapy. Test on the topic: ADDED TAX. Download this presentation. Description of the presentation on individual slides: 1 slide.

Pathogenesis: causative agents are group A beta-hemolytic streptococcus, staphylococci, viruses. Most kidney stones are composed of calcium salts (phosphates, oxalates, carbonates) Radiography of the kidneys Contrast urography Urine culture Ultrasound Scan of the kidneys Opium chromocystoscopy. Be healthy. Thank you for your attention.

Similar presentations: Chronic pyelonephritis. urinary tract infection in children. Pyelonephritis is an inflammatory disease of the kidneys, predominantly of bacterial etiology, characterized by damage to the renal pelvis, calyces and parenchyma of the kidney. Download ppt "Pyelonephritis. Pyelonephritis is an infectious and inflammatory disease of the mucous membrane of the urinary tract and tubulo-interstitial tissue of the kidneys 1.Pyelonephritis.' in .ppt format (PowerPoint). Slide 5 from the presentation "Prevention of kidney diseases" to the lessons of medicine on the topic "Diseases of the urinary system." Inflammation of the kidneys Pyelonephritis. In general, women predominate among patients with pyelonephritis. Presentation on the topic ‘Pyelonephritis’. Download presentation (0.09 Mb). Annotation for the presentation. The presentation ‘Pyelonephritis’ tells about one of the human kidney diseases. The presentation contains all the basic information about pyelonephritis: -Etiology. Classification, etiology, clinic, diagnostics Urinary tract infections Acute pyelonephritis Chronic pyelonephritis. Download this presentation. Get code Our banners. Presentation on the topic: Pyelonephritis. Download this presentation.

Presentation on the topic ‘Pyelonephritis’. These diseases (cystitis, urethritis, pyelonephritis) account for 19.1 per 1000 children. In adults, in 50-70% of cases, the disease begins in childhood. Presentation on the topic ‘Pyelonephritis’ in medicine. Slide text: Pyelonephritis.

Growth trends remain (2. In the Republic of Belarus - 1. In the structure of IMP about 6.

The ratio of sick women and men is 2. 1. Description of the slide: Etiology Pyelonephritis is caused by: Intestinal Escherichia, Enterococcus, Proteus, Staphylococcus, Streptococcus. L-forms of bacteria (recurrence of pyelonephritis) Mycoplasma. Leptospira. Fungi In 1/3 of patients with acute pyelonephritis and in 2/3 of patients with chronic pyelonephritis, the microflora is mixed. In 3.0% of cases, the pathogen is not sown - this does not exclude the infectious process. Description of the slide: Predisposing factors: 1.

Gender - 2-3 times more often in women, 7. Women have 3 critical periods: a) childhood: girls during this period get sick 6 times more often than boys: b) the onset of sexual activity: c) pregnancy. Hormonal imbalance: glucocorticoids and hormonal contraceptives. exchange violations. diabetes mellitus, gout. Anomalies of the kidneys and urinary tract. Description of the slide: Ways of spread of infection: Hematogenous or lymphogenous (descending) Urinogenic (ascending) Description of the slide: More often pyelonephritis develops as a result of an ascending spread of infection.

Causes. They are characterized by inflammatory infiltration by neutrophils and plasma cells, interstitial fibrosis. At the next stage, cellular infiltration and wrinkling of the glomeruli, periglomerular fibrosis appear. Typical lesions of the tubules in the form of generalized atrophy, dystrophy of the epithelium.

Often there is productive endarteritis with perivascular sclerosis. Description of the slide: Classification of pyelonephritis - acute and chronic - rapidly progressive - recurrent - latent. Description of the slide: Latent form - 2.

Most of the time there are no complaints. May be noted - weakness, fatigue, less often subfebrile condition.

Women during pregnancy may have toxicosis. A functional study reveals nothing, unless rarely unmotivated increase in blood pressure, mild pain when tapping on the lower back. The diagnosis is made in the laboratory.

Repeated analyzes are of decisive importance: moderate leukocyturia no more than 1 - 3 g / l proteinuria + Nechiporenko test Stenheimer - Malbin cells is doubtful, but if there are more than 4. Active leukocytes are rarely detected. True bacteriuria *****> 1. Description of the slide: Recurrent form - almost 8. Alternation of exacerbations and remissions. Features: intoxication syndrome with fever, chills, which can be even at normal temperature, leukocytosis in the clinical blood test, elevated ESR, shift to the left, C-reactive protein.

Pain in the lumbar region, often 2-sided, in some of the type of renal colic: the pain is asymmetrical! Dysuric and hematuric syndromes. There may be micro- and macrohematuria. The most unfavorable combination of syndromes: hematuria + hypertension -> after 2-4 years, chronic renal failure. Description of the slide: Acute pyelonephritis. The classic triad is fever, dysuria, and back pain. Severe chills Increase in body temperature up to 4.

Drenching sweat, Pain in the lumbar region (on one side or both sides of the spine) “+” Tapping symptom. On the side of the affected kidney, tension of the anterior abdominal wall, Sharp pain in the costovertebral angle, Symptoms of severe intoxication - general malaise, thirst, nausea, vomiting, dry mouth, muscle pain. Dysuric manifestations. Description of the slide: Acute pyelonephritis. laboratory manifestations. In the urine is determined: mild proteinuria (up to 1 g / l), leukocyturia, leukocyte (white) cylinders of bacteria. The diagnosis is confirmed by bacteriological examination.

In the urine, a large number of leukocytes and microbes are found. The presence of more than 1.00. In the blood test, neutrophilic leukocytosis, aneosinophilia, Sometimes when the condition of patients worsens, leukocytosis is replaced by leukopenia, which serves as a poor prognostic sign. Description of the slide: Acute pyelonephritis. Diagnostics. Anamnesis (recently transferred acute purulent process or the presence of chronic diseases) Characteristic combination of fever with dysuria, pain in the lumbar region, oliguria, pyuria, proteinuria, hematuria, bacteriuria with a high relative density of urine. It should be remembered that pathological elements in the urine can be observed in any acute purulent disease and that pyuria may be of extrarenal origin (prostate gland, lower urinary tract). On a survey radiograph, an increase in one of the kidneys in volume is detected. Excretory urography - a sharp restriction of the mobility of the affected kidney during breathing, the absence or later appearance of a shadow of the urinary tract on the side of the lesion.

Compression of the calyces and pelvis, amputation of one or more calyces indicate the presence of a carbuncle. Description of the slide: Chronic pyelonephritis Among the causes of chronicity, it should be noted: violations of urodynamics, focal infection, inadequate treatment. Chronic pyelonephritis is the cause of chronic renal failure in 1. In most patients, chronic pyelonephritis occurs in childhood, especially in girls. Description of the slide: Chronic pyelonephritis. For many years, it can be hidden (without symptoms) and is detected only when examining urine (latent period, remission period).

Frequent headaches It is characterized by dull constant pain in the lumbar region on the side of the affected kidney. Dysuric phenomena are absent in most patients. For exacerbation of chronic pyelonephritis, the same symptoms are characteristic as for acute pyelonephritis. In the period of exacerbation, only 2. If treatment is not started on time, a serious complication may occur - renal failure. Description of the slide: Chronic pyelonephritis. Changes in urine tests: In the urine sediment, the predominance of leukocytes over other blood cells is determined.

However, as the kidney shrinks, the severity of the urinary syndrome decreases. The relative density of urine remains normal. For diagnosis, detection of active leukocytes in the urine is essential. With an exacerbation of the process, bacteriuria can be detected. If the number of bacteria in 1 ml of urine exceeds 1.

Slide description: The functional state of the kidneys is examined using: chromocystoscopy, excretory urography, clearance methods (for example, determining the coefficient of endogenous creatinine clearance by each kidney separately), radionuclide methods (renography with hippuran, kidney scanning). With infusion urography, a decrease in the concentration ability of the kidneys, a delayed release of a radiopaque substance, local spasms and deformations of the cups and pelvis are determined. Subsequently, the spastic phase is replaced by atony, the calyxes and pelvises expand. Then the edges of the cups take on a mushroom shape, the cups themselves approach each other. Infusion urography is informative only in patients with blood urea levels below 1 g/l. In diagnostically unclear cases, kidney biopsy is performed.

Description of the slide: Laboratory criteria. A) During the period of exacerbation, the following are characteristic: - a decrease in the relative density of urine; - proteinuria with a daily loss of protein not higher than 1.5 - 2 g; - leukocyturia; - bacteriuria over 1. B) During the period of exacerbation are relatively common: - microhematuria; - cylindruria; - positive acute phase reactions; - acidosis. C) During remission, isolated leukocyturia is more often (but not always) determined.

The use of samples with a quantitative count of urine sediment cells (Nechiporenko, Kakovsky - Addis) helps to identify latent leukocyturia. Description of the slide: Pyelonephritis.

In the acute period Bed rest (for the period of fever), appoint a table. During the period of convalescence (after 4-6 weeks), the regimen is expanded.

Unlike other urinary tract infections, the antibiotic should generate high serum concentrations given the high percentage of bacteremia in pyelonephritis. Description of the slide: Empiric antibiotic therapy. Slide description: Antibacterial therapy At present, aminopenicillins (ampicillin, amoxicillin), 1st generation cephalosporins (cephalexin, cefradin, cefazolin), nitroxoline cannot be recommended for the treatment of pyelonephritis, since the resistance of the main causative agent of pyelonephritis - Escherichia coli - to these drugs is about 2 .

Description of the slide: With frequent exacerbations of pyelonephritis, the generally accepted approach is to prescribe monthly preventive courses of antibiotic therapy. Prophylactic use of antibacterial agents should be treated with extreme caution. There is no reliable data indicating the effectiveness and expediency of prophylactic antibiotics in pyelonephritis. Description of the slide: Pyelonephritis. Anti-relapse treatment.

After achieving remission of chronic pyelonephritis, maintenance therapy is prescribed for up to 6 - 1. It includes 7 - 1. NOC and others), herbal medicine. Description of the slide: Pyelonephritis. Ryabov's scheme during remission: First week: 1 - 2 tab. Second week: herbal uroseptic: birch buds, lingonberry leaf, chamomile. Third week: 5-NOC 2 tab.

Fourth week: chloramphenicol 1 tab. After that, the same sequence, but the drugs are changed to similar ones from the same group. Description of the slide: Non-drug measures for the prevention of exacerbations of pyelonephritis include an adequate drinking regimen of 1.2-1.5 liters daily (with caution in patients with impaired heart function), the use of herbal medicine.

Phytotherapy helps to improve urination and does not lead to the development of serious adverse events. Description of the slide: When choosing drugs for herbal medicine, you should consider: Diuretic effect, depending on the content essential oils, saponins, silicates (juniper, parsley, birch leaves) Anti-inflammatory effect associated with the presence of tannins and arbutin (lingonberry and bearberry leaves) Antiseptic effect due to phytoncides (garlic, onion, chamomile). Description of the slide: Nephrolithiasis.

Etiology. Enzymopathies (tubulopathies) with disorders in the distal and proximal tubules. Climatic conditions. Environmental temperature, humidity, mineral composition of water - lead to the concentration of the stone substrate. Difficulty in the flow of urine.

Hyperfunction of the parathyroid glands.

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